Nursing as Profession
FNP LEC (Week 2)
HOW TO ACT PROFESSIONAL AS A
NURSE:
PROFESSION
- An occupation that requires
extensive education or a callings
that requires special knowledge, skill
and preparation.
- Requires a specialized educational
training ​
- requires a mastery of complex set of
knowledge and skills
- founded upon specialized
educational training
- Paid occupation especially one that
involves a prolonged training and a
formal qualification
REMEMBER: A Profession or a
Professional must satisfy an indispensable
social need and must be based upon well
established and socially accepted
principles. It must requires the exercise of
discretion judgment as to time and manner
of the performance of your duty.
TWO TERMS RELATED TO PROFESSION
NEED TO BE DIFFERENTIATE:
1. PROFESSIONALISM
● Refers to a professional
characters,spirit, or methods
(develop attitude on how to
handle specific situations)
● For nurses, it always meant
healing for the sick, nurturing
the wounded, placing
patients first, providing
holistic care, and educating
new professionals.
● Nursing professionalism
owes much to the influence
of Florence nightingale.
● As a nurse, you have to bring
a positive and realistic
attitude to your patient and
coworkers.
● Take time to listen to your
patient.
● Care about your appearance,
don’t put a lot of makeup, be
simple
● Be accountable of your
actions
● Follow ethical practices
especially on making
decisions.
2. PROFESSIONALIZATION
● It is a social process by
which any trade or
occupation transforms itself
into a true profession of the
highest integrity and
competence.
● Professionalism of the nurse
influences the quality of care
the nurse provides to the
client.
● Focuses on how you
influence as a nurse, social
processes.
CHARACTERISTICS OF NURSING
★ Nursing is caring
★ Nursing involves close personal
contact with the recipient of care.
★ Nursing is committed to promoting
individual, family, community, and
national health goals in its best
manner possible.
★ Nursing is committed to
personalized services for all persons
 regardless of color, creed, or
economic status.
CHARACTERISTICS OF A GOOD PROFESSIONAL
NURSE
★ Good communication skills
★ Has an updated knowledge of
general and specific nature
★ Clean, tidy, and well groomed
★ Mature physically and emotionally
★ Intelligent and have critical thinking
skills
★ Confident
★ Punctual
★ Honest
★ Has the ability to teach recipients of
nursing
Criteria of a Profession
1) Specialized Education
- Important aspect of professional
status
In the US today, there are 5 means of entry
into registered nursing:
● Hospital diploma
- 3 years program (1800 to
1960), pre-existing in US
● Associate degree
- 2 year program according to
Mildred Montag (they called it
“Nursing technician or
bedside”(1950s)
- first and the only educational
programs for nursing that
were systematically
developed from planned
research and control
experimentation
- “Nursing technician or
bedside” - Nurses are able
to perform nursing functions
broader than those practical
nurses but with lesser scope
than those professional
nurses.
● Baccalaureate Degree
- started on University of
Minnesota in 1909
- 5 years program, you need to
get a three year diploma
program plus 2 years of
liberal arts education
- But in PH its 4 years only
- Have to pass the board exam
- Have more autonomy but
have more responsibilities
and accountabilities
- Have the chance to
participate in a institutional
decision making
- Career advancement
● Master’s Degree
- In PH, you need to pass the
licensure board exam
- At least have 1 year
experience
- Focuses on preparing nurses
for advance leadership role
in administration, clinical
setting and, in teaching
● Doctoral Degree
- Have faculty rules in nursing
program or those who want
to work in research program
- Highest education
- You can teach
NOTE: This was influenced by nightingale
to recognize nursing as a profession not just
vocation.
2) Body of Knowledge
- As a profession, nursing is
establishing a well defined body of
knowledge and expertise.
 - There are nursing conceptual
frameworks that contribute to the
knowledge base of nursing and give
direction to nursing practice,
education, and on-going research.
Conceptual Research
- refers to analytical tool with several
variations and context that helps and
prepare nurses in providing holistic
nursing care
- Through this concept you can
develop standards leading to skills,
abilities and norms.
- A demand of a body of specialized
and systematized training
3) Service Orientation
- A service orientation differentiated
nursing from an occupation pursued
primarily for profit. Many consider
altruism as the hallmark of a
profession.
ALTRUISM
- a selfless concern for others from
other profession, wherein you have
selfless concern for others,
especially for you patient
- You have the feelings and behavior
that show a desire to help other
people
- They lack of selfishness
4) Ongoing Research
- Is a process in which decisions are
made that result in a detailed plan or
proposal for a study, as well as the
actual implementation of the plan.
- Evidence based nursing.
- “Nursing is an ongoing research”
- A careful study to find solution and
to report new knowledge about
something especially in medical
profession
- Can help us in new trends when it
comes to patient care
- Important activity of getting
information about the subject.
- Considered a careful and diligent
search of something
- It must developed a scientific
technique which is the result of the
tested experience
5) Code of Ethics
- Nursing developed its own codes of
ethics and in most instances has set
up means to monitor the
professional behavior of its
members.
- Nurses have traditionally place a
high value on the worth and dignity
of others
- Nurses are expected to do what is
considered right regardless of its
cost
- Changes as the needs and values of
the society change
Purposes:
- Standards - of care
- Guidelines - on how to take care of
patient
- Distinguish - distinguished from
other courses
- Protect - protect the right of patient
6) Autonomy
- Means having the authority to make
decisions and the freedom to act in
accordance with one’s professional
knowledge base. (Skar R. J Clin
Nurs. 2010)
- Once you are a professional, you
have the autonomy
 - Freedom to act, in accordance with
the knowledge you gain.
- Autonomy in making decisions
especially in the practice
To be Autonomous, A Professional
Group Must Be: ( Once you have the
License )
- Granted legal authority to define the
scope of its practice
- Describe its particular function and
roles
- Determine its goals and
responsibilities in delivering its
services.
7) Professional Organization
- Operation under the umbrella of a
professional organization
differentiates a profession from an
occupation.
- Nurse need to work with their
professional organizations
GOVERNANCE - establishment and
maintenance of social, political and
economic arrangement by which you nurse
as a practitioners control your practice,
discipline, work in condition and
professional affairs and will also help protect
you as a nurse
PERSONAL AND PROFESSIONAL QUALITIES
PHILOSOPHY OF LIFE
➔ Contributes to personal growth that
relates to the moral values and
shapes the aspects of the character.
GOOD PERSONALITY
➔ Consists of deeper traits which come
from the heart.
➔ Nursing should have a bright mind,
caring heart and healing hands.
Nurse
★ Nurse: Male or Female who has
completed a program of basic
nursing education.
★ Bachelor of Science in Nursing
★ Authorized by the appropriate
authority to practice nursing.
Professional Nurse
★ A health worker identified by law as
a registered nurse whether
graduated from bachelor or diploma
degree, and does not include the
assistant nurse.
Personal Qualities Of A Nurse
(6C’s)
1. Care - most unique characteristic of
a nurse, being connected to your
patient, creates positive, provides
presence
2. Compassion - show kindness,
willingness to help others, need to
be thoughtful and listen your patient,
need to show that you are ready to
help
3. Competence - ability to deliver care
successfully and efficiently in which
you are able to apply and use the
related knowledge, the skills,
abilities or attitudes that you learn,
successfully perform critical work
especially once you are in the area
of critical work or functions in your
work setting.
4. Communication - the therapeutic
communication, act of transferring
infos from one person to another
5. Courage - courage to speak up
when you have concerns and to
have the personal strength and
 vision to innovate and to embrace
new ways of working.
6. Commitment - committed to your
profession, need to make actions to
make this vision and strategy a
reality and meet the health care and
support challenges ahead,
dedicating yourself to do something.
1) Care
- The care we deliver helps the
individual person and improves the
health of the whole community.
2) Compassion
- Is how care is given through
relationships based on empathy,
respect and dignity.
- It can also be described as
intelligent, kindness, and is central to
how people perceive their care.
3) Competence
- The ability to understand an
individual’s health and social needs
- The expertise, clinical and technical
knowledge to deliver effective care
and treatments based on research
and evidence.
4) Communication
- Central to successful caring
relationships and to effective team
working.
- Communication is the key to a good
workplace with benefits for those in
our care and staff alike.
5) Courage
- Enables us to do the right thing for
the people we care for.
- Having as strong values and
confident in meeting the challenges
6) Commitment
- A commitment to our patients and
populations is a cornerstone of what
we do.
- We need to build on our commitment
to improve the care and experience
of our patients.
Professional Qualities Of A Nurse
★ Caring nature
★ Empathetic
★ Organized
★ Adaptable
★ Has physical and mental endurance
★ A quick thinker
★ Hard working
CONTEMPORARY NURSING PRACTICES
WHO: NURSING
➔ Nursing encompasses autonomous
and collaborative care of individuals
of all ages, families, groups and
communities, sick or well and in all
settings.
➔ It includes the promotion of health
prevention of illness, and the care of
ill, disabled and dying people.
➔ In many countries, nurses make up
half of health care professionals and
have a vital role in health outcomes.
➔ Nursing is client centered, focus is
on your client
➔ Nursing is holistic, not only the
physical aspect but the whole aspect
of the patient that include the mental
or psychological, spiritual aspect,
physical aspect, and social aspect
NIGHTINGALE AND HENDERSON:
NURSING
Florence Nightingale
● Florence Nightingale: Nursing is an
act of utilizing the environment of the
patient to assist him in his recovery.
● The first one to build “Nightingale
Training School of Nurses ” at St.
Thomas Hospital in England (1860).
● The founder of modern nursing
● “The Lady with the Lamp”
● Influential in developing nursing
- Education
- Practice
- Administration
Virginia Henderson
● Virginia Henderson: Nursing is the
act of assisting the individual, sick or
well, in the performance of those
activities contributing to health or its
recovery (or to a peaceful death)
● The person would perform unaided if
he had the necessary strength, will
or knowledge, and to do this in such
a way as to help him gain
independence as rapidly as
possible.
CERTAIN THEMES ARE COMMON TO MANY
OF THESE DEFINITIONS:
🗸 Nursing is caring
🗸 Nursing is an art - CCR
🗸 Nursing is a science
🗸 Nursing is client centered
🗸 Nursing is holistic
🗸 Nursing is adaptive
🗸 Nursing is concerned with health
promotion, health maintenance, and health
restoration
🗸 Nursing is a helping profession
Nursing as an art
- As a nurse you need to deliver care
artfully with CCR (Compassion,
Caring and Respect) for each
patients dignity and personhood
- Need to provide individualized care
for the client
Nursing is a science
- Nursing practice is based on the
body of knowledge, continually
changing with new discoveries and
innovation
Nursing is concerned with health
promotion
- Involve individual and community
activities to enhance healthy lifestyle
such as improving nutrition and
physical fitness, preventing alcohol
and drug misuse, preventing injuries
Nursing is concerned with prevent
illnesses
- Activities such as immunization,
pranatal, infant care and prevention
sexually transmitted diseases
Health restoration/Restoring Health
- Focus on the patient who is actually
ill. Ex. administering medications
Caring for the dying
- Give the client a comfortable life up
to the last minute of his life to make
her comfortable and also help family
members or loved ones to cope.
> When you integrate ART and SCIENCE of
nursing into practice the quality of care you
provide is at the level of EXCELLENCE that
benefits them and their families <
 RECIPIENTS OF NURSING ● Help the client in the procedure of
● Consumer treatments
- An individual, a group of people, or a
4. CLIENT ADVOCATE
community that uses a service or
● Protect the right of the client
commodity. ● Represent clients needs
● Patient ● Exercising their rights and help the
- Is a person who is waiting for or speak up for themselves
undergoing medical treatment and
care 5. COUNSELOR
● Client ● Recognize and cope with stressful
- Is a person who engages the advice psychological and social problems
or services of another who is ● Provides emotional, intellectual, and
psychological support
qualified to provide this service
6. CHANGE AGENT
SCOPE OF NURSING
● Make modifications of their behavior
● Promoting health and wellness (Ex. Help Lessen smoking intake of the
● Preventing illness patient )
● Restoring health ● Also, changes in the healthcare system,
● Caring for dying technologic change, age of the client,
population, medications etc

7. LEADER
ROLES AND FUNCTIONS OF THE NURSE
● Influences
● Understanding the needs and goals that
1. CAREGIVER motivate people
● Assists/Care the client physically and ● Knowledge to apply the skills
psychologically ● Interpersonal skills
● Nursing process →framework
● The nursing process provides nurses 8. MANAGER
with a framework for providing care. ● Delegates, supervises, evaluates
● A nurse may provide care directly or ● Requires knowledge, organizational
delegate it to other caregivers. structure among others

2. COMMUNICATOR 9. CASE MANAGER

● Identify client problems ● Works with the multidisciplinary
● Able to work with other professionals healthcare team
and people in the community ● Works with primary or staff nurses to
● Gathering data and then share data to oversee the care of a specific caseload
the one responsible such as the doctor ● Measure the effectiveness of the case
or physician of the client management plan and to monitor
outcomes.
3. TEACHER
● Learn about their health 10. RESEARCH CONSUMER
● Assesses client’s learning needs and ● Use research to improve client care
readiness to learn, sets specific goals, (a) have awareness of the process and
enacts learning strategies and language of research
measures their learning.
 (b) be sensitive to issues related to
protecting the rights of human subjects
(c) participate in the identification of
researchable problems
(d) be a discriminating consumer of
research findings

11. EXPANDED CAREER ROLES

● Refers to clinical specialists
● Undergo more trainings

EXTENDED CAREER ROLES

● Nurse Practitioner
● Clinical Nurse Specialist
● Nurse Anesthetist
● Nurse Midwife
● Nurse Researcher
● Nurse Administrator
● Nurse Educator
● Nurse Entrepreneur
● Forensic Nurse
FNP LEC WEEK 2 (PART 2)
1. CONSUMER
- An individual, a group of people, or a
community that uses a service or

DEFINITIONS OF NURSING commodity.

- Use healthcare products or service
are consumers of healthcare.
ANA (1973, p.2)
● Direct, goal oriented, and adaptable
2. PATIENT

to the needs of the individual, the - A person who is waiting for or

family, and the community during undergoing medical treatment and

health and illness. care.

- Comes from the Latin word meaning
“to suffer” or “to bear”.
ANA (1980, p.9)
● Nursing is the diagnosis and
3. CLIENT

treatment of human responses to - Individual who engages to advice or

actual or potential health problems services of another who is qualified

to provide this service.

ANA (1995)
● Science of caring

ANA (2010, p.10) ANA (2015b,p.7) SCOPE OF NURSING

● Nursing is the protection, promotion,
and optimization of health and Nurses provide care for 3 types of
abilities, preventions of illness and clients:
injury, alleviation of suffering through 1. Individuals
the diagnosis and treatment of 2. Families
human response, and advocacy in 3. Communities
the care of individuals, families,
communities, and populations Nursing practice involves 4 areas:

1. Promoting health and Wellness

2. Preventing illness

RECIPIENTS OF NURSING 3. Restoring Health

 4. Caring for the dying 1. Providing direct care to the ill, such
as administering medications, baths,
PROMOTING HEALTH AND and specific procedures and
WELLNESS treatments.

1. Nurses promote wellness in clients 2. Performing diagnostic and

who are both healthy and ill assessment procedures, such as

2. May involve individual and measuring blood pressure and

community activities to enhance examining feces for occult blood

healthy lifestyles, such as improving 3. Consulting with other health care

nutrition and physical fitness, professionals about client problems.

preventing drug and alcohol misuse, 4. Teaching clients about recovery

restricting smoking, and preventing activities, such as exercises that will

accidents and injury in the home and accelerate recovery after a stroke

workplace. 5. Rehabilitating clients to their optimal

functional level following physical or

PREVENTING ILLNESS mental illness, injury, or chemical

● To maintain optimal health by addiction

preventing disease. Nursing

activities that prevent illness include CARING FOR THE DYING
immunization, prenatal and infant 1. Involves comforting and caring for

car, and prevention of sexually people of all ages who are dying

transmitted infections. 2. Palliative care nurses are part of a

medical team that focuses on

RESTORING HEALTH providing relief from the symptoms

● Focuses on the ill client, and it and stress of a serious illness (e.g

extends from early detection of cancer)

disease through helping the client 3. The goal is to improve the quality of

during the recovery period life for both the client and the family
4. The goal is to help people who are
dying to have peace, comfort and
dignity

RESTORING HEALTH ACTIVITIES

ROLES AND FUNCTION OF NURSE
INCLUDE:
● Caregiver
 ● Communicator
● Teacher
● Client advocate
● Counselor
● Change agent
● Leader
● Manager
● Case manager
● Research consumer
● Expanded career roles

SETTINGS FOR NURSING

1. In the past, the acute care hospital
was the main practice setting open
to most nurses.
2. Today, many nurses work in
hospitals, but increasingly they work
in clients’ homes, community
agencies, ambulatory clinics, long
term care facilities, health
maintenance organizations, and
nursing practice centers.

NURSE PRACTICE ARTS

1. Nurse practice acts, or legal acts for
professional nursing practice,
regulate the practice of nursing in
the US, with each state having its
own act.
2. Nurses are responsible for knowing
their state’s nurse practice act as it
governs their practice

PATRICIA BENNER
FROM NOVICE TO EXPERT: EXCELLENCE AND
POWER IN CLINICAL NURSING PRACTICE
BIOGRAPHY & CAREER
o Born on August 31, 1942 in Hampton,
Virginia
o 1964, earned her Bachelor of Arts in
nursing from Pasadena College
o 1960, worked in nursing field
o 1970 – 1975, research associate at the
University of California at San Francisco
School of Nursing
PUBLISHED BOOKS
1. From Novice to Expert: Excellence and
Power in Clinical Nursing Practice
2. Nursing Pathways for Patient Safety
3. The Primacy of Caring
Note: Dr Benner has published nine books,
including From Novice to Expert, Nursing
Pathways for Patient Safety, and The Primacy
of Caring. She has also published many
articles. In 1995, she was awarded the 15th
Helen Nahm Research Lecture Award from the
University of California at San Francisco
School of Nursing.
CO-AUTHORED BOOKS
1. Expertise in Nursing Practice: Caring,
Clinical judgment, and Ethics
2. Clinical Wisdom in Critical Care: A
Thinking-in-Action Approach
METAPARADIGM
NURSING
o Described as an “enabling condition of
connection and concern” which shows a
high level of emotional involvement in the
nurse-client relationship.
o Viewed nursing practice as the care and
study of the lived experience of health,
illness, and disease and the relationships
among these three elements.
PERSON
o Stated that “a self-interpreting being, that
is, the person does not come into the world
predefined but gets defined in the course of
living a life. A person also has… an
effortless and non-reflective understanding
of the self in the world. The person is
viewed as a participant in common
meanings.”
o Believed that there are significant aspects
that make up a person
o She had conceptualized the major aspects
of understanding that the person must deal
with as:
1. The role of the situation.
2. The role of the body.
3. The role of personal concerns.
4. The role of temporality
Goal: Overcome the Cartesian dualism, the
view that the mind and body are distinct,
separate entities.
o Embodiment is the capacity of the body to
respond to meaningful situations.
5 Dimensions of the body (Merle au, Ponty &
Dreyfus)
1. The unborn complex
2. The habitual skilled body
3. The projected body
4. The actual projected body
5. The phenomenal body
HEALTH
o Focused “on the lived experience of being
healthy and ill.”
o Defined health as what can be assessed,
while well-being is the human experience of
health or wholeness.
o Well-being and being ill are recognized as
different ways of being in the world.
o Health is described as not just the absence
of disease and illness. Also, a person may
have a disease and not experience illness
because illness is the human experience of
loss or dysfunction, whereas disease is
what can be assessed at the physical level.
ENVIRONMENT
o Used the term “situation” instead, because
it suggests a social environment with social
definition and meaning.
o Used the phenomenological terms of being
situated and situated meaning, which are
defined by the person’s engaged
interaction, interpretation and
understanding of the situation.
5 LEVELS OF SKILL ACQUISITION & SKILL
DEVELOPMENT
NOVICE
o the person has no background experience
of the situation in which he or she is
involved.
o Context-free rules and objective attributes
must be given to guide performance.
o There is difficulty discerning between
relevant and irrelevant aspects of a
situation.
o Generally, this level applies to nursing
students, but Benner suggested that a
nurse at higher levels of skill in one area of
practice could be classified at the novice
level if placed in an unfamiliar area or
situation.
o A beginner with no experience. They are
taught general rules to help perform tasks,
and their rule-governed behavior is limited
and inflexible. In other words, they are told
what to do and simply follow instruction.
− No experience
− Tasks/skills focus
− Rule follower
− Inflexible
ADVANCED BEGINNER
o The person can demonstrate marginally
acceptable performance having coped with
enough real situations to note, or to have
pointed out by a mentor, the recurring
meaningful components of a situation.
o The person has enough experience to
grasp aspects of the situation.
o Nurses functioning at this level are guided
by rules and are oriented by task
completion.
o Shows acceptable performance, and has
gained prior experience in actual nursing
situations. This helps the nurse recognize
recurring meaningful components so that
principles, based on those experiences,
begin to formulate in order to guide actions.
o They have difficulty grasping the current
patient situation in terms of the larger
perspective.
o However, clinical situations are viewed by
nurses at this level as a stage of their
abilities.
o They feel highly responsible for managing
patient care, yet they still rely on the help of
those more experienced.
o Most newly graduated nurses are placed in
this level.
− 1 year experience
− Has some experience
− Past experience guides actions
COMPETENT
o Through learning from actual practice
situations and by following the actions of
others, advance beginner moves to this
level.
o Typified by considerable conscious and
deliberate planning that determines which
aspects of the current and future situations
are important and which can be ignored.
o Consistency, predictability and time
management are important, and gaining a
sense of mastery through planning and
predictability is the accomplishment.
o Generally, has two- or three-years’
experience on the job in the same field. For
example, two or three years in intensive
care. The experience may also be similar
day-to-day situations. These nurses are
more aware of long-term goals, and they
gain perspective from planning their own
actions, which helps them achieve greater
efficiency and organization.
o There is an increased level of efficiency but
the focus is on time management and the
nurse’s organization of the task world.
o The competent nurse may display hyper-
responsibility for the patient, often more
than is realistic, and may exhibit an ever-
present and critical view of the self.
o This stage is most pivotal in clinical
learning because the learner must begin to
recognize patterns and determine which
elements of the situation warrant attention
and which can be ignored.
o They devise new rules and reasoning
procedures for a plan while applying
 learned rules for action on the basis of the
relevant facts of the situation.
PROFICIENT
o The performer recognizes the most salient
aspects and has an intuitive grasp of the
situation based on background
understanding.
o Nurses at this level demonstrate a new
ability to see changing relevance in a
situation including the recognition and the
implementation of skilled responses to the
situation as it evolves.
o Perceives and understands situations as
whole parts. He or she has a more holistic
understanding of nursing, which improves
decision-making. These nurses learn from
experiences what to expect in certain
situations, as well as how to modify plans
as needed.
o They no longer rely on present goals for
organization and they demonstrate an
increased confidence in their knowledge
and abilities.
o There is much more involvement with the
patient and family.
o This stage is a transition into expertise.
− More than 3 years of experience
− Holistic understanding
− Uses experiences to anticipate
needs
proficient. Benner’s writings explain that
nursing skills through experience are a
prerequisite for becoming an expert nurse.
o Key aspects of the expert nurse’s practice
are:
1. a clinical grasp and resource-based
practice
2. embodied know-how
3. seeing the big picture
4. seeing the unexpected
o The expert nurse has the ability of pattern
recognition on the basis of deep
experiential background.
o Meeting the patient’s actual concerns and
needs is of utmost important, even if it
means planning and negotiating for a
change in the plan of care.
o There is almost a transparent view of self.
− Flexible
− Intuitive
− Lots experience
− Just comes naturally
These different levels of skills show changes in the
three aspects of skilled performance: movement
from relying on abstract principles to using past
experiences to guide actions; change in the
learner’s perception of situations as whole parts
rather than separate pieces; and passage from a
detached observer to an involved performer,
engaged in the situation rather than simply outside
of it.

EXPERT The levels reflect movement from reliance on past

principles to the use of past experience and
o The expert performer no longer relies on change in the perception of the situation as a
analytical principle (rule, guide and maxim)
complete whole with certain relevant parts. Each
to connect her or his understanding of the
step builds on the previous step as principles are
situation to an appropriate action.
refined and expanded by experience and clinical
o The expert nurse as having an intuitive
expertise.
grasp of the situation and as being able to
identify the region of the problem without MAJOR CONCEPTS & DEFINITIONS
wasting consideration on a range of
alternative diagnoses and solutions.
ASPECTS OF A SITUATION
o There is a qualitative change as the expert
performer “knows the patient”, meaning
o The recurring meaningful situational
knowing typical patterns of responses and
components recognized and understood in
knowing the patient as a person.
context because the nurse has previous
o No longer rely on principles, rules, or
experience
guidelines to connect situations and
determine actions. They have a deeper
ATTRIBUTE OF A SITUATION
background of experience and an intuitive
grasp of clinical situations. Their
performances are fluid, flexible, and highly-
o Measurable properties of a situation that
can be explained without previous
experience in the situation.

COMPETENCY
o It is “an interpretively defined area of skilled
performance identified and described by its
intent, functions, and meanings.”

DOMAIN
o An area of practice having a number of
competencies with similar intents,
functions, and meanings.

EXEMPLAR
o An example of a clinical situation that
conveys one or more intents, meanings,
functions, or outcomes easily translated to
another clinical situation.

EXPERIENCE
o An active process of refining and changing
preconceived theories, notions, and ideas
when confronted with actual situations;
implies there is a dialogue between what is
found in practice and what is expected.

MAXIM
o cryptic description of skilled performance
that requires a certain level of experience
to recognize the implications of the
instructions.

PARADIGM CASE
o A clinical experience that stands out and
alters the way the nurse perceives and
understands future clinical situations.
o Paradigm cases create new clinical
understanding and open new clinical
perspectives and alternatives.

SALIENCE
o A perceptual stance or embodied
knowledge whereby aspects of a situation
stand out as more or less important.
 HISTORY OF NURSING IN THE WORLD
ANCIENT CIVILIZATIONS
o Experiments with herbs & plants
o Illness attribute to evil spirits
o Nurses as a Domestic Servants
HERODOTUS – of Halicarnassus, was a Greek
Historian and regarded as the “Father of History”
Men uses black & white magic
PERIOD OF INTUITIVE NURSING (PRIMITIVE ERA)
o Was practiced since prehistoric times
among primitive tribes.
o And lasted until the Christian Era
o Nursing is untaught and instinctive
BELIEFS & PRACTICES OF PREHISTORIC MAN
o Nursing was a function that belonged to a
woman.
o He believed that illness was caused by the
invasion of the victims and evil spirit.
o He believed in “Shaman” or medicine man
or witch doctor that uses white magic.
o He also practiced “Trephening” – drilling a
hole on the skull with a rock or stone
without the benefit of anesthesia as a last
resort to drive evil spirits from the body of
the afflicted)
THE EGYPTIAN CIVILIZATION (CA 3000 BC)
HAMMURABI a first king of Babylonian
Empire
HAMMURABI’S one of the first written
CODE codes of law in recorded
history.
XENODOCHIUM house for the sick
IMHOTEP God of healing and
medicine, the second king
of Egypt’s third dynasty,
who was later worshipped
as the god of medicine in
Egypt and in Greece, where
he was identified with the
Greek god of medicine,
Asclepius.
Architect of the step
pyramid built at the
necropolis of Ṣaqqārah in
the city of Memphis.
o Practice of prophylaxis by the medicine
man and high priest
o Emphasis on personal hygiene, cleanliness
within & outside the body
o Sanitation measures
o Mummification
o recognized 250 different diseases
o developed drugs and procedures
o 480 B.C. (neurosurgery)
HEBREWS (C.A. 1400 BC)
o Founders of public hygiene
o Moses “Father of Sanitation”
o Mosaic Health Code pertained to every
aspect of individual, family & community
hygiene
a. Principles of personal hygiene (rest, sleep,
hours of work, cleanliness)
b. Environmental sanitation
1. Inspection of food
2. Methods of dispose
3. Detecting and reporting diseases
4. Practice of isolation, quarantine,
fumigation and disinfection
5. Detailed instructions on the correct
way of hand washing
ANCIENT GREEKS
ASCLEPIUS God of medicine and healing in
ancient Greek mythology.
Asclepius represents the healing
aspect of the medical arts.
HYGIEIA Daughter of Asclepius.
Goddess of health, cleanliness
and sanitation and afterwards,
the moon.
She was associated with the
prevention of sickness and the
continuation of good health.
PANACEA Daughter of Asclepius &
granddaughter of Apollo
Said to have potion which she
healed sick
The panacea was supposed to be
remedy that would cure all
disease and prolong life
indefinitely.
HIPPOCRATES
o “Father of Medicine” exponent of the
science of preventive medicine
 o Introduced the philosophy of the
interrelationship between physical and
mental health.
o “A healthy mind dwells in a healthy body”
o Treat patient as a whole
o Changed change magic medicine into
science of medicine
o Taught physicians to use eyes and ears
o The Hippocratic Oath is an oath traditionally
taken by physicians pertaining to the
ethical practice of medicine.
3 KINDS OF REFUGE FOR SICK
o Secular – directed by physicians – spas and
resorts.
o Religious – sanctuaries of gods
o Attendants – were basket bearers who
looked after the sick.
ROMANS
o Contributed to the field of sanitation
(building of Aqueducts, purification of water
supply)
o Appointing of public health medical officers
o Establishment of hospitals which
emphasized both preventive and curative
aspects of care
EARLY CHRISTIAN PERIOD
o Christian church expressed succor to
orphans, poor, travelers and the sick.
o Deaconesses (given to women with good
social standing) visited the sick.
o Order of Deaconesses – organized visiting
of the sick called visiting nurses
o forerunner of CHN
o endeavored to practice the corporal works
of mercy (feeding the hungry, caring for the
sick, burying the dead)
PHOEBE a friend of St Paul and the first
Deaconess and first visiting nurse.
FABIOLA A Roman matron of rank. She was
one of the companies of noble
Roman women who.
Influence of St. Jerome
Gave up all earthly pleasures and
devoted themselves to the practice
of Christian asceticism and to
charitable work
She erected a fine hospital at Rome
& she gave large sums to the
churches and religious communities
at Rome, and at other places in Italy.
All her interests were centered on
the needs of the Church and the
care of the poor and suffering.
HOTEL DIEU OF BEAUNE
o One of the most charming old hospitals in
France, and one quite typical of hospitals
established in medieval times.
o Reputed to be the oldest existing hospital
which has continuously occupied its
original building.
o This hospital has a history as colorful as its
steep, gabled roofs.
MIDDLE AGES (1100 – 1300)
o Charitable institutions or sanctuaries
intended for the aged, poor and sick
people.
o Nursing during this era was either done by
charitable institutions or poor people who
worked for the rich.
o Nuns and sisters work as a staff nurse in
the hospitals
o Caregiver are not required to have a formal
training
o Nurses went to the community and
hospitals were built also medical school’s
increase.
o Europe men risked their lives to provide
nursing care
o A group of men, the Parabolani, in 300 AD
started a hospital and provided nursing
care during the Black Plague epidemic.
INFLUENCE OF CRUSADE IN NURSING
o Crusades – Christian military expeditions to
recapture the Holy Land from Muslims
o In 1244 there are approximately 19,000
hospitals in Western Europe.
o There is a spread of leprosy
o after a thousand years there was no
attempt to organized nursing.
3 TYPES OF ORGANIZATION
MILITARY ORDER
 KNIGHT men who went to battle o Third order of St. Francis of Assisi. The
HOSPITALLERS and them retired to members of this organization were devoted
nurse the sick. their time and energy on enhancing the
KNIGHT OF ST. JOHN also known as Knights lives of their friends, neighbors in the
Hospitaller, a Christian community where they lived.
organization that o Caring for the sick and poor was one of the
began as an Amalfitan order’s important activities to both men and
hospital founded in women who serve as nurses.
Jerusalem in 1080 to o There were many Catholic orders caring for
provide care for poor, the sick during the Middle Ages. Even the
sick or injured pilgrims secular orders were associated with the
to the Holy Land. Church. Educated by apprenticeship,
ST. JOHN OF GOD & ST. Two patron saints of lacking knowledge of hygienic measures,
CAMILLUS DE LELLIS nurse’s stem from this and practicing under very primitive
period. Both stated as conditions, the care provided was,
soldiers but later nonetheless, humane and caring.
turned to nursing. − Order of Saint Vincent de Paul
ST. CAMILLUS DE Started the sign of red − Sisters of Charity
LELLIS cross and developed
the first ambulance RENAISSANCE PERIOD (A.D 1400 – 1550)
service.
o Interest in arts and science emerged.
The Order of St. o Geographic explorations by Europeans
Lazarus of Jerusalem o Society was filled with thieves due to social
originated in a leper deprivations.
hospital. It was o Care of the sick was entrusted to those who
originally established were proven guilty of a crime or theft
to treat virulent
o caretakers were not given humane facilities
diseases such as
leprosy. like food & quarters, so all the more they
got buried into evil deeds like stealing the
RELIGIOUS ORDER patient’s foods, accepting bribes.
o Need for care of sick and poor escalated
o Institutions managed by clergy. Throughout o Hospitals were for the weak, aged,
the dark Middle Ages, the hospitals and contagious disease, physically and
nursing system were connected by mentally ill.
religious bodies. o A fee was charged for the hospitalization
o Nurses were provided by male and female o Bubonic Plague epidemic, killing 25 to 50%
monastic orders. Europe’s population
o Nurses wore regular clothes.
o Care of the sick- done by volunteers like St. THOMAS SYDENHAM
Catherine of Siena, her lamp represented
o Founder of clinical medicine and
the sick at Sienna
epidemiology.
o Sisters advanced from probations to
o Emphasized the detailed observation of
wearing white robe to wearing hood.
patients & maintained accurate record.
o Name of oldest foundations:
o He has been calling “the English
− Hotel Dieu in Paris
Hippocrates”
− St. Thomas and St. Bartolome’s in
o First person to set an example of clinical
London methodology.
− The order of St. Augustine and St. o Said that a doctor must rely on his own
John of Jerusalem observation and clinical experience and he
SECULAR ORDER appeared to have practiced largely
common-sense medicine.
 REFORMATION PERIOD (1550s) Proliferation of factories with
introduction of technology.
o The religious upheaval led by Martin Luther FRANCE Barbers function as
destroyed the unity of Christian faith. surgeons.
o The wrath of Protestantism swept away
Leeching, giving enemas
everything connected with Roman
and tooth extraction
Catholicism.
o Properties of hospital and schools were Women make beds, scrubs
confiscated. floors and bathe the poor in
o Nurses fled for their lives; In England many almshouses.
hospitals were closed.
Factory workers endured
o No one to take care for sick.
long hours of work.
o Nursing became the work of the least
desirable of women, took bribes from Medical schools were
patients, stole the patient’s food and used founded – Royal College of
alcohol as a tranquilizer. Surgeon in London (1800)
o Nurses sank in lowest level, medical
End of 18th Century – no
instruction continued along primitive lines.
standards for nurses working
WOMEN’S MOVEMENT (1848) in the hospitals

o Women are not considered equal to men. 20TH CENTURY – MACHINE AGE
o No right to vote or be educated.
o Increased poverty
o Women’s rights convention in Seneca
o Workers are exploited
Falls, NY signaling the beginning of social
o Development of other nursing services
unrest
aside from hospital service: private duty,
o With suffrage, rights of women were
public health, school, government,
advocated & nursing profession advanced.
maternal)
o 1900’s women were accepted to colleges
A. Age of Specialization
and universities
− College & Post graduate nursing
education programs
INDUSTRIAL REVOLUTION (1700’s – 1800’s)
B. Standards are Set
o This was a time of free thought, − 1913-1937
individualism, and the beginning of − standard curriculum
capitalism and democratic forms of − textbooks
government. C. World War I
o Gradually brought forth a more equitable − Nurse was assisted by the National
living style for the people. Red Cross
o Capitalists were protected by law in his D. The Great Depression
exploitation of workers. There were child − October 29, 1929 (Black Friday)
labor and sweatshops where disease and − Financial crisis – unemployed
accidents were the norm. nurses
o Hospitals remained places where the poor
− Military Nurses
went to die.
o Oppression of women PERIOD OF CONTEMPORARY NURSING
MOTHER MARY founded the sisters of Mercy, o This period includes scientific and
CATHERINE religious order emphasizing technological developments and many of
MCAULEY in nursing the poor and sick. the social changes occurring since 1945.
Emancipation of women-fight o World Health Organization – established
for human rights a step in by the United Nations\to assist in fighting
developing nursing disease by providing health information
profession and improving the nutrition, living standard
and environmental conditions of all people.
 o Trends: Cross in LeMans,
− scientific and technological France in 1841.
research FATHER SORIN brought four sisters to
− use atomic energy for medical Notre Dame in South
diagnosis and treatment Bend Indiana in 1841.
− use sophisticated equipment for
diagnosis and therapy. WAR PERIOD
− The advent of space medicine also AMERICAN CIVIL Women played a major
brought about the development of WAR (1861 – role in nursing and
aerospace nursing. 1865) sanitation efforts during
COLONEL developed a comprehensive one- the Civil War, paving the
PEARL E. year course to prepare nurses for way for their entry into the
TUCKER aerospace nursing at Cape nursing profession in
Kennedy greater numbers after the
war, as well as paving the
Nursing involvement in community
way for further
health is greatly emphasized to
support Primary Health Care. professionalization of the
nursing field.
Technologic efficiency has relieved WORLD WAR I The duty of an army
nurses from a numerous tedious (1914 – 1916) nurses much more varied
task. than in civilian nursing
profession.
The nurse of the modern times is
constantly assuming They needed to be
responsibilities of patient care that decisive and quick-
were formerly the sole prerogative thinking when determining
of the physician treatment, cleaning
wounds and attending to
RELIGIOUS INFLUENCES minor surgery.

The strong influence of religions on the Physical strength and

developments of nursing started in India (800-600 high level of efficiency I
B.C.) and flourished in Greece and Ireland in 3 required
B.C. with male-nurse priests.
Endured excessive
THEODOR FLIEDNER revived the churched workload and a lack of
order of Deaconesses staff to meet the
demands.
to care for those in a
hospital he had The conditions made life
founded. He had more difficult to a nurse.
profound influence in
nursing because Also, at risk of contracting
Florence Nightingale contagious disease.
had her training at the
Experienced same
Kaisers Werth hardships as the soldiers.
Institute.
Deaconesses of The harsh, foreign
Kaisers Werth became climate, inadequate basic
famous because they necessities and
consequent dysentery
were the only ones
were all endured by the
formally trained in female nurses as well.
nursing. WORLD WAR II Casualties created an
FATHER BASIL Founded the Nursing (1939 – 1945) acute shortage of
MOREAU Sisters of the Holy caregiver.
 The Cadet Nurse Corps
was established in
response to a marked
shortage of nurses.
(December 25,
1821-April 12,
Auxiliary health care
workers became
prominent.
Practical nurses, aides, LILLIAN D. WALD
and technicians provided
much of actual nursing
care under the instruction
and supervision of better
prepared nurses.
Medical specialties also
arose at that time to meet
the needs of hospitalized
clients.
NURSING PIONEERS
HARRIET Born Araminta Ross, c. 1820
TUBMAN – 10 March 1913
Was an African-American
abolitionist, humanitarian,
and Union spy during the
U.S. Civil War.
Thirteen missions to rescue
over seventy slaves using
the network of antislavery
activists and safe houses ISABEL ADAMS
known as the Underground
HAMPTON ROBB
Railroad. Known as “The
Moses of Her People”
SOJOURNER The self-given name, from
TRUTH (1797– 1843, of Isabella Baumfree.
November 26,
1883) An American abolitionist and
women's rights activist.
Truth was born into slavery in
Swartekill, New York.
Her best-known speech, Ain't
I a Woman? was delivered in
1851 at the Ohio Women's
Rights Convention in Akron,
Ohio.
DOROTHEA Was an American activist on
LYNDE DIX behalf of the indigent insane.
(April 4, 1802 –
Created the first generation
July 17, 1887)
of American mental asylums.
During the Civil War, she
served as Superintendent of
Army Nurses.
CLARISSA A pioneer of America teacher
HARLOWE nurse, & Humanitarian.
BARTON
She has been described as
having a "strong and
independent spirit “and is
1912) best remembered for
organizing the American Red
Cross
Was a nurse, social worker,
(1867 – 1940) public health official, teacher,
author, editor, publisher,
women's rights activist, and
the founder of American
community nursing.
Founder of visiting nursing in
the United States and
Canada.
Provide nursing care to
indigent
First community health nurse
Established Henry Street
Settlement Service in New
York
Supported education for the
mentally challenged
Advocate more lenient
immigration laws
Was one of the founders of
modern American nursing
theory and one of the most
(1860 – 1910)
important leaders in the
history of nursing.
She implemented an array of
reforms that set standards for
nursing education.
One of her most notable
contributions to the system of
nursing education was the
implementation of a grading
policy for nursing students.
President of American
Society of Superintendents
of Training Schools for
Nurses (now known as
National League for
Nursing), and of the
organization that became the
American Nurses
Association.
 She was also one of the
founders of the American
Journal of Nursing.
JANE ARMINDA She started work in 1887 at a
DELANO (March Jacksonville, Florida hospital
13, 1862 treating victims of a yellow
fever epidemic.
Montour Falls,
New York, United She demonstrated her
States – died superior executive and
April 15, 1919 in administrative skills and
Savenay, Loire- developed innovative
Atlantique, nursing procedures.
France.)
A leading pioneer of the
modern nursing profession,
Delano almost single-
handedly created American
Red Cross Nursing when she
united the work of the
American Nurses
Association, the Army Nurse
Corps, and the American
Red Cross. Through her
efforts, emergency response
teams were organized for
disaster relief and over 8,000
registered nurses were
trained and ready for duty by
the time the United States
entered World War I.
During the course of the War,
more than 20,000 of her
nurses played vital roles with
the United States military.
MARY She also was known as Mary
BRECKINRIDGE Carson Breckinridge.
(February 17,
1881-May 19, Was an American nurse-
midwife and the founder of
1965)
the Frontier Nursing Service.
Introduced a model rural
health care system, to
provide professionals
services.
She created a decentralized
system of nurse-midwives,
district nursing centers, and
hospital facilities.
Originally called the
Kentucky Committee for
Mothers and Babies, later the
Frontier Nursing Service
(FNS), the system lowered
the rate of death in childbirth
in Leslie County, Kentucky,
from the highest in the nation
to substantially below the
national average.
Thanks to FNS, nurse-
midwives were no more than
six miles away from any
patients. Providing both
preventive and curative
nursing, FNS continues to
serve this region.
MARY ELIZA Was the first African-
MAHONEY (May American to study and work
7, 1845 – as a professionally trained
January 4, 1926) nurse in the United States,
graduating in 1879.
In 1908, she co-founded the
National Association of
Colored Graduate Nurses
(NACGN).
The NACGN eventually
merged with the American
Nurses Association (ANA) in
1951.
She is commemorated by the
biennial Mary Mahoney
Award of the ANA for
significant contributions in
advancing equal
opportunities in nursing for
members of minority groups.
She encouraged respect for
cultural diversity.
ADAH BELLE African American nurse who
SAMUELS co-founded the National
THOMS Association of Colored
(January 12, Graduate Nurses.
1870 – February
Acting director of the Lincoln
21, 1943) School for Nurses (New
York), and fought for African
Americans to serve as army
nurses during World War I.
She was among the first
nurses inducted into the
American Nurses
Association Hall of Fame
when it was established in
1976.
President of the NACGN
from 1916-1923, and played
a critical role in lobbying for
the rights of African American
women to serve in the United
States military during World
War I.
 Campaigned the American control, Sanger was ahead of
Red Cross permit black her time.
nurses to enroll. SHIRLEY TITUS Nurse, Educator,
LINDA (1892 – 1967) Administrator- advocated
First professionally trained
improved economic security
RICHARDS American nurse.
of nurses.
(July 27, 1841-
April 16,1930) She established nursing
Championed nursing's
training programs in the
responsibility to improve the
United States and Japan.
economic security
First system for keeping
Her 1943 article, Economic
individual medical records for
Security Is Not Too Much to
hospitalized patients.
Ask, asserted that as
In 1885 she helped to employed professionals,
establish Japan’s first nurses need the protection
nurses-training program. of, and the legal right to,
collective bargaining.
She was elected as the first
president of the American
FLORENCE "The Lady with the Lamp",
Society of Superintendents
NIGHTINGALE was a pioneer of modern
of Training Schools, and
(12 May 1820 – 13 nursing, a writer and a
served as head of the
August 1910) noted statistician.
Philadelphia Visiting Nurses
Society. She retired from
Florence's older sister
nursing in 1911, at the age of
was named Parthenope.
seventy
Her parents were William
LAVINIA LLOYD Compiled the first, and long Edward Nightingale
DOCK most important, manual of (1794–1875) and Frances
(1858 – 1956) drugs for nurses, Materia Nightingale née Smith
Medica for Nurses (1890). (1789–1880).
She strove not only to Inspired by what she took
improve the health of the as a Christian divine
poor but also to improve the calling, experienced first
profession of nursing through in 1837 at Embley Park
her teaching, lecturing, and and later throughout
writing. Florence's life, she
committed herself to
She played a major role as a
nursing (though
contributing editor to the
discouraged by her
American Journal of Nursing.
parents).
She also did most of the work
Florence Nightingale's
for A History of Nursing (4
most famous contribution
vols, 1907–12, later revised
came during the Crimean
and abridged).
War, which became her
MARGARET An American birth control central focus when
HIGGINS activist, an advocate of reports began to filter
SANGER negative eugenics, and the
back to Britain about the
(September 14, founder of the American Birth horrific conditions for the
Control League (which wounded.
1879 –
eventually became Planned
September 6, Parenthood).
1966) By 1859, she set up the
Nightingale Training
Woman's choice to decide
School at St. Thomas'
how and when, if ever, she Hospital on 9 July 1860.
will bear children.
In her drive to open the way The first trained
to universal access to birth Nightingale nurses began
 work on 16 May 1865 at or diminished health
the Liverpool Workhouse status.
Infirmary.
HISTORY OF NURSING IN THE PHILIPPINES
She also campaigned and
raised funds for the Royal EARLY BELIEFS & PRACTICES
Buckinghamshire Hospital
in Aylesbury, near her o Treatment for Disease and what cause
family home. them are formed by mysticism and
BELIEFS - Holistic framework superstition
inclusive of illness and 1. Causation of disease:
health a. Beliefs that it could be from another
- Need for theoretical person or a witch
basis
b. Evil spirits
- Liberal Education as
foundation for nursing 2. Persons with powers to expel
practice demons are believed that could
- Importance of creating drive away evil spirits.
an environment that 3. People believed in special gods of
promotes healing healing, with the priest-physician
- Need for the body of (called “word doctors”) as
nursing knowledge
distinct from medical intermediary. If they used leaves or
knowledge. roots, they were called herb doctors
CONCEPT - Having systematic (Herbolarios).
method of assessing
patient EARLIEST HOSPITALS ESTABLISHED DURING THE SPANISH
- Individualized care on REGIME:
the basis of patients’
needs and preferences Hospital Real de Care for the Spanish
- Maintaining Manila (1577) king’s soldiers, founded
confidentiality by Gov. Francisco de
- Nurses should be Sande.
formally educated and San Lazaro Hospital Founded by Bro. Juan
function as client
(1578) Clemente,administered
advocate
ENVIRONMENTAL Adequate ventilation has by Hospitalliers of San
FACTORS also been regarded as a Juan De Dios, exclusively
AFFECTING HEALTH factor contributing to for patient with Leprosy.
changes of the patient's Hospital de Indio By Franciscan order,
process of illness (1586) supported by alms &
recovery. Defined in her
contributions for
environmental theory are
the following factors charitable persons.
present in the patient's Hospital de Aguas Established in Laguna
environment: Santas (1590) near medicinal spring,
founded by BRO. J.
- Pure or fresh air Bautista of the Franciscan
- Pure water Order.
- Sufficient food supplies
- Efficient drainage San Juan de Dios Founded by brotherhood
- Cleanliness Hospital (1596) of Mesiricordia and run by
- Light (especially direct Hospitalliers of San Juan
sunlight) de Dios, support from
alms & rents, general
Any deficiency in one or services for people.
more of these factors
could lead to impaired
functioning of life NURSING DURING THE PHILIPPINE REVOLUTION
processes
The prominent persons involved in nursing works
were:
JOSEPHINE Wife of Jose Rizal
BRACKEN
Installed a field of hospital
in an estate house in
Tejeros Provided nursing
care to the wounded night
and day
ROSA SEVILLA DE Converted their house
ALVERO into quarters for the
Filipino soldiers during the
Philippine-American war
(1899)
DONA HILARIA DE Wife of Emilio Aguinaldo
AGUINALDO
Organized the Filipino
Red Cross under the
inspiration of Apolinario
Mabini
DONA MARIA Second wife of Emilio
Aguinaldo
AGONCILLO DE
AGUINALDO
Provided nursing care for
the Filipino soldiers during
the revolution
President of the Filipino
Red Cross branch in
Batangas
MELCHORA AQUINO Nurse the wounded
(TANDANG SORA) Filipino soldiers and gave
them shelter and food
CAPITAN SALOME Revolutionary leader in
Nueva Ecija
Provided nursing care to
the wounded when not in
combat
AGUEDA Revolutionary leader in
KAHABAGAN Laguna who provided
nursing services to her
troop
TRINIDAD TECSON Stayed in the hospital in
Biak na Bato to care for
the wounded soldiers
HOSPITALS AND SCHOOLS OF NURSING
Iloilo Mission Hospital It was run by the
School of Nursing Baptist Foreign
(Iloilo City,1906) Mission Society of
America.
Miss Rose Nicolet, a
graduate of New
England Hospital for
women and children in
Boston,
Massachusetts. (1st
Superintendent)
Miss Flora Ernst, an
American nurse took
charge of the school in
1942.
St. Paul’s Hospital The hospital was
School of Nursing established by the
(Manila, 1907) Archbishop of Manila.
The Most Reverend
Jeremiah Harty, under
the supervision of the
sisters of St. Paul de
Charters
Philippine General Mainly for “Civil
Hospital School of officers & Employees”
Nursing (1907) in the city of Manila &
became Civil Hospital
St. Luke’s Hospital Hospital in
School of Nursing Episcopalian
(Quezon City, 1907) Institution, began as a
small dispensary.
Opened with 3 fil girls
admitted.
Philippine Christian a. Sallie Long Read
Mission Institute Memorial Hospital
Schools of Nursing School of Nursing
(Laoag, Ilocos Norte,
1903)
b. Mary Chiles Hospital
School of Nursing
(Manila, 1911)
Mary Johnston Hospital “Bethany Dispensary”
and School of Nursing founded by Methodist
(Manila, 1907) Mission for the relief of
suffering among
women & children.
Emmanuel Hospital San Juan de Dios
School of Nursing Hospital School of
(Capiz, 1913) Nursing
(Manila, 1913)
Southern Islands Other schools of
Hospital School of Nursing established
Nursing were the ff:
(Cebu, 1918) a. Zamboanga
General Hospital
School of Nursing
(1921)
b. Chinese General
Hospital School of
Nursing (1921)
c. Baguio General
Hospital School of
Nursing (1923)
 d. Manila Sanitarium school having been impressed with their
and Hospital School of work.
Nursing (1930) o The 1st batch of five sisters arrived in
e. St. Paul’s School of August, 1921.
Nursing in Iloilo City o Mrs. Praxedes Co Tui, RN from PGH was
(1946) appointed as Chief Nurse and Principal of
f. Northern General the School of Nursing.
Hospital and School of
Nursing (1946)
g. Silliman University
School of Nursing
(1947)

1ST COLLEGES OF NURSING IN THE PHILIPPINES

o University of Santo Tomas College of

Nursing (1946)
o Manila Central University College of
Nursing
o University of the Philippines College of
Nursing

NURSING LEADERS IN THE PHILIPPINES

ANASTACIA GIRON- 1st fil. Nurse as chief

TUPAS nurse superintendent,
founder of PNA.
CESARIA TAN 1st fil. To receive a
Master’s degree in
nursing abroad.
SOCORRO SIRILAN Pioneered chief nurse
in San Lazaro Hosp.
ROSA MILITAR A pioneer in school
health education.
SOR RICARDA A pioneer in nursing
MENDOZA education
CONCHITA RUIZ 1st full-time editor of
the newly named PNA
magazine “The Filipino
Nurse”
LORE TUPAZ “Dean of the Philippine
Nursing”; Florence
Nightingale of Iloilo.

HISTORY OF NURSING IN CGHCNLA

o CGHCNLA was founded in 1921 as CGHSN

o Idea was conceived by Dr. Jose Tee Han
Kee, Director of CGH.
o With him were three physicians who
organized the training school.
o The Sisters of the Immaculate Conception
based in HK and Canton were requested
by Dr. Tee Han Kee to help in starting the
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LAW LEGISLATIVE LAW

“The sum total of rules and regulations by • Laws enacted by any legislative
which society is governed. As such, law is body.
created by people and exists to regulate all • When federal and state laws
persons.” (Guido, 2014) conflict, federal law supersedes,
LITIGATION – action of lawsuit and state law supersede local laws
• It regulates the function of nursing
LITIGATORS – lawyers who participate in
practice acts
lawsuit
• Law which has been promulgated
LAWSUIT – a case in a court of law involving (or "enacted") by a legislature or
a claim, complaint, etc., by one party other governing body or the
against another; suit at law
process of making it. Whether a
given bill will be proposed and is
generally a matter of
the legislative priorities of
government.
• Legislation is defined as laws and
rules made by the government.
An example of legislation is a new
state rule that changes textbook
requirements.
SOURCES OF LAW
ADMINISTRATIVE LAW
CONSTITUTIONAL LAW
• Rules and regulation created by the
• Foundation of the justice system administrative agency when the
and created legal rights and state legislature passes a statute.
responsibilities. • The body of law that regulates the
• It establishes the general operation and procedures of
organization of the federal government agencies.
government grants certain powers Administrative law is a branch of
to the government and places limits public law that is concerned with
on what federal and state the procedures, rules, and
government may do. regulations of a number of
• The body of rules, doctrines, and governmental agencies.
practices that govern the operation An example of administrative law is
of political the regulation and operation of the
communities. Constitutional law is Social Security Administration, and
the channel, or vehicle, for the administration of benefits to the
our constitutional rights. That people.
means there are over
10,000 republic acts. Add a few COMMON LAW
more for other documents such • Law evolving from court decisions
as the constitution, • In deciding specific controversies,
the court generally adhere to the
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doctrine of the stare decisis – to
stand by things decided
• System of law which is based on
judges' decisions and on custom
rather than on written laws.
• A common law relationship is
regarded as a marriage because it
has lasted a long time, although no
official marriage contract has been
signed.
• An example of common law is a
rule that a judge made that says
that people have a duty to read
contracts
THE HIERARCHY OF LAW:
KINDS OF LEGAL ACTIONS
Examples of civil actions include, among
others:
o Personal injury claims based on the
negligent acts of others that cause
VIERNES, JINGER KIM M.
harm to others, such automobile
accidents.
o Breach of contract actions, based
upon the failure of a party to live up
to the terms of a contract.
EXAMPLES OF VIOLENT CRIMES
o Murder.
o Manslaughter.
o Rape.
o Arson.
o Terrorism.
o Domestic violence.
o Gang violence.
o Kidnapping.
MANSLAUGHTER – the crime of killing a
human being without malice aforethought,
or otherwise in circumstances not
amounting to murder. Manslaughter is an
unlawful killing that doesn't involve malice
aforethought—intent to seriously harm or
kill, or extreme, reckless disregard for life.
The absence of malice aforethought means
that manslaughter involves less moral
blame than either first- or second-degree
murder.
TYPES OF LAW
PUBLIC LAW
• Refers to the body of the law that
deals with relationships between
individuals and the government and
governmental agencies
• Law comprises of constitutional law,
administrative law, tax law, criminal
law, and procedural law.
CRIMINAL LAW
• Deals with actions against the
safety and welfare of the public.
(homicide, theft, arson, active
euthanasia, sexual assault)
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PRIVATE LAW • assists in maintaining a standard

of nursing practice by making
• The body of law that deals with nurses accountable to the law
relationships among private
individuals. BRIEF HISTORY OF PHILIPPINE NURSING
- Contract Law
1915 - Act No.2493 – which regulated the
- Tort Law
practice of medicine. This act provided for
• Found in an organizations and
the examination and registration of nurses
employment (no smoking at
in the Philippine Islands
headquarters)
1919 - Act 2808 was passed, this is known
CONTRACT LAW as the First True Nursing Law. It created
among others a board of examiners for
• Involves the enforcement of
nurses. However, it was in 1920 that the
agreements among private
first board examination in the Philippines
individuals or payment of
was given.
compensation for failure to fulfil
agreements. June 19, 1953 - Philippine Nursing Law or
R.A. 877 was passed. This act regulated
THE CIVIL JUDICIAL PROCESS the practice of nursing in the Philippines.
One of the landmarks in the history of the
nursing profession in the Philippines is the
Presidential Proclamation of a Nurses'
Week.

October 17, 1958 - Proclamation No. 539,

the President of the Philippines designated
the last week of October every year
beginning in 1958 as Nurses' Week

June 18, 1966 - Republic Act 4704

amended certain portions of R.A. 877
COMPLAINT – a document filed by a person.
1991 - Republic Act 7164, introduced by
PLAINTIFF – a person who filed a complaint
Senator Heherson Alvarez, codified and
DEFENDANTS – accused
revised all the laws regulating the practice
= complaint-answer-discovery-trial-
of nursing in the Philippines. It was known
decision/verdict (by a judge or jury)
as the Philippine Nursing Act of 1991

FUNCTIONS OF LAW IN NURSING October 21, 2002, Republic Act No. 9173
otherwise known as “The Philippine
• provides a framework for
Nursing Act of 2002” replaced R.A. 7164
establishing what nursing actions in
the care of patients are legal
R.A 9173 “THE PHILIPPINE NURSING ACT OF
• delineates the nurse’s
2002
responsibilities from those of other
professionals
TITLE AND DECLARATION OF POLICY
• helps to establish the boundaries of
independent nursing actions
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This Act shall be known as the “Philippine
Nursing Act of 2002.”
• Declaration of Policy. — It is hereby
declared the policy of the State to
assume responsibility for the
protection and improvement of the
nursing profession by instituting
measures that will result in relevant
nursing education, humane working
conditions, better career prospects
and a dignified existence for our
nurses.
• The State hereby guarantees the
delivery of quality basic health
services through an adequate
nursing personnel system
throughout the country.
ORGANIZATION OF THE BOARD OF NURSING
• SEC. 3. Creation and Composition
of the Board. — There shall be
created a Professional Regulatory
Board of Nursing, hereinafter
referred to as the Board, to be
composed of a Chairperson and six
(6) members.
• They shall be appointed by the
President of the Republic of the
Philippines from among two (2)
recommenders, per vacancy, of the
Professional Regulation
Commission, hereinafter referred to
as the Commission, chosen and
ranked from a list of three (3)
nominees, per vacancy, of the
accredited professional
organization of nurses in the
Philippines who possess the
qualifications prescribed in Section
4 of this Act.
• SEC. 4. Qualifications of the
Chairperson and Members of the
Board. — The Chairperson and
Members of the Board shall, at the
VIERNES, JINGER KIM M.
time of their appointment, possess
the following qualifications:
(a) Be a natural born citizen and
resident of the Philippines;
(b) Be a member of good standing
of the accredited professional
organization of nurses;
(c) Be a registered nurse and
holder of a master’s degree in
nursing, education or other
allied medical profession
conferred by a college or
university duly recognized by
the Government: Provided,
That the majority of the
Members of the Board shall be
holders of a master’s degree in
nursing: Provided, further, That
the Chairperson shall be a
holder of a master’s degree in
nursing;
(d) Have at least ten (10) years of
continuous practice of the
profession prior to
appointment: Provided,
however, That the last five (5)
years of which shall be in the
Philippines; and
(e) Not have been convicted of any
offense involving moral
turpitude;
• Provided, That the membership to
the Board shall represent the three
(3) areas of nursing, namely:
nursing education, nursing service
and community health nursing.
• SEC. 5. Requirements Upon
Qualification as Member of the
Board of Nursing. — Any person
appointed as Chairperson or
Member of the Board shall
immediately resign from any
teaching position in any school,
college, university or institution
offering Bachelor of Science in
Nursing and/or review program for
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the local nursing board
examinations or in any office or
employment in the government or
any subdivision, agency or
instrumentality thereof, including
government-owned or controlled
corporations or their subsidiaries as
well as those employed in the
private sector.
• He/she shall not have any
pecuniary interest in or
administrative supervision over any
institution offering Bachelor of
Science in Nursing including review
classes.
• SEC. 6. Term of Office. — The
Chairperson and Members of the
Board shall hold office for a term of
three (3) years and until their
successors shall have been
appointed and
qualified: Provided, That the
Chairperson and Members of the
Board may be reappointed for
another term.
• Any vacancy in the Board occurring
within the term of a Member shall
be filled for the unexpired portion of
the term only.
• Each Member of the Board shall
take the proper oath of office prior
to the performance of his/her
duties.
• The incumbent Chairperson and
Members of the Board shall
continue to serve for the remainder
of their term under Republic Act No.
7164 until their replacements have
been appointed by the President
and shall have been duly qualified.
• SEC. 7. Compensation of Board
Members. — The Chairperson and
Members of the Board shall receive
compensation and allowances
comparable to the compensation
and allowances received by the
VIERNES, JINGER KIM M.
Chairperson and members of other
professional regulatory boards.
• SEC. 8. Administrative Supervision
of the Board, Custodian of its
Records, Secretariat and Support
Services. — The Board shall be
under the administrative
supervision of the Commission.
• All records of the Board, including
applications for examinations,
administrative and other
investigative cases conducted by
the Board shall be under the
custody of the Commission.
• The Commission shall designate
the Secretary of the Board and shall
provide the secretariat and other
support services to implement the
provisions of this Act.
• SEC. 9. Powers and Duties of the
Board. — The Board shall
supervise and regulate the practice
of the nursing profession and shall
have the following powers, duties
and functions:
(a) Conduct the licensure
examination for nurses;
(b) Issue, suspend or revoke
certificates of registration for the
practice of nursing;
(c) Monitor and enforce quality
standards of nursing practice in the
Philippines and exercise the
powers necessary to ensure the
maintenance of efficient, ethical
and technical, moral and
professional standards in the
practice of nursing taking into
account the health needs of the
nation;
(d) Ensure quality nursing
education by examining the
prescribed facilities of universities
or colleges of nursing or
departments of nursing education
and those seeking permission to
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open nursing courses to ensure that
standards of nursing education are
properly complied with and
maintained at all times. The
authority to open and close colleges
of nursing and/or nursing education
programs shall be vested on the
Commission on Higher Education
upon the written recommendation
of the Board;
(e) Conduct hearings and
investigations to resolve complaints
against nurse practitioners for
unethical and unprofessional
conduct and violations of this Act, or
its rules and regulations and in
connection therewith,
issue subpoena ad
testificandum and subpoena duces
tecum to secure the appearance of
respondents, and witnesses and
the production of documents and
punish with contempt persons
obstructing, impeding and/or
otherwise interfering with the
conduct of such proceedings, upon
application with the court;
(f) Promulgate a Code of Ethics in
coordination and consultation with
the accredited professional
organization of nurses within one
(1) year from the effectivity of this
Act;
(g) Recognize nursing specialty
organizations in coordination with
the accredited professional
organization; and
(h) Prescribe, adopt, issue and
promulgate guidelines, regulations,
measures and decisions as may be
necessary for the improvement of
the nursing practice, advancement
of the profession and for the proper
and full enforcement of this Act
subject to the review and approval
by the Commission.
VIERNES, JINGER KIM M.
• SEC. 10. Annual Report. — The
Board shall at the close of its
calendar year submit an annual
report to the President of the
Philippines through the
Commission giving a detailed
account of its proceedings and the
accomplishments during the year
and making recommendations for
the adoption of measures that will
upgrade and improve the conditions
affecting the practice of the nursing
profession.
• SEC. 11. Removal or Suspension
of Board Members. — The
President may remove or suspend
any member of the Board after
having been given the opportunity
to defend himself/herself in a proper
administrative investigation, on the
following grounds:
(a) Continued neglect of duty or
incompetence;
(b) Commission or toleration of
irregularities in the licensure
examination; and
(c) Unprofessional, immoral or
dishonorable conduct.
• Scope of Nursing. — A person shall
be deemed to be practicing nursing
within the meaning of this Act when
he/she singly or in collaboration
with another, initiates and performs
nursing services to individuals,
families and communities in any
health care setting.
• It includes, but not limited to,
nursing care during conception,
labor, delivery, infancy, childhood,
toddler, pre-school, school age,
adolescence, adulthood and old
age.
• As independent practitioners,
nurses are primarily responsible for
the promotion of health and
prevention of illness.
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• As members of the health team, • Provide health education to

nurses shall collaborate with other
health care providers for the
curative, preventive, and
rehabilitative aspects of care,
restoration of health, alleviation of
suffering, and when recovery is not
possible, towards a peaceful death.
IT SHALL BE THE DUTY OF THE NURSE
TO:
individuals, families and
communities
• Teach, guide and supervise
students in nursing education
programs including the
administration of nursing services in
varied settings such as hospitals
and clinics; undertake consultation
services; engage in such activities
that require the utilization of
knowledge and decision-making
skills of a registered nurse; and
• Undertake nursing and health
human resource development
training and research, which shall
include, but not limited to, the
development of advance nursing
practice;

THE ICN CODE OF ETHICS FOR NURSES

• An international code of ethics for
nurses was first adopted by the
Provide nursing care through the utilization International Council of Nurses
of the nursing process. (ICN) in 1953.
• It has been revised and reaffirmed
• Nursing care includes, but not
at various times since, most
limited to, traditional and innovative
recently with this review and
approaches, therapeutic use of self,
revision completed in 2021.
executing health care techniques
and procedures, essential primary
PURPOSE OF THE CODE
health care, comfort measures,
health teachings, and
administration of written
prescription for treatment,
therapies, oral, topical and
parenteral medications, internal
examination during labor in the
absence of antenatal bleeding and
delivery. In case of suturing of
perineal laceration, special training
shall be provided according to
protocol established;
• Establish linkages with community
resources and coordination with the • It guides everyday ethical nursing
health team; practice and can serve as a

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regulatory tool to guide and define
ethical nursing practice.
• Provides ethical guidance in
relation to nurses’ roles,
responsibilities, behaviors,
decision-making and relationships
with patients and people who are
receiving nursing care.
• It is to be used in combination with
the laws, regulations and
professional standards of countries
that govern nurses’ practice.
• The values and obligations
expressed in this Code apply to
nurses in all settings, roles and
domains of practice, and should be
aspired to by all nursing students.
4 FUNDAMENTAL NURSING RESPONSIBILITIES
o PROMOTE HEALTH
o PREVENT ILLNESS
o TO RESTORE HELATH
o TO ALLEVIATE SUFFERING
ELEMENTS OF THE CODES
NURSES & PATIENTS OR PEOPLE
REQUIRING HEALTH
• 1.1 Nurses’ primary professional
responsibility is to people requiring
nursing care whether individuals,
families, communities or
populations (hereinafter referred to
as either ‘patients’ or ‘people
requiring care’).
• 1.2 Human rights, values, customs,
religious and spiritual beliefs
• 1.3 Nurses ensure that the
individual receives accurate,
sufficient and timely information in a
culturally appropriate manner on
which to base consent for care and
related treatment.
• 1.4 Nurses hold in confidence
personal information and respect
the privacy, confidentiality and
VIERNES, JINGER KIM M.
interests of patients in the lawful
collection, use, access,
transmission, storage and
disclosure of this information.
• 1.5 Nurses respect the privacy and
confidentiality of colleagues and
people
• 1.6 Nurses share with society the
responsibility for initiating and
supporting action to meet the health
and social needs of all people.
• 1.7 Nurses advocate for equity and
social justice in resource allocation,
access to health care and other
social and economic services.
• 1.8 Nurses demonstrate
professional values such as
respect, justice, responsiveness,
compassion, empathy,
trustworthiness and integrity.
• 1.9 Nurses provide evidence-
informed, person-centered care,
recognizing and using the values
and principles of primary health
care and health promotion.
• 1.10 Nurses encourage a culture of
safe health care and raise any
concerns regarding the safety of
people and health services.
• 1.11 Nurses support and protect the
right to self-determination of all
patients and other health care
professionals.
• 1.12 Nurses ensure that use of
technology and scientific advances
are compatible with the safety,
dignity and rights of people. In the
case of devices, such as robots,
nurses ensure that care remains
person-centered and that such
devices support and do not replace
human relationships.
NURSES AND PRACTICE
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• 2.1. Nurses carry personal
responsibility and accountability for
nursing practice, and for
maintaining competence by
continual learning. They engage in
continuous professional
development and lifelong learning.
• 2.2 Nurses maintain fitness to
practice so as not to compromise
the ability to provide care.
• 2.3 Nurses practice within the limits
of their individual competence and
use judgement when accepting and
delegating responsibility.
• 2.4 Nurses value their own dignity,
well-being and health. They know
that positive practice environments,
characterized by professional
recognition, education, support
structures, adequate resourcing,
management practices and
occupational health and safety, are
pivotal to achieve them.
• 2.5 Nurses, at all times maintain
standards of personal conduct
which reflect well on the profession
and enhance its image and public
confidence. In their professional
role, nurses recognize and maintain
personal relationship boundaries.
• 2.6 Nurses share their knowledge
and provide feedback, mentorship
and guidance for the professional
development of nursing students,
novice nurses, other nurses and
other health care providers.
• 2.7 Nurses foster and maintain a
practice culture that promotes
ethical behavior and open dialogue.
• 2.8 Nurses may conscientiously
object to participating in a particular
medical procedure or research
study but must ensure that people
receive care.
• 2.9 Nurses maintain a person’s
right to give and withdraw informed
VIERNES, JINGER KIM M.
consent to access their genetic
information, including activities
linked to genetic and genomic-
based research. They protect the
use, privacy and confidentiality of
genetic information and human
genome materials. They also foster
the equitable access to genomic
technologies.
• 2.10 Nurses develop and sustain
collaborative and respectful
relationships with colleagues and
other members of the health care
team. They recognize and respect
their knowledge, skills and
perspectives.
• 2.11 Nurses take appropriate
actions to safeguard individuals,
families and communities when
their health is endangered by a co-
worker, any other person, policy,
practice or misuse of technology.
• 2.12 Nurses are active participants
in the promotion of patient safety.
They promote ethical conduct when
errors or near misses occur, speak
up when patient safety is
threatened, and work with others to
reduce the potential of errors.
NURSES AND THE PROFESSION
• 3.1 Nurses assume the major role
in determining and implementing
acceptable standards of clinical
nursing practice, management,
research and education.
• 3.2 Nurses are active in developing
a core of research-based, updated
professional knowledge that
supports evidence-informed
practice.
• 3.3 Nurses are active in developing
and sustaining a core of
professional values.
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• 3.4 Nurses, through their reduce environmentally harmful

professional organizations, practices in order to promote health
participate in creating a positive and well-being.
practice environment that supports • 4.7 Nurses collaborate with other
individual practice and ensures safe health professions and the public to
quality care, and maintains safe, uphold principles of justice by
equitable social and economic promoting responsibility in human
working conditions for nurses. rights, equity and fairness and by
• 3.5 Nurses contribute to positive promoting the public good and a
and ethical organizational healthy planet.
environments and challenge
unethical practices and settings.
• 3.6 Nurses engage in the creation,
dissemination and use of research.
• 3.7 Nurses prepare for and respond
to emergencies, disasters, conflicts,
epidemics and conditions of scarce
resources.

NURSES AND GLOBAL HEALTH

• 4.1 Nurses value access to health
care as a human right, affirming the
need for universal health coverage.
• 4.2 Nurses uphold the dignity, PATIENT’S RIGHTS
freedom and worth of all human
beings and oppose all forms of Are policies and rules that must be
exploitation, such as human preserved and protected by Health
trafficking and child labor. Facilities toward patients and their families.
• 4.3 Nurses lead or contribute to
health policy development. RIGHT TO APPROPRIATE MEDICAL CARE &
• 4.4 Nurses support and work HUMAN TREATMENT
towards the achievement of the
• Right to health and medical care
United Nations Sustainable
and good quality.
Development Goals.
• If the patient has to wait for care, he
• 4.5 Nurses recognize the
shall be informed of the reason for
significance of the social
the delay.
determinants of health. They
contribute to, and advocate for, • Patients in emergency shall be
policies and programs that address extended immediate medical care
them. and treatment without any deposit,
pledge, mortgage or any form of
• 4.6 Nurses collaborate and practice
to preserve, sustain and protect the advance payment for treatment.
natural environment and are aware
RIGHT TO INFORMED CONSENT
of its consequences on health.
They advocate for initiatives that

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• The patient has a right to a clear,
truthful and substantial explanation
and will not be subjected to any
procedure without his written
informed consent, except in the
following cases:
a) in emergency cases
b) when the health of the
population is dependent on the
adoption of a mass health
program to control epidemic;
c) when the law makes it
compulsory for everyone to
submit a procedure;
d) When the patient is either a
minor, or legally incompetent, in
which case. a third-party
consent Is required;
e) when disclosure of material
information to patient will
jeopardize the success of
treatment, in which case, third
party disclosure and consent
shall be in order;
f) When the patient waives his
right in writing.
RIGHT TO PRIVACY & CONFIDENTIALITY
• The patient 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 patient waives this
right in writing.
RIGHT TO INFORMATION
VIERNES, JINGER KIM M.
• Right to be informed of the result of
the evaluation of the nature and
extent of his/her disease.
• Right to examine and be given an
itemized bill of the hospital and
medical services
• Right to be informed by the
physician or his/her delegate of
his/her continuing health care
requirements following discharge.
RIGHT TO CHOOSE HEALTH CARE
PROVIDER & FACILITY
• The patient is free to choose the
health care provider to serve him as
well as the facility
• The patient has the right to discuss
his condition with a consultant
specialist, at the patient’s request
and expense.
RIGHT TO SELF-DETERMINATION
• Right to avail himself/herself of any
recommended diagnostic and
treatment procedures provided that
a) he is informed of the medical
consequences of his choice;
b) he releases those involved in
his care from any obligation
relative to the consequences of
his decision;
c) his decision will not prejudice
public health and safety.
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:
• Provided, that such a right shall not
be imposed by parents upon their
children who have not reached the
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legal age in a life-threatening
situation as determined by the
attending physician or the medical
director of the facility.
RIGHT TO MEDICAL RECORDS
• He has the right to view the
contents of his medical records,
except psychiatric notes and other
incriminatory information obtained
about third parties, with the
attending physician explaining
contents thereof.
RIGHT TO LEAVE
• The patient has the right to leave
hospital or any other health care
institution regardless of his physical
condition: Provided that
a) he/she is informed of the
medical consequences of
his/her decision
b) he/she releases those involved
in his/her care from any
obligation relative to the
consequences of his decision;
c) his/her decision will not
prejudice public health and
safety.
RIGHT TO REFUSE PARTICIPATION IN
MEDICAL RESEARCH
• 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.
RIGHT TO CORRESPONDENCE AND TO
RECEIVE VISITORS
VIERNES, JINGER KIM M.
• 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
RIGHT TO EXPERIENCE 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.
• Such a system shall afford all
parties concerned with the
opportunity to settle amicably all
grievances.
RIGHT TO BE INFORMED OF HIS RIGHTS &
OBLIGATIONS AS A PATIENT
• It shall be the duty of health care
institutions to inform of their rights
as well as of the institution's rules
and regulations that apply to the
conduct of the patient while in the
care of such institution.
NURSING JURISPRUDENCE
• department of law which comprises
all legal rules and principles
effecting the practice of nursing
• includes the study and interpretation
of rules and principles and their
application in the regulation of the
practice of nursing
LEGAL LIABILITIES IN NURSING
• As nurses begin their professional
obligations, their legal
responsibilities begin as well.
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• Their license to practice attests that
they are qualified under the law to
practice their profession.
• The Philippine Nursing Act of 1992
is the best guide the nurse can
utilize as it defines the scope of
nursing practice.
• There are also standards of care
that may be used as criteria in
evaluating their work.
• The nurses are enjoined to be
familiar with the Philippine Nursing
Law, and the standards of nursing
care, other laws which affect
nursing practice and their code of
ethics
RESPONSIBILITY & ACCOUNTABILITY FOR
THE PRACTICE OF PROFESSIONAL
NURSING
Responsibility – refers to the execution of
duties associated with a nurse’s particular
role. That is, the nurse is responsible
for providing care within established
standards of the profession.
Accountability – refers to the ability to
answer for one’s own actions. The nurse is
accountable to herself most of all. He/she
also balances accountability to the patient,
the profession, the employing institution,
and society.
Liability – an obligation one has incurred or
might incur through any act or failure to act.
-When the nurse fails to meet the legal
expectations of care, the client can initiate
action if harm or injury is incurred by the
client.
DEFINITION OF TERMS
ETHICS
o expected standards of behavior of a
particular group
VIERNES, JINGER KIM M.
o rules of behavior based on ideas
about what is morally good and
bad. A branch of Philosophy dealing
with what is morally right or
wrong/moral judgement
MORAL
o personal standards of right and
wrong
o based on what you think is right and
good/ agreeing with a standard of
right behavior. (honest, just, decent)
CRIMES
o an act committed in violation of
public (criminal) law & punishable
by fine or imprisonment. Punished
through criminal action by the state
against the individual.
o an illegal act for which someone
can be punished by the
government; activity that is against
the law, an illegal act in general, an
act that is foolish or wrong.
• FELONIES – ex: Murder or
rape (a serious crime)
• MISDEMEANOR – a crime
that is not very serious
(misdeed) – ex: Defacing
(ruin the surface with writing
or pictures) school property
TORT
o a civil wrong committed against a
person or a person’s property.
Usually litigated in court by civil
action between individuals.
• Unintentional
• Intentional
o a wrongful act that causes harm to
someone but that is not a crime and
dealt with a civil court
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NEGLIGENCE
o Omission or failure to do that which
a reasonable and prudent man
would do
MALPRACTICE
o Any professional misconduct,
unreasonable lack of skill or fidelity
in professional duties, evil practice
or illegal or immoral conduct
PROFESSIONAL NEGLIGENCE
o Refers to the commission or
omission of an act, pursuant to a
duty, that a reasonably prudent
person in the same or similar
circumstances would or would not
do and acting or the non-acting is
the proximate cause of injury to
another person or his property.
o The elements of professional
negligence are
(1) existence of a duty on the part of
the person charged to use due care
under circumstances,
(2) failure to meet the standard of
due care,
(3) the foreseeability of harm
resulting from failure to meet the
standard, and
(4) the fact that the breach of this
standard resulted in an injury to the
plaintiff.
TORTS (INTENTIONAL)
Assault Attempt or threat to
touch another person
unjustifiably;
precedes battery; it is
the act that causes the
person to believe a
battery is about to
occur.
Battery Is the willful touching of
a person that may or
may not cause harm
VIERNES, JINGER KIM M.
False Unlawful restraint or
Imprisonment detention of another
person against his or
her wishes
Right of Privacy Right of an individual to
withhold himself and
his property from
public scrutiny
Defamation Communication that is
false or made with a
careless disregard
from the truth and
results in injury to
person’s reputation
Libel – printed, written
or pictures
Slander – spoken
words
NEGLIGENCE
Negligence Is misconduct or practice
that is below the standard
expected of an ordinary,
reasonable, and prudent
person.
Gross Involves extreme lack of
Negligence knowledge, skill, or
decision making that the
person clearly should
have known would put
others to harm
AREAS OF POTENTIAL LIABILITY
Categories of Negligence that result in
Professional Negligence Lawsuits
o Failure to follow standards of care
o Failure to use equipment in
responsible manner
it o Failure to communicate
o Failure to document
o Failure to assess and monitor
o Failure to act as a client advocate
MALPRACTICE
o In the usual sense implies the idea
of improper or unskillful care of a
patient by a nurse. It would also
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see that malpractice also denotes THE 4 Cs OF MALPRACTICE PREVENTION

stepping beyond one's authority
with serious consequences Caring Sincere caring
decreases the like
6 Elements hood that a patient
Duty Nurse must have a will sue of
relationship with the outcomes are
client that involves unsatisfactory or
providing care & adverse events
following an acceptable occur
standard of care. Communication Develop trust and
Breach of Nurse must have a respect with
Duty relationship with the patients by
client that involves communicating
providing care & professionally and
following an acceptable confirming that you
standard of care. have been
Foreseeability A link must exist understood.
between the nurse’s act Competence Maintain
& the injury suffered. competence and
Causation It must be proved that update knowledge
the harm occurred as a and skills
direct result of the frequently
nurse’s failure to follow Charting Document is proof
the standard of competence.
Harm or Plaintiff must Chart every
injury demonstrate some type conversation and
of harm or injury as a interaction you
result of breach of duty have with a patient.
owed the client.
Damages If malpractice caused the KINDS OF LEGAL ACTIONS
injury, the nurse is held
liable for damages that CIVIL ACTIONS Deals with the
may be compensated. relationships
among individuals
TYPES OF NURSING MALPRACTICE in the society. (man
file a suit against a
o Medication error person who
o Failure to follow a Physician’s believes he
orders cheated him,
o Delaying patient care and/or failure negligence,
to monitor a patient malpractice)
o Incorrectly performing a procedure, CRIMINAL ACTIONS Deals with
or trying to perform a procedure disputes between
without training individual and the
o Documentation error society as a whole
o Failure to get informed patient (a man shoots a
consent person; society
brings him to trial)
LITIGATION Action of lawsuit.

VIERNES, JINGER KIM M.

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THE DOCTRINE OF “RES IPSA LOQUITOR” • patient’s/client’s name, age

and sex, and date of
o “The thing speaks for itself.” prescription.
o Conditions: o R.A. 6675 requires that the drugs
• Injury was of such nature be written in their generic names.
that it would not normally
occur unless there was a INTRAVENOUS THERAPHY & LEGAL
negligent act. IMPLICATIONS
• Injury caused by an agency
within control of the o "In the administration of
defendant. intravenous injections, special
• Plaintiff did not engage in training shall be required according
any manner that would bring to protocol established."
about injury. o Therefore, nurses have to
undertake a certified training course
MEDICAL ORDERS, DRUGS, & MEDICATIONS on intravenous therapy.

o R.A. 6675 states that only validly TELEPHONE ORDERS

registered medical, dental and
veterinary practitioners, whether in
private institution/ corporation or in
the government, are authorized to
prescribe drugs.
o Prescriptions made by
unauthorized persons constitute
illegal practice of medicine,
dentistry or veterinary medicine and
is punishable under R.A. 2832 of
the Medical Act of 1959, R.A. 4419
of the Dental Act, and R.A. 382 or
the Veterinary Act
R.A 5921, THE PHARMACY ACT AS
AMENDED
o An act regulating the practice of
pharmacy and settings standards
pharmaceutical education in the
Philippines and of the other
purposes.
o All prescriptions must contain the
following information:
• name of the prescriber,
• office address,
• professional registration
number,
• professional tax receipt
number,
VIERNES, JINGER KIM M.
o There are legal risks by telephone
orders. These may be
misunderstood or misinterpreted by
the receiving nurse.
o Sometimes too, messages from
telephones may sound unclear or
garbled because of some trouble in
the telephone lines.
o Most importantly, the signature of
the ordering physician is not
present and this order may later be
denied incase errors exist or court
litigations arise.
CONSENT TO MEDICAL & SURGICAL
PROCEDURE
o Consent is defined as a “free and
rational act that presupposes
knowledge of the thing to which
consent is being given by a person
who is legally capable to give
consent.”
o The consent signed by the patient
or his authorized
representative/legal guardian
upon admission is for the initial
diagnosis and treatment.
o Subsequent treatments/operations
require individual, informed
consent.
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o Before any medical or surgical
procedure can be performed on a
patient, consent must be obtained
from the patient or his authorized
representative who may be his
parent or guardian.
o It is only in case of emergency
where the consent requirement
does not apply.
o The physician should give as much
information about a contemplated
procedure and the patient should
receive enough information to allow
him to give an informed consent for
such procedure or treatment.
o The intentional touching or unlawful
beating of another person without
authorization to do so is a legal
wrong called battery.
NATURE OF CONSENT
o Consent is an authorization, by a
patient or a person authorized by
law to give the consent on the
patient's behalf that changes a
touching from non-consensual to
consensual.
o It is the nurse who actually secures
the consent of the patient upon
admission.
o This consent is usually for
diagnostic procedures and initial
treatment deemed necessary by
the medical staff.
o To substantiate the patient’s
consent, a written authorization is
needed as proof against any liability
that may arise due to an alleged
unlawful touching of a patient.
VIERNES, JINGER KIM M.
INFORMED CONSENT
o The essential elements of informed
consent include
(1) the diagnosis and explanation
of the condition;
(2) a fair explanation of the
procedures to be done and
used and the consequences;
(3) a description of alternative
treatments or procedures;
(4) a description of the benefits to
be expected;
(5) material rights if any;
(6) the prognosis, if the
recommended care, procedure,
is refused.
PROOF OF CONSENT
o A written consent should be signed
to show that the procedure was the
one consented to and that the
person understood the nature of the
procedure, the risks involved and
the possible consequences.
o A signed special consent is
necessary before any medical or
surgical treatment is done such as
x-rays, special laboratory tests,
blood transfusions, operations,
cobalt therapy, or chemotherapy
and the like.
WHO MUST CONSENT
o Ordinarily, the patient is the one
who gives the consent in his own
behalf.
o However, if he is incompetent (such
as in the case of minors or the
mentally ill) or physically unable
and is not an emergency case,
consent must be taken from
another who is authorized to give it
in his behalf.
CONSENT OF MINORS
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o Parents, or someone standing in
their behalf, give the consent to
medical or surgical treatment of a
minor.
o Parental consent is not needed
however, if the minor is married or
otherwise emancipated.
CONSENT OF MENTALLY ILL
o A mentally incompetent person
cannot legally consent to medical or
surgical treatment.
o The consent must be taken from the
parents or legal guardian.
EMERGENCY SITUATION
o When an emergency exists, no
consent is necessary because
inaction at such time may cause
greater injury.
o A mother who is on the advanced
stage of labor or a patient who goes
to the emergency room gives an
implied consent to an immediate
treatment or attendance.
o However, if time is available and an
informed consent is possible, it is
best that this be taken for the
protection of all parties concerned.
REFUSAL TO CONSENT
o A patient who is mentally and
legally competent (sane mind and
of legal age) has the right to refuse
to permit touching of his body or to
submit to a medical or surgical
procedure no matter how
necessary, nor how imminent the
danger to his life or health if he fails
to submit to treatment.
o Examples are patients who,
because of their religious beliefs,
may refuse blood transfusion.
o A patient may refuse to consent due
to inadequate information regarding
the procedure to be done. If after
the explanation, he still refuses to
VIERNES, JINGER KIM M.
sign the consent form, he should be
made to fill out the release form to
protect the hospital and/or agency
and its personnel from any liability
that may result from his refusal.
o If he refuses to sign the release
form, this should be noted in his
chart. The competent person has a
legal and ethical right to refuse
treatment, and this right is formally
established.
MEDICAL RECORDS
o value = scientific and legal.
o "If it was not charted, it was not
observed or done.”
o In the performance of their duties,
nurses are expected to record fully,
accurately, legibly, and promptly
their observations from admission
to the time of the patient’s
discharge.
o Daily notes should include not only
medications and treatments given
or rendered but also the physical
and emotional symptoms exhibited
by the patient.
o Data Privacy is essential
o Permission has to be taken from the
hospital authorities for authorization
to secure any information from the
patient’s chart.
o Nurses are responsible for
safeguarding the patient’s record
from loss or destruction or from
access by persons who are not
legally authorized to read such.
LEGAL RESPONSIBILITIES OF STUDENTS
o Nursing students are responsible
for acquiring the knowledge and
skills necessary to become a
safe practitioner.
o Included in this knowledge and
skill development is the awareness
of ethical principles and the process
of ethical decision making.
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o Nursing students must act as
reasonably prudent persons,
equivalently with education and
experience, when performing
nursing duties.
o They must perform only those tasks
that they are competent to perform
LIABILITY FOR THE WORK OF NURUSNG
STUDENTS
1. Nursing students should always be
under the supervision of their
Clinical Instructors.
2. They should be given assignments
that are in level of their training,
experience and competency.
3. They should be advised to seek
guidance specially if they are
performing a procedure for the first
time.
4. They should be oriented to the
policies of the nursing unit where
they are assigned.
5. Their performance should be
assessed frequently to determine
their strengths and their
weaknesses.
6. Frequent conferences with the
students will reveal their problems,
which they may want to bring to the
attention of their instructors or vice-
versa. Discussions of these
problems will iron out doubts and
possible solutions may be provided
CHARTING DONE BY NURUSNG STUDENTS
o When a nurse or a clinical instructor
countersigns the charting of a
nursing student, she attests that
she has personal knowledge of
information and that such is
accurate and authentic.
o Anyone who countersigns without
verification commits herself to
possible legal risk
INCIDENT REPORTS
VIERNES, JINGER KIM M.
o The primary purpose of an incident
report is to document and prevent
possible consequent injuries.
o Classifying an event, as an incident
does not imply that someone made
a mistake, it only means that
something unusual happened.
ETHICO-LEGAL-MORAL FUNCTION &
RESPONSIBILITIES OF A NURSE
LEGAL PROTECTIONS IN NURSING
PRACTICE
o Laws and strategies are in place to
protect the nurse against litigation.
o Providing safe and, competent
practice is a major safeguard for
nurses.
o Accurate and complete
documentation is also a critical
component of legal protection for
the nurse
GOOD SAMARITAN ACTS
o are laws that protects the health
care provider who provide
assistance at the scene of an
emergency against claims of
professional negligence.
Guidelines for nurses who choose to
render emergency care are as follows:
o Limit actions to those normally
considered first aid, if possible
o Do not perform actions that you do
not know how to do
o Offer assistance, but do not insist
o Have someone call for additional
help
o Do not leave scene until the injured
person leaves or another qualified
person takes over
o Do not accept any compensation
PROFESSIONAL LIABILITY INSURANCE
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o It covers all costs incurred by the
nurse up to the face value of policy.
However, the insurance company
may have the right to make the
decisions about the claim and
settlement.
o Common claims that professional
liability insurance covers are
negligence, misrepresentation
o A Primary care provider or a hospital
can be sued because of the
negligence conduct of a nurse and
the nurse can also be held liable for
professional negligence
o Hospitals are known to countersue
nurses when they find negligence
and the hospital is required to pay
that’s why nurses are advised to
provide their own insurance
coverage and not rely on hospital
provided insurance.
NURSE AS WITNESSES
o A nurse who is asked to testify in a
situation regarding legal action
must seek the advice of an attorney
before providing testimony and that
the lawyer can also provide support
and counsel during the legal case.
o A nurse may also provide testimony
as an expert witness. An expert
witness has a special training,
experience, or skill in a relevant
area and is allowed by the court to
offer an opinion on some issue
within his/her area of expertise.
REGULATIONS OF NURSING PRACTICE
The standards of professional nursing
practice are authoritative statements of the
duties that all registered nurses, regardless
of role, population or specialty are
expected to perform competently” (2010, p.
2) – AMERICAN NURSES ASSOCIATION
(ANA)
VIERNES, JINGER KIM M.
WHAT ARE THE LEGAL ASPECTS OF
NURSING FOR?
o The legal aspects of nursing have
an impact on the manner in which
care is delivered to patients by
nurses.
o Legal concerns shape the
environment in which nursing is
practiced and determine how
documents are kept or shared.
Ultimately, nurses and the nursing
care they provide are judged based
on a legal definition for the standard
of care for nurses.
o Written "standards of care and
"guidelines" are available as
resources for determining how
nursing care is to be delivered and
the quality of care. However, the
legal definition of the standard of
care for nurses is not a "guideline"
or a "policy" set by any one
individual or institution. Rather, it is
the embodiment of collective
knowledge for what is required of
the average nurse and sets the
minimum criteria for proficiency.
o The reason for having such a
general definition is to allow for
changes in the manner in
which nursing is practiced.
NURSE PRACTICE ACTS
o State Nurse practices acts also
legally control nursing practice;
many states require.
o The practice of nursing is a right
granted by a state to protect those
who need nursing care. and safe,
competent nursing practice is
grounded in the guidelines of the
state nurse practice act (NPA) and
its rules.
o All nurses have a duty to
understand their NPA and to keep
up with ongoing changes as this
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dynamic document evolves and the
scope of practice expands.
o Republic Act (RA) No. 9173,
otherwise known as the "Philippine
Nursing Act of 2002. “As with the
new driver, education and
standards provided
by laws designed to protect the
public provide guidance in nursing
practice
CREDENTIALING
1. Is the process of determining and
maintaining competence in nursing
practice.
2. Is one way of in which the nursing
profession maintains standards of
practice and accountability for
educational preparation of its
members and is recognized as
qualified to carry out a tasks
3. Includes the following:
1. Licensure
2. Certification
3. Accreditation
o The process of establishing the
qualifications of licensed medical
professionals and assessing their
background and legitimacy.
o The process of obtaining, verifying,
and assessing the qualifications of
a practitioner to provide care or
services in or for a health care
organization. Credentials are
documented evidence of licensure,
education, training, experience, or
other qualifications.
FACTORS INCLUDED IN CREDENTIALING
LICENSURE
o A license is a legal permit that a
government agency grants to
individuals to engage in the practice
of a profession and to use a
particular title.
VIERNES, JINGER KIM M.
o Nursing License is mandatory in all
states. For an occupation to obtain
the right to license to its members,
three criteria must generally be met:
1. Need to protect the public safety
or welfare
2. The occupation is clearly
delineated as a separate,
distinct area of work.
3. A proper authority has been
established to assume the
obligations of the licensing
process.
IMPORTANCE OF LICENSURE
o According to Nurse Attorney. Brous,
(2012). He stated that “Nurses don't
have the right to practice nursing or
to hold themselves out as nurses
unless their nursing licenses are in
good standing."
o A professional license in nursing is
important because it sets minimum
and pervades assuranete to ese
public that predetermined
standards have been met.
CERTIFICATION
o The voluntary practice of validating
that an individual nurse has met
minimum standards of nursing
competence in specialty areas.
o National certification may be
required to become licensed as an
advanced practice nurse.
o Certification programs are
conducted by the American Nurses
Association (ANA) and by specialty
nursing organization.
o The action or process of providing
someone or something with an
official document attesting to a
status or level of achievement.
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ACCREDITATION/APPROVAL OF BASIC
NURSING EDUCATION PROGRAMS

o Depending on the state, a state

board of nursing must either
approve or accredit a nursing
program.
o Nursing programs can also choose
to seek voluntary accreditation from
a private organization such as the
Accreditation Commission for
Education in Nursing (ACEN) and
the Commission on Collegiate
Nursing Education (CCNE)
o The action or process of officially
recognizing someone as having a
particular status or being qualified
to perform a particular activity.
o Accreditation is important because
it: Helps determine if an institution
meets or exceeds
minimum standards of quality.
Helps students determine
acceptable institutions for
enrollment. Assist institutions in
determining acceptability of transfer
credits.

STANDARDS OF CARE
o The skills and learning commonly
possessed by members of a
profession (Guido, 2014).
o Nursing standards of care can be
classified into two categories:
internal and external standards.
o Internal standards of care include
“the nurses job description,
education. and expertise as well as
individual institutional policies and
procedures” (Guido. 2014, p.55)
o External standards consist of the
following:
a. Nurse practice acts
b. Professional organization
c. Nursing specialty – practice
organizations
d. Federal organizations and
federal guidelines.

VIERNES, JINGER KIM M.