Professional Adjustment

Profession
A calling in which members
profess to have acquired special
knowledge,
by
training
or
experience or both, so that they
may guide, serve or advice
others in that special field

Characteristics of a profession
Special Education
Code of ethics
Research Orientation
Autonomy, Authority, Accountability
Body of knowledge
Service Orientation
Professional organization

Professional
Nursing
The performance for salary or
remuneration, of professional
nursing service, particularly that
of diagnosing and treating
human responses and potential
health problems.

Legal Basis of Professional

Nursing Practice
Republic Act 9173 or the nursing law
of 2002
> Defines nursing, set standards for the
nursing profession and give guidance in
the scope of practice.
> Contains general statements of
appropriate nursing actions
> Goal: protection of the general public

As a registered nurse, which of the following can

be performed within the meaning of the Nursing
Act of 2002?
1. Internal examination during labor and delivery in
the absence of ante natal bleeding
2. Suturing of perineal lacerations
3. Nursing care of pregnant mothers during labor and
delivery
4. Administration of medications and therapies
including IV

a. 1,2,3
b. 1,3,4
c. 2,3,4

Answer: B

Petra chose nursing as her life-long career.

It is necessary that she must understand
this profession as to guide her practically
and professionally as a nurse. Which among
the following phrases best describes what
professional nursing is all about?

a. A nurse has always experienced proper

community health training
b. Has independence towards the proactive of her
nursing profession
c. Always observe ethical and professional practice
d. Provide diligent care for all regardless of their
financial status

Answer: C

To avoid legal embarrassment, the

nurse should do the following?
a. He must have basic knowledge
regarding the new Philippine Nursing
Law
b. He is aware of the laws affecting nurses
c. Upgrade ones skills and competence
as a nurse
d. All of the above

Answer: D

Carmelita is a nurse who just passed the

local licensure examination for nurses.
She knows that professional practice of
nursing involves all the following, except:
a. Administration of intravenous injection after
completion of training
b. Motivation of individuals, families and
communities
c. Undertaking consultation services
d. Participation in teaching, guidance and
supervision of students

Answer: C

Common Law
is derived from principles or
social mores rather than from rules
and regulations. It consists of
broad, interpretative principles
based on reason, traditional
general and common sense.

Nursing
Jurisprudence
Department of law which
comprises all the legal rules and
principles affecting the practice of
nursing the study and interpretation
of rules and principles and their
application in the regulation on the
practice of nursing

Law
Are rules and regulations established
by a governing authority (sovereign
power) to institute and maintain
orderly coexistence by commanding
what is right and prohibiting what is
wrong.

Functions of Law in the Society

1. define relationships among
members of a society and state
which activities ate permissible or
not
2. describe what forces maybe
applied to maintain rules and by
when is to be applied.
3. provide solutions to problems
4. refine relationship between person
and group when conditions of life
change.

Basic Principle of Law

Based on concern for justice and
fairness
Characterized by change
Actions are judged on basis of
universal standards of what is similarly
trained, reasonable and prudent
person would done rather in similar
circumstances
Each individual has right and
responsibilities

Types of Law
Law govern the relationship of private
individuals with government.
Public Law
Refers to the body of law that deals with
relationship between individual and the
government and the governmental agencies. An
important segment of public law is criminal law
which deals with actions against the safety and
welfare of the public Examples are homicide,
manslaughter and theft.

Private Law or Civil Law

Is the body of law that deals with
relationship among private
individuals. It can be categorized
into a variety of legal specialties
such as contract law and tort law

Contract law involves the

enforcement of agreements
among private individuals
Torts laws define and enforce
and enforce duties and right
among private individuals that
are not based on contractual
agreement.

Sources of Law
Constitution
The constitution of the Philippines is the
supreme law of the country. It established
the general organization of the
government, grants certain powers to the
government, and places limits on what
government may do. The constitution
created legal rights and responsibilities
and the foundation for a systems of
justice.

Legislation (Statutory law)

Laws enacted by any legislative body
are called statutory laws.
Administrative Law
When a state legislature passes a
structure, an administrative agency is
given the authority to create rules and
regulation to enforce the statutory laws.

Functions of law in the

profession
Provides a framework for
establishing what nursing actions in the
care of patients are legal.
Delineates the nurses responsibilities
from those of other professionals.
Helps to establish the boundaries of
independent nursing actions.
Assists in maintaining a standard of
nursing practice by making nurses
accountable to the law.

Nurses and legal offenses

Crimes
Actions/behaviors which violate law
and is punishable by fine,
imprisonment or death
There 2 types according to severity:
felonies and misdemeanor

Felonies
Relatively serious offenses punishable
by imprisonment, fines or even death.
Offenders lose their civil rights.
Misdemeanor
Is less serious crime punishable by fine
and short-term jail sentence.

Board Question!

When the law attaches the capital

punishment, the felony is
considered:
a. grave
b. less grave
c. light felony

Answer: A

Which of the following is a grave

felony?
a. Guilty of committing euthanasia
b. Untidy appearance while on duty
c. Reporting a wrong doing of a colleague

Answer: A

Felony is considered consummated when:

a. All the elements necessary for its execution are
present
b. The offender performs all the acts of execution
which would produce the felony as a
consequence but nevertheless do not produce it
by reason of causes independent of the will of
the perpetrator
c. The offender commences the commission of a
felony and does not perform all the acts of
execution which should produce the felony
d. None of these

Answer: A

Criminal liabilities can be

classified according to:
Manner of commission
Dolo deceit; deliberate intent
Culpa - fault; product of
imprudence, negligence, lack of
foresight or skills

Stage of execution
Consummated all elements for execution
of the crime has been completed
Frustrated offender performs everything
as intended but fails due to external causes
Attempted overt actions to commit crime
has been commenced, but the elements
were not completed due to reactions other
than this own spontaneous desistance.

Degree of participation
Principals direct part in the execution of a
crime; cooperate in committing an act which
crime will not be accomplished
Accomplice cooperate in execution of
offences by previous/stimulation acts
Accessories profit or assist offenders to
profit from crime; conceals, destroy the body
of crime, effects, instruments to prevent
discovery of crime; harbor, conceals, and
assists in escape of principal with abuse of
authority

Board Question!
Situation:

Vivian is two months

pregnant. Her friend Donna referred her
to Sandra, an abortionist. Vivian without
the consent of Carlo had an abortion.
If those involved be charged legally,
who is considered as the principal of the
crime?
a. Vivian
b. Sandra
c. Donna

Answer: B

Who is to be charged as an
accomplice?
a. Donna
b. Sandra
c. Vivian

Answer: A

A nurse becomes liable as an

accomplice in an abortion if she:
a. performs the act
b. refers the pregnant mother to
abortionist
c. conceals the evidence of the crime

Answer: B

If during the investigation, the

pieces of evidence were not found
because Carling, the maid of Juaning
burned it. Carling is considered as:
a. Accomplice
b. Accessory
c. Principal
d. Co-Principal

Answer: A

Contract
- An agreement between two or more
persons upon sufficient consideration to
do or not to do some lawful act.
- One binds self with respect to other
give something or to render some
service.
- An agreement which creates an
obligation
- Can be written or oral

Expressed contract
When two parties discuss and agree orally
in writing to its terms

Implied contract
- One in which there has been no
discussions between parties, but the law
considers that a contract exists
- Law ascribes an objective intention to
enter a contract facio ut des ( I do that
you may give)

Elements of a valid contract

Agreement/ Mutual consent contracts
must be binding for both parties
Legal Subject matter nothing in the
contacts is contrary to law or public order
Cause of the obligation which is
established
Contractual capacity parties are
eligible to enter a contract

Objects of contracts
All things which are within the
commence of man
All rights which are
transmissible
Future inheritance

Prerequisites in entering a contract

Be of legal age

Be sound of mind

Not under the influence of

intoxicating substances or fear of
bodily harm

Mentally competent

Termination of Contract
Most nurse patient contracts end
when
Treatment is complete
Bills
Has been paid
Waiver to discharge against
medical advise has been signed

An agreement between two or more

persons to do or not to do a
particular thing is known as:
a. agreement
b. contract
c. subpoena

Answer: A

A contract is:
a. A bond gathered by a nurse from the
patient
b. A document that permits two person to
offer the same services
c. A written agreement between the nurse
and the patient
d. An agreement which creates an
obligation

Answer: D

When a patient enters a doctors

clinic for treatment, this is an
example of:
a. formal contract
b. implied contract
c. single contract

Answer: B

Which of the following statement is

false about an implied contact?
a. Its agreement is presumed
b. Its agreement is inferred from the acts
of the parties
c. It must still have consent by the parties
d. It is a formal contract

Answer: D

A verbal agreement where one

undertake to render service to
another in which either party agrees
to give for a fee or renumeration is
enforceable:
a. Formal written contract
b. Contract that is null and void
c. Form of an informal contract
d. Form of an implied contract

Answer: D

Legal offense
Breach of Contract
is the failure to perform an
agreement whether expressed or
implied, without cause

Legal excuse or defense

Torts
A civil wrong committed against a
person or property, excluding
breach of contact, which calls for
compensation in damages
The wrongdoing can be inflicted
by commission or omission
Can be intentional or
unintentional
See Intentional Torts Table

Unintentional Torts
Negligence
Doing an act which a prudent person
would not do or not taking an act which a
prudent person would do in the same
situation

Can be considered as grave felony if

done with obvious disregard of the safety
of others, or indifference to injury that is
bound to fallow ones act, specifically
when it results to injury or death
Nurses are liable for poor outcomes if
and only if there conduct is negligent.

Gross Negligence/ Reckless

Imprudence
Involves extreme breach of care, in
which the damage caused was not
immediate or danger is not evident or
manifested
Simple Negligence
Manifesting lack of precaution in which
the damage caused was not immediate
or the danger is not evident or
manifested.

Malpractice
Professional negligence
Failure to meet the standards of
acceptable care which results to harm
to other person
Negligence that occurred while the
person was performing as a
professional

Elements of Negligence and

Malpractice
1. Duty
2. Breach of Duty
3. Foreseeability & Causation
4. Harm or injury
5.

Damages

Doctrines Applicable To
Negligence Suits
Respondeat Superior
let the master answer for the
subordinates
where an agent acts through the
agency of another (superior), the latter
is himself acting through the former

Res Ipsa Loquitor

the thing speaks for itself
when a thing which has caused an injury is
shown to be under the management of the party
charge with negligence, the accident is as such
as in the ordinary course of thing will not happen
if those who have such management used
proper care, the accident itself affords
reasonable evidence in the absences of an
explanation by the parties charge that is those
from the want of proper care.

 Three elements
(1)

the event would have not

occurred if the nurse exercised
prudent care,

(2) the accident occurred within

exclusive control of the nurse,
(3) no voluntary action was done
by the injured party.

Force Majeure
irresistible or superior force
no one shall be held liable for
negligence done due to an event that
human prudence cannot foresee,
prevent or control
pertains to act of God and of nature

Situation: Nurse Robert is the scrub nurse in the

surgical team which performed exploratory
laparotomy. Dr. Leonard was the surgeon, Nurse
Cha was the circulating nurse and Dr. Siony was
the anesthesiologist. After the operation, the
patient complained of severe abdominal pain
while in the recovery room. X-ray showed a
mosquito forceps left in the patients abdomen.
The nurses are considered guilty based on the
doctrine of:
a. Res ipsa loquitur
b. Respondeat superior
c. Force majeure

Answer: A
The

thing speaks for itself

The doctrine of respondent superior

applies:
a. Where the injury occurs while the servant is
not within the legitimate scope of his
authority
b. When the injury occurred in the course of his
employment
c. When the injury occurred outside the
commerce of man
d. When the instrumentality was with in the full
control of the servant

Answer: B

The test for liability under the

doctrine of respondent superior is
the:
a. Power of master servant
b. Inquire itself
c. Extent of damage caused
d. Circumstances surrounding the act

Answer: A

The nurses were guilty of professional

negligence, which of the following are the
elements of the act?
1. existence of a duty on the part of the person
charged
2. failure to meet standards of care
3. foreseeability of harm resulting from failure to
meet standards
4. the power to control over the circumstances
a. 1,2,4
b. 1,3,4
c. 1,2,3,4

Answer: D

The following are possible penalty

of the act except:
a. revocation of license
b. life imprisonment
c. monetary penalty

Answer: A

The professional license that has

been revoked means:
a. suspension to practice nursing
b. removal of license number
c. cancellation of the license

Answer: A

A nurse who executes a doctors

order, which to her honest belief or
judgment may endanger the life of
the patient can be accused of:
a. Malpractice
b. Accessory
c. Accessory
d. Criminal negligence

Answer: D

Negligence means failure to:

a. Observe the behavior of an
unscrupulous person
b. Behave properly as a professional
nurse
c. Carry out ones duties and function
d. Do what is supposed to do

Answer: C

Definition of Terms
Murder killing of another person other
than relative with proven malice or
premeditation
Parricide killing of father, mother or child,
whether legitimate or illegitimate, or any of
his ascendants or descendants including the
spouse.
Homicide killing of any human creature. It
is not necessarily a crime, committed
without criminal intent and without criminal
consequence.

Infanticide killing a child less than 3 days

of age
Abortion expulsion of fetus so early that it
has not yet acquired the power of sustaining
independent life
Simulation of Birth substituting one child
to another, falsification of birth favoring
adoption
Burglary entry into building with intent to
commit a theft or felony inside the building

Robbery direct taking of property from another

by the use of force, intimidation or fear
Arson burning a building or structure with
malicious intent
Rape Forcible penetration of organ o
copulation or any inanimate object to any body
orifice of the offended party
Child molestation engaging in any sexual act
with a person under age 18
Drug charges possession and/or trade of
control substance

The essential element to determine

parricide is:
a. Presence of the body of the crime
b. Kind of weapon used
c. Part of victims body at which the
weapon is aimed
d. The relationship of the offender with
the victim

Answer: D

Infanticide is the unlawful killing of

an infant under:
a. Three days old
b. Three months old
c. Under 3 lbs. baby weight
d. Three years old

Answer: A

Any person who kills his father is

guilty of:
a. Parricide
b. Murder
c. Infanticide
d. Abortion

Answer: A

Considerations to Criminal Liability

Justifying Circumstances (there is no
crime in the eye of the law)

unlawful aggression on the part of the

offended or injured party
reasonable necessity of the means
employed by the offender
lack of sufficient provocation on the part
of the offender

Exempting Circumstances (there is

crime committed but no criminal on account of
absence of free will or voluntariness)

imbecile or insane person, unless

the latter has acted during a lucid
interval
under nine years old
over nine and under fifteen years
old (unless acted on discernment)

under the compulsion of an

irresistible force
any person who while a
performing a lawful act with due care,
causes an injury by mere accident,
without fault or intention of doing it
acting on impulse of an
uncontrollable fear of an equal or
greatly injury
failure to perform an act required
by law when prevented by some
insuperable cause

Mitigating Circumstances (penalty is

lessened)

circumstances otherwise justifying

or exempting
under 18 years of age; over 70
years old
offender had no intention to
commit so grave a wrong as that
committed
sufficient provocation or threat on
the part of the offended party
immediately preceded the act

the act was committed in the

immediate vindication of a grave
offense to the committing felony, his
spouse, relatives whether legitimate
or not
acted on impulse so powerful as
naturally to have produced passion or
obfuscation
surrendered himself or voluntarily
confessed his guilt

 deaf, dumb, blind or other physical

defects that restricts better
communication
illness that would diminish the
exercise of his will power without
however depriving him of
consciousness of his acts

Aggravating Circumstances (penalty is

increased)

advantage taken by the offender of

his public possession
crime committed in contempt or
with insult to public authorities
act committed with abuse of
confidence or obvious ungratefulness
crime committed during
conflagration, shipwreck, earthquake,
epidemic or misfortune

crime committed in consideration

of a piece, reward, or promise
crime committed by means of
inundation, fire, poison, explosion,
standing of a vessel or anything
involving great waste or ruin
act committed with evident
premeditation
fraud or disguise are employed

Circumstances or actions which are

said to be in accordance with law is
said to be:
a. Justifying
b. Exempting
c. Mitigating
d. Aggravating

Answer: A

All of the following are exempting

circumstance except:
a. Imbecile
b. 8 years old
c. performance of a lawful act
d. offender id deaf and dumb

Answer: A

When a politician takes advantage

of his power in the performance of
lawful actions this is considered as:
a. justifying circumstances
b. exempting circumstances
c. mitigating circumstances
d. aggravating circumstances

Answer: D

Which of the following is a

mitigating circumstances?
a. Act committed during epidemic or
calamity
b. Obeying a lawful order of the superior
c. Accidental killing
d. None of the above

Self-Protection of the Nurse

familiarity with the laws, code of

ethics, rules and regulation, and
standards of practice
clinical competence
cultural sensitivity and respect
self-awareness
sound management
concept of personal liability
documentation/recording

Documentation
Principles of documentation
Records are legal documents and are
admissible as evidence in a court of law
Nurses must accurately document each
step of the Nursing Process in the clients
records
Records entries should be brief,
accurate, legible chronologic, made on
consecutive lines and appropriately signed
Falsification is illegal, including omission
of relevant information

Incidents Reports
Purpose of incident reports:
to memorize in writing any unusual event at time
of its occurrence by a person who was a direct
personal witness. It is generally used for
management and documentation purposes only.
The whole purpose of incident reporting is to
LEARN from the mistakes and how to eliminate,
reduce and manage the risks we have to deal
with on a daily basis. It cannot be used as
evidence in lawsuits.

What an incident report should

contain
> The date
> The place
> The position of the individual
reporting (not necessarily the name)
> A description of the incident or
issue
> Whom it is reported to

What should be done to correct it

What has been done to correct it
A space for follow up reporting
The signature of the individual
reporting
The date and time the reporting is
received by the Risk Manager
> Action of the Risk Manager

Common situations that

require Incident report
Break in aseptic technique
Incorrect sponge count in surgery
Medical legal incident
Client or family refuses treatment
as ordered and refuses to sign
consent

* Client or family voices

dissatisfaction with care and
situation, cannot be or has not been
resolve
Complication from diagnostic or
treatment procedures ( e.g. blood
sample stick, biopsy, x-ray, invasive
procedure. Bronchoscopy)
Failure to report change in
patients condition
Falls
Patient is burned

Each professional nurse must be legally

accountable in all his action which
involves proper monitoring and recording.
The legal implication of this is due to:

a. That regardless if the nurse re recorded his

observation or not, he shall still be
accountable and liable
b. If the nurse did not document anything, he
shall be liable
c. If it was not written although it was performed,
it is considered as not having been done at all
d. Because a chart needs to be completed by
handwritten words

Answer: C

Nursing Ethics
Morality - usually refers to private,
personal standard of what is right
and wrong. Moral issues involve
important social values and norms

Ethics refers to a method of inquiry

about the rightness or wrongness as
a human actions; the practices or
beliefs of a group; and the standards
of moral behavior described in the
groups formal code of ethics

Bioethics ethics as applied to

life situations (e.g. decisions
about euthanasia, prolonging
life, abortion)

Nursing ethics ethical issues

that occur in the context of
nursing practice questions that
must address with regard to
their own actions

Values - freely chosen, longlasting beliefs or attitudes about

the worth of something (e.g. a
person or an idea)

Value system a personal set

of beliefs on a continuum from
most to least important, thus
providing the basis for decisions
and choices

Moral theories guide nurses

in ethical decision making

Consequence based judge

the rightness of the action
based on the consequences it
produces (the end justifies
the means)

Utilitarianism views a good

act as one that brings the
least harm and the most
good to the people choose
the lesser evil

Principle based emphasis

on individual rights, duties
and obligations. An action is
moral if it follows an
impartial, objective principle

Relationship based
stresses courage, generosity,
commitment and the need to
nurture and maintain
relationships, promote the
common good or the welfare
of all group, rather than
stressing the individual
rights.

Bioethical Principles
Autonomy from the Greek
work autos meaning self
and nomos meaning rule
or law, thus refers to self
law. Implies individual
rights, privacy and choice.
Autonomy entails the ability
to make a choice from
external constraints.

Beneficence - the duty to do

good and the active
promotion of benevolent acts
(e.g. goodness, kindness,
charity)

Confidentiality relates the

concept of privacy.
Information obtained from
an individual will not be
disclosed to another unless it
will benefit the person or
there is a direct threat to the
social good.

Double effect a principle

that may morally justify
some actions that some may
produce both good and evil
effect.

Fidelity promise keeping;

duty to be faithful to ones
commitments and promises

Justice fair, equitable and

appropriate treatment
according to what is due or
owed to persons.

Nonmaleficence the duty

not to inflict as well as to
prevent and remove harm.

Sanctity of Life the

perspective of that life is the
highest good.
Thus all forms of life
,including mere biologic
existence should take
precedence over external
criteria for judging quality of
life.

Veracity the obligation to

tell the truth and not to lie or
deceive others

Which of the following principles

apply to the action of the nurse to
refrain from discussing the
condition of the patient with those
who are not involved in his care?
a. beneficence
b. non maleficence
c. autonomy

Answer: B