nursing research, leadership and management

Nursing Research, Leadership and Management

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NURSING REASEARCH, LEADERSHIP AND

MANAGEMENT

I. Nursing research

a. Definition of terms

b. Characteristics

c. Purpose

d. Ethics of Scientific Research e. Steps in Nursing Research

II. Nursing Leadership

a. Definition of Terms b. Elements of Leadership

c. Nursing Leadership

d. Reasons for the Study of Nursing Leadership

e. Theories of Leadership

f. Leadership Style g. Powers of a Leader

h. Skills and qualities of a Leader

III. Nursing Management

a. Definition of Terms

b. Theories of Management

c. Manager/ Types

d. Management Process

e. Sample Questions or Post-test ** CBQ : Common Board Question

I. Nursing Research :

Definition : according to Kerlinger, nursing research is the : a. systematic

b. empirical

c. controlled, and

d. critical investigation

of a hypothetical proposition in relation with a phenomenon.

* First thing to do in nursing research is to choose a problem

related to a phenomenon.

Nursing problem : is anything that influences the human lives /

existence. Ex. : diseases, infections, pollution etc

Example of a problem : Tuberculosis

1. You need to apply a hypothetical proposition.

Hypothesis : represents not the final answer to the nursing problem being studied BUT is :

a. an educated guess

b. a scientific guess

c. a tentative answer only.

* IS a big question mark in the researcher’s mind. 2. Hypothesis for the problem of TB :

“ Environmental pollution in Manila increases the cases of TB at

San Lazaro

General Hospital”.

Four Major Characteristics of a Scientific Research :

1. Systematic : the study must follow a step-by-step

process/procedure.(**CBQ)

2. Empirical/ Empiricism : the study should be dealt with

objectivity : the data related to the problem should be readily observable or gathered through

the senses.

3. Controlled/ Appropriate Research Design : study should be

directed, designed or

manipulated by appropriate system, method or process to control all variables of

the study.

4. Based on a Critical investigation : the study should be a fact-

finding investigation on a

population or human beings to gather data to answer the hypothesis.

Four Basic Purposes of Nursing Research :

1.Descriptive purpose : 100 % knowledge on the subject; study

is done for richer

familiarity and is carried out by mere active observation of a

phenomenon.

2. Exploratory purpose : 50 % of the answer is already known. 3. Experimental purpose : you determine the cause and effect

ratio by applying active

manipulation bec you are doing active intervention.

4. Developmental purpose : done to improve the system or

quality of care for our patients. * The main purpose of nursing research is to improve the quality

of patient care.(**CBQ)

Ethics of a Good Scientific Research : (SCIENTIFIC)

Scientific objective : the study should have an objective beneficial to your patients.

Consent : consent should be secured when obtaining all data

needed in the study.

**CBQ : If the patient is dead : the hospital legally owns the

records. The information in the patient’s records : owned by the patient.

If the patient wants an explanation about information in his

chart, ONLY

the physician is legally allowed to explain the diagnosis,

prognosis, treatment etc.

Integrity : should be based on honesty and soundness; no “short-

cuts”, no withholding of

information for personal benefit.

Equity / Equitable : it should include spaces for appropriate acknowledgement for the

contribution of others as well as consent for references used.

**CBQ :

Plagiarism / Illegal replication : unauthorized use of another’s

work /study. Noble / Nobility : the researcher must respect the rights of

his/her subjects.

Three basic rights of a research participant:

1. Right not to be harmed 2. Right to self-determination

3. Right to privacy

I. Types of harm or injury :

1. Physical : may happen during the experimental process through

negligence :

a. by commission : through performance of wrong intervention.

b. by omission : by not doing what was rightfully expected of

him/her from the very start. Ex : omitting to do CPR to someone who fainted in your

presence.

* CPR :

Adult : compression-blow ratio : 15 : 2

Infants : compression-blow ratio : 5 : 1 2. Mental : may be two kinds :

a. assault : subjecting one to mere mental fear or threat.

b. battery : forcible or illegal physical introduction of a

substance

e.g. an invalid administration of a drug or injection. 3. Moral : may either be :

a. slander : when you orally destroy the moral reputation of the

patient.

b. libel : when the defamation is published, written, or recorded.

II. Right to self-determination : the patient personally

determines whether to join

or not in the research; subject must be free from coercion,

restraint, force,

undue influence. It must be voluntary. Informed consent should be sought.

III. The right to privacy may either be :

a. anonymity : refers to privacy as regards the identity of the

Informant; identity may not be disclosed. b. confidentiality : refers to privacy as regards to the information

or data obtained; information acquired must not be

disclosed.

** CBQ : In the process of doing research, the researcher is very


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careful

not to disclose the name of her subjects. This is :

a. protection of client

b. confidentiality c. anonymity

d. informed consent

Truthfulness : should only contain facts not mere fabrications.

Importance : significance to the nursing profession.

Factual : a nursing research is a fact-finding study (facts not fiction)

Ideal : must proceed following the 10 formal steps in nursing

research process.

Courageous : the research should embody the courage to get all

the pertinent facts/data

* CBQ : The main contribution of research towards the

improvement of nursing

profession is which of the following? a. provide a scientific basis for nursing care

b. assist the nurse administrator in planning nursing staff

requirements.

c. assist the faculty in developing the nursing curriculum.

d. facilitate the development of staff development.

Ten Major Steps in Nursing Research :

1. Identification of a research problem.

2. Review of related literature

3. Formulation of a conceptual and theoretical framework. 4. Choose an appropriate hypothesis

5. Choose an appropriate research design.

6. Sampling or obtaining a sample from the population

7. Collection of data phase

8. Analysis of data phase 9. Interpretation of the data

10. Dissemination of conclusion or recommendations.

.** CBQ : The correct sequence of steps in research process is :

1. Formulate problem information.

2. Review literature information 3. Analyze data.

4. Determine research design

5. Make conclusions and recommendations.

a. 1,2,4,3,5

b. 1,3,2,4,5 c. 1,2,4,5,4

d. 2,1,3,5,4

I. Identification of a research problem :

A research problem is anything that requires solution through a scientific investigation.

1. Sources of problems for nursing research :

C : different nursing concepts.

L : health literatures

I : issues affecting the profession E : essays

N : Nursing assessment

T : Nursing theories (** CBQ)

2. Characteristics of a good nursing research problem :

(GReFIN) General applicability : the study is helpful and advantageous for

the common

good and not just for a selected few.

Based on applicability, a problem may be :

a. Basic/ Pure : applicable only to the researcher and done primarily to :

1. Answer personal querries or curiosity

2. To increase personal knowledge.

b. Applied : focused on solving the problems of other people.

Researchable : the problem is capable of being investigated through observation,

manipulation, etc

Feasible : measureable as to :

1. Time 3. Experience of the researcher 5. Population

2. Money 4. Research instruments availability Importance

Novelty : originality (** CBQ)

S ignificance to the nursing profession

*CBQ : Which of the following criteria is least considered in

determining whether

or not a problem is researchable?

a. time factor

b. availability of a research instrument c. nationality of the researcher

d. cost of the investigation.

3. Variable : anything that is subject to change or manipulation.

Two types of variables :

1. Independent : or the causal variable; the cause of the study. 2. Dependent : the effect of the manipulation on the target

population/variable

reaction..

Ivan Pavlov : formulated the theory that a stimulus when applied

to a certain organism will elicit a corresponding response.

Stimulus ---------Organism --------------Response

(Independent Cause) (Target Population)

(Dependent Cause) 4 Definition of terms :

1. Conceptual : taken in its ordinary /common meaning;

dictionary-based meaning

2. Operational : how the researcher used the definition in his

study. Ex. The word “toxic”:

Conceptual meaning : poisonous; hazardous

Operational meaning : heavy workload for an undermanned staff

II. Review of related literatures :

**CBQ : What is the main purpose of review of related literatures?

Ans.: to form a conceptual and theoretical framework.

Two sources of the researcher’s review of related materials :

Conceptual Research

Examples Books,

internet

Research papers

Who were the sources?

Authors Researchers

For what purpose/s?

For general use

For future research studies only

III. Formulation of a conceptual and theoretical framework :

A. Theoretical framework : the theories involved in the

researcher’s study.

B. Conceptual framework : the structural relationship (in an illustrated form) between the

independent and dependent variables.

C. Paradigm : the structural or diagrammatic presentation of the

researcher’s conceptual

framework.

Ex. # 1 : A study on the difference in the professional

opportunities of Filipino nurses

working in the Philippines and those working abroad.

Purpose : “Is to compare the professional opportunities of Filipino nurses working abroad

and those working in the Philippines.

Independent

Variable

Target

Population

Dependent Variable

Place of work

(subject to

manipulation)

Filipino

nurses

Opportunities for

professional growth

(result of

manipulation)

IV. Choose an appropriate hypothesis :

Kinds of hypotheses :

1. Null/ Statistical hypothesis : any statement that has NO

relationship or difference between 1 variable to another single variable. This is mostly used because

it is aesy to reject or

accept a null hypothesis.


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“ There is no difference regarding the professional opportunities

of Filipino nurses

working in the Philippines from those working abroad”.

2. Simple/ Operational hypothesis : states the anticipated

relationship or difference between 1

independent variable to another single dependent variable.

“ Filipino nurses working abroad have more professional growth opportunities than those

working in the Philippines”.

3. Complex hypothesis : states the anticipated relatioship

between 2 or more variables to other variables (intervening variables)

Ex. # 2. “Filipino nurses who worked for 5 years and passed the

CGFNS, TOEFL, TSE,

and NCLEX have greater opportunities to acquire immigrant visas, higher

starting salaries, insurance benefits and study grants“.

4. Directional hypothesis : specifies the direction of the

relationship between variables.

Ex. # 3. “Filipino nurses working in the USA have more

professional opportunities than

those working in the Philippines”

5. Non-directional hypothesis : only predicts the relationship,

but has no specific direction

between variables.

** CBQ : can lead to ambiguity or confusion.

Ex. # 4. “ There is a big difference between a Filipino nurse

working in the USA and

those working in the Philippines.”

V. Selecting an appropriate research design : A systematic, controlled plan for finding answers to a problem;

it is a roadmap, blueprint to

provide a result; a plan, structure or strategy of conducting an

investigation.

* it is used to control the researcher’s variable/s;the skeletal framework in his research.

Three basic classifications of research designs :

1. According to applicability :

a. Basic / pure b. Applied

2. According to data collected :

a. Qualitative : refers to the quality of the data : these are not

subject to numerical

interpretations; can’t be measured quantitatively; based on subjective data

such as :

a. perception d. feelings

b. understanding e. emotions

c. attitudes & beliefs f. behaviors b. Quantitative : readily observable by the senses; can be

numerically interpreted;

based on objective data.

3. According to method :

a. Non-experimental method : when the method presents no

need for any

intervention or manipulation :

1. Passive participation 2. Researcher simply has to observe, describe and record the

results.

3. It is usually done in the natural setting : where the people

(sample)

naturally exist. Ex. : homes, community, schools etc.

b. Experimental type of research design :

1. Active participation

2. Manipulation is needed to get the cause and effect ratio to

determine its

effectiveness (of the manipulation/intervention).

3. It is done in a more controlled setting like labs, research units

etc.

Types of non-experimental research design :

1. According to time : past, present and future.

A. Past :

a. Ex-post facto : retrospective style : a study done on a group of people who

had naturally experienced a natural phenomena (after

a fact)

but is a subject of a present study.

b. Historical type : involves a study of things that happened in the past

which are already :

1. written about

2. documented

3. published, and 4. recorded

Ex. : charts of patients’ data.

Two sources of historical data :

1. Primary sources : nurse’s notes / diaries which give f irsthand

information.** You rely only on this type of source.*CBQ 2. Secondary sources : second hand information : information is

supplied by a person other than the one who experienced it.

B. Present :

Descriptive : based on present occurrence or happening.

C. Future : Prospective : the study is done in the present, the result of which

will be

known only in the future; based on a future

occurrence/happening.

2. Based on the number of participants involved :

Survey type of research design : based on the answer of the

majority

(majority = 50% + 1)

Types of surveys : 1. According to groups:

a. small group : face-to-face interview method where you have

the

advantage of immediately getting the answer / response.

b. large group : utilization of mailed survey forms where you may

have problems with feedback.

2. According to methods

3. According to orientation :

a. Cross-sectional type : 1. Involves two or more evidential groups.

2. Done only once.

3. For the purpose of comparative study

b. Longitudinal type :

1. Involves one core group only

2. Entails doing an initial survey and follow-up survey/s.

3. For the study on the progress/ development of the group

*CBQ : Ex. Is the Sangkap Pinoy movement.

Experimental Type of Research Design

Four compulsory steps of experimental research design :

1. Control stage : the population is divided into two groups :

a. control population : no intervention or manipulation is done to the

group.

b. experimental population : the group subjected to manipulation

or

intervention. 2. Randomization stage : choosing the data by chance where

each member of the

group is given equal chance to be chosen as a sample.

3. Manipulation

4. Evaluation of effects. * CBQ :

Quasi-experimental research design : if a researcher did not

perform all the

procedures of an experimental research design.


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Implication : cannot properly evaluate your results bec of lack of

comparative data.

Characteristics of a good research tool or instrument :

1. Reliability : refers to the accuracy or precision of the tool- if it is administered twice,

the instrument should provide identical data.

2. Validity : refers to the relevance of the measurement to the

study being done.

3. Sensitivity : means that the fine lines of difference amomg the study subjects can be

determined from the measurements, examples of which are

ratings and

thermometers.

4. Meaningfulness : the measurement must have a practical application.

5. Appropriate : if it is applicable to the subjects being tested.

6. Objective : one that is free from bias.

7. Ethical : tools should not violate the human rights of clients.

VI. Sampling/Sample from the population :

Population : refers to the largest body of the case or individuals

being researched that conform to

a specific set of particulars or eligibility criteria.

Sampling : the process of selecting a portion of the population to represent the entire population.

Sample : a group of people coming from the population that will

become the recipients of the

experimentation treatment in an experimental type of research.

Factors that determine the sample size :

1. Accessibility of sample participants : when it is not feasible to

study a whole

population, a sample is taken.

2. Cost : funds available limit the size of the sample. 3. Amount of time available : if the time is limited, only a small

sample may be

gathered.

Two major types of sampling and selection techniques :

I. Probability Sampling : randomization is applied and each member of the population is

given an equal opportunity to be a participant in the study.

1. Simple random sampling : the selection of the sample is done

by chance; used

only for a smaller population made up of identical groups. Ex. : fishbowl technique, lottery draws or table of random

numbers

2. Stratified random sampling : the population is subdivided into

areas, sections,

then random samples are taken from each. This is used for unidentical

groups. (Sub-strata before randomization is done). * CBQ

Ex. Divide the students into year levels : first, second, third, and

fourth

year, and then get random samples from each. 3. Systematic random sampling : using a tool called a “sampling

frame” wherein a

sample is taken every nth number. This is used in a big / large

population.

Sampling frame : a list of names appearing inyour population. Ex. : yellow pad technique.

4. Cluster random sampling : a small sample is taken from

various sections of the

total population. (sub-areas before randomization)

Ex. In studying the attitudes of nurses in Metro Manila towards their work,

a small sample from each hospital will be taken.

II. Non-probability sampling : involves the study of a pre-

selected group (bias group) since the start.

1. Accidental/Convenience sampling : data is collected from

anyone most

conveniently available -- accessibility is the main factor for

sample choice. * This is the weakest form of sampling (bias) *CBQ

2. Purposive / Judgmental sampling : researcher selects and

studies a specific

number of a special group that represents the target population

with

regards to certain characteristics such as age, sex or economic

status. The

selection is based on the common knowledge/understanding of the

researcher.

Ex. Study on poor prostitutes : samples are taken fron Ermita,

Mla.

Study on TB patients : you go to San Lazaro Gen Hosp. 3. Snowball / Network sample : a kind of convenience sampling

that involves

subjects suggesting or referring other subjects who meet the

researcher’s

eligibility criteria; last referral to gain momentum- those qualified but not

referred will not get the chance to participate.

4. Cross-cultural sampling : study is done in a variety of cultural

settings.

Ex. Getting samples from Tagalogs, Ilocanos, Visayans etc. 5. Longitudinal sampling : a given group of subjects are studied

for an extended

period of time, which may either be retrospective or prospective.

Examples :

Prospective : Mastectomy patients are studied from operation to 3

years after discharge.

Retrospective : Growth of newborns two years ago to the

present.

6. Cross-sectional sampling : subjects are only observed at only one point in time.

Ex. Asking high school students their choices of career after

graduation.

7. Quota sampling : the researcher identifies the strata of the

population and determines the proportion of elements needed in the various

segments

VII. Collection of data phase : the most time- and budget-

consuming part of research. Different methods of collecting data :

1. Questionaire : a form prepared and distributed to secure

responses to questions that are

intended to obtain information about conditions or practices on

which the respondents is presumed to have knowledge; method of collecting data using

pen and paper.

Different types of questionnaires :

a. dichotomous : those that require only two answers e.g. Yes or

No, True or False b. rating/checklist : ratings of variables are asked e.g. 1,2,3,4,5,

or poor,fair,good

c. multiple choice : diff alternatives are given as choices :

a,b,c,d, or e.

2. Written records : utilization of those pre-recorded or pre-existing data.

Ex. Patient’s charts (written, documented and recorded)

3. Interview : the oral method of collecting data; oral

communication is used.

Types of interviews : a. structured interview : one wherein specific or pre-seleted

questions are asked

wherein an interview schedule is read to the respondent.

b. non-structured : one where open-ended or generalized

questions are asked by way of an interview guide and the respondent is allowed to

pursue

relevant ideas in depth.

4. Observation : by employing the senses or occular inspection

wherein the researcher may be : a. Participant : active participation is required of the researcher.

The researcher may be

disguised as a patient, nurse, or just a plain eager learner taking

part in the

activity. The attractions and repulsions of the group members are assessed by

plotting their interactions on a devoce called a sociogram.

b. Non-participant : the researcher stands outside the phenomena

being studied and


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records the data as objectively as possible even with a passive

participation only.

Two basic problems under data collection : 1. Hawthorne effect : people may deliberately change their

behavior bec they know that

they are being studied or observed.

* Common in experimental study and is not reliable bec the

behavior of the subjects are consciously altered.

*CBQ : How to avoid ? By the use of double-blind research.

2. Halo effect : the observer may have the tendency to rate

certain subjects consistently

high or low on everything bec of the overall impression the subjects give the rater.

The data collected is untrue bec of a special

relationship/treatment between the

researcher and his sample.

VIII. Analysis and interpretation of data phase :

The stage where the researcher is forming a body of knowledge

or conclusion out of the data

collected either to affirm or negate his hypothesis. The

researcher can answer the hypothesis with finality; the presentation of data relevant to the

problem and sufficient to

answer the hypothesis.

* Tabulation of tha data is necessary before an analysis can be

done.

Different methods of tabulating or measurement of data

collected :

1. Nominal : data are tabulated per category (used in surveys)

2. Ordinal : data are classified according to characteristics as ranked.

3. Interval : data are tabulated per space, distance or

measurement using numerical values.

Ex. Temperature : 150/90 - 120/80 mm Hg

Two methods of interpreting data : (conclusions are made)

1. Quantitative style : data collected are presented in numerical

or graphical forms ;

a. pie graph

b. line graph : usually utilized in longitudinal studies. c. bar graph

2. Qualitative style : interpretation by the use of the narrative

form or approach.

IX. Dissemination of conclusion and recommendations : A. Conclusion : final answer to the problem.

B. Recommendations : suggestions on how to affect the results

of the study positively.

Different methods of dissemination :

1. You can write a book about the study 2. You can hold symposium/symposia

3. Publish the study

4. Through the internet.

II. Leadership

L e a d e r

Group

Followers I

Leadership : is a style or a process whereby a person called a

nurse leader will influence a group

of people known as the followers for the purpose of attaining a single goal or objective

towards the good of his patients.

* If doing the independent roles : the person is a leader.

Different styles of leadership : 1. Autocratic/ Authoritarian / Dictatorial / Bureaucratic or

Traditional : a unilateral style

of leadership; the leader and only the leader himself performs

the decision-making

towards patient care without getting the inputs of his

subordinates.

>Also called “centric” bec the leader makes decision for the

group, he/she, being the only center of attention.

> Also called “Theory X” by McGregor, meaning, this is boss-

centered.

Possible character traits of an autocratic/authoritarian leader :

Apathy : insensitive toward others Boisterous speech

Consistency

Demanding attitude

Egoistic and self-centerde

Ferocious behavior * Generally not a good leader; may be acceptable ONLY during

emergency/crises.

2. Laissez-faire Style / Freestyle / Permissive / Ultraliberal style

of leadership : one in which there is excessive freedom /liberalities and the leader

abdicates the

leadership responsibility and leaces workers without direction,

supervision or

coordination. > “let alone” style of leadership

*Implication : there could be breakdown of power control and

responsibility and

may result to high incidents of negligence.

> This is effective when working with highly motivated professionals, like those

in research, where independent thinking is rewarded..

> Not useful in highly structured organizations e.g. the health

care delivery system

where organization and control form the baseline of most operations.

3. Democratic / Participative / Consultative leadership : is

people oriented; focuses on

human aspects and builds effective teamwork; mutual style of leadership.

>The nurse leader gets the opinions, inputs, and suggestions

from the staff and

members of the team.

> Performance standards exist to provide guidelines and permit performance

appraisal.

> Also called “Theory Y” by McGregor : the leader sees the

workers as ambitious

and she/he does not resist change, is creative and exercises self-direction

and self-control.

> Also called “radic” bec he radiates out to encompass the needs

of others.

> The most desirable form of leadership and leads to high productivity.

Different types of leader powers :

1. Formal/Legitimate/Exclusive power : the power or authority

to give orders or tasks to his subordinates.

2. Referrent power : a charismatic power: the leader uses his/her

charm. *CBQ

3. Expert power : power attained by virtue of his/her extra-

ordinary skills, trainings and abilities.

4. Reward power : the positive power on the part of the leader to

compensate or

remunerate staff members by rewards, incentives, promotions,

commendations etc 5. Coercive power : the negative power of a leader to implement

sanctions, suspensions

and or terminations as a form of disciplinary power.

* General rule :

“Whoever is at the top, has the right to implement discipline.” Ex. Co-member of the team caught with alcohol breath : report

to the supervisor nurse.

Theories :

1. Great man Theory : to become a leader, such person must be


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born to be a leader.

2. Trait or Character Theory : one must have the following to

become a leader :

A. The personality : a. Adaptability : to cope or adjust to the assessed needs of the

community

b. Independence : capable of critical thinking

c. Creative/assertive : must be able to utilize the resources

available to deliver primary health care to the community.

d. Advocate : he must be a defender of the rights of the patients;

performance of duties should be within the realm of the Patient’s

Bill of Rights.

B. Intelligence : a. Proper judgment } a leader should be more

knowledgeable than

b. Proper decision-making }the patient : use

assessment skills.

c. Fluency of speech : one should be able to use proper communication

*CBQ : When dealing with tribal groups, the most important

skill a nurse

leader must possess is proper communication skills.

C. Leadership ability : a. Influence others : *CBQ : you can properly influence others

through

health teachings.

b. Command : should have the aura of power w/o being bossy

c. Respect : should be respectable in any way to be able to gain respect.

d. Participates }esp in performing care for the comatose patients.

A leader

e. Cooperates }should also be willing to do any job in any

contingencies. 3. Charismatic Theory : one can become a leader by virtue of

his/her charm or charisma.

4. Situational/Contingency : one can be a leader in a situation

when his style of

leadership, managing skills, and expertise matches the needs of a situation

> A good leader in one situation but only a follower in other

situations.

> This is a case-to-case basis kind of leadership.

*CBQ : Advantage of this style of leadership : you can have the BEST person for

the needs of the situation.

Skills and Qualities of a Good Leader :

Appropriate authority Leadership Behavior

Communication skills

Decision-making skills

Ethics

Ability to Face conflicts

* Note :

RA 3573 : Law on Notifiable Diseases :

1. Report within 24 hours : Polio and Measles 2. Report within 1 week : Severe Acute Diarrhea, HIV, Tetanus

Neonatorum

I. Appropriate authority : the basis of the leader to issue tasks,

responsibilities, and orders to his/her subordinates.

Types :

1. Centralized : when flow of authority is from the top to the

bottom

2. Decentralized : when authority does not necessarily come from the top.

II. Five leadership behaviors :

Specialized body of knowledge and skills and training.

Ex.: Who is allowed to do IV insertion? *CBQ

Ans. : In RA 7164 (1991) : qualifications for IV insertion are the following

1. Must be a registered nurse (RN)

2. 1-week didactic training

3. Completion form of 50 IV insertions

4. Certification from a duly authorized nursing organization.

ANSAP : Assoc. of Nrsg Services and Administrators of the

Phils.

In RA 9173 (Oct 21, 2002) : qualifications are : 1. Must be a registered nurse

2. 1-week didactic training

Patient-centered behavior

Accountability

Confidentiality : breaking this is “Invasion of Privacy” or “Breach of Privacy”

General Rule : Everything heard and read should be dealt with

confidentiality.

Exceptions to the rule :

Patient’s consent Inform/report to the health care team as a precautionary measure

*CBQ

Communicable + standing order from DOH

Crime : to fulfill a duty to the society e.g. in cases of child abuse

which is to be reported within 24 hours.

Basic things to do in case of child abuse/crime :

Safety : most important thing to do first

Report

Referral: for further assessment like trauma management. Ethics : (to be discussed later)

III. Communication Skills : the ability to transfer information

with understanding.

Communication barriers or backlogs : hinders the communication process.*CBQ

The communication process :

1. Sender : the one who initiates the communication

2. Message : the data that is to be transmitted 3. Encoding : both verbal and non-verbal method of transmitting

the message

4. Receiver : the intended recipient of the message

5. Decoding : the process/manner of interpretation of the data

being transmitted 6. Feedback : action in return by the receiver to the sender.

IV. Decision-making : involves the independent judgment of the

nurse leader.

Step-by-step process of scientific decision-making :

1. Identify the problem.

2. Identify the person/s affected : patients, nurses, members of

the health team

3. Collect options or alternative solutions :

a. Brainstorming : scrutiny of the problem within the

group.*CBQ

b. Delphi technique : seeking for other experts’ advice/opinions

4. Choose the BEST option and implement it. 5. Evaluation : if possible should always be done.

V. Ethics : In essence is good manners and right conduct.

Principles of ethics :

1. Autonomy : independent judgment and decision-making; self-determination. The nurse

should respect the client’s / patient’s decision.

*CBQ : 1. Who would decide for the care of the patient?

a. the doctor

b. nurse c. patient himself

d. relatives

2. Informed consent should always be obtained in invasive

procedures.

Failure to do so would constitute battery. 3. In cases where a patient refuses to give his informed consent

:ra waiver

must be signed by him stating his refusal.

4. In cases where the patient is profusely bleeding and refuses to

undergo blood transfusion, you should :

1. Respect the patient’s decision

2. Physician should explain the risk to the patient (consequence

of


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the refusal of the procedure)

3. Let the patient sign a waiver.

5. An Islamic patient died, the relatives request to do the post

mortem: * Respect the patient’s cultural tradition.

6. A nurse is doing a health teaching in a squatters’ area in

Manila,

suddenly, a mother stood up and said she is against condom use

: respect mother’s views.

2. Principle of Double-effect : if one is made to choose between

two alternatives, he/she

should choose the one with more of good effects and less of the evil effects.

* CBQ : This principle frees the health practitioner of legal

liabilities.

3. Principle of Veracity : telling the truth or not intentionally deceiving or misleading

patients. The patient has the right to know the truth regarding his

state of health.

> Avoid false reassurance : it is non-therapeutic.

Principle of Beneficence : this allows the doing of anything that is good and avoiding

harm to the patient.

Exceptions :

1. If the intervention is non-therapeutic

2. If the confidentiality is violated.

4. Non-maleficence : “Do no evil or harm” principle.

5. Justice : refers to the obligation to be fair to all people.

Prioritize needs of all patients

under one’s care bec different patients have different needs and levels of care.

*CBQ : How can justice be achieved ? By applying the nursing

care process.

Characteristics of the Nursing Care Process : *Acceptable universally *CBQ : NCP should be universally

acceptable.

Based on patient’s assessed needs.

*Client-centered

*Dynamic : based on ever-changing needs of the clients’ situations

Equitable : interventions should be always based on what you

see is the patient’s need

Familiarity

*Goal-oriented : should always be geared towards solving the patient’s health care needs

*CBQ : A dynamic NCP would prioritize the need of which

patient?

a. asthmatic patient who had an attack 2 days ago.

b. CVA patient needing discharge instructions c. patient with head injury

d. 2-year old patient with high fever.

* This is an exception to the ABC rule (airway, breathing and

circulation) bec

although asthma is an airway and breathing problem, the patient had the

attack 2 days ago.Patient c would need immediate attention bec

of the head

injury (may have increased ICP).

* Dynamism can also be done in the choice of patients’ food.

VI. Face conflicts :

A conflict is any clash of ideas resulting to crisis in the

organization.

Different methods of resolving conflicts : Avoidance behavior : putting the problem aside but not paying

any attention to it which is

not actually solving the conflict.

Smoothing behavior : a temporary relief by appealing to a

person’s kindness. Unilateral action : by application of force, inflicting fear and

threats.

Negotiation : the best way to solve conflicts : both parties

mutually discuss and solve the

problem. *CBQ

III. Management

> the process of judicious use of available human and material resources, directing their tasks

towards the achievement of a goal or objective.

> the process of coordinating and supervising personnel and

resources to accomplish

organizational goals. Theories :

1. Human Resource Theory : there must be proper relationship

between the manager and

his members.

2. Frederick Taylor’s Scientific Management Theory : the best manager is a person who

has the following :4 T’s :

Tao

Tools

Trainings Treatment

3. Douglas McGregor’s Motivational Theory :

Theory Y assumes that people are self-directed and will accept

responsibility

under favorable conditions. Individual goal are emphasized. These people

need minimal supervision bec they are :

Efficient

Effective

Diligent and love their jobs. Theory X assumes that people dislike their work and must be

directed and

controlled. Organizational goals are emphasized. These people

need more

motivation (negligent) and close supervision. 4. Henry Fayol’s Theory : management principles :

a. Unity of Command : one group should only get orders from

one manager.

b. Unity of Direction : the whole team should have only one

goal/objective. c. Esprit de corps/Team Spirit : the achievement or fault of one,

is the

achievement or fault of all.

*CBQ : A teenaged patient who had appendectomy, complained of pain. There

was no standing orders for pain medications.

a. don’t give medications without doctor’s orders

b. positioning : YES

4. Respondeat Superior : command responsibility principle : “Let the master answer for

the negligent subordinate who caused injury, harm or death”.

* Note : Head nurse can only delegate the responsibility but not

the accountability.

5. Subordination of general over personal interest : in case of emergency such as in fire :

Rescue your patient.

Alert : sound the fire alarm

Contain the fire in one area

Extinguish the fire. 6. Proper remuneration of your personnel :

Start of work : probationary for the 1st 6 mos

Regular employee : work 8 hours/day for 5 days or 40 hours/

week.

Overtime pay : + 25% Night shift differential : + 10%

Spec Non-working holiday : + 30%

Legal holidays : + 100%

Work-related disability :

a. gov’t. employees : GSIS : ECC (Employees Compensation Com)

b. private employees : SSS : ECC

Both work and non-work-related diseases : PHILHEALTH

(Nat’l Health Ins Act)

> benefits do not include dental, aesthetic and cosmetic procedures.

Maternal/paternal leave allowances :

Mother Father

NSD 60 days 7 days with


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pay

CS 78 days

* Note : allowed only on the 1st 4 pregnancies of the legitimate

spouse. Senior Citizen’s Act : gives 20% discounts for people 65 yrs and

above.

Five steps of management process :

Planning Organizing

Directing

Coordinating

Evaluation

I. Planning : defined as pre-determining a course of action in

order to arrive at a desired

result; forecasting of events and based on which decisions are

made, goals are set

and prioritized and policies and standards are developed. No actual intervention yet; mere conceptualization stage :

1. Planning process should be clear.

Vision : states what the organization wants to achieve in the

future. *DOH : Health for all Filipinos.

Mission : describes and reflects the organization’s core value. It

is the present

reason why the organization was formed.

Philosophy : the set of values and beliefs of the organization; a statement of

beliefs that influence the nursing practice.

Goal : the general statement of the organization’s mission.

Objective : more specific statement of the team’s mission.

Policies : set of rules and regulations in the organization.

2. Budgeting : planning, controlling, and proper allocation of all

resources for the

patients/clients : a. operational : refers to the everyday use of the patients (gowns,

caps, etc)

b. personnel : for the salaries and compensation of staff

c. capital : allocations for long-term use equipments.

II. Organizing Stage : structuring the team to accomplish the

tasks necessary to meet its goals.

* for the purpose of managing the care of patients.

Organizing your team :

Nurse manager Tasks Staff Style

xx xx xx

xx

Nursing tasks are as follows : Assessment : only the nurses should assess the patients, never

the

subordinates.*CBQ

Teaching : health teachings should be done upon admission,

orientation or initial contact with the patient.

Explaining of procedures

Preparation of patients : for procedures to be undertaken

Administration of :

Treatment and medication Evaluation

Judgment

Subordinates’ tasks :

Routinary tasks : include standard, unchanging procedures e.g.

toileting & bathing Stable patients : they may handle patients with predictable

outcomes.

Supervision of nurses : they should be directly supervised by

RN’s.

Staffing : refers to the correct ratio or mix of nursing personnel

in a nursing unit for a

period of 24 hours.

Different types of staffing schedules :

1. Traditional : 8 hours/day, 40 hours/week

2. Non-traditional : 10 hours/day, 40 hours/wk, 4 working

days/wk

3. On call : utilized when there is a sudden increase of number of patients

with less number of nurses.

4. Baylor Plan :

a. weekdays : one works only on weekdays for 8 hours (M -F)

b. weekends : one works only on weekends for 12 hours (Sat/Sun)

Styles of Nursing Care Delivery (Modalities of Nursing Care) :

1. Primary Nursing : the nurse cares for the patient for 24 hours.

* The only type that provides 240care for one patient from the time of

admission until the patient is discharged.

* Done by private duty nurse.

2. Functional method : practiced in congested agencies such as

PGH. Duty/task : specific task is assigned to

One nurse : to be done to all or to the majority of patients

Highly recommended : when there’s a shortage of nursing staff

and budget

* The poorest method of giving care. 3. Case nursing/ Case method :

Total care to a patient per shift

One-on-one handling : in extreme shortage of nurses : 1:2

.

III. Directing / Delegation : The process by which a manager assigns specific tasks, duties,

or procedures to workers

with commensurate authority to perform the job (someone else

performs a

job/task in behalf of the person delegating with authority). *CBQ : One can only delegate the responsibility but NEVER the

accountability.

Ex. : The nurse delegates the preparations for the celebration of

the hospital’s

anniversary but she’s responsible for the outcome of the preparations.

Two important criteria in delegation :

1. The ability of the worker to carry out the task

2. Fairness not only to the employee but to the team as a whole.

Exceptions to the power to delegate : 1. Disciplinary tasks : the authority to discipline erring staff such

as sanctions,

suspensions etc cannot be delegated.

2. Technical tasks : highly technical procedures which require

special trainings or skills should never be delegated.

3. Confidential tasks : tasks which are strictly personal duties /

confidential cannot

be delegated. Ex. : charting should be done by the attendant

health care provider and cannot be delegated.

IV. Coordinating / Collaboration Stage :

Unites personnel and services toward a common objective.

Synchronization of activities among the various services and departments enhances

collaborative efforts resulting in

efficient, smooth and harmonious flow of work.

Ex. : At the unit level, Supervising Nurses and Head Nurses

coordinate their work with the other departments, services or units by conveying

clearly-defined

policies, standard operating procedures, policies, and guidelines

using the

proper channels of communication. *CBQ : Most common instances of collaboration are in cases

where referrals for some

aspects of the patient’s care such as :

a. In patients with tophi, dietary considerations are made to the

dietician bec we always employ the interdisciplinary approach.

b. Food rich in purines :

a. canned foods

b. sardines


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c. anchovies

d. vegetables

Types of collaboration :

1. Intradepartmental/Interpersonal : a collaboration between one single person to

another person under one and the same unit or department.

Ex. : endorsement between shifts.

2. Interdepartmental : a collaboration between 2 or more units or

two or more departments but under one and the same institution.

Ex. : A woman admitted for CS will be referred to the DR, RR,

etc

3. Interagency/Interinstitutional : collaboration between two or

more health care institutions for the benefit of the patient.

Ex. : A patient from a health center is referred to a district

hospital.

*CBQ : Reasons why the nurses have the responsibility to

coordinate : 1. The patient is entitled to continuous care by a nurse.

2. Nurse should provide holistic care.

V. Evaluation / Controlling Stage :

the stage wherei the nurse will determine whether his/her plan, goal or objective for the patient is

achieved or met according to the standards of care.

Different types of evaluation :

1. Nurses’ rounds : done twice per shift (short term plan) Illustration of proper evaluation : If you are working in the 6-2

shift, you do 2 rounds :

a. Around 6am, your team does an ocular inspection around the

ward/unit after

which, you do a nurses’ conference (First rounds). b. around 2 pm, you evaluate the effectiveness of the shift’s plan

of care for the

patient.( Second rounds)

*CBQ : Nurses’ rounds are not done/contraindicated in the

following areas : a. Emergency room

b. OR/DR

c. Inensive care unit (ICU)

d. Psyche ward : bec it may not be safe to do so.

2. By the use of a checklist : use of ratings scale such as when the HN, UM or NM uses scales of

their staff’s evaluation.

3. Peer evaluation : evaluation done by co-workers.

*CBQ : This is the poorest method of evaluation bec it might be

affected by halo effect. 4. By the use of performance appraisal sheet/form : this is done

by the client or patient, being the

recipient of care as in the evaluation forms given to patients

immediately after/before

discharge from the hospital. *CBQ : This is the best method of bec the recipient of care does

the evaluation.

IV. Professional Adjustments and Ethico-Legal Nursing

Profession : it is a calling, in which its members profess to have

acquired a unique or specialized

body of knowledge or skiils for the purpose of properly guiding

or caring for others.

* Nursing is a profession.

Calling : nurses should always be service-oriented.

Specialized body of knowledge /skills : there should be a degree

of expertise for competency.

Others : refers to the patients or clients; nurses should be “others-oriented.”

Primary characteristics of a profession :

Accountability : being liable for the results of one’s actions and

responsible for their practice decisions.

Competency : one must know what he/she is doing (practice

should be backed-up with

scientific rationale)

Caring : nursing is a “caring profession”

Ethics : the nursing practice is governed by a Code of Ethics

which embodies its

professional and social values Service : as a caring profession, it should be service-oriented.

Specialized body of knowledge /skills : nurses, as professionals

should have expertise in

their fields of practice and show a degree of competency.

*CBQ : What is the most important attribute of a professional nurse?

Ans. : to observe ethical practice.

Is nursing a profession?

Ans. : YES, nursing is a profession. It has all the characteristics of a profession.

The informed consent form is a contract between :

1. The patient and the members of the health care team

2. The patient and the hospital

RA 9173 : The Philippine Nursing Law (promulgated on Oct. 21, 2002)

Expanded roles of a nurse :

1. Promotive, preventive, curative and rehabilitative care of

patients in all health care settings and in the event that recovery or rehabilitation is not possible, to

provide for a peaceful death.

Promotive : through health teachings

2. Appropriate health education

3. Utilization of the nursing care process : part of the duties of a nurse.

4. Collaboration of patients’ care

5. Link of patients to the different community resources.

6. Supervision and training of nursing students

*CBQ : A nursing student affiliated in a ward gave an erroneous medication killing the

patient. Who is liable for the patient’s death?

a. the nursing student

b. the clinical instructor of the student

c. the staff nurse of the ward d. the hospital

7. Supervision of other personnel such as midwives, nursing

aides etc.

8. Accurate reporting or recording of patient’s care

9. Proper execution of valid doctor’s orders : the only dependent duty of a professional nurse.

* CBQ : What is the liability of a nurse if he/she gives

prescriptions?

Ans. : Malpractice

Valid doctor’s order : only when an order put into writing and

duly signed by the prescribing

physician.

Rationale : Whatever wasn’t put into writing and signed by the

doctor is considered as not being ordered at all.

* CBQ : Whenever a patient solicits a medical advice : refer to

the doctor.

General Rule : A nurse should never prescribe any medication noe administer drugs without a

valid doctor’s order.

Exceptions to the general rule :

1. In case of emergency

2. In cases of national calamity 3. In cases of epidemic

PLUS : there’s no doctor around and the patient is in grave

danger of death.

Good Samaritan Act : the universal doctrine that protects from any liability, any person who will

give an aid to another person whose life is in danger.

* This law provides immunity from civil liability when a person

provides assistance in an


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emergency.

* This doctrine is the basis of RA 8344 which mandates the “NO

DEPOSIT POLICY” in

any health care facility or hospital in emergency cases only.

*CBQ : An emergency case where a child had ingested a

considerable amount of Aspirin,

what should the nurse do?

Ans. : induce vomiting. What would the discharge health teaching include ?

Ans. : ways on childproofing the house.

What is the most common form of poisoning?

Ans. : Lead poisoning from chipped paints bec paint chips taste

sweet and are conducive for a child’s PICA : appetite for eating non-food

items.

In emergency poisoning cases : 1. Determine the poisonous material involved.

2. If non-corrosive : induce vomiting

If corrosive : NEVER induce vomiting bec it will cause irritation

of the

esophageal mucosa and may lead to aspiration. * give calcium EDTA

Different areas of professional nursing practice :

1. Institutional Nursing Practice : done in the hospital setting.

Characteristics : Direct supervision of a head nurse or nurse manager.

Acquire different technical skills/learning

Confidence in your practice.

2. Public Health Nursing : the functions of which encompass the

4 P’s : Promotion of public health.

Prevention of disease

Psychological and social adjustments : bec one will be taking

care of numerous clients.

Public relations is maintained with all members of the community, the health care team

and the family.

*CBQ : The main thrust toward promotive and preventive

nursing practice is Primary

Health Care (PHC).

LOI 949 : the PHC Law of 1979 adapting the concepts of the

First International

Conference on PHC held in Alma Ata, USSR on Sept 6-12,

1978. Signed into law by Pres Ferdinand E Marcos on Oct 19. 1979.

Coverage of LOI 949 are the following :

1. Preventive Nursing Law :

PD 996 : the EPI Law : mandating the compulsory immunization of children

below 8 years old to reduce the morbidity and mortality among

infants and

children caused by the six childhood immunizable diseases :

1. Diphtheria 4. Polio 2. Pertussis 5. Hepatitis B

3. Tetanus 6. Measles

* Not included is chicken pox bec the vaccine is expensive.

2. Micronutrient Supplementation Law : RA 8976 : to fight

childhood malnutrition PD 825 : Environmental Sanitation Law : promotion of

cleanliness and sanitation

in everything outside of one’s environment.

PD 856 : Sanitation Code of the Philippines : promulgates

sanitation : 1. Within an establishment : covers food and water sources

e.g. carinderia and canteen food.

2. Commercial Sex workers : mandatory and proper screening :

a. Syphilis : every 6 weeks

b. Gonorrhea : every 2 weeks Red ID : health clearance of CSW who had undergone screening

issued by

the city health officer.

*CBQ : How can you handle health care delivery in the

community?

`` Ans. : Active community

partnership or participation.

RA 7160 : Local Government Code : Decentralization/ Devolution of Health Care

It’s a partnership :

DOH DILG } Local Health Board : public health

Active community } care

services/local gov’t.

Partnership } unit; headed

by the city or Participa } municipal mayor or the

tion } governor.

}

LGU : barangay

city municipality

province

Rationale for RA 7160 : it makes quality public health care

services accessible in

accordance with the present vision of DOH.

3. Occupational/Industrial/Company Health Nursing : done in

factories, companies or

industrial zones with the following functions :

a. Curative and rehabilitative : Care : provide immediate care for both the sick and injured

worker

Referral : proper referrals should be done for clients who need

higher

levels of care. Visit : home visits should be done for follow up care.

b. Promotive and preventive :

Nutritional health teaching : given to the workers for optimal

functioning

and productivity. *CBQ : The most important consideration when doing health

teachings to these workers :

Ans. : income of employees /financial status.

Safety and sanitation in the workplace

Counseling : appropriate health counseling can be provided to avoid or

prevent occupational diseases/hazards.

*CBQ : Health teaching considerations : use of contraceptives.

What health hazards should the nurse’s study focus on?

Ans. : Past trends of frequent diseases in the workplace.

4. Clinical Instructor :

Four major qualifications of a clinical instructor (per RA 9173) :

Accredited member of a nursing organization such as PNA.

MAN : a masters degree in nursing or other allied courses One year clinical nursing experience.

Registered nurse

LOI 1000 : requires compulsory membership of professionals to

an accredited professional organization such as PNA, PMA etc

Facts about the Philippine Nurses Organization :

PNA : founded on October 22, 2002

Founder : Anastacia Giron-Tupas Present President (2005) : Ruth Padilla

Objective of PNA : Reasons why they give trainings :

1. Advancement of the knowledge and skills of the Filipino

nurses.

Professional well-being : it is a professional organization

composed and headed

by nurses

Unity : it promotes professional unity


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Promotes reciprocity even from outside the Philippines

Advancement of the knowledge and skills of the nurse

Ethics : it promulgates its own Code of Ethics

First College of Nursing (BSN) in the country : UP

First nursing schools :

Iloilo Mission Hospital School of Nursing (1906)

Philippine General Hospital (1907) Luke : St Luke’s Hospital School of Nursing (1907)

Mary Johnston Hospital School of Nursing (1907)

St. Paul’s Hospital School of Nursing, Iloilo (1907)

San Juan de Dios Hospital School of Nursing (1907)

Proclamation order # 539 : proclaimed the last week of October

as Phil. Nurses’ Week.

Legal responsibilities of a nurse : these applies in almost all

kinds of settings : 1. Consent : it is the responsibility of the nurse to see to it that

the client’s informed

consent was taken before any procedure is done.

2. Last will and testament

3. Illegal detention 4. Medication and prescription

5. Charting, documentation/recording

I. Consent : the legal permission given by the client before any

procedure or treatment after receiving proper information or explanation about the treatment

or procedure to be done.

Characteristics of a valid consent :

Voluntariness : the consent form must have been signed with the absence of fear, force,

coercion, or threat.

Opportunity : the patient should be given ample opportunity to

ask for further

explanations if he needs it. Treatment, surgery, or procedure should be properly explained :

By the surgeon : whoever is primarily performing the procedure

has the

responsibility to explain it fully to the patient.

The nurses only act as witnesses to the signing of the consent which involves:

1. Witnessing the exchange between the client and the physician

2. Witnessing the client affix his signature

3. Establishing that the client really understood

Understood by the patient Matured both physically and mentally : the signatory should be

at least 18 y/o or older.

* Consent may not be given by the patient in cases of :

1. Insanity

2. Imbecility 3. Unsound mind

EXCEPT if the patient signs it in his lucid intervals.

*CBQ

* CBQ : Who can give consent in behalf of a mentally ill child?

Proxy consent may be given by the following : 1. Parents

2. Guardians

3. Guardian ad litem :

a. Social welfare personnel : in cases where the child is abandoned.

b. Surgeon or the attending physician : in cases of emergency

Example : A psychiatric patient needs a stat appendectomy :

surgeon or attending physician signs the consent for the patient’s behalf.

In vasectomy, who gives the consent ?

a. both the husband and wife

b. husband only :bec although the issue of vasectomy affects

both spouses, the procedure is done on the husband only (Vas deferens is not a

conjugal property)

II. Last Will and Testament : an act whereby a person is

permitted by law to have a control in the

manner of disposing his estate but will take its effect at the time

of his death.

Decedent : a deceased person

Testator : the dead person who made the will (male)

Testatrix : the dead person who made the will (female)

Two types of succession by heirs :

1. Testate succession : the mode of succession wherein the heirs inherit by virtue

of a last will and testament.

2. Intestate : succeeding by law and not governed by a will.

* Without a last will and testament : heirs should divide estate in

equal sharing.

Two types of last will and testament :

Concerning properties Concerning body / life

1. Notarial/Ordinary will 1. Advanced directives

2. Holographic will

Notarial or Ordinary Wills :

The following are the nursing considerations :

1. Check the patient’s level of consciousness : the nurse must

ascertain that the patient is

capacitated to make a will 2. Check the proper locations of the signatures :

a. at the end of the will written by the patient

b. in all pages at the sides of the paper, by the testator/testatrix

and 3 witnesses.

3. Presence of three witnesses.

Holographic Will : wills that are executed during emergencies

but the patient is still conscious.

Requisites of a holographic will :

1. It should be entirely handwritten 2. It should be dated and signed

using the hands of the testator/testatrix.

* If nobody witnessed the writing of the will, comparison to

other documents made by the

testator/testatrix is necessary to ensure its validity.

Advanced directives : are directions or instructions made by the

patient in advance with what to do with

the patient’s body, such :

1. Living will 2. Instructions for DNR, cremation, organ donation, and funeral

services

III. Legal rights of a nurse and illegal detention :

Illegal detention is a crime if a person, such as a nurse, will limit the freedom of a patient

to move or travel from one position / place to another

Exception : when there are quarantine regulation orders such as

what happen in migration

IV. Medications and prescriptions :

General rules :

1. Only the following have the right to prescribe medications :

MD, DMD, DVM

2. Do not follow unless 3 vital informations are present : a. name of physician, location of office, PTR/PRC license no.

b. Patient’s name, age, sex,

c. Name of the drug itself : both generic and brand name (RA

6675)

RA 6675 : the Generics Act of 1988 which requires that all

prescriptions of drugs

should include the generic name and the brand name or the

generic name

alone. Purpose : to let the patient choose among the different brand

names available of a


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specific generic drug name.

Impossible prescription : are prescriptions written by a doctor in

which the generic

and brand names do not correspond to each other. Exception to RA 6675 : The physician can only be allowed to

write only the brand

name if only one brand is available for the particular drug being

prescribed.

Ex. : Alaxan, Minocin 3. Responsible for the 10 R’s of giving medications :

1. The right drug

2. The right storage

3. In the right dose

4. By the right route 5. To the right patient

6. At the right time

7.With the right documentation

8.

9. 10.

For accuracy and safety, the nurse should do the three checks :

1. When choosing the medication to take out of the drawer or

cupboard 2. When the dose is in hand and can be held side-by-side with

the record to

compare the label and the medication administration record

(MAR)

3. One last time after all drugs have been located and before leaving the

medication cart or room for the patient’s bedside.

*CBQ : What is the method to identify the right patient in all

health care settings?

a. ask his name and let him spell it : only possible if patient is conscious

b. through the patient’s wristband

c. through the name hung on the door

d. confer with the doctor

4. Oral/ Telephone orders : General Rule : Generally, an order done orally or through the

telephone is not a

valid order EXCEPT in emergency cases where the nurse should

simul-

taneously write the order, the physician’s name and time it was given and

repeat it to the ordering physician and have it signed by the

prescribing

physician when he/she arrives later.

5. Doubtful medications and prescriptions :

General Rule : In case there is doubt on the correctness of the

prescription or in

cases where the medication is wrong, the nurse has the right to

object to such and call the attention of the prescribing authority and let

him rectify

the wrong order. This is for the protection of your patient

(Advocacy)

6. IV training

V. Charting / Documentation / Recording : in the patient’s chart

which is legally, absolutely a

legal document.

Nurse’s responsibility : to write chronologically, truthfully and accurately on the patient’s

clinical record what he/ she has seen, encountered or observed in

connection with

the care and treatment of the patient.

A fundamental legal principle about medical record : “If information is not charted, it was not done or observed”.

Purposes of charting :

Communication : it was created as a means of communicating

among the health care providers.

Assurance of quality care : records the patient’s whole treatment

and care regimen

Research purposes

Legal documentation

Statistics : are good bases for studies since they are deemed

accurate and true.

*Ownership of the charts/records belongs to the

hospital/institution although the

information in it belongs to the patient.

* Charts, being confidential records cannot just be used by

anybody even for legal purposes EXCEPT when the court issues a subpoena.

Subpoena : an order from the court which is of two types :

1. Subpoena duces tecum : issued against documents, papers,

materials/orders Ex. : patient’s chart

2. Subpoena ad testificandum : issued for somebody to act as a

witness.

DO’s and DON’T’s of charting :

DO’s DON’T’s

Full, factual & objectively

accurate

Legible handwriting

Immediately upon doing

the procedure. Addendum : late entries

entered in the chart

Personal/confidential

document

*Proper way to terminate chart : write the

profession, not the position

Language :avoid

language/words/jargons

unacceptable in nursing

Improper corrections : follow

the agency’s policy on corrections; or the std way

Space/skips : avoid leaving

spaces/skips in

between every charting.

Avoid frequent use of abbreviations : some words

if abbreviated will result to diff

definitions

Ex. : Ambulated pt to BR

(wrong bec the BR intended to mean bathroom

may be taken

another way by others)

Doctrines affecting the professional nurse :

1. Professional negligence

2. Professional malpractice 3. Res ipsa loquitor

4. Force majeure

1. Professional Negligence : refers to the failure to do something

which a reasonable and prudent nurse should have done, under a particular situation.

Types :

1. Commission :doing something which a prudent or reasonable

person would not do.

2. Omission : not doing something which a reasonable or prudent person would do.

Three elements to prove negligence :

1. There must be the existence of duty

2. There must be a failure to to do the duty 3. Injury or harm has resulted from the failure to do the duty.

*CBQ : This is a major reason for suspension/revocation of

license.

2. Professional Malpractice :

Elements in order for malpractice to exist : 1. RN

2. Acts or conducts self

3. Does something for which he/she is :

a. not authorized

b. not licensed to do c. not trained or skilled to do.

4. And has resulted in injurious or non-injurious consequences.

*CBQ : RN can do the following :

1. Episiorrhaphy : after training but not episiotomy

2. Internal exam (IE) : but only in the absence of antenatal bleeding and abnormal

complications.

3. Res ipsa loquitur : “The thing speaks for itself”: when the

harm that resulted from negligence


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and the responsibility for the harm are clear that anyone would

agree on it.

*CBQ : This principle accelerates the identification of the last

person attending to the patient which caused the negligence.

4. Force majeure : An act of God or nature; an irresistible or

superior force, one that cannot be

foreseen or prevented; fortuitous event.

Principle : “No person shall be hels liable or accountable for non-

performance of what was

expected of him/her if the cause of the non-performance was a

force

majeure or for those events beyond one’s control”.

Classifications of crimes affecting nurses :

I. According to the manner of its commission :

1. Dolo (Deceit) : one which is done with real criminal intention.

Ex. : putting poison in a medication to kill the patient. 2. Culpa (Fault) : one in which there is no real criminal intent

and is merely just a result

of one’s negligence.

Ex. : inadvertently poisoning a pateint bec of erroneous drug

administration.

II. According to the degree/level of execution :

1. Consummated crime : when all the elements to fully commit

the crime were all present

and the crime was committed or executed. 2. Frustrated crime : when one performed everything to

consummate the crime but failed.

3. Attempted crime : consists only of overt acts to commit the

crime; it is merely showing

the intent to commit the crime.

III. According to the degree of participation :

1. Principal : one who performs a very important or

indispensable role in the crime, being

the “author of the crime” itself. 2. Accomplice : one who performs a dispensable role, appearing

only before or during the

time the crime was committed.

3. Accessory : one who ONLY appears after the crime was

committed : a. by profiting from the effects of the crime committed

b. by concealing/destroying any evidence relating to a crime to

prevent its

discovery.

c. by assisting in the escape of the criminal.

Different crimes affecting the Filipino nurses :

1. RA 7877 : Anti-Sexual Harassment Law :

Protects employees against sexual harassment. Sexual

harassment is committed by ….any person who exercises authority, influence or moral

ascendancy over

another… by demanding, requesting or requiring sexual favor

regardless of

whether or not…is accepted by the object of sexual solicitation. * CBQ : Mere indecent proposal constitutes sexual harassment.

2. Rape : there are two types of rape, namely :

a. Ordinary rape : any forcible penetration of an organ for

copulation : a sexual

organ penetrating another sexual organ (only female victims) b. Sexual assault : results from anything inserted to any body

orifice with sexual

malice (both genders can be victims).

3. Abortion : termination of the products of conception before

age of viability (3-6 mos/12-24 weeks)

4. Infanticide : killing of a person less than 3 days or less than

72 hours of life.

5. Parricide : killing of a person to whom one has familial

relationship : parents / siblings. *CBQ : adopted children are included.

6. Homicide : unintentional killing of a person more than 3 days

old to whom one has no

familial relationship. Most cases in nursing involve drug errors

which are mere

results of negligence.

7. Murder : intentional killing of a person

8. Simulation of birth : committed by any person who shall substitute one child with

another child or alter a child’s identities for the purpose of

losing the child’s civil

status.

Ex. : Mara and Clara *CBQ : Non-registry of a live birth : constitutes simulation of

birth bec a birth

certificate is a symbol of identity.

PD 651 : Mandatory reporting :of any incidence of live birth

within 30 days to the local Civil Registrar’s Office.

Different laws affecting nurses in the Philippines :

RA 2808 (1919) : the first official Nursing Law in the

Philippines. Board of Nursing composition : 3-man-team :

1. The Chairman }

2. Two members } all nurses

1920 : the official Licensure Examination was given to nurses

one year after the first BON was created.

RA 7164 (1991) : the second to the last nursing law : the

Philippine Nursing Act of 1991

Board of Nursing composition : 5-man-team :

1. The Chairman } all nurses chosen from 12 nominees and appointed

4. Four members } by the President.

Board of Nursing : 1991 (RA 7164) : OLD

Master of Arts in Nursing holder

Accredited member of a nursing organizations like PNA Five-man-team :

1 Chairman

4 members

S ixty-five years old and sits for a term of not > 3 years

One-year interim period Not convicted of any crime in the Philippines

Pecuniary/monetary interest : absence of

Ten years of nursing experience/practice

Citizen of the Philippines

NEW Board of Nursing : RA 9173 :

Master of Arts in Nursing

Accredited member of a nursing organization e.g. PNA

Seven-man team :

1 Chairman 6 Members

Immediately resigned only assumption of office

Not convicted of any crime in the Philippines

Pecuniary/monetary interest : absence of

Ten years of nursing experience/practice, the last 5 yrs should be in the Phil.

Citizen and resident of the Philippines

Duties and responsibilities of the BON :

Licensure Examinations formulation Issue certificates of registration

* CBQ : Just a privilege not a right

Monitor the standards of nursing practice in the Phil

Education quality evaluation :

*CBQ : Inspect and recommend to the CHED : 1. Opening of a nursing school

2. Closure of a non-performing nursing school

Code of Ethics formulation

Hear and decide cases of negligence and malpractice :

1. Suspension of license 2. Revocation of license

Qualifications of a Dean of a College of Nursing :

1. Must be a registered nurse (RN)

2. Must be hold a MAN


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3. Must have 5 yrs nursing experience

Qualifications of nursing service administrators :

A. Hospital setting : 1. Nursing supervisors/ Managers/Head : responsible for a unit,

ward or department :

BSN and RN


Nine (9) units of post-graduate Nursing Management Two (2) years of general nursing practice

2. Nursing Chief or Director :

RN and MAN

Five (5) years of supervisory nursing experience

B. Community nursing Supervisors/Managers : BSN and RN


MAN or MPH (Public Health)

Five (5) years of experience as PHN/CHN

Present requirements for a Nursing Licensure examinee :

1. Good moral conduct

2. Proof/s of citizenship

3. Proofs that applicant is a valid holder of BSN degree whose

curriculum is approved by CHED.

Other relevant laws of nursing practice :

PD 223 : Creation of PRC (professional Regulation

Commission) RA 1080 : Civil Service Act

RA 6425 : Dangerous Drugs Act : covers two types of drugs :

1. Prohibited drugs : totally prohibits the sale, administration

and use by human

beings. Ex. : shabu, marijuana, opium derivatives 2. Regulated drugs : can be used provided it is covered with a

prescription from a

licensed physician authorized by BFAD and PDEA.

Ex. : Dormicum, Ativan

Liabilities of a health care provider :

1. Fines : depends on the weight /grams

2. Imprisonment

3. Revocation of license

RA 7600 : Mother-Baby Friendly Hospital Act : requires early bonding through :

1. Breastfeeding

2. Rooming-in technique

SSS : Sariling Salat sa Suso

GSIS : Galing Sa Ina ang Sustansya * CBQ : How to promote bonding between fathers and

newborns?

1. Cuddling

2. Embracing

PRC Licensure Examination

RA 8981 : New PRC Computerization and Modernization Act :

mandates that

examination results be out by at least the 5th day after the

examination date.

Results are available at :

1. www.prc.gov.ph

2. PRC rating Family name,First name

Registration : 1. Take an oath

2. Pay the registration fee

3. Sign the book of RN’s in the Philippines

Two types of registration :

1. Regular /Ordinary : by those who passed and are qualified already

2. Special : registration by reciprocity :

a. need to show proofs that one is an RN in a foreign country

b. that foreign country offers employment opportunities for

Filipino RN’s in return.

Grounds for disqualification as RN :

A person may be denied a license after passing the licensure

examination due to:

Dishonorable conduct

Unsound mind

Moral torpitude crime involvement Indecent, immoral conduct

Grounds for revocation of license :

Malpractice acts

Unprofessional conduct Negligence

Immoral, indecent conduct

Dishonesty, deceit, and fraud

Ethics : violations of the Code of Ethics

Suspended license but continues to work

After five (5) years of inactivity (non-practice profession), one

cannot go back to practice

at once. To do so, one needs to comply with the following

requirements : 1. One (1) month didactic training

2. Three (3) months practicum

Prohibited Practice of Nursing : Illegal nursing practice :

License : practicing without the necessary license Owns another RN’s license/COR as his/hers

Invalidated license/COR

S igns name and affix the title of RN illegally

Advertisement that is false

Falsification of school/nursing documents Assist another person in the illegal practice of nursing

Underwaging subordinates/nurse employees

Review/training center operations without gov’t. accreditation

Any person violating the Phil Nurses’ Act

Penalties for illegal nursing practice :

1. Fines of Php50,000 - Php100,000. } for conviction of any of

the ten illegal

2.1-6 years imprisonment } nursing practice

nursing research, leadership and management

Documents