Definition of a Profession

 An occupation that requires extensive education or calling that requires special

knowledge, skills and preparation.
 Professionalism refers to professional character, spirit or methods. It is a set of attributes,
a way of life that implies responsibility and commitment.
 Professionalization is the process of becoming professional, acquiring characteristics
considered to be professional.

Criteria of a Profession

 Requirement of a prolonged, specialized training to acquire a body of knowledge

pertinent to the role to be performed.
 Orientation of the individual toward service in the community or to an organization.
 Ongoing research contributing to nursing practice.
 Autonomy means independence of work, responsibility and accountability for one’s
actions.
 A professional organization. The nursing profession requires integrity of its members, a
member is expected to do what is considered right regardless of the personal cost. (Code
of Ethics to monitor the professional behavior of its members).

Professional Organization

The ANA and the PNA is a professional organization that “advances the nursing profession by
fostering high standards of nursing practice, promoting the rights of nurses in the workplace,
projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory
agencies on health care issues affecting nurses and the public.”

Factors Influencing Contemporary Nursing Practice

 Health Care Reform

Health care delivery’s focus has shifted from acute care to primary preventive care and
treatment of chronic conditions using health care teams and information technology.
Leading change, advancing Health:
1) nurses practicing to the fullest extent of their skills and knowledge
2) nurses achieving higher levels of education
3) nurses being full partners with physicians and other and other health care
professionals
4) improving data collection and an information in infrastructure.

 Quality and Safety in Health Care

6 Core Competencies needed to improve 21st century Health Care:
1) patient-centered care
2) teamwork and collaboration
3) evidence-based practice
4) quality improvement
5) safety and
6) informatics
 Consumer demands
1)The public’s concept of health is that health is a right of all people, not just a
privilege of the rich.
2) Individuals must assume responsibility for their own health by obtaining a physical
examination regularly, checking for the nine danger signals of cancer
3) maintaining their mental well-being by balancing work and recreation.
4) people want energy, vitality and a feeling of wellness.
  Family structure
Support services such as day care centers, preventive immunizations/vaccines.

 Science and Technology

New drug therapies to prolong life.
Use of sophisticated computerized equipment to monitor or treat patients.
Nurses require increasing education to provide effective, safe nursing
practice.
 Information, Telehealth and Telenursing
Internet sources of information for clients and their families.
Telehealth is the use of medical information exchanged from one site to another via
electronic communications to improve the patient’s health status.
Telemedicine is often associated with direct client clinical services, whereas telehealth is
a broader definition of remote health care services.
Telenursing is the use of telecommunications and information technology to provide
nursing practice at a distance.

Definitions of Nursing

Florence Nightingale defined nursing as “the act of utilizing the environment of the patient to
assist him in his recovery.” Nightingale considered a clean, well-ventilated and quiet
environment essential for recovery.

Virginia Henderson defined nursing as “assisting the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful death)
that he would perform unaided if he had the necessary strength, will or knowledge and to do
this in such a way as to help him gain independence as rapidly as possible”.

Nursing refers to the “diagnosis and treatment of human responses to actual or potential
health problems” (American Nurses Association).

Definition of Terms

Terms Meaning

1. DIAGNOSIS – identified HEALTH PROBLEM OR NURSING DIAGNOSIS

Types of Health Problems:

1. Actual – problem is present “NOW”

2. Potential – problem is not yet present, but may arise in the

“FUTURE” if not prevented
 Example: Ineffective Airway Clearance
Hyperthermia – fever

2. TREATMEN – refers to NURSING INTERVENTIONS

T – ACTIONS done by the nurse to help the patient

TYPES OF NURSING INTERVENTIONS:

A. Independent Nursing Intervention

 Done only by the nurse

1. Check vital signs

2. Assist patient in mobility

3. Health teaching

B. Dependent Nursing Intervention

 done by nurse + doctor (needs a doctor’s order)

1. Giving oral medication

2. Giving medicines by IM route

3. Providing oxygen to patient

C. Interdependent Nursing
intervention Different referral system
 done by all members of a. Diet of patient  Nutritionist
the health care team
(nurse + doctor laboratory
science technician +
nutritionist + others
 b. Preparation of patient  OR
team

d. Preparation for x-ray 

Radiology Department

c. Laboratory investigation 
Laboratory Science Department

3. Human – Refers to a REACTION TO A Types of Reactions:

responses DISEASE
1. Physical
2. Psycho-emotional
3. Spiritual
4. Intellectual
WHO IS A NURSE?

A. Etymology: comes from the Latin word “NUTRIRE” – which means to NOURISH

B. Definition:

1. One who CARES for the sick, the injured, physically, psychologically disturbed

2. A MEMBER OF THE HEALTH TEAM who cares for individuals, families and
communities

Individuals Families
 Communities

3. A PROFESSIONAL – One who has completed a program of basic nursing

education and who is qualified to practice nursing in her country (LICENSE)

SCOPE OF NURSING PRACTICE:

1. Promoting health and wellness

 Activities and behavior that enhance quality of life
Examples:
YES to healthy lifestyles:

Good food

Good rest and sleep

Good environment

NO to…

(a) Smoking

(b) Alcohol and drug misuse

2. Preventing Illness
 Activities that stop diseases from happening
Example:

Immunization - vaccination

Prenatal and infant care

3. Restoring Health
 Focuses on early detection of disease and helping patient during the recovery period
Example: Administering medication (as ordered)

 Teaching about recovery activities (ex. Exercise, diet)

4. Caring for the Dying

  Caring for people of all ages who are dying
Example: Giving comfort

ROLES & FUNCTIONS OF THE NURSE

ROLE DESCRIPTION
1. CAREGIVER Provides care and comfort like a mother. (physical,
psychosocial, developmental, cultural and spiritual levels.)
 Full care
 Partial care
 Supportive-educative care
2. TEACHER Provides information on patient’s health care needs.
Assess client’s learning needs and readiness to learn, sets
specific learning goals to restore or maintain their health.
Teach personnel to whom they delegate care and share
their expertise with other nurses.
3. COUNSELOR o Listens carefully to patient’s problems
o Assists & guides patient to solve problems
4. CHANGE AGENT o Assists clients to make modifications in their
behavior.
5. CLIENT ADVOCATE o Protects patient’s rights.
o Makes sure that patient’s needs are met
6. LEADER Influences others to work together to accomplish goals of
treatment for patient.
7. MANAGER Works as supervisor of nursing personnel.
Delegates nursing activities to other nurses.
8. RESEARCHER Investigates problems to improve nursing practice.
Use research to improve client care.
9. CASE MANAGER Works with multidisciplinary health care team to measure
the effectiveness of the case management plan and to
monitor outcomes.
 EXPANDED ROLES OF NURSES

1. Nurse A nurse that has advanced expertise in special areas

Specialist 1. ICU (Intensive Care Unit)
2. NICU (Neonatal Care Unit
3. Hemodialysis
4. OR (Operating Room)
2. Nurse  Certified by governing body to practice independently
practitioner  Should have a master’s degree
3. Nurse clinician  Certified by governing body to practice independently
 May or may not have a master’s degree
4. Nurse  Investigates nursing problems to improve nursing care and expand
researcher nursing knowledge.
5. Nurse  Manages client care and delivery of nursing services.
administrator  Budgeting, staffing and planning programs.
6. Nurse  Employed in nursing programs, at educational institutions and in
educator hospital staff education.
7. Nurse  Manages a health-related business.
entrepreneur
8. Forensic nurse  Provides specialized care for individuals who are victims or
perpetrators of trauma.
9. Nurse  Administer anesthetics for surgery under the supervision of an
anesthetist anesthesiologist; assess postop status of clients.
10. Nurse midwife  Manage deliveries in normal pregnancies , conduct PAP smear and
breast exam.

CRITERIA/CHARACTERISTICS OF A NURSING PROFESSION

Nursing is S-A-C-H-A.

1. S…science

2. A…art

3. C…caring

4. H…holistic

5. A…adaptive

QUALITIES OF A NURSE
 1. Good personal  clean looking
appearance  wears appropriate uniform
2. Honest  tells the truth (do not lie)
 Ethical principle of veracity
3. Loyal  faithful
4. Trustworthy  dependable
5. Helpful  assists patients
6. Respectful for others  treats people well (or fairly)
7. Professional  skilled, competent

HISTORY OF NURSING IN THE WORLD

FOUR (4) PERIODS OF NURSING IN THE WORLD

1. PERIOD OF INTUITIVE NURSING

 Time: Pre-historic time to early Christian era

 Nursing was not taught . It is a product of instinct (intuitive)
Done out of love
Belief in “shaman” and magic.

2. PERIOD OF APPRENTICE NURSING

 Time: 11 t h century to 1836
 Nursing was taught informally (no school) by more experienced nurses.
o Theodore Fliedner – changed his home into a hospital.
 Apprentice

3. THE DARK PERIOD OF NURSING

 Time: 17 t h (Reformation until the US Civil War)
 Nursing became the work of the least desirable women.
o took bribes from patients
o stole food
 DARK PERIOD

4. PERIOD OF EDUCATED NURSI NG.

 Time: 1860
 Nursing was taught formally in school especially to
women.

Example: FLORENCE NIGHTINGALE

 o Strong willed and intelligent
o Florence Nightingale School of Nursing opened at St. Thomas
Hospital in London.

HISTORY OF NURSI NG IN THE PHILIPPINES

The Start of Nursing Practice (1911- 1921)

 First True Nursing Law was enacted through Act 2808.

 The first nursing board examination was given on 1920.
 The first executive officer of the Board Examiners for Nurses is a physician.

Early Beliefs, Practices and Care of the sick

 Early Filipinos subscribed to superstitious belief and practices in relation to health and sickness
 Diseases, their causes and treatment were associated with mysticism and superstitions.
 Cause of disease was caused by another person (an enemy of witch) or evil spirits.
 Persons suffering from diseases without any identified cause were believed bewitched by
“mangkukulam.”
 Evil spirits could be driven away by persons with powers to expel demons.
 Belief in special Gods of healing: priest-physician (called “word doctors”).
 If they use leaves or roots they were called herb doctors (“herbolarios”).

Early Hospitals during the Spanish Regime

 Religious orders exerted efforts to care for the sick by building hospitals in different parts of
the Philippines.
 Hospital Real de Manila San Juan de Dios Hospital
 San Lazaro Hospital Hospital de Aguas Santas
 Hospital de Indios

Prominent Personages involved during the Philippine Revolution

1.Josephine Bracken – wife of Jose Rizal installed a field hospital in an estate in

Tejeros that provided nursing care to the wounded night
and day.
2.Rose Sevilla de Alvaro – converted their house into quarters for Filipino soldiers
during the Phil-American War in 1899.

3. Hilaria de Aguinaldo –wife of Emlio Aginaldo organized the Filipino Red Cross.
4. Melchora Aquino – (Tandang Sora) nursed the wounded Filipino soldiers, gave
them shelter and food.

5. Captain Salomen – a revolutionary leader in Nueva Ecija provided nursing

care to the wounded when not in combat.

6.Agueda Kahabagan – revolutionary leader in Laguna also provided nursing

services to her troops.

7. Trinidad Tecson (Ina ng Biak na Bato) – stayed in the hospital at Biac na Bato
to care for the wounded soldiers.
School of Nursing

 1900: St. Paul’s Hospital School of Nursing, Intramuros Manila.

 1906: Iloilo Mission Hospital Training School of Nursing.
 1907: St. Luke’s Hospital School of Nursing; opened after four years as a
dispensary clinic.
 1907: Mary Johnston Hospital School of Nursing.
 1909 – Distinction of graduating the 1st trained nurses in the Philippines
with no standard requirements for admission of applicants
except their “willingness to work.”
 1910: Philippines General Hospital school of Nursing.
 April 1946 – a board exam was held outside of Manila. It was held in
Iloilo Mission Hospital thru the request of Ms. Loreto Tupas,
principal of the school.

College of Nursing

1. 1877: UST College of Nursing – 1st College of Nursing in the Philippines.

2. June 1947: MCU College of Nursing – 1st college who offered BSN 4- year program.
3. June 1948: UP College of Nursing
4. June 1955: FEU Institute of Nursing.
5. October 1958: UE College of Nursing.

1909
 3 female graduated as “qualified medical-surgical nurses.”
1919
 The 1st Nurses Law (Act#2808) was enacted regulating the practice of the nursing profession in
the Philippines. It also provided the holding of exam for the practice of nursing on the 2nd
Monday of June and December of each year.
1920

 1st board examination for nurses was conducted by the Board of Examiners, 93 candidates
took the exam, 68 passed with the highest rating of 93.5%-Anna Dahlgren
 Theoretical exam was held at the UP Amphitheater of the College of Medicine and Surgery.
Practical exam at the PGH Library.
1921
 Filipino Nurses Association was established (now PNA) as the National Organization of Filipino
nurses.
 PNA: 1st President – Rosario Delgado
 Founder – Anastacia Giron-Tupas
1953
 Republic Act 877, known as the “Nursing Practice Law” was approved.

NURSING LEADERS

Florence Nightingale (1820-1910)

Considered the founder of modern nursing, Florence Nightingale (1820-1910) was influential in
developing nursing education, practice and administration. Her publication Her publication, Notes on
Nursing: What It Is, and What Is Not, first published in England in 1859 and in the United States in 1860,
was intended for all women.

Clara Barton (1821-1912

She organized the American Red Cross, which linked with the International Red
Cross when the U.S Congress ratified the Geneva Convention in 1882.

Linda Richards (1841-1930)

Was America’s first trained nurse.

Mary Mahoney (1845-1926)

Was the first African-American Trained Nurse.

Lillian Wald (1867-1940)

Founded the Henry Street Settlement and Visiting Nurse Service (circa 1893), which
provided nursing and social services and organized educational and cultural activities.
She is the founder of public health nursing.

Lavinia L. Dock

Participated in protest movements for women’s rights that resulted in the constitutional
amendment in 1920 that allowed women to vote.

Margaret Sanger (1879-1966)

Founder of Planned Parenthood, was imprisoned for opening the first birth
control information clinic in Baltimore in 1916.

Mary Breckinridge (1881-1965)

A nurse who practiced midwifery in England,

Australia, and New Zealand, founded the Frontier Nursing Service in Kentucky in
1925 to provide family-entered primary health care to rural populations.

MEN IN NURSING
Luther Christman (1915-2011)

One of the founders of American Assembly for Men in Nursing (AAMN). Graduated from Pennsylvania
Hospital School Nursing for Men in 1939. Experienced discrimination while in nursing school. He was
not allowed a maternity clinical experience.

After his doctorate, as university dean.

First man nominated for president of the ANA.
First man elected to the American Academy of Nursing (he was named a “Living
Legend” by this organization)
First man inducted into ANA’s Hall of Fame for his extraordinary contributions to nursing.

NURSING THEORIES & CONCEPTUAL FRAMEWORKS

Definition of THEORY:

 Theory is an organized system of ideas presumed to describe, explain, predict and control a given
phenomenon.

Organized Knowledge

COMPONENTS OF A THEORY

1. CONCEPT – the building blocks of theories.

A mental image of a thing.
Example:
HOW THE ICE MELTS

2. DEFINITION - descriptions which convey a general meaning.

DEFINITION FROM BOOKS

– CONCEPTUAL DEFINITION (Books)

 DEFINITION FROM A PERSON AS USED IN HER STUDY

– OPERATIONAL DEFINITION (STUDY)

Example: Florence Nightingale’s Definition of Nursing:

“Nursing is the act of using the environment of the patient to assist him in his recovery.”

3. ASSUMPTION
o A statement of a research paper that specifies the connection of factual concepts

o A person holds as TRUE based from OBSERVATION (not proven by

research)
Example: All patients are bad.

4. PROPOSITION (a judgement or opinion)

o Also called THEORETICAL STATEMENTS (proven by research)

o Explains the RELATIONSHIPS OF DIFFERENT CONCEPTS
Example:

FEAR OF INJECTIONS LESSER DAYS OF STAY IN HOSPITAL

(Concept #1) (Concept #2)

NO FEAR OF INJECTIONS LONGER DAYS OF STAY IN HOSPITAL

(Concept #1) (Concept #2)

PURPOSES OF NURSING THEORY

PURPOSE PICTURE DESCRIPTION

1. In EDUCATION Develops and guides nursing education, and
to improve the status of the profession.

2. In RESEARCH Provides answers to questions encountered in

practice.

Guide data analysis and interpretation in a

given phenomenon.
3. In CLINICAL Serves as guide for what nurses do to respect
PRACTICE the different values and beliefs of diverse
people.

Example: How nurses could use Orem’s self-

care deficit theory to work with children with
special health care needs.

TYPES OF NURSING THEORIES:

NAME TITLE OF THEORY CONCEPT

1. Florence Nightingale Environmental Nursing is the act of using the

theory environment of the patient to assist him
in his recovery .

2. VIRGINIA Need theory Nu rsin g i s a un i qu e fun ct i on of t h e nu rse ,

HENDERSON t o assi st the i ndi vi dual s, si ck or wel l , i n the
pe rform an ce of t hose act i vi t i es cont ri but i ng
t o t he he al t h or it s r ecove ry (or t o peac eful
de at h) so he can gai n indep endenc e as
r api dl y as possi bl e.

3. HILDEGARD Psychodynamic Nursing is a significant , therapeutic,

PEPLAU Nursing interpersonal process .
Nursing is a healing art (therapeutic) of
Interpersonal human relationship .
Relations in Nursing

4. BETTY NEUMAN Health Care Systems N ursi ng is con cerned wi t h t he w hol e

Theory person.

Model s t he i ndi vi dual ’s rel at i onshi p to

st ress, rea ct i on to i t , and r econst i t ut i on
f act ors t hat a re dynami c (ad apt at i on to
st ressors ).

5. IMOGENE KING Goal Attainment Nursing is a process of action, reaction

Theory and interaction between nurse and
patient to achieve goals for client.

Importance of a client’s participation in

decisions that influence care & focuses
on the nurse-client interaction and the
outcomes of care,

6. DOROTHEA OREM Self-Care Deficit Nursi ng is a process of hel pi ng cl i ent s t o

Theory of Nursing i dent i fy ways t o perfo rm sel f- car e.

S el f- car e ne eds/ requi si t es ar e a ct i ons t o

m ai nt ai n heal t h and wel l -bei ng.

S el f- car e de fi ci t expl ai ns how peopl e can

be assi st ed - whol ly, pa rt i al l y or
support i ve- educ at i ve nursi ng syst em .
7. FAYE GLENN Patient-Centered Nursi ng is b ased on th e prob l em -sol vin g
ABDELLAH Approach m eth od .
1. Id ent i fy t he probl em
2. S el ect dat a
3. Mak e a hypot hesi s
4. Test t he hypot hesi s
5. C oncl ude

Nursi ng seeks t o d eter mi n e th e h eal th

n eed s b ased on a 21- prob l ems li st .
8. MADELEINE Transcultural Nursi ng is a hum ani st i c and sci ent i fi c m ode
LEININGER Nursing of hel pi ng a cl i ent t hrough speci fi c
C ULTUR A L C AR ING PR OCE SS E S
( cul tu ral val u es, b el i efs and p rac ti ces ).

P rovi de a cul t ural l y-cong ruent nursi ng

c are.

3 Int e rvent i on m odes:

o C ult ur e c are prese rvat i on and
m ai nt enan ce
o C ult ur e c are ac com m odati on or
negot i at i on
o C ult ur e c are rest ruct u ri ng and
r epat t erni ng.
9. MARGARET JEAN Philosophy and Nursing is a human science of people
WATSON Science of Caring with CARING as its core.

10. PATRICIA BENNER From Novice to Nursi ng goes t hrough fi ve st ages of ski l l s
Expert acqui si t i on

Novi ce (no experi en ce)

1. Advanced begi nner (1-2 years of
experi en ce)
2. C om pet ent (3- 5 years of exp.)
3. P rofi ci ent (5-10 years of experi ence )
4. Expert (> 10 years of experi enc e)
 Carper’s and Benner’s Stages of Clinical Competence

Barbara Carper's fundamental ways of knowing.

Empirical
Factual knowledge from science.
Personal
Knowledge and attitudes derived from personal self-understanding and empathy.
Ethical
Attitudes and knowledge derived from an ethical framework, including an awareness of
moral questions and choices.
Aesthetic
Awareness of the immediate situation, seated in immediate practical action; including
awareness of the patient and their circumstances as uniquely individual.
(Aesthetic in this sense is used to mean "relating to the here and now", from the Greek
αἰσθάνομαι (aisthanomai), meaning "I perceive, feel, sense.”

OVERVIEW OF THE PROFESSIONAL NURSING PRACTICE

Benner's Stages of Clinical Competence
 Stage 1: Novice
Beginners have had no experience of the situations in which they are expected to perform.

Novices are taught rules to help them perform. As such, novices have no "life experience" in the
application of rules.
 "Just tell me what I need to do and I'll do it."

 Stage 2: Advanced Beginner

Advanced beginners are those who can demonstrate marginally acceptable performance, those
who have coped with real situations to note, or to have pointed out to them by a mentor, the
recurring meaningful situational components.

These components require prior experience in actual situations for recognition. The principles are
based on experience.

 Stage 3: Competent
Competence develops when the nurse begins to see his or her actions in terms of long-range goals
or plans of which he or she is consciously aware. Helps achieve efficiency and organization.
Have a feeling of mastery and the ability to cope with and manage the many contingencies of
clinical nursing.

 Stage 4: Proficient
The proficient performer perceives situations as wholes rather than in terms of parts or aspects.

Proficient nurses:

 understand a situation as a whole.

 learns from experience what typical events to expect in a given situation and how plans
need to be modified in response to these events.
 uses maxims as guides which reflect what would appear to the competent or novice
performer as unintelligible nuances of the situation.
 has a deep understanding of the situation overall, however, the maxim provides direction
as to what must be taken into account.

 Stage 5: The Expert

 The expert nurse, with an enormous background of experience, now has an intuitive
grasp of each situation, has a deep understanding of the total situation.
 Highly skilled analytic ability.

THE ROLE OF A PROFESSIONAL NURSE TODAY

Communicator
Nurses are prepared to collaborate with a healthcare team to effectively
perform treatments and procedures. Thus, nurses manage patient care. They
ensure cohesive and coordinated care for successful patient outcomes.

Holistic Caregiver
Nurses to demonstrate cultural awareness and sensitivity. Patients may have
specific needs and preferences due to their religion or gender. Nurses need to
be respectful of, and knowledgeable about, diverse backgrounds while
remaining vigilant in providing quality care.

Instructor
Instruct patients about medical apps that can enhance traditional care. Patients
can now use apps to monitor their glucose, track their blood pressure or access
helpful information.

THE ROLE OF THE HEART FAILURE SPECIALIST NURSE

Specialists
By choosing the appropriate medical specialization, nurses can address complications related to diabetes,
obesity, heart problems, kidney disease and dementia.
Researcher
Nurses use research to deliver care. They gather and analyze data to glean insights they
can apply to facilitating patient care and pinpointing best practices.

What Are Some Trends in Nursing?

 Informatics.
Nursing informatics is a field of nursing that incorporates nursing,
computer, and information sciences to maintain and develop medical data and
systems to support the practice of nursing, and to improve patient care outcomes.
Technologies that have evolved due to health care/nursing informatics include:

 Computerized provider order entry (CPOE)

 Electronic medical records (EMRs)
 Test results
 Progress notes
 Nursing notes
 Medication records

 Genetics. The integration of genetics into nursing.

Genetics nursing is a nursing specialty that focuses on providing genetic

healthcare to patients.

 Genomics.
Genetics focuses on the individual genes in the genome, generally
addressing those conditions resulting from single gene errors. Genomic
information focuses on the interaction of specific genes within the
genome and with external factors within the environment.
 Telehealth.
the use of telemedicine and technology to conduct nursing and deliver
care in a remote location.

Counseling over the phone. However, technology today allows

telehealth nursing to reach patients, monitor their conditions and
interact with them using computers, audio and visual accessories
and telephones.

Module It provides an overview of ethical decision making and the legal system to help nurses manage
common ethical and legal dilemmas in nursing.

ETHICAL ASPECTS IN NURSING

ETHICS
 Greek word “ethicos”
 French word “ethos”
 Custom
 Good and bad
 Societal norms
 “Science of right and wrong, good and bad,
 governs our relationships with others and
 based on personal beliefs and values.” (Sullivan & Decker, 2010)

o Ethics is a concept that deals with moral issues of good and bad based societal norms
 o It is the code written and unwritten that guides the behavior of human beings in the context of
different cultures and situations. This moral code may vary from society to society. However
there are certain aspects that hold good in every situation. The application of this principles
would be dependent on the person and the situation. In short, it is a judgment quote.

o As we talk abt ethics to guide our behavior in the practice of our profession, we have the code of
ethics
CODE OF ETHICS – a specific set of professional behaviors and values the professional must know
and abide by including integrity, accuracy, privacy and confidentiality.
CODE OF ETHICS for Nurses

1. Provide services with dignity and uniqueness of individuals.

The nurse in all professional relationships, practices with compassion and respect for
the dignity, worth and uniqueness of every individual.
2. Are committed to the patient.
The nurses’ primary commitment is to the patient whether an individual, family, group
or community.
3. Advocate for the patient.
The nurse promotes and advocates for the pt. and strive to protect the health, safety
and rights of the patient.
4. Accountability and responsibility for nursing judgments and actions.
The nurse is responsible and accountable for individual nursing practice and determines
the appropriate delegation of tasks consistent with the nurse obligation to provide optimum pt
care.
5. Competence in nursing skills and practice.
Nurses are responsible to maintain competence in nursing skills and practice
6. Positive environments for care.
Nurse participates in improving the healthcare environments and conditions conducive
to the provision of quality healthcare.
7. Participation to ongoing professional development.
The nurse participates in the advancement of the profession
8. Collaborative practice.
The nurse collaborates with other health professionals to meet the health needs of our
pt.

ETHICAL THEORIES – could guide us, what could be good behaviors

 UTILITARIANISM
“The greatest good for the greatest number of people”
We have policies, we have rules that would benefit the majority. Greatest good means the
highest good the life of the righteous. Greatest number means the highest common factor. The only
moral framework that can justify an action. Action is morally right if it serves the greatest happiness for
the greatest number of people.
Ex. Mass Vaccination – The greatest good for the greatest number of people. Do what produces the
best consequences. In healthcare, utilitarianism is society centered, what is good for the society.

 DEONTOLOGY
“An act is good only if it springs from goodwill”
It is patient centered, an act is good only if it springs from goodwill.
Ex: Decision based on the duties and obligations of a doctor to the best interest of the pt.
Deontology means duty, actions that obey rules are ethical. Morally obligatory
regardless of their consequences for human welfare

 TELEOLOGY
“All’s well that ends well”
 Moral obligation from what is good or desirable as an edge to be achieved.
Ex: Stealing could be right or wrong depending on the consequences. Why do we take care of
people? So we come up with teleological explanation to help them achieve optimal health

 CARING
“Promote the common good or the welfare of the group”

Ethics is the philosophical study of morality

MORALITY – application of ethics, the guide to good or right conduct. To do what are the best reasons
for doing good.
“Behavior in accordance with custom or tradition and usually reflects personal or religious
beliefs”
A person who is moral has the willingness to do the right thing is what morality is all about.
Morality protects the life and is respectful of others

VIRTUE
 Moral goodness
 Person rather than action base. It’s a moral character of the person caring out an action
- A good person is someone who lives virtuously, who possesses and lives the virtues
 It is a behavior that shows higher moral standards behaving in the right manner
Characteristics
 Compassion
 Discernment
 Trustworthiness
 Integrity

ETHICAL PRINCIPLES – that would play a role in solving ethical dilemmas that nurses may experience in
their practice
 Autonomy
respect for individual’s liberty, it could mean independence, respect for an individual’s
right to self-determination, self-reliance. The recognition that people have the right to make
their own choices, hold their own values and take actions based on their personal values and
belief systems, respecting patient’s wishes even when you do not agree with them. Autonomy is
not an absolute right, under certain circumstances, the individuals rights do not prevail over the
rights of others. Idiv autonomy that does not prevail Ex. When it interferes with the rights, the
health, and well-being of another. Ex. A nurse has the right to refute to render care to a pt, bec
of religious beliefs. However, if the safety of the pt is jeopardized bec of that lack of care, the
nurse may suffer legal consequences if care is not provided. In addition, the nurse has an ethical
obligation to be sure that pt has adequate care.

 Beneficence
to do good to others- It is the duty of nurses to help others by doing what is best for
them.
 It means the duty to do good to others, it is an ethical principle with the idea that the
nurse action should promote good.

 Nonmaleficence
doing no harm
 An ethical principle that requires an intention to avoid harm or injury that can arise
through acts of commission or omission which is called negligence. One has the duty not
only to do good, but also not to inflict harm or to risk harm to others. A beneficent nurse
acts with empathy for the pts and staff and without resentment. A nurse who acts in
bad faith or who makes false accusations concerning a pt or colleague violates the
 principle of beneficence. In many instances, when an individual does not desire what
others determine to be in that persons best interest such as in a parent or pt refuses
treatment, the principles of beneficence and autonomy conflicts. Generally speaking, in
conflict situation involving pt care decisions, the principle of autonomy over right the
principle of beneficence.

 Justice
principle of fairness
 Justice is giving the person that which he or she deserves. Justice means right to fair
treatment, equitable distribution of healthcare benefits for instance, treating others
equitably and with fairness regardless of gender, religion or socio economic status so
every pt has the right to be given equally and fairly. Now allocation and rationing of
resources are the most important ethical issues facing nurses today. Allocation, is a
decision society makes regarding how many of its health resources will be devoted to a
particular case. Rationing is a decision regarding who gets the healthcare resources and
who does not. Ex. Mass vaccination – they come up with a list of priorities who would be
first vaccinated .. so there is equal allocation and rationing of the vaccines.

 Fidelity
principle of keeping one’s word or promise
 The duty to do what one has promised. It is honoring commitments to clients to be
faithful to agreement and promises. Nurses make promises such as, I will find out for
you about you pain medication and nurses should take these promises seriously
2 TYPES
 Implicit Promise – promises that are implied, not verbally communicated. Ex. When pt
comes in the hospital they expect to be cared for
 Explicit Promise – those that we verbally communicate. Ex. Telling them that you’d be
back with pain meds.

 Respect for others

right of people to make decisions. Related to the principle of autonomy

 Confidentiality
protect patient privacy
 It is adherence to the standards of confidentiality that would help us in promoting a
trusting relationship with clients. Breaking confidentiality is both an ethical and legal
issue. The ethical consideration in confidentiality is that confidentiality is right of all pts .
The code of ethics for nurses asserts duty of the nurse to protect confidentiality of pts.
 However, there is also a legal consideration of confidentiality. Under the requirements
of health insurance portability and accountability act (HiPAA) health info may not be
released without pt consent except to those people for whom it is necessary in order to
implement the treatment plan.

 Veracity
obligation to tell the truth
 Ex. Patient asking do I have cancer.

 Accountability
acceptance of responsibility

PATIENT’S RIGHTS
1. Participate in treatment decisions
2. Provide informed consent to treatment.
3. Receive considerate and respectful care.
 4. Review records.
5. Be informed of hospital policies.
6. Expect reasonable and appropriate continuity of care after hospitalization.

LEGAL ASPECTS OF NURSING (nursing juries prudence )

Nurse’s legal responsibilities is to do no harm pt since a nurse is responsible for a pt care. The
legal aspects of nursing associated with helping and caring people in the healthcare industry
have beome an important pre requisite to be aware of. Cases of negligence had increased
resulting to less people wanting to get into the healthcare industry with fear of legal aspects and
law suits. Thus, we have the nursing law, the nurse practice act to regulate our practice. The
legal aspects need to be applied by nurses in their roles and ensure that necessary care is
present in maintaining the health and safety of pts

ACCOUNTABILITY AND RESPONSIBILITY

Accountability
 Acceptance of responsibility,
 Being answerable for one’s nursing practice or actions.
client – you hold yourself out to the client as someone having the special knowledge, training
and skills associated with nursing
employer – As an employee you have the responsibility to work within the scope of
employment as defined by the employer. You are responsible to know your terms of
employment and to work within those terms
profession – as a nurse, you are accountable to meet the standards of your profession. These
standards may be contain in the nurse practice act
Responsibility
 Obligation to perform
duties
tasks
roles

LAW
Rule of conduct prescribed by the supreme power in a state commanding what is right and
prohibiting what is wrong.

TYPES OF LAW according to source of authority

 Divine law

 Human law

TYPES OF HUMAN LAW

 Private or civil law
Deals with relationship among private individuals.
 Public law
Deals with relationship between individuals and the government.
e.g. Criminal law, Administrative law
 International law
Regulates the intercourse of nations.

SOURCES OF LAW
 Constitutional Law - Supreme law of the land.
 Legislation (Statutory) Law - Laws enacted by any legislative body
 Common Law - Laws evolving from court decisions.

LEGAL PROTECTION IN NURSING PRACTICE

 Good Samaritan Acts
A nurse who renders first aid or treatment at the scene of an emergency , acting in good faith, is
relieved of the consequences of the act.

LEGAL CONCEPTS & ISSUES IN NURSING

 Liability
An obligation or debt enforced by law.
e.g. Malpractice – A person who is liable of malpractice is usually required to pay for damages
 Damages
Compensation in money.
 Negligence
-Failure to do something which a reasonable and prudent person should have done.
- Neglect or failure
 Types of Negligence
 Commission - Wrong doing
 Omission - Total neglect of care – didn’t do anything.
 Examples of Negligence
 Burns. - comission
 Objects left in the patient’s body.
 Falls of elderly, children.
 Failure to observe & take appropriate action as needed.
 Failure to report observations to attending physicians. Omission
 Mistaken identity.
 Wrong medicine, wrong concentration, wrong route, and wrong dose.

 Res ipsa loquitor

 “the thing speaks for itself”
 Doctrine that infers negligence from the very nature of an accident or injury in
the absence of direct evidence on how any defendant behave
 Respondeat superior
 “let the master answer”
 Doctrine that a party is responsible for acts of their agents. A legal principle that allows
the court to hold an employer responsible for the actions of an employee when performing services
for the organization
 Force majeure
 “superior force”
 Frees both parties from liability or obligation when an extraordinary event beyond their
control, prevents them from fulfilling their obligations under contract.
 Malpractice
 Acts or conduct not licensed to perform resulting to injuries.
 Professional negligence. It evolves from negligence and the premise that all individuals
are responsible for the consequences of their actions
 Refers to any misconduct, lack of skill in caring out professional responsibilities.
 For malpractice to exist, 4 elements must be present
 Duty
 Breach of duty
 Causation
 Injury
 Examples of Malpractice
 Misdiagnosis of an illness.
 Birth injuries.
 Surgical complications.
 Prescription errors.
 Failure to provide treatment.
  Incompetence
 Lack of ability, legal qualifications or fitness to discharge the required duty.
 A nurse who performs a task for which she is not qualified can be sued and nurses are
expected to refuse an assignment for which they are not qualified.
 Five Rights of DELEGATION
 Right task.
 Right circumstances.
 Right person.
 Right direction/communication.
 Right supervision.

MEDICAL RECORDS
■ A means of communication
– To provide legal documentation
– To obtain third party payments (health insurance)
■ “If information was not charted, it was not done or observed”
■ CHARTING DONE BY STUDENT NURSES
When a nurse or clinical instructor counter signs the charting of the nursing student, he/she has
personal knowledge of information and that such is accurate and authentic.
■ INCIDENT REPORT
It is an administrative report required of nurses if there are violations of standards and policies
whether or not injury occurs.

CONSENT TO MEDICAL AND SURGICAL PROCEDURE

CONSENT
“free and rational act that presupposes knowledge of the thing – given by a person who is legally
capable to give consent
INFORMED CONSENT – written consent, and it should be signed to show that the procedure is the one
consented to and that “the person understands the nature of the procedure”
3 requirements for informed consent
1. Voluntary
2. Informed
3. Indiv is capable of giving consent

Who must consent?

 Patient of legal age (21 y/o above)
 Parents give consent of minors (below 21 y/o)
 Mentally & physically competent
 Parental consent is not needed if the patient is married or emancipated
Refusal to consent
 Patient who is mentally and legally competent has the right to refuse. Ex. The touching
of her body

TORT Law
 A ‘private or civil wrong or injury”
  Involves malpractice and negligence cases which many take time to learn
 TORT- wrongful act, committed against a person or property. It could be intentional or
unintentional that causes harm.
A Tort can be:
a. Denial of person’s legal rights.
b. Failure to comply with public duty.
c. Failure to perform private duty that harms another person.

Unintentional Tort
 Malpractice.
 Neglect.

Intentional Tort
 Assault.
 Battery.
 Defamation of character

Tort Charges
 Assault.- threatened but not touched. Ex. Punching a pt face.
 Battery. – unwanted physical contact upon another person.
 False imprisonment. -
 Invasion of privacy.
 Defamation of character. (Slander or Libel )
o Libel – written defamation. Ex. Article, photo caption
o Slander – spoken defamation
o How to handle? Handle it with sensitivity and maturity. You explain you issues and
concerns and explain your stand. As Abraham Lincoln said, “truth is the best
vindication against slander, do not hold back, take the necessary actions”
 Fraud.

False Imprisonment
 Unjustifiable detention of a person without a legal warrant.
 Unjustified or illegal confinement of a person, preventing the person from moving or not
allowed to leave. It is making someone wrongfully feel that she cannot leave the place
 Ex. Confining the pt because the fam cannot pay the hospital bills
Use of Restraints
• Behavior is out of control
• To prevent patient and others from injury
• Risk to the physical safety of patient and others
Use of Restraints
 In emergency situations
 Requires a physician’s order
 Nurses responsibility in the use of restraints: have to use constraints with caution and
discretion. Need to monitor and check the circulation such as skin redness around the restraints.
Need to document the observation and the behaviordisplayed
Types of Restraints
1. Mechanical – use of equipment like special mittens, belt, bedrails etc
2. Physical –holding pt to restrict the pts movement
3. Chemical - use of medications to calm the pt
4. Technological Surveillance – use of CCTV to monitor pts movement, door alarms etc.
5. Psychological – giving instruction just like taking away a persons lifestyle. Ex. You are not allowed
to…

INVASION TO RIGHT OF PRIVACY AND BREACH OF CONFIDENTIALITY

 ■ RIGHT to PRIVACY
 Right to be left alone
 Right to be free from unwarranted publicity and exposure to public view
 Right to live one’s life without having anyone’s name, picture or private affairs made public
against one’s will

ETHICAL and LEGAL ASPECTS of NURSING

SPECIFIC ETHICAL ISSUES RELATED TO THE NURSING PROFESSION

 Commitment to the patient

 Commitment to your employer
 Commitment to your colleagues
 Commitment to your personal excellence
 Commitment to the nursing profession
ETHICS is a concept that deals with moral issues of good and bad, based on societal
norms.

ETHICAL PRINCIPLES:
 AUTONOMY Respect patient’s wishes, even when you do not agree with them
 BENEFICENCE Actively seeking to do good,
 NONMALEFICENCE Actively seeking to do no harm.
 FIDELITY Honoring commitment to clients, colleagues and students, being faithful
to one’s commitments
 JUSTICE Right to fair treatment; fairness or equity
 VERACITY telling the truth
 Patient CONFIDENTIALITY
Ethical considerations: Confidentiality is right of all patients.
                                        Code of Ethics for Nurses asserts duty of nurse to
                                                    protect patient confidentiality.
          Legal considerations: Health Insurance Portability and Accountability Act (HIPAA)
2003, Health information may not be released without patient’s consent, except to those for
whom it is necessary in order to implement the treatment plan.

DEFAMATION
Libel and Slander

ELEMENTS OF DEFAMATION
1. Defamatory Language - Anything that really harm a person’s reputation
2. Of and Concerning the Plaintiff – Defamatory statement must relate to the plaintiff
3. Publication to 3rd Party – Any kind of communication by any method when its communicated to
one or more people who understand it. Publication can be:
Intentional – where the defendants intent was to defame the person. Intentionally spoke or wrote
something about the plaintiff
Negligent – occurs when a person types up a defamatory email intending just to say that on their
computer
4. Damage to Plaintiff’s Reputation – where slander and liable comes in .
Slander – Spoken – must prove special damages unless defamation falls in to slander groups
Libel – Written – no need for plaintiff to prove special damages general damages preassumed

Matter of public concerns

5. Falsity
6. Fault

FALSE IMPRISONMENT
■ A crime that involves a person holding a victim against his or her will
■ The victim is simply not allowed to leave
■ The captor can face a civil lawsuit due to injuries the victim sustained, in addition to
facing criminal charges
■ Confinement of a person to a limited area. Robbery – preventing people from moving
and leaving the area

BATTERY – Harmful or Offensive contact

PROTECTION OF PTS CONFIDENTIALITY

■ Revealing the identity is a violation to the patients’ rights
■ Confidentiality of records that could identify subjects should be protected, respecting the privacy
and confidentiality rules in accordance with the applicable regulatory requirements
1. The obligation to tell the truth. - Veracity
3. The duty to do good.- Beneficence
4. Failure to do an act which a reasonable and prudent person should have done. - Negligence
7. Defamation by means of print, writing or pictures.- Libel
10. Attempt or threat to touch another person unjustifiably. - Assault
11. The duty to do what one has promised.- Fidelity
13. Requires a doctor’s order used as a last resort, to restrict the patient’s movement. - Restraint
15. The obligation to do or cause no harm to another. - Nonmaleficence
17. Law that creates legal rights and
responsibilities and is the
foundation for a system of justice.
– Constitutional Law
18. Moral goodness, kindness and
compassion. - Virtue
20. Promises that are implied, not verbally communicated. Implicit
2. Health information may not be released without patient’s consent. - Confidentiality
5. False communication resulting in injury to the person’s reputation. - Defamation
6. Civil wrong committed against a person or a person’s property. Tort
8. Sum total of rules/regulations by which a society is governed. Laws
9. The equitable distribution of benefits and tasks in which clients should be cared for. - Justice
12. “All’s well that ends well.” - Teleology
14. Respect for an individual’s right to self-determination. - Autonomy

Descriptive Statements Field of Nursing

1. A registered nurse who gives comprehensive nursing care to a

Private Duty Nurse
client on a one on one ratio, either in the hospital or in the home.
2. A nurse who teaches and prepares nurses for entry into practice Nurse Educator
positions, Also, teach in various patient care settings to provide
 continuing education to licensed nursing staff.
3. A nurse who provides medical /nursing care to patients in the
Military Nurse
military hospitals/clinics.
4. Provides spiritual care and facilitator of support groups, health
Community Nurse
counselor and liaison to community resources and referral agent.
5. Have specialized education and experience beyond the basic Advances Practice
nursing program. Registered Nurse
6. Responsible for school activities in the areas of health service,
School Nurse
health education and environmental health and safety.
7. Specializes in assisting persons with disabilities and chronic
illness to attain optimal function, health and adapt to modified Rehabilitation Staff Nurse
lifestyle.
8. Monitor standards and procedures for infection control including Infection Control
prevention of COVID-19 viral infections. Nurse
9. Provides a family-centered care and bereavement care, allows Family Caregiver/
client to live and remain at homes with comfort. Family Nurse
10. Possess good communication assessment skills and good insight
to anticipate and interpret patient’s needs for medical check-up Nurse Facilitator
or consultation.

Item Statement Name or Focus of the Nursing Organization ANSWERS

1. ADNEP Association of Diabetes Nurse Educators
H
of the Philippines
2. GNAP Gerontology Nurses Association of the
Philippines J

3. CCNAPI Critical Care Nurses Association of the Philippines

I
4. RENAP Renal Nurses Association of
G
the Philippines
5. PHICNA Standards in Infection Control in Health
B
care facilities.
6. PNIA Use of information and technology in health care
A
system.
7. PONA Training-workshop to equip the nurse
with knowledge & skills to provide safe
E
care for cancer patients on
chemotherapy and biotherapy treatment
8. ENAP/PSECN Care of patients who require prompt
medical treatment to avoid long-term D
disability or death.
9. ORNAP To promote the professional highest
standards of perioperative nursing F
practice.
10. PNRS Recognizing nursing as a scientific
C
discipline.