CONTRACT Meeting of minds between two persons whereby one binds himself, with respect to other, to give something

or to render some service A promise which the law recognizes as a duty and when that duty is not performed the law provides a remedy (Breach) KINDS OF CONTRACT Formal- refers to an agreement between parties and is required to be in writing. E.g. marriage contract .. Informal- one in which the law does not require the same to be in writing. Express- the conditions and terms of contract are given orally or in writing by the parties concerned. E.g. PDN under the doctrine of "facio ut des" means I do that you may give. Implied- one that is concluded as a result of acts of conduct of the parties into a contract. Void- one that is inexistent from the very beginning and therefore may not be enforced. Illegal- one that is expressly prohibited by law Those that are made In protection of the law Consent obtained by fraud; duress; undue influence and material misrepresentation CONSENT a free and rational act that presupposes knowledge of the thing to which consent is being given by a person who is legally capable to give consent Informed Consent- a written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of the procedure Nurses responsibility regarding informed consent (1) witness the exchange between the client and the physician (2) witnessing the client affix his signature (3) establishing that the client really understood. Characteristics of a Valid Consent Voluntariness; free from coercion Opportunities to ask questions expalined Treatment explained Understood by the patient Maturity of parties (physically and mentally) CRITERIA OF GOOD CONSENT Eighteen years old and above Mentally capacitated Proxy consent- <18 and mentally incapacitated Parent Guardian (in order) Physician Guardian ad litem Exceptions to an Informed Consent Married & mature minors Emancipated minors Emergency cases Minors seeking birth control or pre-natal treatment Over specific age (12 years old & above may give consent for STD, HIV testing, AIDS treatment, drugs & alcohol treatment without parents consent. Sexually abused minors & adolescents LEGAL CONSIDERATIONS IN CHARTING PURPOSE OF THE PTS. CHART Communication and continuity Assurance of quality care Research Legal document Statistics of the disease 1|Page

*The chart is owned by the hospital DOS & DONTS IN CHARTING DOS Full, factual and objectively accurate Legible Immediate Personal DONTS Language or unacceptable words Improper corrections Spaces & skips Abbreviation, not standard Dont tamper the medical record by: Adding Rewriting Destroying original record Observe agencys standards on documentation Complete & Concise Specific & Standard abbreviations Writing an Incident Report: A tool used as a means of identifying and improving client care. They are usually made immediately after its occurrence and validated immediately by co-workers. Purpose: to provide accurate documentation of occurrences affecting the client as to have basis for its intervention. The following are common situations that require an incident report: MOST OF THEM ARE NEGLIGENT ACTS Falls , burns & medication error Break in the aseptic technique Incorrect sponge count during surgery Failure to report the clients condition Rules in Incident Report Dont use the word error or include lawful judgment or inflammatory words NURSES AND WILLS, GIFTS, ADVANCE DIRECTIVES WILLS- legal declaration of a persons intentions upon death. Called a testamentary document because it takes effect after the death of its maker An act whereby a person is permitted with the formalities prescribed by law, to control a certain degree the deposition of his estate, to take effect after death. Decedent a person whose property is transmitted through succession whether or not he left a will Testator a person who left a will. Testatrix a woman who is making a will Heir a person called to succession either by the provision of a will or by operation of law Testate a person who dies leaving a will Intestate a person who died without leaving a will Probate validation of a will in court Administrator one who administers the provision of the will Estate the interest a person has in lands or in any other subject to property Attestation Clause- means the clause wherein the witness certifies that the instrument has been executed before them, and the manner of the same. TYPES OF WILLS Holographic will a will is written, dated and signed by the testator Nuncupative will or Nuncupation- an oral will WHO CAN MAKE A WILL? Sound mind Eighteen years old & above Not prohibited by law 2|Page

WHO CAN WITNESS? Sound mind Eighteen years old & above Able to read and write Not blind, deaf or dumb The Nurses obligation in the Execution of a will Note the soundness of the pts mind Ensure there was freedom from fraud or under influence The pt should be above 18 years of age Note the will was signed by the testator and that the witnesses signed the will in the presence of the testator For protection, the nurse must make a notation on the pts chart Gifts:Another way of disposing property Four legal requirements for a gift: gift must consist of personal property Intention to make the gift Indication of transfer of control over such property acceptance by the recipient Gifts Causa Mortis or Donation Causa Mortis Gifts made by a person because of anticipation of death or beliefs in approaching death. ADVANCE CARE DIRECTIVE: a document written or completed by the client and used by a facility or hospital to provide care at a time when client cannot make his own decision SUBJ ECTS: 1. Show risk for early dementia 2. Show risk for stroke 3. Activities- severe head injuries 4. Severe and recurring psychiatric illness 5. Terminally ill Characteristics of Advance Directives a. Allows clients to participate in choosing health care providers b. Allows also in choosing the type of medical treatment the client desires. c. Allows clients to consent or refuse treatments TYPES: 1. INSTRUCTIVE DIRECTIVE- specifies life- sustaining treatment to be withheld or withdrawn. LIVING WILL-legal document stating person does not wish to have extra-ordinary life saving measures when not able to make decisions about his own care. -applicable for life saving treatment only. Example: DNR 2. PROXY OR DURABLE POWER OF ATTORNEY: legal document giving designated person authority to make health care decisions on the clients behalf when the client is unable to do so. Do not Resuscitate (DNR) Factors in giving order of resuscitation: 1. Clients will and advance directives 2. Disease prognosis such as cancer or HIV 3. Clients ability to cope 4. Whether CPR will be given or not Reasons for refusing to perform resuscitation Epidemic or widespread disease or debilitating condition & that CPR is not beneficial CPR will aggravate or prolong the agony of the client against cultural & religious suffering Advance directives & Will

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Organ Donation REQUIREMENTS: Any person 18 years of age or older may become an organ donor by written consent. Informed choice to donate an organ can take place with the use of a written document signed by the client prior to death, a will, or a donor card or an advance directive. In the absence of appropriate documentation, a family member or legal guardian may authorize donation on the descendants organs. In case of newborns, they must be full term already (more than 200 grams) TYPES: 1. Autotransplantation- donor and recipient are one and the same Ex: skin and bones 2. Heterologous- donor and recipient are two different individuals. a. animal to human b. human to human c. cadaver donor d. living donor Types of organs used : 1. Those that regenerate - bone marrow, skin 2. Those that come in pair - kidneys, eyes Religions that have different views regarding organ donations Russian Orthodox: permits all donations EXCEPT THE HEART. Jehovahs Witness: DOES NOT ALLOW organ donation and all organ to be transplanted must be drained of blood first. Judaism: They permit organ donation as long as with RABBINICAL CONSULTATION. Islam: will NOT USE ORGAN STORED IN ORGAN BANKS. NURSING ETHICS ETHICS: Came from the Greek word ETHOS moral duty Studies how people make judgment in regard to right or wrong MORALITY It is the right or wrong; good or evil; proper or improper, cruel or benevolent acts Health Care ethics: Division of ethics that relates to human health Bioethics: Focuses on moral issues in the field of health care NURSING ETHICS: The examination of all ethical and bio-ethical issues from the prospective of nursing theory and practice PRINCIPLES IN BIOETHICS BENEFICENCE: means to do only whats good NON- MALEFICENCE: Principle of do no harm AUTONOMY: the right to make ones own decision; self-determination STEWARDSHIP: not harm our body because it is Gods not ours JUSTICE: The right to be treated fairly, justly and equally FIDELITY: refers to the obligation to be faithful to the agreements, commitments and responsibilities that one has made to oneself and others VERACITY: Truthfulness or honesty RESPECT: treat all individuals as persons with rights with or without abnormality. INVIOLABILITY/ SANCTITY OF LIFE: No one can violate or destroy life SHARING OR ALLOCATION OF RESOURCES: applies when resources are scanty or very limited

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Standards of Care: Guidelines for determining whether nurses have performed duties in an appropriate manner & guidelines in which the nurse should practice PATIENTS BILL OF RIGHTS 1. Right to considerate and respectful care:nurse avoids discriminating acts that tends to bring the appearance of favoritism; a tender loving care attitude 2. Right to information about diagnosis, treatment and prognosis 3. Right to informed consent: refers to the capacity of the patient to accept or refuse treatment options offered by the health care provider. Elements: Voluntariness Informed Competent parties Knowledgable info. provided Signed prior to pre-op meds 4. Right to an advance care directive 5. Right to Privacy 6. Right to confidentiality: all records and communications held in confidence when to divulge information: 1. patient placed in serious danger 2. public welfare 3. legal proceeding 7. Right to go over records 8. Right to services and to transfer: Referral 9. Right to know relationship with other health care and educational institutions 10. Right not to be subjects of research or experimentation 11. Right to expect reasonable continuity of care:follow up consultations 12. Right to know what hospital rules and regulations apply to his conduct as a patient MORAL PRINCIPLES The golden rule: Do unto others what you would like others do unto you The two fold effect: May have bad and good effect Must be morally good Good effect must be willed and the bad effect merely allowed Good effect must not come from an evil action Good effect must be greater than the bad effect The Principle of Totality: The whole is greater than any of its parts Epikia : Exception to the general rule One who acts through an agent is himself responsible Ex. Nurse recommends patient to another clinic for abortion but does not want to perform No one is obliged to betray himself/herself No one can force any person to answer a question if such will incriminate him/her The end does not justify the means Giving sleeping tablets to someone who has chronic illness Defects of nature may be corrected Corrected by plastic surgery If one is willing to cooperate in the act, no injustice is done to him/her With patients consent A little more or less does not change the substance of an act Stealing The greatest good for the greatest number Have more good effects for more people than a smaller group

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No one is held to the impossible :Do not promise impossible things The morality of cooperation: Formal cooperation is an evil act and never allowed Principle relating to the origin and destruction of life: Thou shall not kill PATIENTS RESPONSIBILITIES Providing information Complying with instructions Informing the physician of refusal to treatment Paying hospital charges Following hospital rules and regulations Showing respect and consideration NURSES BILL OF RIGHTS Registered nurses promote and restore health Prevent illness Protect the people entrusted to their care Alleviate suffering Provide services that maintain respect for human dignity CODE OF ETHICS FOR REGISTERED NURSES Four basic ethical principles: 1. Fundamental responsibility of the nurse is four-fold 2. Nurse renders service regardless of race, creed, nationality or political belief. 3. Nurse protects life and respects the dignity of man. 4. Nurse works in collaboration with members of the health team REGISTERED NURSES AND PEOPLE Ethical Principles: Values, customs and spiritual beliefs shall be respected Individual freedom to make decisions Personal information acquired must be held in confidence Guidelines to be observed: a. individuality and totality of patients b. respect c. uphold the rights of individuals d. take into consideration culture and values in the event of conflict, welfare and safety take precedence REGISTERED NURSES AND PRACTICE Ethical Principles a.Human life is inviolable b.Quality and excellence in the care of patients c.Accurate documentation- nursing accountability Guidelines to be observed: a. know the definition and scope of nursing practice b. be aware of duties and responsibilities c. acquire and develop competence in knowledge, skills and attitude d. optimum standard of safe nursing practice e. be morally and legally responsible f. patients records considered confidential RNS are aware that their actions have professional, ethical, moral and legal dimensions Guidelines to be observed: 1. Duties in conformity with law 2. Not allow to be used in advertisements that demean image of the profession 3. Decline any gift, favor or hospitality from patient 4. Not demand and receive any commission, fee for recommendations made 5. Avoid any abuse of relationship

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REGISTERED NURSES AND THE PROFESSION Ethical Principles: 1. Maintain loyalty 2. Compliance with by laws of accredited professional organizations 3. Commitment to continual learning 4. Contribute to the improvement of the socio-economic conditions and welfare of nurses Guidelines to be observed: a. Be a member of accredited prof organization (PNA) b. Strictly adhere to nursing standards c. Strive to secure equitable working conditions through appropriate legislation and other means d. Assert for the implementation of labor and work standards

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