EXAMINING IN

NURSING PRACTICE

Ethics is a system of principles (fundamental truths) a society develops to guide decision making what is right from wrong.

NursingNursing Ethics

(8) GUIDING PRINCIPLES/FUNDAMENTAL LAWS of HEALTH CARE ETHICS

1. Preserve Life

2. Do Good

3. Respect Autonomy

Contract – is a meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or render some service.

When a nurse enters into a contract with an employer, it Is usually an agreement to be paid a certain amount of money and be provided certain benefits in exchange for such services. Elements: Offer, Object, Acceptance, Obligation

Requisites of a Contract:

*Two or more person must participate.

ELEMENTS of CONTRACT

1. Two parties involved must give consent to the contract.

2. The object/acceptance which is the subject matter of the contact must be specified.

3. The cause of obligation/consideration is established. The time, price and subject matter are to be expressed.

* Contracting parties must be of legal age; be of sound mind; not under the influence of drugs, or fear of bodily harm; and not mentally incompetent.

Kinds of Contract

1. Formal Contract – refers to an agreement among parties involved and is required to be in writing by some special laws. Ex: marriage contract, mortgages, deeds of sale, work contracts.

Kinds of Contract

2. Informal Contract – is one which is concluded as a result of oral and spoken discussion between the parties concerned.

Kinds of Contract

3. Express Contract – is one in which the conditions and terms of the contract are given orally or in writing by the parties concerned.

***kind of services offered, salary, date and time of effectivity including fringe benefits are specified. Ex: a private duty nurse is asked by the physician to go on special duty for his patient.

4. Implied Contract – is one that is concluded as a result of acts of conduct of the parties to which the law ascribes an objective intention to enter into contract.

To avoid subsequent problems, nurses are advised to clarify the terms and conditions of employment before assumption of work with the prospective employer.

5. Void Contract – is one that is inexistent from the very beginning and therefore may not be enforced.

6. Illegal Contract – is one that is expressly prohibited by law.

7. Breach of Contract

* Four ELEMENTS of CONTRACT *

Veracity• To maximize the efficiency of

health care, the patient and the health care providers are bound to tell the truth.

• The nurse has the responsibility to provide, an accurate and complete information about his patient’s complaints, past illness, previous hospitalizations, medications taken, allergies, religious restrictions, and other matters relevant to his health.

1. Principle of Confidentiality – any information gathered by nurses during the course of caring for their patients should always be treated confidential.

Confidential information is also termed as privileged communication because it is

given based on trust.

2. Principle of Privacy – the rights to privacy includes privacy of one’s thoughts, opinions, and physical presence and privacy of one’s records.

The subject has the freedom to decide the time, the extent and circumstances he/she will willingly share his/her presence, thoughts, beliefs, attitudes and behavior with others.

3. Fidelity – loyalty, truthfulness (promise keeping)

4. Upholds Justice

5. Be Honest

6. Be Discreet

7. Keep Promise

8. DO NO HARM

DEFINITION OF TERMS

1.Profession - an occupation or calling requiring advance training and experience in some specific or specialized body of knowledge which provides service to society in that specific field.

2. Vocation - an occupation of calling.

DEFINITION OF TERMS

3. Ethics - refers to a standard to examine and understand moral life

4. Health Care Ethics - the division of ethics that relates to human health.

DEFINITION OF TERMS:

5. Morality - refers to social consensus about moral conduct for human beings and society.

6. Professional Ethics - a branch of moral science concerned with the obligations that a member of the profession owes to the public.

7. Nursing Ethics - related to all the principles of right conduct as they apply to the profession.

8. Nursing Jurisprudence - that department of law which comprises all the legal rules and principles affecting the practice of nursing..

9. Law - the sum total of rules and regulations by which people live/society/countryf is governed.

10. Justice – In health care, justice refers to the right to demand to be treated justly, fairly and equally.

• Professional Nurse – is a person who has completed a basic nursing education program and is licensed in his/her country or state to practice professional nursing.

• Prerequisite before license*

• License - is a legal document given by the government that permits a person to offer to the public his/her skills and knowledge in a particular jurisdiction.

REGISTRATION

• Registration – is the recording of names of persons who have qualified under the law to practice their respective professions.

• Licensure Examination – All applicants for registration as a nurse and issuance of professional ID card to practice nursing shall be required to pass a written examination which shall be given by the Board of Nursing

• Renewal of Nurses License – Every registered nurses shall renew his/her license every three years with the PRC, not later than the due date indicated in the PRC license card and pay the prescribed fee.

REVOCATION & SUSPENSION

• Suspension – means that the nurse is not allowed to practice temporarily until final judgment of the case against him/her is rendered.

• Revocation – means that the license to practice is confiscated permanently.

The Board of Nursing and the Professional Regulation Commission shall have the power to revoke professional license upon the following grounds:

• For any of the causes mentioned in Section 22 of RA 9173

• For unprofessional and unethical conduct

• For gross incompetence and serious ignorance

• Malpractice or serious negligence

• Use of fraud, deceit, or false statements in obtaining certificate of registration or professional license.

• Violation of Code of Ethics, Standard for Nursing Practice

• For practicing his/her profession during the time of I.Dcard suspension.

RA 9173 - Sec 22. Non- registration and Non-Issuance of COR,/ Professional License or Special/ Temporary Permit.

Grounds For Non- Registration PL, or Special/Temporary Permit …

• If he has been convicted by final judgment of a criminal offense involving moral turpitude/wickedness.

• If he is guilty of immoral or dishonorable conduct

• If he has been declared by the court to be of unsound mind

UNSOUND MIND refers to one who is incapable of managing himself or his affairs & that includes insane people..

• Re-issuance of Revoked Certification/ Replacement – the Board may, after the expiration of a minimum of (4) years from the date of revocation of a certificate when the cause of revocation has been cured or corrected. License may be reissued upon payment of fees.

y

Due process– is defined as “law which

hears before it condemns, which proceeds upon inquiry and renders judgment only after trial”.

THE LICENSING BOARD

1. Power to regulate the Profession

2. Organization & Composition

3.Qualification of Members of the Board

The Board has the following powers:

• Issue and revoke certificates of registration for practitioners of the nursing profession.

• Study the conditions affecting the practice of the nursing profession in all parts of the Philippines.

• Exercise the power conferred by the law to maintain efficient, ethical and technical standards in nursing profession.

• Promulgate regulations governing the nurse examination and standards to be attained.

DIFFERENT FIELDS OF NURSING

1. Military Nursing (services)

2. Hospital/Institutional Nursing (areas & specialization)

3. Private Duty Nurse/Special Duty Nursing

4. Company/ Industrial Health Nursing (Airlines, Occupational Health)

5. Public Health Nursing/ Community Health Nursing

6. Hospital/Institutional Nursing: ChiefNurse….Nursing Education,,FEU

7. School Nursing

8. Independent Nursing Practice

Military Nursing (Nurse Corps, AFP)

Functions of the Nurse Corps

The AFP Nurse Corps provides comprehensive and quality nursing care to all military personnel, their legal dependents and authorized relatives.

Military Nursing (Nurse Corps, AFP)(services)

Functions of the Nurse Corps

To meet the nursing needs of today’s patients (soldiers) in AFP medical facilities.

1. To prepare each nurse corps officer (regular and reserve) for future assignments at the higher level of responsibility in the different stations and general hospitals in times of peace and war;

2. To teach and train enlisted personnel who perform nursing functions under supervision.

Qualifications of the Military Nurse

1. BSN, RN2. Natural born Filipino citizen3. Single, never been married (Male & Female)4. Mentally and physically fit and cleared by appropriate

agency5. With pleasing personality and have a good moral

character6. Skillful in applying nursing process in various setting

Communicating and relating with others, and have sound judgment

7. Interested and willing to work in both peaceful and wartimes condition

8. Not more than 32 years of age9. Minimum height of 62 inches for males, and 60 inches for

females

Hospital/Institutional Nursing (areas & specialization)

Nursing in hospitals and related health facilities such as extended care facilities, nursing homes, and neighborhood clinics, comprises all of the basic components of comprehensive patient care and family health. Basic Qualification: BSN, RN

Advantage of Staff Nurse in the Hospital:

1. There is always a supervisor whom one can consult if problem exists.

2. Nurses are updated with new trends in medicine and in nursing care of patients.

3. They undergo rotation to different units and have the chance to determine their choice area

4. They have 8 hours/day and 40 hours/week which provides 2 days rest day.

Advantage of Staff Nurse in the Hospital:

5. They have the chance to get promoted to a higher position if they are qualified.

6. Salary increases are given periodically according to merit.

7. They are important members of the health team in providing care to patients.

8. More staff development programs are available in hospitals.

Private Duty Nurse/Special Duty Nursing

A registered nurse who undertakes to give comprehensive nursing care to a client on a one-to-one ratio.

Nurses in private practice are expected to be expert clinicians as well as expert generalists in nursing.

Company/ Industrial Health Nursing (Airlines, Occupational Health)

• Occupational Health Nursing is the special practice that provides and delivers health care services to workers. The practice focuses on the health promotion, protection, and supervision of workers’ health within the context of safe and healthy work environment.

Company/ Industrial Health Nursing (Airlines, Occupational Health)

• Occupational health nursing is autonomous and occupational health nurses make independent nursing judgments in providing health services. This field of nursing requires special skills especially in emergency nursing.

Public Health Nursing/ Community Health Nursing

• Public Health Nursing refers to the practice of nursing in the local, national, and city health departments which include health centers and public schools. It is community health nursing practice in the public sector.

• Community Health Nursing is broader as it encompasses nursing practice in a variety of roles, which at times include independent nursing practice. The term use for CHN includes parish nursing, community mental health nursing, and school nursing.

Advantage of CHN1. The focus of nursing care is on family and community

health rather than on an individual basis.2. It gives nurse a better perspective of health

conditions of the community, health programs of the government, and to appreciate the nurse’s role in nation building.

3. It maximizes efforts to improvise where there are no sufficient facilities, supplies and equipment.

4. It enables the nurse to utilize various community resources and maximize coordination with other members of the health team.

5. Focus of care is more on educational and promotiveand preventive aspects.

6. Individuals families and communities are motivated to assume responsibility for their own health care.

Nursing Education

Nurses who would like to consider teaching as their field of expertise. The career ladder in nursing education starts with a Clinical Instructor’s position up to that of the Dean of the College of Nursing.

Qualification:1. BSN, RN2. Have at least 2 years of clinical practice in the field of

specialization3. Member of good standing in the accredited professional

organization4. Holder of Master of Arts in Nursing, education or other

allied, medical and health sciences, preferably, Doctor of Education& Doctor of Philosophy conferred by a reputable college or university duly recognized by the government.

School NursingSchool nurse is responsible

for the school’s activities in the areas of health service, health education, and environmental health and safety.

Responsibilities of a school nurse:1. Organizing and implementing the

school health program;1. Coordinating school health program2. Undertaking functions directly related

to pupil’s health3. Evaluating school health programs; and4. Carrying out functions related to health

of school personnel.

Independent Nursing Practice

The nurse is self employed and provides professional nursing services to clients and their families.

Most of them are community based. They perform both independent and collaborative functions. They make referrals and collaborate with physicians and other disciplines as needed by the client or family.

• ARH

MORAL & SPIRITUAL RESPONSIBILTIES OF NURSES

• Golden Rule

• Two-Fold Effect

• Principle of Totality

• Epikia

• The end does not justify the means

• The greatest good for a greatest number

Amended Code of Ethics for Nurses

• 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.

• ( slide;document)

NURSING CODE OF ETHICS

PRINCIPLES:1. Nurses and People2. Nurses and Practice3. Nurses and Co-workers

a. Nurses and the Societyb. Contributing members of the society

4. Awareness for the call of change 5. Nurses and the profession6. Responsibility of the nurse to the patient7. Responsibility of the nurse to the physician8. Responsibility of the nurse to her colleagues9. Responsibility of the nurse towards themselves

NURSING CODE OF ETHICS

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.

RESPONSIBILITIES OF THE NURSE TO THE PATIENTS

5. Know the patient’s Bill of Rights.

6. Be patient advocate. Treat patient in a manner that will show concern whether the patient is rich or poor.

7. Nurses should not leave a patient or any agency without proper permission or resignation or without relief

8. Nurses should commit themselves to the welfare of those entrusted to their care

• MORAL/SPIRITUAL

RESPONSIBILITIES of

NURSES: # 1 to 13…….

PATIENT’S BILL OF RIGHTS1. 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.

PATIENT’S BILL OF RIGHTS

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.

PATIENT’S BILL OF RIGHTS

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 in so far as his care is concerned.

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.

PATIENT’S BILL OF RIGHTS

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.

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 environment 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.

NURSES’ BILL OF RIGHTS

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.

Basic Standards of Clinical Nursing Practice as Taking Orders thru Phone

• Attending Physician should be the one responsible for making important and urgent orders through phone call.

• The order must be read twice

by nurse to ensure clarity

• The nurse who received the

order must inform the head

nurse immediately

• The nurse must see to it that the attending physician who made the order must sign the order within 24 hours.

Golden Rules for Administering Medicines Safely

• Right Patient

• Right Drugs

• Right Time

• Right Dose

• Right Route of Administration

• *

Helpful Tips About Nursing Ethics and Jurispridence

•Five (5) common legal issues in nursing: What every nurse should know?.

1. Signatures are Golden

2. Document, Document,

Document

3. Report it or Tort it

4. Right to Privacy

5. You’re Dosing What?

LEGAL ASPECT (Accountability in the practice of profession)

•Another major ethical and legal issues that is common to the nursing profession is

NEGLIGENCE.

• Here are some examples

Tort a civil wrong & can be done intentional or unintentional.

Incompetence lack of ability, legal qualifications or fitness to discharged the required duty.

Negligence - refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person 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.

Elements of Professional Negligence:

• Failure to meet the standard of due care.

• The foreseeability of harm resulting from failure to meet the standard.

• The fact that the breach of this standard resulted in an injury.

Malpractice - the idea of improper or unskillful care of a patient by a nurse;

*denotes stepping beyond one’s authority with serious consequences.

Have you been in any of this situation?

• Unsafe Patient to Nurse Ratio

– You’ve been assigned to an area where you would handle 20 patients at the same time.

– Big Question: Who will you prioritize? What method will you use in determining who will receive the first intervention you’ll give.

• The nurse has an ethical duty to keep her patients safe. An ethical dilemma happens when a nurse finds herself in a situation where she has too many patients and cannot provide adequate care for all of them on her own.

• Inappropriate Medication Orders

– The Doctor has ordered a medication for your patient that you are unsure of.

– Big Questions: What will you do? Will you aggressively go and research information about the medication? Do you have the courage to challenge the physician as an advocate of your patient? Or you’ll just let go

• Giving wrong medication dosages or medication for the wrong illness is unsafe for patients and may lead to death… .. Nurses can find themselves in an ethical dilemma when they have to challenge a medication order written by a physician.

• Inappropriate Tasks

– You have been assigned to a new area where you don’t gave any experience at all. Your charge nurse has instructed to do an intervention you have read but doesn’t have any experience doing the actual thing

– Big Questions: Will you do it? Or Not?

• Nurses float from department to department in the course of their career. When a nurse finds herself in an unfamiliar department and is asked to provide care she is inadequately trained for, she may have to refuse to provide care to avoid making the patient unsafe or request assistance from the charge nurse or the headnurse

• Life Threatening Patient Decisions

– Your patient have refuse any treatment to be given to her. Very timely that she experience an attack and needs intervention to save her life

while knowing her decision, WHAT WILL YOU DO?

• Patients sometimes make decisions that are unsafe, such as refusing treatment, taking medication or life saving procedures. The nurse finds herself in an ethical dilemma because not giving the needed treatment goes against the Principle of Beneficence and giving it ignores patient Autonomy.

/Nurses adhere to certain ethical principles when

caring for patients. These principles include beneficence which is doing NO harm to the patient,

maleficence which is doing harm to a patient for positive outcome, based on need and patient

autonomy which is respecting the patients right to make health decisions. Conflict with these principles results in an ethical dilemma.

• Burns resulting from hot water bags, heat lamps, sitz bath,

• Objects left inside the patient’s body & sponges, loose dentures lodged in the patient trachea,

• falls of the elderly & to patient’s who are not fully recovered from anesthesia...”Liability for negligence therefore shall be imposed upon the nurse who has failed to behave as a reasonable, prudent nurse”.

» Failure to report observations to attending physician

• Mistaken Identity

• Wrong medicine, wrong concentration, wrong route, wrong dose

• Administration of medicine without a doctor’s order

• Defects on the equipment such as stretchers & wheelchairs may lead to fall thus injuring the patient.

• Failure to exercise diligently that is required in a given situations..attended pt delivery w/o prenatal check up,,,placental delivery>> bleeding>>uterine atony>death

Elements of Professional Negligence:

• Failure to meet the standard of due care.

• The foreseeability of harm resulting from failure to meet the standard.

• The fact that the breach of this standard resulted in an injury.

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.

LEGAL DOCTRINES TO DESCRIBE PROFESSIONAL NEGLIGENCE

Doctrine of Res Ipsa Loquitur – “the thing speaks for itself”

This means that injury could

not have happened if someone

was not negligent that no further

proof is required.

LEGAL DOCTRINES TO DESCRIBE PROFESSIONAL NEGLIGENCE

Examples:1. A sciatic nerve was injured after an administration

of an injection. The patient complain of severe pain & eventually got paralyzed.

2. The presence of sponges in the patient’s abdomen after an operation

3. Fracture of newly delivered baby born by breech presentation.

Doctrine of Respondeat Superior - “let the master answer for the acts of the subordinate”.

• Under this doctrine, the liability is expanded to include the master as well as the employee and not a shift of liability from the subordinate to the master. Therefore, when a person, through his negligence, injures another, he remains fully responsible.

Doctrine of Respondeat Superior - “let the master answer for the acts of the subordinate”.

Examples:1. The hospital will be held liable, if an effort to cut

down on expenses decides to hire under board nurses in place of professionals, and these persons prove to be incompetent.

2. The surgeon will be held responsible in case a laparotomy pack is left in a patient’s abdomen.

Doctrine of Force Majeure – means an irresistible force, one that is unforeseen or inevitable.

Under the Civil Code of the Philippines, no person shall be responsible for those events which cannot be foreseen.

RECOGNIZE LIMITATIONS

• PARTRICIA BENNER’STAGES

(5 stages)

Law

• the sum total of rules & regulation s by which society is governed or can be defined as a rule of conduct pronounced by controlling authority & which may be enforced

Jurisprudence

• philosophy or science of law upon which a particular legal system is built.

Nursing Jurisprudence

• a science of law which pertains to nursing practice.

A. According to Source of Authority

1. Divine Law -

2. Human Law -

B. Groups of Human Law

1.2. International Law - the law which regulates the intercourse of nations

1.2.1. Public International Law - control the conduct of independent state in their relation to each other.

1.2.2. Private International Law - conflict law

B. Groups of Human Law1.3. Political Law - Threats the science of politics

(Government) Regulates the relation between the state and individual.

1.3.1. Constitutional Law - law that relates to a set of rules governing an organization or the supreme laws & rights of the country.

1.3.2. Administrative Law - the body of rules and regulations

and orders and decisions created by administrative

agencies of government.

B. Groups of Human Law1.4. Private Law - law that relates the private

matters which do not concern the public at large (Administrative between citizen and citizen)

1.4.1. Civil Law - organizing the family and regulating property.

1.4.2. Commercial Law - relates to the rights of property and the relations of persons engaged in commerce.

1.4.3. Remedial Law - methods of enforcing rights or obtaining redress (correcting the wrong)*arh*

Definition Of Terms• Plaintiff or Accuser

• Defendant or Respondent

• Witness

• Accomplice

• Tort/Crime

• Summons

• Subpoena

• Justice

• Felony

Crime – an act committed or omitted in violation of the law.

Criminal offenses are composed of two elements:

1. Criminal act

2. Evil/criminal intent

Criminal offenses are composed of two elements:

1. Criminal act – deal with acts or offenses against public welfare

This may vary from minor offenses, misdemeanors, and felonies

2. Evil/criminal intent – is the state of mind of a person at the time the criminal act is committed that is, he/she knows that an act is not lawful and still decided to do it.

Felony – is committed with deceit and fault. A crime of a serious nature usually punishable for a period of longer than one year or by death.

Deceit (Dolo) – exist when the act is performed with deliberate intent.

Fault (Culpa) – when the wrongful acts result from imprudence, negligence, or lack of skill or foresight.

Stages of Felony according to the degree of the acts of execution:

1. Consummated Felony – when all the elements necessary for its execution and accomplishment is present.

2. Frustrated Felony – when the offenders performs all the acts which will produce the felony but, do not produce it by reason of causes independent the will of the perpetrator.

3. Attempted Felony - when the offender commences the commission of the acts, and does not perform all the acts or execution.

Stages of Felony 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 –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.

Justice

• Refers to the right to demand to be treated justly, fairly and equally.

• Fair treatment to all regardless of gender, race, religion and others.

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY

Justifying Circumstances A person may not incur criminal liability under the following circumstances:1. When he acts in defense of his person or rights provided.2. there is unlawful aggression on the part of the offended party3. there is reasonable necessity for the means employed by the person

defending himself to prevent such aggression;4. there is lack of sufficient provocation on the part of the person

depending himself5. When he acts in defense of the person or the rights of his spouse,

ascendants, descendants, or legitimate or natural or adopted brothers/sisters or relatives.

6. When he acts in defense of the person or rights of a stranger provided in the first circumstance and that the person defending is not induced by revenge, resentment or other evil motives.

7. When any person who, in order to avoid an evil or injury, does an act damage to another and there is no other way to prevent it.

8. When he acts in the fulfillment of a duty or in lawful exercise of a right or office

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY

Exempting Circumstances

The following persons under the circumstances stated are expressly exempted by law from criminal liability for the crime they may have committed:

1. An imbecile or insane person, unless the latter has acted during a lucid interval.

2. A person under nine years of age

3. A person over nine years of age and under fifteen unless he acted with discernment

4. A person causing an injury which is merely an accident without fault or intention of causing it.

5. Any person who acts under the compulsion of an irresistible force

6. Any person who acts under the impulse of an uncontrollable fear of an equal or greater injury

7. Any person who fails to perform an act required by law, when prevented by some lawful or insuperable cause.

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY

Mitigating Circumstances

• Are those which do not constitute justification or excuse of the offense in question, by which in fairness and mercy, may be considered as reducing the degree of moral culpability.

The following are some circumstances considered by law as mitigating:

1. When the offender has no intention to commit grave act.

2. When the offender is under eighteen years of age or over seventy years of age.

3. When sufficient provocation or threat on the part of the offended party immediately precedes the act.

The following are some circumstances considered by law as mitigating:

4. When the person acts upon impulse so powerful as naturally to have produced the crime.

5. When the offender voluntarily surrenders self to a person in authority, or voluntarily confess his guilt before the court prior to the presentation of the evidence for the prosecution.

6. When the defender is deaf and dumb, blind o suffering from some physical defect which thus restrict his means of action, defense or communication with his fellow beings.

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY

Aggravating Circumstances

• Are those attending the commission of a crime and which increase the criminal liability of the offender or make his guilt more severe.

Circumstances considered by law aggravating include the following:

1. When the offender takes advantage of his public position;

2. When the crime is committed in contempt of or with insult to public authorities;

3. When the act is committed with insult or in disregard the offended party on account of his rank, age, or sex.

4. When the act is committed with abuse or confidence or obvious ungratefulness;

5. When the crime is committed in a place of worship;

6. When the crime is committed on the occasion of shipwreck, earthquake, epidemic, or other calamity or misfortune.

Circumstances considered by law aggravating include the following:

7. When the crime is committed in consideration of a price, reward, or promise.

8. When the act is committed with evident premeditation or after an unlawful entry;

9. When craft, fraud, or disguise is employed8

Alternative Circumstances• Are those which may be taken into

consideration as aggravating or mitigating according to the nature and effects of the crime and other conditions attending its commission..

.

RECOGNIZE LIMITATIONS

• PARTRICIA BENNER’STAGES

(5 stages)

LAWS & ORGANIZATION PROTECTING NURSES

Republic Act No. 2493 dated February 5, 1915 – The first law affecting the practice of nursing in the Philippines. It consists of two sections:

a. Sec. 7 – states that every person desiring to practice nursing in the Philippines shall apply to the Director of Health for a Certificate of registration as a nurse.

Sec. 8 – states that it shall be unlawful for any person to practice as a nurse in any of its branches in the Phil. until the proper certificate of registration has been obtained.

This is also an act that provides for the examination and registration of nurses in the Philippines.

Republic Act No. 2808 dated March 1, 1919 – an act regulating the practice of nursing profession in the Philippines otherwise known as the Nursing Law (this is first considered as the first Nursing Law).

Significance of this LawThe first board of examiners for nurses was created composed of three members appointed by the Secretary of Interior (one doctor of medicine as chairman and two members who are registered nurses, had experience in the nursing profession for at least five years of reputable character)

The Board has the following powers:

• Issue and revoke certificates of registration for practitioners of the nursing profession.

• Study the conditions affecting the practice of the nursing profession in all parts of the Philippines.

• Exercise the power conferred by the law to maintain efficient, ethical and technical standards in nursing profession.

• Promulgate regulations governing the nurse examination and standards to be attained.

• Republic Act No. 4007 dated December 5, 1931 (Reorganization Law) – took effect the conduct of board examination and placed the direct supervision of the Bureau of Civil Service.

NURSING LAWS PASSED IN JUNE 1950

RA 465 - standardized the fees charge by the examining board.

RA 546 - reorganized and placed all the board examinees under the direct supervision of the Pres. of the Phil.

RA 877 dated June 19, 1953 – was enacted as an entirely new law created by the Filipino Nurses associated (NOW PNA) namely: Ms. Obdulia Kabigting as chairman; Dean JV Sutejo and Conchita Ruiz. The act was sponsored by Sen. Geronima Pecson. The purpose is to “regulate the practice of nursing in the Philippines and to set up provisions for the registration of the nurses for the establishment and maintenance of standards of nursing education and practice.”

RA 1080 dated June 15, 1954 – An act declaring the BAR and BOARD OF EXAMINATION as “Civil Service Examination”

Cognizant of the complexities in the Nursing Profession on 1970, the nursing leader mad steps to re-align the nursing law a tuned times. The following event took place:

1975

Dean JV Sotejo called on then Pres. Marcos for the revision of the Nursing Law to enable nurses to practice more effectively and with legal protection within the framework of an expanding and changing health care delivery system (this did not materialized).

July 1977

Dr. R. Diamante worked for the decree instituting a professional regulation code and the proposed amendments of the Nursing Law.

May 13, 1982– Coping of the propose amendment of the Philippine Nursing Act of 1982 was submitted to health minister Azurin for him to sponsor at Batasan Pambansa.

These events laid the foundation for RA 7164 with Senator Heherson Alvarez as primary sponsor. It was finally passed in the lower house and appraisal in November 21, 1991 by Pres. Corazon Aquino “Nursing as a dynamic profession continues to seek ways and means to make it more responsive and relevant. This is the prime motive for the birth of RA 9173 – sponsored by Hon. Carlos M. Padilla of the House of Representatives. Said bill was approved on the third meeting by the low House on August 22, 2000 but was not acted upon by the Senate.

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.

THE PHILIPPINE NURSING LAW (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

• 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.

LAWS & ORGANIZATION PROTECTING NURSES

• A. Philippine Nursing Act of 2002 (RA 9173)

• B. Philippine Constitution 1987

• C. Philippine Nurses Association

• D. Magna Carta for Health Workers (RA 7305)

• E. Code of Ethics for Nurses

Magna Carta for Health Workers (RA 7305)

The state shall instill health consciousness among our people to effectively carry out the health programs and projectsof the government essential for the growth and health of thenation.

AIMS:1. To promote and improve the social and economic well being

of the health workers, their living and working conditions andterms of employment

2. To develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects.

3. To encourage those with proper qualifications and excellentabilities to join and remain in government service.

REFERENCES:

Lydia M. Venzon, RN, MAN, PhD, FPCHA and Ronald M. VenzonProfessional Nursing in the Philippines11th Edition, C&E Publishing Corp., 2010

Rustico T. De Belen and Donna Vivian De BelenNursing Law, Jurisprudence & Professional Ethics 1st Edition, C&E Publishing

Corp., 2007

DOH Nursing Service Manual, 2005

Kozier, Erb, Berman and SnyderFundamentals of Nursing: Concepts, Process and Practice8th Edition, C&E Publishing Corp

Commission on Higher Education CHED Memorandum Order (CMO) no. 14,S. 2009

Thank You