legal aspects and the nurse-jay lapaz andres,rn

8/6/2019 LEGAL ASPECTS AND THE NURSE-JAY LAPAZ ANDRES,RN

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Legal Aspect andthe nurse


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Professional Negligence refers to the commission or

omission of an act, pursuant to

a duty, that a reasonably

prudent person in the same, or

similar circumstance would or

would not do, and acting or the non acting of which is the

proximate cause of injury to

another person on his

property.


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Elements of Professional Negligence

1) Duty- duty is owed to a client

> nurse fails to meet standard of care

> scope of duty is within professional

nursing boundaries.2) Breach of duty deviation from standard of care

is established.

3) Injury physical, emotional harm is established

4) Causation direct cause for failure to meet

standard of care clearly established.


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INFORM CLIENTS ABOUT????

Currentmedical status

and generalcourse of illness

Risks andbenefits of

proposedtreatment

Alternatives toproposed

treatment

Proposedtreatment

rationale


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EXAMPLES:

1) Failure to report observations to attending physician.

2) Failure to exercise the degree of diligence which the

circumstances of the particular case demands.

3) Mistaken identity.

4) Wrong medicine, wrong concentration, wrong route,

wrong dose.

5) Defects in the equipment such as stretchers &

wheelchairs may lead to falls thus injuring the patient.


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6) Errors due to family assistance.

7) Administration of medicine without a doctors

prescription.


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DOCTRINE OFRES IPSA LOQUITOR The thing speaks for itself

Conditions:

1) That the injury was of such nature that it would

not normally occur unless there was a negligent

act on the part of the someone;

2) That the injury was caused by an agency within

the control of the defendant.

3) That the plaintiff himself did not engaged in any

manner that would tend to bring about the

injury.


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DOCTRINE OFRESPONDEAT SUPERIORLet the master answer for the acts of the subordinate

DOCTRINE OF FORCE MAJEUREIrrisistable Force

Legal Defense in Negligence

When the nurse know and attain that standard of care

in giving service & that they have documented the care

they give in a concise & accurate manner.


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An injury

occurred

within the

Breadthof duty of

the nurse

whereCause of

injury is

the failure

toperform

the

Duty!

Denotes stepping

beyond ones authority

with serious

consequences.

Refers to a negligent act

committed in the courseof professional

performance.

M

A

L

P

R

A

C

T

IC

E


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COMPONENTSOF

MALPRACTICE

1. Nurse has a duty

2. Nurse fails to follow

the set standards

3. Actual harm occurs

4. Failure to act accdg

to standards caused

the injury.


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STANDARD OFCAREis.

what a nurse with

similar experience

and education with

sound judgment

would have donegiven the similar

situation.


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CONFIDENTIALITYOFINFORMATION

Also termed as PRIVILEDGED COMMUNICATIONgiven based on trust

May only be revealed WHEN:

1.) The patient himself/herself permits such

revelations as in the case of claim forhospitalization, insurance benefits, among others;

2.) The case is MEDICO-LEGAL such as

attempted suicide, gunshot wounds which have tobe reported to the local police or NBI or

constabulary;

3.) The patient is ill of communicable disease and

public safety maybe jeopardized, and;


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4.)Given to members of the health team if

information is relevant to his case.

it may also be revealed as provided for by the

law in ARTICLEIV, SEC. 4. of the new

constitution, which states that:

The privacy of communication &

correspondence shall be inviolable except

upon lawful order in the court or when public

safety & order requires otherwise as

prescribed by law.


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RESPONSIBILITIES OF THE NURSE

TO THE PATIENTS Primary responsibilities to give him/her the kind of

his/her condition needs.

NEEDS

PHYSICIANS ORDERSAILMENT

Regardless of his/her:

1. Race

2. Creed

3. Color

4. Nationality or status


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Patients Responsibilities

Providing information.

Complying with instructions.

Informing the physician of refusal to

treatment.

Paying hospital charges.

Following hospital rules & regulations.

Showing respect & considerations.


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RESPONSIBILITIES OF NURSE TOTHE PHYSICIAN

Sec. 28 (a) of R.A. 9173 states that:

It shall be the duty of the nurse to:

1.) Provide nursing care through the utilization of the

nursing process.

2.) Nursing care includes, but not limited to, traditional

and innovative approaches, therapeutic use of self,

executing health care techniques and procedures,comfort measures, health teachings, & administrative

of written prescription for treatment, therapies, oral,

topical, & parenteral medications.


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3.)Internal examinations during labor in the absence of

antenatal bleeding & delivery;

4.)In case of suturing of perineal laceration, special

training shall be provided according to protocol

established.


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RESPONSIBILITIES OF NURSES

TOTHEIRCOLLEAGUES

1.) To be able to get along smoothly with their colleagues.

2.) Shall adjust themselves to the organization and knows

its policies and procedures.

3.) Shall establish good working relationship with co-

workers

4.) Knows their place in the total organization so that they

may cooperate, coordinate & maximize their work.


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RESPONSIBILITIES OF NURSES

TOTHEMSELVES1.) Maintaining competence by continuous learning.

2.)Conduct must bring credit to the profession.

3.)Live a life that will uphold their self respect

DRESS-CODE.

4.) Act in a manners that is worth emulating.


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LIABILITYOF NURSESFORTHE WORK

OF NURSING AIDES

Performs activity under the direct

supervision of nurses.

NURSESNURSES should not delegate their functions to nursing

aides.


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LIABILITYFORTHE WORKOF NURSING STUDENTS

RA 9173

Nursing students do Supervised by their

not perform professional Clinical Instructors.

nursing duties.


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MEASURES TO MINIMIZE ERRORS

1) Nursing students should always be under

supervision of their clinical instructors.2) They should be given assignments that are at

their level of training, experience and

competency.

3) They should be advised to seek guidanceespecially if they are performing first time

procedures.

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 strength &

weakness.

6) Frequent conference with the students.


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Living Wills or Advance Directives

Fundamental Requirements:

1.)It is signed by the patient.

2.)Witnessed by two other persons who declare

that the patient signed the weal.3.) Sound of mind.

4.) Free of duress or undue influence.

5.)Witness must be 18 y/o.

attached to patients chart

it has a force of law


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TELEPHONE ORDERS

1) Read back such orders to the physician.2) Orders must be signed within 24 hrs.

3) Sign the name of the physician per her

own & note the time the order was

received.4) At least 2 R.Ns as a witness.


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INFORMED Voluntary without

coercion or force

Informed

Competent, having the

capacity Knowledgeable

information provided

Signed prior to pre-opmedications

C

O

NS

E

N

T


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Free and rational act that presupposes

knowledge of the thing to which consent is beinggiven by a person who is legally capable to give

consent.

ELEMENTS:1)Diagnosis and explanation of the

condition.

2) Fair explanation of the procedures

to be done & its consequences.


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3)Description of alternative treatments

4)Description of benefits

5) Prognosis

PROOFOFCONSENT

WHO MUSTCONSENT

CONSENTOF MINORS

CONSENTOF MENTALLYILL

EMERGENCY SITUATION

REFUSAL TOCONSENT

CONSENTFOR STERILIZATION


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LegalProtection

Hospital

rsesDoctors

IF IT W AS OTCHARTED, IT W AS OT OBSERVED OR DO E


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TORT

Is a legal wrong, committed against a

person.

EXAMPLES:

1. Assault and Battery

2. False imprisonment orIllegal Detention

3. Invasion of Right to Privacy and Breach ofConfidentiality

4. Defamation


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CRIME

ACT

COMMITTEDOROMITTED

IN VIOLATION OFLAW


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CRIME

CRIMINAL ACT CRIMINAL INTENT-acts or offenses -state of mind of a person

against a public at the time the criminal act

welfare is committed, that is, he

knows that an act is notlawful, and still decided to

do it anyway


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general name for a criminal offense which

does not in law amount to felony.- punishment- fine or less than one year

imprisonment.


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public offense for which a convicted person is liable

to be sentenced to death or to be imprisoned.

Deceit Fault

Deliberate intent Wrongful acts


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C

Exist when two or

more persons agree

to commit a

felony and decide to

do it.

CONSPIRACYTOCOMMITA

CRIME


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CLASSIFICATION OFPERSONS WHO

COMMITFELONIES

PRINCIPAL

ACCOMPLICESACCESSORIES


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CLASSESOFFELONIES

CONSUMMATED

FRUSTRATEDATTEMPTED


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GRAVEFELONIES

capital punishment (6years and 1 day to life

imprisonment, fine of not > 6,000)

LESS GRAVE

1 month and 1 day to 6 years; not

exceeding 6,000 but not less than 200

LIGHTFELONY

arresto menor; 1 day to 30 days; fine not

exceeding 200


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CIRCUMSTANCESAFFECTING CRIMINAL

LIABILITY

Justifying Circumstance the acts of the

actor are in accordance with the law ,

hence he incurs no criminal and civil

liability ( no crime, no criminal).

Self- defense

Defense of Relative

Defense of stranger

State of necessity Fulfillment of duty

Obedience to superior order


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Exempting Circumstance those wherein

there is an absence in the agent of the

crime any of all the conditions that would

make an act voluntary and hence,

although there is no criminal liability, there

is civil liability ( no criminal but there is

crime ).

Imbecility and Insanity

Minority

Accident


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Mitigating Circumstances those that have

the effect of reducing the penalty due to

the lesser perversity of the offender.

Voluntary Surrender Voluntary plea of guilty

Deaf, and dumb, blind

Incomplete self-defense

Offender is below 18 or over 70 years old


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Aggravating Circumstance

those which increases the

penalty. Taking advantage of official

position

Crime is committed incontempt of or with insult to

public authorities


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Alternative Circumstance

either aggravating or

mitigating depending on thefacts of the situation.

degree of relationship

intoxication illiteracy or lack of education


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POINTSTOOBSERVEIN ORDERTOAVOID

CRIMINAL LIABILITY

1. Be very familiar with the Philippine

Nursing Law

2. Beware of laws that affect nursing

practice

3. At the start of employment, get a

copy of your job description, the

agencys rules, regulations and

policies

4. Upgrade your skills and

competence


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5.Accept only such responsibility that is

within the scope of your employment and

your job description

6. Do not delegate your responsibility to

others

7. Determine whether your subordinates are

competent in the work you are assigning

them

8. Develop good interpersonal relationship

with your co workers, whether they be your

supervisors, peers or subordinates


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9. Consult your superiors for problems that

may be too big for you to handle

10. Verify orders that are not clear to you or

those that seem to be erroneous

11. The doctors should be informed about

the patients condition

12. Keep in mind the value and necessity of

keeping accurate and adequate records

13. Patients are entitled to an informed

consent


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WILLS

Is a legal declaration of a

persons intentions upon

death. It is calledTESTAMENTARY

DOCUMENTbecause it

takes effect after thedeath of its maker.


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DECEDENT is a person whose property

is transmitted through succession whether

or not he left a will.

TESTATRIX if the person making a will

is a woman

TESTATOR if the person left a will

TESTATE a person who dies leaving a

will

INTESTATE one who dies without a will

PROBATE validation of a will in a court.


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GIFTSFOUR LEGAL REQUIREMENTS

the gift must consist of personal

property

there must be an intention to make the

gifts

there must be an indication of transfer

of control over such property

there must be acceptance by the

recipient


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Act # 1931 Created for theESTABLISHMENTOF NURSING SCHOOLSin the country under the Bureau ofEducationin 1909.

Act # 1975 An act that transferred theschool ofNURSING UNDERTHEBUREAUOF HEALTH.

Act # 2468 An act that authorized theGRANTING OFTHETITLES of graduate innursing and midwifery from the school ofnursing of Philippine General Hospital in 1915.


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Act # 2808 This act provided for the earliestand TRUE NURSING LAW that served as thebasis of the practice of nurses in thePhilippines in 1919 and a year after itspassage, the first local licensure or boardexamination for nurses was held in 1920. TheFirst Board Examiners were created underact # 2808 composed of three members thenappointed by the Secretary Interior. Thechairman was a doctor of medicine and the

other two are registered nurses who mustpossess an experience in the nursingprofession for at least five years and with areputable character.


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RA # 649 provided for the standardization

of nurses salaries both in institutions and

in public health.

RA # 465 an act which STANDARDIZEDTHEFEES charged by the Examining Boards

forExamination and Registration.

RA # 546 An act that reorganized andplaced all the BOARD OFEXAMINERS under

the direct supervision of the President of the

Philippines.


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RA # 877 An Act also known as the PhilippineNursing Law of1953 approved on June 19,1953.This Law was sponsored by SenatorGeromina T.Pecson which enacted to regulate the practice ofnursing in the Philippines and to set up provisions forthe registration of nurses, for the establishment and

maintenance of standards of nursing education andnursing practice.

RA # 1080 This act approved on 1954 is alsoknown as, An Act Declaring the Bar and BoardExaminations as CIVIL SERVICEEXAMINATIONSwhich means that when a four year degree coursegraduate had passed the board examinations or theBar examinations for lawyers they automaticallybecome first grade civil service eligible.


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RA # 6136 In 1971, This Republic Act

introduced otherMINORREVISIONSIN

THE NURSING LAW of1966 thus

amending RA 4704 of1966.

RA7164 PHILIPPINE NURSING ACT

OF1991 was sponsored by Senator

Heherson Alvarez and was approved and

signed by President Corazon Aquino onNovember 21, 1991.


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ILO convention 149 andRecommendations 157 In 1977, thePhilippine Nurses Association, formerlyknown as the Filipino Nurses Association

established in 1922 lobbied ourgovernment for the adoption ofILO 149and Recommendations 157 that wereadopted in Geneva. It set the concerns ofemployment of nursing personnel and the

CONDITIONSOFTHE LIFEAND WORKOF NURSES and in 1978; the PNApassed The Declaration on the Economicand Social Welfare of Filipino Nurses.


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Proclamation No. 539 The President ofthe Philippines declared on October 17,1958 that the last week of October (through this proclamation ) as the

NURSES WEEK

Presidential Decree No. 223 Thisdecree formed the PROFESSIONALREGULATION COMMISSION on June 23,

1973. Among its power is the regulation ofdifferent profession which used to beunder the Civil Service Commission.


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RA 6511 This Act Amended RA 465 in1972, which STANDARDIZED theexamination and REGISTRATION feescharged by the various Board Examiners.

Letter ofInstruction No.1000 thisrequired that the members of AccreditedProfessional Organizations (eg. PNA) shallbe given PRIORITY in the HIRING of

employees in the government service andin the engagement of professionalservices.


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RA1612 Refers to the payment of

PRIVILEGETAX before any business or

occupation can be lawfully begun or

pursued.

RA7392 This Act provided that only

licensed midwives could practice and that

nurses must pass first the MIDWIFERY

EXAMINATION before they can practicemidwifery


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RA 2382 PHILIPPINE MEDICAL ACT ;defines the practice of medicine in thePhilippines. Section 10 of this Act provides:

Act constituting the practice of medicine. Aperson shall be considered as engaged in the

practice of medicine who shall for compensation, fee, salary, or reward in anyform paid to him directly or through another oreven without the same may physicallyexamine any person, and diagnose, treat,operate or prescribe any remedy for anyhuman disease, injury, deformity, physical,mental, physical condition or ailment nature,real or imaginary, regardless of the remedy ortreatment administered, prescribed or recommended


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Presidential Decree 541 a decree

allowing former Filipino (BALIKBAYANS)

professionals to practice their respective

profession in the Philippines.


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RA 6425 DANGEROUS DRUG ACTenacted in 1972 declaring that sale,administration, delivery, distribution, andtransportation of prohibited drugs arepunishable by law.

Act No. 3573 This Act in 1929 declaredthat all COMMUNICABLE DISEASES shall beREPORTED to the nearest health station, andthat any person may be inoculated,administered or injected with prophylactic

preparations.

RA1082 creation ofRURAL HEALTHUNITS in the Philippines.


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RA 4073 liberalizes the LEPROSYTREATMENT.No person shall be confined inleprosarium unless such disease requiresinstitutional treatment.

Presidential Decree 996 COMPULSORYIMMUNIZATION for allchildren below eight years old.

RA 8981 PRCMODERNIZATION ACTOF 2000 This Act gave the Professional

Regulatory Commission its regulatory powersand is now an agency of its own.


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Presidential Decree 825 providedpenalty for improper disposal ofGARBAGE and other forms ofuncleanliness.

Presidential Decree 856 CODEOFSANITATION,provides for control of allfactors in mans environment that affecthealth including the quality of water, food,

milk, control of insects, animal carriers,transmitters of disease, sanitary andrecreation facilities, noise, unpleasantodors and control of nuisance.


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Presidential Decree 148 WOMAN ANDCHILD LABOR LAWThe employable age is16 years and above and further provides forthe privileges of working women.

RA 6365 established a National Policy onPopulation and created the Commission onPopulation (POPCOM).

PD 791 revised population Act.Empowered nurses and midwives to provide,dispense and administer acceptableMETHODS OFCONTRACEPTION afterhaving undergone training and having beengranted authorization by POPCOM.


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PD 166 Strengthened FAMILYPLANNINGprograms through participation of privateorganizations and individuals in theformulation and implementation of theprogram planning policies.

General Order No.18 enjoins all citizensof the Philippines, universities, colleges,schools, government offices, mass media,voluntary and religious organizations of all

creeds, business and industrial enterprises topromote the concept of family welfare,responsible parenthood and family planning.


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PD 48 limits paid MATERNITY LEAVE

privileges to four children.

PD 69 limits the number of children toFOUR forTAXEXEMPTIONS purposes.

PD 965 requires that couples intending

to get married must first undergo a family

planning and responsible PARENTHOOD

INSTRUCTION prior to the issuance of

marriage license.


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RA1054 requires the owner, lessee oroperator of any commercial, industrial oragricultural establishment to furnish freeEMERGENCY, medical, and dental

ASSISTANCEto his employees andlaborers.

RA 4226 HOSPITAL LICENSUREACT requires all hospital in the country to

be licensed before it can offer to serve thecommunity. The licensing agency is theOffice For Hospital and Medical Services,Department of Health.


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RA5901 nurses working in agencies with100-bed capacity and/or above and areworking in area of one million population aresupposed to WORK 40 HOURSA WEEK.

PD 442 LABORCODEOFTHEPHILIPPINESprovides the right of the workersto self-organization and collective bargainingagreement.

PD 603 CHILD AND YOUTH WELFARECODEprotects and promotes the rights andwelfare of children and youth.


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PD 651 decrees the REGISTRATION OF

BIRTH of a child within 30 days with the Civil

Registrar.

PD 1519 MEDICAREBENEFITSTOALLGOVERNMENTEMPLOYEES regardless of

status of appointment.

P

D 626EM

PL

OYEECO

MPE

NSATIO

NAND STATEINSURANCEFUND

RA 6675 GENERICSACTOF1998


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RA 6758 - standardized the salaries of

government employees which include the

nursing personnel.

RA7160 LOCAL GOVERNMENT

CODEOF1991devolution of powers from

national to local government.

RA7305 MAGNACARTAFOR

PUBLIC HEALTH WORKERS


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RA7600 ROOMING-IN AND BREASTFEEDING ACTOF1992 provides that babies born in private and governmenthospitals should be roomed-in with their mothers to promotebreastfeeding and ensure safe and adequate nutrition tochildren.

EO51 MILKCODE

RA7432 SENIORCITIZENSACT does honor andjustice to our peoples long tradition of giving high regard toelderly. 20% discount in all public establishments such asrestaurants, pharmacies, public utility vehicles and hospitals.

PRCResolution No. 2004-17Series of 2004 RE-

IMPLEMENTED CONTINUING PROFESSIONALEDUCATION requiring sixty (60) credit units for three yearsfor professionals with bachelors degree


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The Patients Bill ofRights

(Filipino)

The patient has the right to considerate andrespectful care, irrespective of socioeconomicstatus

The patient has the right to obtain from hisphysician complete current informationconcerning his diagnosis, treatment andprognosis in terms the patient can reasonablybe expected and understand. When it is notmedically advisable to give such information tothe patient, the information should be made

available to an appropriate person in hisbehalf. He has the right to know by name andin person, the physician and nurse responsiblein coordinating his care


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The patient has the right to receive from hisphysician information necessary to give informedconsent prior to the start of any procedure and/ortreatment. Except in emergencies, such informationfor informed consent should include but not

necessarily limited to the specific procedure and/ortreatment, the medically significant risks involved,and the probable duration of incapacitation. Wheremedically significant alternatives for care ortreatment exist, or when the patient requestsinformation concerning medical alternatives, the

patient has the right to such information. Thepatient has also the right to know the name of theperson responsible for the procedures and/ortreatment.


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The patient has the right to refusetreatment/life giving measures, to the extentpermitted by law, and to be informed of themedical consequences of his action.

The patient has the right to every

consideration of his privacy concerning hisown medical care program. Case discussion,consultation, examination and treatment areconfidential and should be conducteddiscreetly. Those not directly involved in hiscare must have the permission of the patientto be present.

The patient has the right to expect that allcommunication and records pertaining to hiscare should be treated confidential.


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The patient has the right to expect thatwithin its capacity, a hospital must makereasonable response to the request ofpatient for services. The hospital must

provide evaluation, service and/or referralas indicated by the urgency of care. Whenmedically permissible a patient may betransferred to another facility only after hehas received complete informationconcerning the needs and the alternativesto such transfer. The institution to whichthe patient is to be transferred must firsthave accepted the patient for transfer.


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The patient has the right to obtain information

as to any relationship of the hospital to other

health care and educational institutions in so

far as his care is concerned. The patient has

the right to obtain information as to theexistence of any professional relationship

among individuals, by name, who are treating

him.

The patient has the right to be advised if the

hospital proposes to engage in or performhuman experimentation affecting his care or

treatment. The patient has the right to refuse

or participate in such research project


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The patient has the right to expect reasonablecontinuity of care; he has the right to know inadvance what appointment times thephysicians are available and where. Thepatient has the right to expect that the hospitalwill provide a mechanism whereby hisphysicians or a delegate of the physician ofthe patients continuing health carerequirements following discharge informs him.

The patient has the right to examine andreceive an explanation of his bill regardless ofsource of payment.

The patient has the right to know whathospital rules and regulations apply to hisconduct as a patient.


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NURSES BILL OFRIGHTS

Nurses have the right to practice in a manner that

fulfills their obligation to society and to those whoreceive nursing care.

Nurses have the right to practice in environments

that allow them to act in accordance with

professional standards and legally authorized

scopes of practice.

Nurses have the right to a work environment that

supports and facilitates ethical practice, inaccordance with the code ofEthics for nurses and

its interpretive statements.


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Nurses have the right to freely and openly advocatefor themselves and their patients, without fear orretribution

Nurses have the right to a fair compensation for

their work, consistent with their knowledge,experience, and professional responsibilities.

Nurses have the right to a work environment that issafe for themselves and their patients.

- Nurses have the right to negotiate the conditionsof their employment, either as individuals orcollectively, in all practice settings


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AMENDED CODEOFETHICS

Their conduct should be such that would bringcredit to the profession. Just like any otherprofessional, nurses are looked upon withrespect in the community. They shouldtherefore endeavor to live a life that would

uphold their self-respect.

Especially when nurses are on duty, theyshould try to look neat and attractive. Femalenurses are advised to use moderate make-up

and have a neat hairstyle. They should wearuniforms that are not too short or tight fittingthat would tend to restrict movements, norexpose unnecessarily


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any part of the body while giving care to

the patients. Clean uniforms and clean

bodies tend to enhance the image of

nurses. Use of anti-perspirant is advised

most specially during hot summer months.

Male nurses are likewise advised to be

clean, shaven, hair clipped close to the

nape of the neck instead of flowing to theshoulders.


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The use of the uniform should be specified in the policy of

the hospital/agency. It should be worn only when on duty.

Dining in the public, shopping or going to the market while in

uniform is discouraged. Nurses caps are worn only while on

duty. These are either carried in bags or are left in their

places of assignment.

Jewelry, such as earrings, necklaces or bracelets are not

allowed while on duty. However, wedding rings, school ringsor school pins may be worn.


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Nurses are looked upon by nursing students

as their role models. Therefore, especially

while they are on duty, they should act in a

manner that is worth emulating. Sincere and

compassionate attitudes toward patients are

caught by those around them. Soon their

working environment becomes permeated with

good working relationships that are so vital in

dealing with patients.


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GENERAL REMINDERS!!!

legal aspects and the nurse-jay lapaz andres,rn

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