Beruflich Dokumente
Kultur Dokumente
Institute of Nursing
AY 2010 - 2011
RESOURCE UNIT IN
NURSING ETHICS & JURISPRUDENCE
NF Cañizares, BSN, RN, MAN
NURSING ETHICS
Main Concept:
•
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•
Establishment of connection with community resources
•
Motivation of individuals, families and communities
• Participation in teaching guidelines and supervision • Undertaking nursing and health manpower
development
ETHICAL APPROACHES
A. Teleological Approach or Act of Utilitarianism
•
Virtue Ethics, known as aretaic ethics (from the Greek word “arête”) is
focused
primarily on the heart of the person performing the act.
•
It focused on the traits and virtues of a good person such as courage,
temperance,
wisdom and justice.
•
Intellectual virtue is the power to deliberate about things good for oneself.
•
Moral virtues must be lived over time in order to be learned.
D. Divine Command Ethics
•
Is based on the theory that there is a Supreme or Divine being that sets down
the
rules to provide guidance to moral decisions.
UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS
A. Autonomy
•
Comes from the Greek word “autos” meaning self and “nomos” meaning
governance.
•
It involves self-determination and freedom to choose and implement one’s
decision, free from deceit, duress, constraint or coercion.
B. Veracity
•
To maximize the efficiency of health care, the patient and the health care
providers are bound to tell the truth.
•
The patient has the responsibility to provide, to the best of his knowledge,
accurate and complete information about his complaints, past illness,
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previous hospitalizations, medications taken, allergies, religious restrictions,
and other matters relevant to his health.
C. Beneficence / Peace Education
•
The principle of beneficence promotes doing acts of kindness and mercy
that directly benefit the patient.
•
These acts promote the health of the patient, prevent illness or
complications, alleviate suffering and assist towards peaceful death if
the
inevitable comes.
D. Nonmaleficence
•
Is stated as an admonition in the negative form to remind health
practitioners to do no harm.
E. Justice
•
Refers to the right to demand to be treated justly, fairly and equally.
IMPORTANCE OF ETHICAL CODES
1. It is a systematic guide for developing ethical behavior.
2. It answers normative questions of what beliefs and values should be
morally
accepted.
NURSING CODE OF ETHICS
1. Importance:
It strongly emphasizes the four-fold responsibility of nurse, the
universality of the nursing practice, the scope of their responsibilities
to the people they serve, to their co-workers, to society and
environment, and to their profession.
2. Brief History:
a. 1982
•
The Philippine Nurses Association Special Committee, under the
chairmanship of Dean Emeritus Julita V. Sotejo, developed a Code of
Ethics for Filipino nurses.
b. 1984
•
The Board of Nursing, Professional Regulation Commission adopted
the Code of Ethics of the International Council for Nurses through
Board Resolution No. 633 adding “promotion of spiritual environment”
as the fifth- fold responsibility of the nurse.
•
This was enforced up to 1989.
c. 1989
•
The Code of Ethics promulgated by the Philippine Nurses Association
was approved by the Professional Regulation Commission and
through Board Resolution No. 1955 was recommended for use.
•
This was approved by the general assembly of the Philippine Nurses
Association during the Nurses Week convention on October 25, 1990.
3. Amended Code of Ethics for Nurses
a. Pursuant to Section 3 of Republic Act No. 877, known as the Philippine
Nursing Law, and Section 6 of PD No. 233, the amended Code of
Ethics for Nurses recommended and endorsed by the Philippine
Nurses Association was adopted to govern the practice of nursing in
the Philippines.
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b. The Code was adopted under Republic Act 9173 and promulgated by the
Board of Nursing under Resolution No. 220 Series of 2004 last July 14, 2004.
PRINCIPLES:
1.
Nurses and People
2.
Nurses and Practice
3.
Nurses and Co-Workers
4.
Nurses and the Society
a.
Contributing members of the society
b.
Awareness for the call for change
5.
Nurses and the Profession
6.
Responsibility of the Nurse to Patient
7.
Responsibility of the Nurse to the Physician
8.
Responsibility of the Nurse to her Colleagues
9.
Responsibility of the nurse toward themselves
THE ICN CODE FOR NURSES [2006] & THE UNIVERSAL
PRINCIPLES IN NURSING
1. Nurses and People
•
Nursing care
•
Environment that respects the rights, values, and spiritual beliefs of patients
•
Informed consent/ information dissemination
•
Confidentiality
2. Nurses and Practice
•
Responsibility and accountability for nursing practice and the maintenance
of competence
•
Standard of care wherein the ability to provide care is not compromised
•
Assess individual competency
•
Maintain standards of personal conduct
•
Client safety with regard to the use of technology and scientific advances
3. Nurses and the Profession
•
Assume the major role in determining and implementing acceptable
standards in practice, management, education and research
•
Be active in developing of core of research-based professional knowledge
•
Participate in creating and maintaining safe, equitable, social, and economic
working conditions in nursing through professional organization
4. Nurses and Co-Workers
•
Cooperation and collaboration
•
Patient Protection from co-worker or other individuals
IMPLEMENTING RULES IN THE ICN CODE OF ETHICS
1. Nurses shall perform professional duties in conformity with the existing
laws and
generally accepted principles of moral and ethical conduct and
proper decorum
2. Nurses must know responsibilities in the practice of the profession
3. Solicitation, direct or indirect from patients is repugnant to the honor
and dignity
of nursing profession that constitutes unethical conduct
4. Nurses must not allow the use of their names in the promotion of any
commercial
products or service
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RESPONSIBILITIES OF THE NURSE TO THE PATIENTS
1. Give him/her the kind of care his/her condition needs regardless of his/her
race,
creed, color, nationality or status.
2. The patient’s care shall be based on needs, the physician’s orders, and the
ailment.
3. The nurse shall involve the patient and/or his/her family so that he/she or
any of
the family can participate in his/her care.
4. Know the patient’s Bill of Rights.
5. Be patient advocate. Treat patient in a manner that will show concern
whether the
patient is rich or poor.
6. Nurses should not leave a patient or any agency without proper permission
or
resignation or without relief.
7. Nurses should commit themselves to the welfare of those entrusted to their
care.
PATIENT’S BILL OF RIGHTS
1. The patient has the right to considerate and respectful care.
2. The patient has the right to obtain from his physician complete and
current information concerning his diagnosis, treatment, and prognosis
in terms the patient can be reasonably expected to understand.
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.
4. The patient has the right to refuse treatment 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.
6. The patient has the right to expect that all communications and records
pertaining
to his care should be treated as confidential.
7. The patient has the right to expect within its capacity, a hospital must make
reasonable response to the request of a patent for services.
8. The patient has the right to obtain information as to any relationship his
hospital has to other health care and educational institutions insofar as
his care is concerned.
9. The patient has the right to be advised if the hospital proposes t engage in
or
perform human experimentation affecting his care or treatment.
10.The patient has the right to expect reasonable continuity of care.
11.The patient has the right to examine and receive an explanation of
his bill.
12.The patient has the right to know what hospital rules and regulations apply
to his
conduct as a patient.
PATIENT’S RESPONSIBILITIES
1. Providing information
2. Complying with instructions
3. Informing the physician of refusal to treatment
4. Paying hospital charges
5. Following hospital rules and regulations
6. Showing respect and consideration
NURSES’ BILL OF RIGHTS
1. Nurses have the right to practice in a manner that fulfills their obligations
to
society and to those who receive nursing care.
2. Nurses have the right to practice in environments that allow them to act in
accordance with professional standards and legally authorized scopes of
practice.
3. Nurses have the right to a work environment that supports and
facilitates ethical practice, in accordance with the Code of Ethics for
Nurses and its interpretative statements.
4. Nurses have the right to freely and openly advocate for themselves and
their
patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with
their
knowledge, experience and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and
their
patients.
7. Nurses have the right to negotiate the conditions of their employment,
either
individuals or collectively, in all practice settings.
NURSES’ RESPONSIBILITIES IN RESEARCH ON HUMAN
SUBJECTS
1. Employment in settings where research is conducted.
2. Vigilant protection of human subjects’ rights
3. Scope of Application
4. Supporting accrual of knowledge
5. Informed consent
6. Representation of Human Rights Committee
BASIC HUMAN RIGHTS OF RESEARCH SUBJECTS
1. Right to informed Consent
2. The right to refuse and/or withdraw from participation
3. Right to privacy
4. Right to confidentiality or anonymity of data
5. Right to be protected from harm
EXPERIMENTAL SUBJECT’S BILL OF RIGHTS
1. To be told about the nature and purpose of the study.
2. To be told about the procedures to be followed in the research study,
and whether any of the drugs, devices, or procedures is different from
what would be used in standard practice.
3. To receive a description of any side effects, discomforts, or risks that you
can
reasonably expect to occur during the study.
4. To be told of any benefits that you may reasonably expect to from the
participation in the study, if applicable.
5. To receive a description of any alternative procedures, drugs, or
devices that might be helpful, and their risks and benefits compared to
the proposed, drugs or devices.
6. To be told of what sort of medical treatment, if any, will be available if any
complications should arise.
7. To be given a chance to ask any questions concerning the research study
both
before agreeing to participate and at any time during the course of the study.
8. To refuse to participate in the research study. Participation is
voluntary. You may refuse to answer any question or discontinue your
involvement at any time without penalty or loss of benefits to which
you might otherwise be entitled. Your decision will not affect your right
to receive the care you would receive if you were not in the
experiment.
RESPONSIBILITIES OF THE NURSE TO THE PHYSICIAN
•
Section 28(a) of RA 9173 states that: It shall be the duty of the nurse to:
(a) Provide nursing care through utilization of the nursing process.
Nursing care includes, but not limited to, traditional and innovative
approaches, therapeutic and innovative approaches, therapeutic use
of self, executing health care techniques and procedures, comfort
measures, health teachings, and administration of written prescription
for treatment, therapies, oral, topical and parental medications,
internal examination during labor in the absence of antenatal bleeding
and delivery. In case of suturing or perineal laceration, special training
shall be provided according to protocol established.
RESPONSIBILITIES OF NURSES TO THEIR COLLEAGUES
1. Establish good working relationships with co-workers.
2. Nurses shall adjust themselves to the organization and know its policies
and
procedures.
RESPONSIBILITIES OF NURSES TO THEMSELVES
1. Develop their own skills.
2. Their conduct must bring credit to the profession.
3. They shall endeavor to live a life that will uphold their self-respect.
4. Wear uniform with respect and dignity (clean, neat hair style,
moderate make-up,
without jewelries)
5. Must act in a manner that is worth emulating especially while they are on
duty.
Special Concepts and Principles which Guide Client-health Professional
Relationship
1. Right to Health Care
2. Right to Informed Consent
3. Promise Keeping (Fidelity)
4. Truth-Telling (Veracity)
5. Confidentiality
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RESPONSIBILITIES OF THE NURSE TO THE PHYSICIAN
•
Section 28(a) of RA 9173 states that: It shall be the duty of the nurse to:
(a) Provide nursing care through utilization of the nursing process.
Nursing care includes, but not limited to, traditional and innovative
approaches, therapeutic and innovative approaches, therapeutic use
of self, executing health care techniques and procedures, comfort
measures, health teachings, and administration of written prescription
for treatment, therapies, oral, topical and parental medications,
internal examination during labor in the absence of antenatal bleeding
and delivery. In case of suturing or perineal laceration, special training
shall be provided according to protocol established.
RESPONSIBILITIES OF NURSES TO THEIR COLLEAGUES
1. Establish good working relationships with co-workers.
2. Nurses shall adjust themselves to the organization and know its policies
and
procedures.
RESPONSIBILITIES OF NURSES TO THEMSELVES
1. Develop their own skills.
2. Their conduct must bring credit to the profession.
3. They shall endeavor to live a life that will uphold their self-respect.
4. Wear uniform with respect and dignity (clean, neat hair style,
moderate make-up,
without jewelries)
5. Must act in a manner that is worth emulating especially while they are on
duty.
Special Concepts and Principles which Guide Client-health Professional
Relationship
1. Right to Health Care
2. Right to Informed Consent
3. Promise Keeping (Fidelity)
4. Truth-Telling (Veracity)
5. Confidentiality
MORAL PRINCIPLES
1. The Golden Rule
2. The Two-fold Effect
3. The Principle of Totality
4. Epikia
5. One who acts through an agent is himself responsible
6. No one is obliged to betray himself/herself
7. The end does not justify the means
8. Defects of nature may be corrected
9. If one is willing to cooperate in the act, no justice is done to him/her
10.A little more or less does not change the substance of an act
11.The greatest good for the greatest number
12.No one is held to the impossible
13.The morality of cooperation
14.Principle relating to the origin and destruction of life
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The counterpart bill in the Senate (SB No. 2292) with Senator
Flavier as sponsor. The BM and PNA and Legislation Committee
worked and put the bill in its final form. The Pres. GM Arroyo during
the 80th Anniversary of the Nurses Week celebration on October 21,
2002 in Manila Midtown Hotel.
RA 9173 October 21, 2002 – an act providing for a more responsive
nursing
profession repealing for the purpose RA # 7164, otherwise known as the
Philippine
Nursing Act of 1991.
PHILIPPINE NURSING LAW (RA 9173)
Title of the law and its provision (Article I)
Declaration of Policy (Article II)
Organization of the Board of Nursing (Article III)
Examination and Registration (Article IV)
Nursing Education (Article V)
Nursing Practice (Article VI)
Health Human Resources Production, Utilization and Development (Article
VII)
Penal and Miscellaneous Provisions (Article VIII)
Reference for RA 9173 – Primer of RA 9173, Twelfth Congress,
Second Regular Session – Board of Nursing Resolution No. 425,
Series of 2003, Implementing Rules and Regulation of the
Philippine Nursing Act of 2002.
ELEMENTS INVOLVED IN LEGAL LIABILITY:
1.Negligence – refers to the commission or omission of an act, pursuant
to a duty, that a reasonably prudent person in the same or similar
circumstance would or would not do, and acting or non-acting of which
is the proximate cause of injury to another person or his property.
2.Malpractice – the idea of improper or unskillful care of a patient by a
nurse; denotes stepping beyond one’s authority with serious
consequences. It is the term for negligence or carelessness of
professional personnel.
3.Incompetence – the lack of ability, legal qualifications or fitness to
discharge the
required duty.
4.Ignorance – means want of knowledge.
5.Moral Turpitude – an act of baseness, vileness or depravity in social or
private
duties.
6.Fraud – a wrong doing or misconduct, an act resulting from a willful act to
deceive; deceitful practice, rules of common honesty.
7.Deceit – any act. Declaration or practice which misleads a person or which
causes him to believe what is false.
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4. Captain of the Ship Doctrine
5. Doctrine of Corporate Liability
TORTS– a legal wrong, committed against a person or property independent
of a contract
which renders the person who commits it liable for damages in a civil action.
Examples of Torts:
1.Assault – the imminent threat of harmful or offensive bodily contact.
2.Battery – an intentional, unconsented touching of another person.
3.False Imprisonment or Illegal Detention – means the unjustifiable
detention of
a person without a legal warrant within boundaries fixed by the defendant by
an
act or violation of duty intended to result in such confinement.
4.Invasion of Right to Privacy and Breach of Confidentiality
5.Defamation
•
Slander – oral defamation of a person by speaking unprivileged or false
words by which his reputation is damaged.
•
Libel – defamation by written words, cartoons or such representations that
cause a person to be avoided, ridiculed or held in contempt or tend to injure
him in his work.
CRIMES, MISDEMEANORS AND FELONIES
1.Crimes – an act committed or omitted in violation of the law.
2.Elements of Criminal Offenses:
a. Criminal Act
b. Evil/ Criminal Intent
•
Conspiracy to commit a crime
•
Criminal Actions
•
Criminal Negligence
•
Criminal Intent
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CLASSIFICATION OF FELONY:
A. According to Degree of the acts of Execution:
1.Consummated – when all the elements necessary for its execution and
accomplishment are present.
2.Frustrated – when the offender performs all the acts or execution which
will produce the felony as a consequence but which nevertheless, do
not produce it by reason of causes independent of the will of the
perpetrator.
3.Attempt – when the offender commences the commission of the same
directly overt (open or manifest) acts, and does not perform all the
acts or execution which shall produce the felony, by reason of some
cause or accident other than his own spontaneous desistance.
B. According to Degree of Punishment:
1.Grave Felonies – those to which the law attaches the capital punishment
(death) or penalties which in any of their periods are afflictive
(imprisonment ranging from six (6) years and one (1) day to life
imprisonment not exceeding P6,000.00).
2.Less Grave Felonies – those which the law punishes with penalties
which in their maximum period are correctional (imprisonment ranging
from one month and one day to six (6) years, or a fine not exceeding
P6,000.00 but not less than P200.00).
3.Light Felonies – those infractions of law for the commission of which the
penalty of arresto menor (imprisonment for one (1) day to thirty (30)
days or a fine not exceeding P200.00 or both of which are imposed).
This is punishable only when they have been consummated, with the
exception of those committed against a person or property.
CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY
1. Justifying Circumstances
2. Exempting Circumstances
3. Mitigating Circumstances
4. Aggravating Circumstances
5. Alternative Circumstances
CRIMES WHICH CONCERNS NURSES
1.Parricide – a crime committed by one who kills his/her father, mother, or
child
whether legitimate or illegitimate, or any of his/her ascendants or descendants
of
his/her spouse.
2.Murder – the unlawful killing of a human being with intent to kill.
3.Homicide – the killing of a human being by another.
4.Infanticide – the killing of a child less than three (3) days of age.
5.Abortion – the expulsion of the product of conception before the age
of viability.
6. Giving assistance to suicide
7.Illegal Detention – unlawful taking of a person or property as in the
case of
forcible entry or detention.
8.Simulation of birth, substitution of one child for one another, or
abandonment of a legitimate child.
9.Criminal Negligence
Reckless Imprudence – when a person does an act or fails to do it
voluntarily
but without malice, from which material damage results immediately.
Simple Imprudence – when the person or nurse did not use precaution and
the damage was immediate or the impending danger was not evident or
manifest.
Legal Responsibilities of Nurses into the Following Areas:
A. Contracts
B. Informed Consent
C. Wills
D. Nursing Care
E. Operation of Patients
F. Abortion Cases
G. Unauthorized Discharge of Patient
Points to Observe by Nurses in Order to Avoid Criminal Liability
1. Be very familiar with the Philippine Nursing Law.
2. Beware of laws affect nursing practice.
3. At the start of employment, get a copy of your job description, the
agency’s rules,
regulations and policies.
4. Upgrade your skills and competence.
5. Accept only such responsibility that is within the scope of your
employment and
job description.
6. Do not delegate your responsibility to others.
REFERENCES:
1. Lydia M. Venzon, RN, MAN, PhD, FPCHA and Ronald M. Venzon
Professional Nursing in the Philippines
11th Edition, C&E Publishing Corp., 2010
10th Edition, C&E Publishing Corp., 2005
2. Rustico T. De Belen and Donna Vivian De Belen
Nursing Law, Jurisprudence & Professional Ethics
1st Edition, C&E Publishing Corp., 2007
3.DOH Nursing Service Manual, 2005
4. Kozier, Erb, Berman and Snyder
Fundamentals of Nursing: Concepts, Process and Practice
8th Edition, C&E Publishing Corp
5. Commission on Higher Education CHED Memorandum Order
(CMO) no. 14,
S. 2009
6. Commission on Higher Education CHED Memorandum Order
(CMO) no. 30,
S. 2001