nursing research, leadership and management
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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
Accredited member of a nursing organization e.g. PNA
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
Accredited member of a nursing organization e.g. PNA
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