ZIGA MEMORIAL DISTRICT HOSPITALTabaco City

Tel. Nos. (052) 830-5200, 487-5903“A PHIC Accredited Health Care Provider”

Note Taking Guide for Midwifery Licensure Examination

PROFESSIONAL GROWTH &

DEVELOPMENTPrepared by: Eduard E. “Kuya” Gandul Jr., R.M,R.N

Adjustment: An educational process referring to changes in behavior towards better life, better relationships and better contribution to society

Profession: A calling by which members profess to have special knowledge by training, by experience or both on that they may guide or advice or serve other in that field.

CRITERIA OF A PROFESSION

1. Mastery of the Craft- the profession must possess the necessary skills and attitude.2. Service orientation-Hall mark of the profession3. Autonomy-reasonable independent being (self-regulated)

Accountability-the essence of profession4. Political Power- Adhere own sets of values5. Professional Organization- Must be a member of an accredited Organization (e.g IMAP)

EVOLUTION OF MIDWIFERY IN THE PHILIPPINES

Care of the sick in Primitive Times Animism. Babaylan, catalonan, Superstitious and mystical beliefs: wind theory, natural Order and forces (mangkukulam or

manggagaway)Spanish Period

Individual sin (Gaba or Bad Karrma), poot and Aswang Materia medica (MOrga. Governador-General in 1595-1596 noted used of wine as medicine:

Lambanog and Tuba) Fore runner of Filipino Red Cross

American Period Separation of Producers, distributors, and consumers of health Exchange calue Iloilo Mission Hospitals School of Nursing (1906)

Contemporary Dr. Jose Fabella, first secretary of the department of health founded the first midwifery school in

the 1922 as a response to high infant mortality rate.

Objectives of the First Midwifery Schools: Train young women to replace hilots (traditional birth attendant) Train doctors and nurses for Rural assignments and Provide health service and education with emphasis on maternal and child health (MCH)

PROFESSION OF MIDWFERY

Is the performance or offer to perform or render for a fee, salary, or other reward or compensation of service recurring an understanding of the principles and application of procedures and techniques in the supervision of and care of women during pregnancy, delivery and puerperium.

1. Management of Normal Delivery2. Performance of Internal examination during Labor, except when patient has antenatal bleeding.3. Health education of patient family and community, including nutrition and family Planning4. Carrying out the written order of the physician with regards to ante-natal, intra natal and post

natal care of the normal pregnant women5. Giving Immunization6. Oral and parenteral dispensing of oxytocic after the delivery of the placenta7. Suturing perineal laceration to control bleeding8. Giving intravenous fluid during obstetrical emergencies provided they were trained for that

purpose9. May inject vitamin K to new born

Characteristic of Profession There is especial preparation and training With clearly defined permanent membership Acceptance of the service motive

Determinants of Professional Practice Problems and needs by the people Policies and regulation Current socio-economic political and cultural system

SPHERE OF MIDWIFERY PRACTICE IN THE PHILIPPINES

1. Traditional Function of the Midwife (R.A No. 7392). The Philippine Midwifery Act of 1992 provides the midwife:

a. Gives supervision care and advice to women during pregnancy, labor and post-partum period.

b. Conduct deliveries on her own responsibilityc. Cares of the newborn including the detection of abnormalities and counseling of parents

or couple.d. Gives health Educatione. Executive emergencies measuresf. Procures medical supplies

2. Expanded Function of the Midwifesa. Oral and parenteral dispensing of oxytocic drugs after delivery of the placentab. Suturing perineal lacerations to control bleedingc. Giving of intravenous fluids during obstetrical emergenciesd. Injecting of vitamin K. to the Newborn

PROFESSIONAL ORGANIZATION OF MIDWIVES

INTEGRATED MIDWIVES ASSOCIATION OF THE PHILIPPINES (IMAP)

Brief History:In the 1961 two organization were founded the Philippine Midwives association of the

Philippines or the PHIMIDAS with Atty. Angelina Fonce as first president and the National Federation of Filipino Midwives or the NFFM with Mrs. Leoncia Chuatoco as first president.

In 1974, the two were integrated to become IMAP with Ms. Juana Reyes as its first president. It is presently the only professional midwives association recognized by the Philippine Regulatory Commission (PRC)

Letter of Instruction 1980Compulsory membership to professional association accredited by the professional regulations

commission

ETHICO-MORAL RESPONSIBILITY

Ethics – part of philosophy that deals with systematic approaches to questions of morality. A term for the study of how we make judgments regarding right and wrong. A system of MORAL PRINCIPLES or moral standards governing conduct.

Morals- Human conduct in the application of ethics. Concerned with JUDGMENT PRINCIPLES of right and wrong in relation to human actions and character.CODE OF ETHICS

Fundamental responsibilities of midwife Render medical services regardless of the religious belief , political belief or creed

FREEDOM OF RELIGIONNo law shall be made respecting the establishment of a religion or to prohibit the free exercise

there of. The fee exercise and enjoyment of religious profession and worship without discrimination shall forever be allowed.

Two aspects of freedom of Religiona. Freedom to Believe - Absoluteb. Freedom to Act – Relative (It must be in conformity to the law, morals, customs and traditions) Render medical services on the ground medical neutrality – don’t take the background of pt. Protect life and respect the dignity of man

Trained Worker Dignity – respect Bill of Rights One who perform lethal injection to the person found guilty

The Patients Bill of Rights (Filipino)

1. The patient has the right to considerate and respectful care, irrespective of socioeconomic status2. The patient has the right to obtain from his physician complete current information concerning

his diagnosis, treatment and prognosis in terms the patient can reasonably be expected and understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person in his behalf. He has the right to know by name and in person, the physician and nurse responsible in coordinating his care.

3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include but not necessarily limited to the specific procedure and/or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient has also the right to know the name of the person responsible for the procedures and/or treatment.

4. The patient has the right to refuse treatment/lifegiving measures, to the extent permitted by law, and to be informed of the medical consequences of his action.

5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present.

6. The patient has the right to expect that all communication and records pertaining to his care should be treated confidential.

7. The patient has the right to expect that within its capacity, a hospital must make reasonable response to the request of patient for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of care. When medically permissible a patient may be transferred to another facility only after he has received complete information concerning the needs and the alternatives to such transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer.

8. 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 the existence of any professional relationship among individuals, by name, who are treating him.

9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research project.

10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby his physicians or a delegate of the physician of the patient’s continuing health care requirements following discharge informs him.

11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.

12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.

Bill of Rights of Patients1. Right to informed consent2. Right to refuse and/or withdrawal from participation or autonomy3. Right to privacy4. Right to confidentiality5. Right to quality care

1. Right to Informed ConsentConscious – all medical practice are not authorized ŝ consentUnconscious – all medical practice are authorized as if consent is given to you

Rule in Giving Consent Patient her/himself

If the Pt. is married the consent of the spouse is not necessary, provided of sound mind and legal age.

2. Right to Make Decisions Or Autonomy - Right to Self Determination - Justice Cardozo

“A Person who is of a sound mind and of legal age shall have the right to determine what is supposed to be done to his body.”

PERSONS TO MAKE DECISIONS IN CONSCIOUS PATIENT1. parents2. grandparents

paternal maternal

3. eldest brother/sister4. relatives/guardians5. teachers

Telephone – overheard by two credible witnessesFiancé – authorize to give consent for conscious if no parents, grandparents, brother/sister, guardians.

Q: How do you respect the dignity of patient?A: By respecting the bill of rights of patient.

Between the conflict of pt. and doctor, loyalty will always be on the patient.

3. Right to Privacy and ConfidentialityPrivacy of Communication “It shall be inviolable except upon the lawful order of the court and when public safety, public health requires it.”*Cannot be violated at all – SECRECY ACT LAW

Q: Who owns the medical chart?A: Hospital

Q: Who owns the communication in the medical chart?A: Doctor and Patient

*Duty: Keeps in proper place (medical chart rack) with honesty, confidentiality, and integrity

Relative Privacy Absolute PrivacyDoctor – Patient Midwife – Spouse Midwife – Patient Midwife – lawyer (case)

Midwife – Priest (religion)

Husband – wife = absolute privacy; order from court, no order to divulge/ reveal or right not to tell

Q: What is Privacy? A: Privacy is any not related to health condition.

Q: What is Confidentiality?

A: Confidentiality is any related to health condition.

Breach – Violation of right, e.g. breach of confidentiality

4. Right to Quality CareAutonomy – “Freedom to CHOOSE”Beneficence – “Do only what’s GOOD”, respect, privacyNonmaleficience – “Do NO harm”, e.g. side rails upVeracity – “Tell the TRUTH”Justice – “Be FAIR”Fidelity – “Keep your word”, keeping promises “LOYALTY”

MIDWIFERY ETHICS – the code governing the NURSE’S BEHAVIOR, especially towards patients, employing authority and to the profession.

Beneficence - any action that would BENEFIT others. The principle that imposes upon the practitioner to seek the good for the patients under all circumstances. Beneficence connotes positive action toward preventing or removing harm and promoting good such as:

(1) One ought to prevent evil or harm(2) One ought to remove evil or harm(3) One ought to do or promote good.

Nonmaleficence – states the idea to REFRAIN from inflicting harm. “one ought NOT to inflict evil or harm. The admonition of nonmaleficence is stated in the negative manner while the beneficence is in the positive.

Justice – The basic principle that deals with FAIRNESS, just deserts, and entitlements in the distribution of goods and services.

Some methods of distributing goods and services in our society are as follows:(1) To each, an equal share(2) To each, according to need(3) To each, according to effort(4) To each, according to contribution(5) To each, according to merit(6) To each, according to ability to pay

Autonomy - In health care, it means the form of personal LIBERTY, where the individual is free to choose and implement ones’ own decisions, free from deceit, duress, constraint, or coercion. Three Basic elements involved:

(1) ability to decide (2) power to act upon your decisions(3) a respect for the individual autonomy of others.

Stewardship – refers to the actions made for by the health practitioner IN BEHALF of the patient and for the greater benefit of the patient.

Truth Telling/Veracity – The patient must tell the truth in order that appropriate care can be provided. The health practitioner needs to disclose FACTUAL INFORMATION so that the patient can exercise personal autonomy.

Confidentiality - is also known as PRIVILEGED COMMUNICATION which refers to any information obtained by the nurse or the health team during the course of caring for the patient. The information gathered may only be disclosed under the following:

(1) the patient agrees to divulge such information with written consent(2) the information is material in a criminal case investigation(3) if public safety is jeopardized (communicable disease)(4) such information is relevant to his care to be utilized by other health team

Privileged Communication may be divided into two classes:(1) Absolute privileged communication – is one made in the interest of the public service or the due

administration of justice and is practically limited to legislative and judicial proceedings and other actions of the state.

(2) Qualified privileged communication – is a slanderous statement uttered in good faith, and made on a proper occasion, from a proper motive, based upon a probable cause and in honest belief that such statement is true.

MORAL PRINCIPLES

GOLDEN RULE – “ Do unto others what you would like others do unto you”. It is a basic moral principle that if you want others to respect you, you must also accord respect to them.

THE TWO FOLD-EFFECT - facing a situation which would have good and bad effects requires the following basis for arriving a decision:

a. that the action must be morally goodb. that the good effect must be willed and the bad effect merely allowedc. that the good effect must not come from an evil action but from initial action itself

directly; andd. that the good effect must be greater than the bad effect.

THE PRINCIPLE OF TOTALITY – states that the whole is always greater than its parts. To save the patients’ life as a whole, it is justified under this principle to surgically cut-off a disease body part of the patient.

EPIKIA – “exception to the general rule”. It is reasonable presumption that the authority making the law will not wish to bind a person in some particular case, even though the case is covered by the letter of the law.If a mentally ill patient becomes berserk and the doctor could not be contacted, the patient may be restrained by virtue of epikia.Another example of this is allowing a relative to see a seriously ill patient who expresses the desire the relative although it is not yet visiting hours

THE END DOES NOT JUSTIFY THE MEANS – giving a sleeping tablet to a chronically ill person so he/she can de in peace is morally wrong.

THE GREATEST GOOD FOR THE GREATEST NUMBER – during an epidemic, immunization against communicable diseases is administered to the people. Although there may be some who may have slight reactions to the vaccine, the greater majority of the population shall be considered.

NO ONE IS HELD TO THE IMPOSSIBLE – the doctors and nurses are not guarantors of life. They cannot be held liable as long as they have done everything that modern medicine can afford to save a patient from dying.THE MORALITY OF COOPERATION – formal cooperation in an evil act is never allowed. A nurse shall not participate upon immoral operations such as abortion even if the doctor commands it.

PRINCIPLE RELATING TO THE ORIGIN AND DESTRUCTION OF LIFE – mercy killing or euthanasia is not allowed because it will lessen the incentive to medical research. The state recognizes the sanctity of life. It shall protect the life of the mother and the unborn since conception.

Any direct attack on the life of a fetus for whatever cause is immoral. A fetus shall be buried in consecrated grounds. If it is dead and came from dead mother, it shall be buried with the mother.

Privacy – the right to be left alone or be apart from others. This right is guaranteed by most civilized state laws and enshrined also in the patients’ bill of rights. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. This right also includes privacy of one’s thoughts, opinions and physical presence and privacy of one’s records.

Informed Consent –The patient UNDERSTANDS the reason for the proposed intervention, with its benefits and risks, and agrees to the treatment by affixing his signature in the consent form. It generally contains the following elements:

(1) disclosure(2) understanding(3) voluntariness(4) competence(5) permission giving

In our present jurisdiction under the 1987 Constitution, the age of majority is 18 years old. It means that only 18 years old and above can sign for themselves in legal matters such as the signing of consent (hospital admission, contracts, will etc..)

I. THE PHILIPPINE MIDWIFERY LAW

Section 1: “Philippine Midwifery Act of 1992”,

Section13: Qualification of Applicants for Examination Filipino Citizen Good Moral Character Graduate of midwifery in government recognized and duly accredited institution

Fraud/Deceit – causing someone to believe what is not trueNeosoly – place of birth (Rule of Soil)Sanguine – blood from parents (Rule of blood)Naturalize – change of citizenship such American to Filipino

ORGANIZATION OF THE BOARD OF MIDWIFERY

RA6809 – age of majority is 18 yrs All licenses can be acquired at age of majority; such in movie watching rated A, Parental

Guidance (PG), General Patronage, R18.

RA 7392/2644 – Philippine Midwifery Law

Section 2: Composition of BOM 1 Chair/chairperson 4 members of the board

Note: 3 members shall be registered midwifes1 Nurse-midwife

Appointment:By the president of the Philippines from among the recommendees of the Commissioner of the

Professional Regulation Commission

Duties and Function Enforce provision of this act Administer oaths accordance to the provision of this act Issue, suspend or revoke certificate of registration Investigate violations of the act subpoena and subpoena duces tecum Conduct yearly Board examination Look into conditions affecting midwifery practice in the country, maintain standards and ethics

practice Adopt an officials seat to authenticate it officials documents

Section 3: General Qualifications of BOM Natural Born Filipino Citizen & resident of the Philippines (Born in Philippines, without taken

action) Good Moral Character Thirty (30) years of age Not a member of the faculty whether full time or part time in a midwifery school & to pecuniary

benefit in such during his term (monetary interest) – (type of disqualification)

Citizenship – right to political communityNationality – not change at all

*Citizenship may change if person stayed for 10 years or marry a Filipina/Filipino citizen to reduce stayed

years*End of term, can teach again*Resign from any employment, as qualified & appointed as BOM

Qualifications of Chairperson Registered Obstetrician 10 years of practice before appointment Natural born Filipino citizen Good Moral Character 30 years of age

Qualifications of 3 Members of BOM Registered Midwife Degree holders preferably in the field of health and social sciences (e.g. psychology, medtech,

pharmacist) 10 years of midwifery practice, 5 years of which is supervisory position 30 years old Natural born Filipino citizen

Qualification of 1 Member of BOM Registered Nurse-Midwife 10 years of experience & nurse-midwife Natural Born Filipino Citizen Good Moral Character

Steps in Appointment of BOM

IMAP(Nominating Body)

PRC

(Recommending Body)

PRES.(Appointing Body)

Integrated midwives of the Philippine integrated association of Obstetrician PRC President of the Philippines

Section 5: Powers of BOM1. Conduct the Midwifery Examination (Discretionary Power, Examining Power) duty: preserve the

integrity & honesty in Board Exam2. Issue, suspend/revoke certificates of Registration (Discretionary Power)

PRC – release license, (as custodian of Record) – Venue of Board Exam.

LICENSURE

Examination RequirementsPass a written examination given by the Board of midwifery.

Section 18: License Contains / Certificate of Registration1. full name of registrant2. Serial number3. official seal of commission4. signature of Chairperson of Commission5. Members of the Board

Scope of Examinationa. Infant care and feedingb. Obstetrical Anatomy and physiologyc. Principles of Bacteriologyd. Obstetricse. Midwifery Proceduresf. Domicilliary midwiferyg. Domicilliary Hygiene and first aidh. Nutritioni. Ethics of midwifery practicej. Primary Health Carek. Professional Growth and Development

l. Family Planningm. others That Board may seem necessary

Section 7 R.A. 8981: Grounds for the Suspension / Removal of BOM Neglect of Duty Gross incompetence/serious ignorance Unprofessional/Immoral or Dishonourable conduct

*Commision of Irregularities (revoked)Tolerating Irregularities (releasing while arising of questions such RETAKE!Inhibit – not participate on that particular exam

3. To administer Oath (Ministerial Power)Oath – first action after passing board exam

Section 16. All successful candidates are required to take the oath, to BOM or Government authorized to administer.

The oath such as ambassador, consul, mayor, vice mayor. License never is issued without the oath.

*Newborn place of birth when in airplane is where it was registered*Midwife can attend the delivery while in place in DOCTRINE of GOOD SAMARITAN

Article 3 Section 1. DUE PROCESS – Law that hears first before it condemns (trial, hearing)

4. Monitor & enforce quality midwifery practice (Examining Power, Dispensing Power)5. Monitor & enforce quality midwifery education

CHED – closed midwifery schoolBOM – agreed/ recommended, Memorandum of Agreement (MOA)

6. Quasi-legislative powers – independent body, promulgating rules & regulation within its jurisdiction

7. Quasi-Judiciary Powers – independent body, from regular judges, for hearing revoked license8. Executive Powers – under the office of the President poetically appointed, supervision of the

Board & Custodian of its RECORDS

Section 8: Supervision of the Board and Custodian of its Record

Office of the President

PRC (Custodian of all Records)

BOMSection 4: Terms of Office of BOM-3 years chairman and members may be reappointed for another term

APPOINTMENT OF BORD OF MIDWIFERY (BOM)

Regular Appointment – when the BOM is appointed to serve for a period 3 years

Ad Interim Appointment – when a board member is appointed to fill vacancy or to continue the unexpired period of term of regular appointeeHold Over – hold an office after his term of office has expired until his successor is appointed

Note: Oath is Mandatory!

License – permission to practice the profession for life not unless revoked or suspended Jurisdictional – applicable in the place where issued

Misdemeanor – practice without license or practice with expired licenceMisrepresentation – using of other licenseMalpractice – go beyond scope

Ratings in the Board Exam75% as general rating with no grade lower than 50%(old) 60%(new) in one subject 120 days, the

BOM shall report the rating of each candidate to the PRC Commissioner.

Section 17: Report of the Results of the ExaminationThe Board shall, within 120 days after the examination, report the ratings obtained by each candidate t the commissioner of PRC.

Q: When a midwife practice in another country making use of one’s license in the Phil.?A: Section 22: Reciprocity – Latin term, re-back, pro-forward Du Ut Des - I give that you may also give Reciprocal Duty – Give and takeRelationship between 2 persons/states International Agreement – TREATY mostly in Middle East

It can only be entered into the Pres. conquer 2/3 in senate not in congress An international agreement whereby one country would grant to true citizens of the other country

the privilege of being admitted to practice ones profession

SPECIAL PERMITS Internationally recognized expert in the field of midwifery Medical mission Exchange of professor program

Section 7: Ground for the Revocation/Suspension of License Immoral & dishonourable conduct Conviction of a crime involving moral turpitude

MIDWIVES AND CRIMES

Criminal law – is that branch of law which defines crime and treats of their nature.

Ignorance of the law excuses no one from compliance therewith Laws take effect after 15 days from the publication in the official gazette or any newspaper of

national circulation. It serves as a constructive notice to all persons so that no one is exempted from complying with the law or to claim that he or she is ignorant from the passage of that law.

The power to define and punish an act is within the powers of the Legislative Department (House of Congress) where the legislative power is vested in the fundamental law and has the power to define and punish an act or omissions as a crime. The Chief Executive has also the prerogative.

Theories of Criminal Law

1. Classical Theory a. man is essentially a moral creature with an absolutely free will to choose between good

and evil and therefore more stress is placed upon the result of the felonious actb. Basic criminal liability is human free will and the purpose of penalty is retribution.c. Crime is a juridical entity and penalty is an evil and a means of juridical tutelage

2. Positivist Theory – Man is subdued occasionally by strange and morbid phenomenon which conditions him to do wrong in spite of or contrary to his volition. The basis of criminal responsibility of the criminal is his dreadfulness or dangerous state.

The major source of our criminal law is Act # 3815 otherwise known as the Revised Penal Code of the Philippines that took effect on January 1, 1932.

Crime consists of internal and external acts. Internal acts are not punished in our jurisdiction. Voluntariness is an element of felony because if an act is committed or performed with deliberate

intent then it implies that the act is voluntary or freely committed. Felony is an act or omission punishable by the law

Moral Turpitude – an act of baseness, vileness or depravity in social or private duties which man owes to his fellow or to society in general, an act contrary to the accepted customary rule of rights & duty b/w men– Any act that is CONTRARY to LAW, MORALS, HONESTY, & JUSTICE

1. Adultery – disloyalty of wife to her husband having other man Paramour – Man of A Married Woman (Kabit) Mistress – Girl of a married Man (Kabit) Cuncubinage – disloyalty of husband to his wife having other woman/ mistress

Crimes -act committed or omitted in violation of the law.

Felony -public offense for which a convicted person is liable to sentenced to death or to be imprisoned in a penitentiary or prison

-committed with deceit and fault-act is performed with deliberate intent,-wrongful acts result from imprudence, negligence, lack of skill or foresight

Misdemeanor - criminal offense which does not in law amount to felony. Punishments is usually a fine or imprisonment for a term of less than one year

The professional practice of a Midwife entails with it the legal responsibilities that he or she must know and understand in order to avoid liabilities in the discharge of his/her functions.

The following are crimes that a midwife must be familiar with:ASSAULT – An unlawful attempt or offer to beat or to do bodily injury to another.

BATTERY – The unlawful beating or touching of another person. The unlawful beating or use of force upon a person without his consent.

MURDER – is the unlawful killing of a human being by another with intent to kill (DOLO is an element).

hyle – soulmorfe – body

HOMICIDE – killing of a human being by another. It is committed without criminal intent by any person who kills another, other than his father, mother, child or any of his ascendants/descendants/his spouse. (Culpa-fault).

death because of lack of knowledge, skill, competence and foresight.

ABORTION – Termination or expulsion of the product of conception even before the age of viability. Abortion is a crime penalized in our jurisdiction. A nurse who advises a woman on what drugs to take is criminally liable.

Art. II Sec. 15 the Constitution of the Philippines-Protects life of the unborn from conception

Intentional Abortion (Art. 256) – willful killing of the fetus in the uterus, or the violent expulsion of the fetus from womb resulting to its death.

Unintentional Abortion (Art. 257) – abortion by violence but unintentional Abortion Practiced by the woman herself (Art. 256) Abortion Practiced by a physician or midwife and dispensing of abortive (Art. 256)

INFANTICIDE - killing of a child less than three days of age.

PARRICIDE – is committed by one who kills his/her father, mother or child whether legitimate or illegitimate, or any of his/her ascendants or his/her espouse.

*means of blood relationshipConstitute parricide:

Spouse, legally adapted children, stepbrother Murder homicide

Example:Parricide – when mother throw the infant after birth in the taxi

ILLEGAL DETENTION – any private individual who shall detain another or, in any other manner, deprive him of his liberty.

ARBITRARY DETENTION – any person in authority (public officer) who shall detain another or, in any other manner, deprive him of his liberty.

SIMULATION OF BIRTH – any person who shall substitute one child for another or who shall conceal or abandon any legitimate child with intent to cause such child to lose its civil status.

ROBBERY/THEFT – crime against a person/property the taking of personal property of a person from him (preserving the privacy of patient)

Robbery – committed with FORCE upon person or thing

SEXUAL HARASSMENT – is committed by a person who, having authority, influence or moral ascendancy over another in a work, training or education environment, demands, requests or otherwise requires any sexual favor from the other regardless of whether such demand, request or requirement for submission is accepted.

Rape – mere touching of the labia by the male organ

CLASSES OF FELONY: 1. Consummated- all elements executed, with successful result

2. Frustrated- all elements executed but no successful result3. Attempted- not all elements executed

There is No rape committed such as of:- Same sex- frustrated rape- digital or Anal

ARSON/Conflagration (in cases of fire)- the medical practitioner should

R-emove the patientA-lert the fire alarmC-onfine the fireE-xtinguish the fire

- attempted arson- consummated arson- no frustrated arson

CRIMINAL NEGLIGENCE – is negligence of such character or occurring under such circumstances, as to be punishable as a crime by statute.

PROFESSIONAL NEGLIGENCE – breach of professional duty. Negligence committed in the practice of a profession.

NEGLIGENCE - is often referred to as that “doing of a thing which a reasonably prudent man would not have done and not doing a thing which a reasonably prudent man would have done”. It also 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 do or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property

TORTS – legal wrong, committed against a person or property, independent of a contract which hinders the person who commit it liable for damages in a civil action

a. Assault – imminent threat of harmful or offensive bodily contactb. Battery – unconsented touching another personc. False Imprisonment or Illegally detention – unjustifiable detention of a person without a legal

warrant (Doctrine is liberty of abode)

Liberty of Abode/ travel“Liberty of abode/ travel shall not be impaired except upon the lawful order of the court and when public safety, public health requires it.”> right where you wanted to go/ leave

d. Invasion of right to privacy and breach of confidentiality – the right to privacy is the right to be left alone, the right to be freed from unwarranted publicity and exposure to the public view is well as the right to live one’s life without having anyone’s name, picture/ private affairs made public against one’s will

e. Defamation – character assassination, be it written or spoken• Slander – oral defamation of a person by speaking unprivileged or false words by which his

reputation is damaged• Libel – defamation by written words

f. Malpractice-illegal, corrupt, or careless professional behaviour. -any professional misconduct which involves any conduct that exceeds the limits of one’s

professional standards means going beyond the context or scope of allowed nursing practice resulting to injurious or non-injurious consequences.- stepping beyond one’s authority

Example:a. prescribing drugsb. giving anesthesia c. doing surgery

ELEMENTS OF MALPRACTICE (P-R-E)P- professional SPECIFIC standards of care is requiredR- required obedience E- exceeds the limits of the standards of care

g. Negligence- Unintentional failure of an individual person to perform an act or omission to do something that a reasonable prudent person would do or not do

-Failure to observe the protection of one’s interest, the degree of care, and vigilance of circumstances.-Most common unintentional tort

Example:a. Incorrect sponge counts b. burns: heating pads ,solutions & steam

vaporizers c. failure to take & observe appropriate actions – forgetting to take vital signs to a newly post –operative client.

d. Falls: side rails left down, baby left unattendede. loss of or damage to a patient’s propertyf. failure or ignore to report to the superiors or client’s familyg. mistaken identity, wrong medicine, dose & route

ELEMENTS OF NEGLIGENCE LAWSUIT (B-R-O-D) –OR-- ELEMENTS OF PROFESSIONAL NEGLIGENCE

B- breach of duty was the cause of the 1. Existence of DutyR- Real or actual proof injuries 2. Foreseeable Crisis plaintiff’s injury 3. Breach of Standard of CareO- owed specific nursing duty 4. Present of Injury to the standards of care 5. Procimate CauseD- defendant breach the duty

CLASSIFICATION OF CRIMINAL LIABILITIES

Conspiracy to Commit a CrimePrincipal – -take direct part in the execution of the act, who directly force or induce others to commit

it, who cooperate in the commission of the offense by another act without which it would not have been accomplished. 1. direct participation 2. inducement (order, command, influence, convince, persuade)

Accomplice (BEFORE THE FACT )– -who, not being principals, cooperate in the execution of the offense by previous or simultaneous act, must be shown that he had knowledge of the criminal intention of the principal, demonstrated by previous or simultaneous acts that contribute to the commission of the offense as ais thereto, whether physical or moral.

1.Essential ,necessary, destroy materials material

Accessory –( AFTER THE FACT) - Having knowledge of the commission of the crime, either as principals or accomplices, take part subsequent to its commission by profiting themselves or assisting the offender to profit from the effects of the crime by concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery or by harboring, concealing or assisting in the escape of the principal of the crime, provided the accessories act with abuse of their public functions or are known to be habitually guilty of some other crimes.

Q: Patient get out to get sunlight old woman introduce herself as a relative midwife let the woman go inside the room old woman get everything (theft)A: Midwife: accomplice

Q: Midwife, Hospital – liable on what doctrine?A: RESPONDEAT SUPERIOR (applied to employers)(Let the master answer for the offense of their employees)

Q: The patient approaches the nurse and said that she is pregnant. The nurse said that she has a calling card on the table with a no. of midwife who can perform abortion. (may or may not get it). Abortion took place.A: Midwife: principal by direct participation Nurse: accomplice Patient: principal by inducement Mother: accessory Doctor: accomplice

Circumstances that affect Criminal Liabilities

DEATH (Capital Mngt.)

Reclusion Perpetua (>1°/ 20 – 40years)

Reclusion Imperal (<1°/12 – 20years)

Exempting Circumstances No crime at all, exempted from criminal liability

1. Imbecile or insane person, unless he acted with lucid interval2. The person is under 9 years of age3. Over 9 years but under 15 years unless he/she acted with discernment (know the own consequences)4. When it is mere accident (force majoure)5. When the person acted under the impulse of an uncontrolled fear

6. When the person acted under the compulsion of an irrestible force e.g. in school – loco parenti (parental authority and custody transfer in teacher)

sunera – exerting circumstances, with freewill, unvoluntaryness to act, insanity

Mitigating Circumstances Lowering down by 7 years (Prison Mayor)

1. When the offender is under 18 years/ over 70 years of age2. When there is voluntary surrender3. When there is passion/ obfuscation4. When there is sufficient provocation (alcohol)5. When the person is deaf, mute, dumb, and blind6. When there is no intention to commit so grave a wrong as the one committed any kind of mental illness that will diminished will power (bipolar)

Aggravating Circumstances Committed with plan, 1° higher

1. When one takes advantage of public position2. When there is an abused of confidence3. When the crime is committed inside the Church4. When the crime is committed on the occasion of fire, shipwreck, epidemic/ other calamity5. When it is committed because of a price reward6. When it is committed in times of natural calamities7. When it is committed with evident premeditation8. When it is committed with craft, fraud and disguise* One’s you commit in confidence to your patient

Justifying Circumstances Without 1, not justified

ELEMENTS1. When there is an unlawful aggression2. When the person is under imminent danger3. When there means employed in order to prevent or to repel the aggression must be reasonable4. Obedience to an order issued by superior for some lawful purpose

*no man apply self – defence

GUIDELINES TO PREVENT CRIMINAL LIABILITY: 1. Be very familiar with the Philippine Nursing law2. Be familiar with the laws affecting nursing practice3. Know agency rules, regulations, policies4. Upgrade skills and competence5. Develop good IPR with co-workers6. Consult superior as needed7. Verify vague/ erroneous orders8. Always keep doctor updated regarding patient9. Ensure accurate recording and reporting10. Get informed consent11. Do not delegate responsibilities to others

LEGAL CONSIDERATIONS IN CHARTING:1. Don’t tamper with medical records- adding, rewriting and destroying original record2. Observe agency’s standards on documentation

• complete, concise, specific, use standard abbreviations• telephone orders

TIPS FOR AVOIDING LEGAL PITFALLS:1. Patient Falls

• do proper assessment• appropriate assistance is given• use protective measures• document all nursing interventions

2. Medication errors• observe 7 R’s of drug administration• Check dr’s order• Understand the medication you will administer• Consult drug handbook/ pharmacy• Not exempt from liability for following doctors’ order

3. Equipment injuries• refuse to use a device not know how to operate• report adverse events to superiors• monitor patient regularly• bring questionable orders to the attention of the doctor or superior• familiarize self with existing protocol

1.Failure to communicate• promptly report changes in the patient’s symptoms and signs of distress to the Doctor• proper documentation of all assessments and telephone conversations with the Doctor

LEGAL RESPONSIBILITIES OF MIDWIFE

1. Contract – an agreement between two people which creates an obligation recognized by the law

Elements of Valid Contract Consent must be freely given (voidable) Competent parties (void) Legal objects (void) Valid considerations (voidable)

Valid – no questionVoidable – valid until question: force, threat, intimidationVoid – with questions arise, < 18 as incompetent

Two kinds of Contract1. According to Format Formal Contract – written down and it follows at all times the legal document/ long bond paper,

notarized Informal Contract – orally done/ written down but does not follow the legal documents2. According to Statement Expressed Contract – terminal conditions are written down and the beginning and

ending of the contract are also expressed e.g. job description

Implied Contract – it is actually based in the reaction and behavior of contracts parties

2. WILL – an act whereby a person disposes of his property to take effect after his deathTestator/ testatrix – a person who makes the willProbate – to prove the validity of the will in courtTestament – an act whereby a person disposes of his personal property to take effect after his

deathEscheat – when his property is transferred in the name of Republic of the Philippines

Two kinds of Will

1. Holographic Will – when the testator entirely writes down the will. Date and signed of the testator should be indicated in the will.

2. Notarial/ Nurcupative/ Authenticated Will – when the testatorally makes the will and will ask someone to write it down or him.

TWO KINDS OF SUCCESSION1. Testate – when there is a will executed by the testator2. Intestate – when there is no will executed by the testator

* The Midwife serves as a witness in making a will of your patient.* Ethical obligation – right to refuse in making patients will* Durable Power Attorney – appointing someone if your not capable to decide* Disinherited by parents, relatives – only when attempt to kill/ against their own life

Personal Property – movable property e.g. jewelries, given as testamentReal Property – immovable property e.g. land, house, bldgs., given as will

Will to the court (probate) Void from the start. Intestate*Illegitimate siblings has < share of properties than legitimate siblings*Adapted siblings has = properties to legitimate siblings*spouse has ¼ of the properties* ¼ free portion – for the taxes to be paid after getting the properties *Prenuptial Agreement – agreement before marriage, which husband property different from wife

property vice versa/ have separate property even they’re married*Conjugal Agreement – husband’s properties is also wife’s properties/ vice versa

3. Lawsuits – proceedings in courtPurpose: To enforce a right, to redress a wrong

PARTIES:a. Criminal Action

Complainant – person who file a case with a court against another, a concise statement of the ultimate facts constituting cause of action.

Respondent – the person against whom the caseb. Civil Action

Plaintiff – person who file a case with PRC

Defendant – the person against whom the caseSub Poena ad testicandum/ Sub Poena – court summons is served directing a witness to appear and

give testimony on the date and time ordered Sub poena duces tecum – served to a witness requiring him to bring records, papers or chartsTestimony of facts – testifying only on what he knows based on facts Tesstimony of opinion – may only be given by expert witnessExpert witness – one who is qualified to testify based on special knowledge, skill and trainingPerjury – false swearing under oathPrivileges against self – incrimination – right not to answer any questions that will incriminate him/her

>mind/ imagination purely e.g. ejaculation to excrete sperm/semen> not self – incrimination – mechanical e.g. pregnancy test, drug test, urine test, DNA test, pubic hair, purgative/ laxative, blood sample

Hearsay evidence – repetition of what the witness heard others sayAnte mortem statement – dying declaration considered hearsay except when made by a victim of a crime

You go to a Court: When rights are violated To correct a wrong and have it correctedRemedies going to court: Quasi – Administration Body

Municipal Regional Board of Appeal Supreme Court