Professional adjustment for nursing

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PROFESSION
 An occupation or calling requiring advance training
 Experience in some specific or specialized body of knowledge
 Provides service to society in that special field
 The term profession is honoric and should be carried with pride and honor
NURSING
 An occupation requiring a unique body of knowledge and skills and which serves society
PROFESSIONAL NURSE
 Completed a basic nursing education program
 Licensed in his/her country or state to practice professional nursing
NURSING PRACTICE
 Primary responsibility promotion of health and prevention of illness
 Collaborate with other health care providers
o Curative
o Preventive
o Rehabilitative aspects of care
o Restoration of health
o Alleviation of suffering
o Towards a peaceful death

2.  Provide nursing care through the utilization of the nursing process
o Therapeutic use of self
o Executing health care techniques and procedures
o Essential primary health care
o Comfort measures
o Health teachings
o Administration of written prescription for treatment
o Therapies
o Oral
o Topical
o Parenteral medications
o Internal examination during labour in the absence of antenatal bleeding and delivery
o Suturing of perineal laceration
 Establish linkages with community resources
 Coordination with the health team
 Provide health education to individuals, families and communities
 Teach, guide and supervise students in nursing education programs
 The nurse is required to maintain competence by continual learning through continuing professional education
QUALIFICATIONS AND ABILITIES OF A PROFESSIONAL NURSE

3.  Professional Preparation
o Have a license to practice
o Bachelor of science degree in nursing
o Be physically and mentally fit
 Personal Qualities and Professional Proficiencies
o Interest and willingness to work and learn
o Warm personality and concern for people
o Resourcefulness and creativity, well balanced emotional condition
o Capacity and ability to work cooperatively with others
o Skill in decision making
DEFINITION OF LICENSE
 A legal document given by the government that permits a person to offer to the public his or her skills and knowledge in a particular
jurisdiction
CONTRACT
 Meeting of minds between two persons whereby one binds himself, with respect to other, to give something or to render some service
 A promise or a set of promise which the law recognizes as a duty and when that duty is not performed the law provides a remedy
NURSING ETHICS
 Ethics came from the Greek word ETHOS moral duty
 Standard to examine and understand moral life
 Guides of human conduct provided by ethical systems

4.  How people make judgement in regard to right or wrong
 Critical reflection about morality and rational analysis about it
 JOHNSTON- examination of all ethical and bio-ethical issues from the prospective of nursing theory and nursing ethics
 VERCOE- the fields of nursing ethics be focused on the needs and experiences of practicing nurses, the exploration of its meaning and that
of ethical practice in terms of the perception of these nurses
Morals
 Specific ways of behaviour or of accomplishing ethical principles
 Greek work MORALIS
 Social consensus about moral conduct for human beings and society
 Morality is what you believe is right and good
Health Care ethics
 Division of ethics that relates to human health
 Realm of human values, morals, customs, personal beliefs and faith
Bioethics
 Specific domain of ethics that focuses on moral issues in the field of health care
 Result of life and death dilemmas faced by health care practitioners
 Systematic study of human behaviour in the field of life science and health care in the light of moral values and principles
TELEOLOGICAL APPROACH
 Greek word TELOS or goal or end

5.  The right thing to do is the good thing to do
 Act utilitarianism- good resides in the promotion of happiness or the greatest net increase of pleasure over pain
 If the act helps people, then it is a good act
 If the act hurts people then it is a bad act
FLETCHER’S GUIDELINES FOR MAKING ETHICAL DECISIONS
1. Consideration for people as human beings
2. Consideration of consequences
3. Proportionate good to come from the choices
4. Propriety of actual needs over ideal or potential needs
5. A desire to enlarge choices and reduce chance
6. A courageous acceptance of the consequence of the decision
DEONTOLOGICAL APPROACH OR DUTY ORIENTED THEORY
 Basic rightness or wrongness of an act depends on the intrinsic nature rather than upon the situation or its consequences
 Greek word DEON meaning DUTY
 Immanuel Kant- rational human being with freedom and social worth
 A person is morally good and admirable if his actions are done from a sense of duty and reason
W.D ROSS- PRIMA FACIE DUTIES- WHAT ONE SHOULD DO WHEN OTHER RELEVANT FACTORS IN A SITUATION ARE NOT CONSIDERED
 Duties of fidelity- telling the truth, keeping promises
 Duties of reparation- righting the wrong we have done to others

6.  Duties of gratitude- recognizing the service others have done for us
 Duties of justice- preventing distribution of pleasure or happiness that is not in keeping with the merit of people involved
 Duties of beneficence-helping to better the condition of other beings
 Duties of self improvement- bearing ourselves with respect to virtue or intelligence
 Duties of nonmaleficence- avoiding or preventing injury to others
VIRTUE ETHICS APPROACH
 ARETIC, Greek word ARETE, heart of the person performing the act
 Traits and virtues of a good person, courage, temperance, wisdom, and justice
DIVINE COMMAND ETHICS
 Supreme or divine that sets down rules to provide guidance to moral decisions
UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS
 To determine right or wrong in regard to value issues
 Autonomy-
o Greek word AUTOS meaning self and nomos meaning governance
o Self determination
o Freedom to choose and implement one’s decision
o Informed consent
o Allowing the patient to refuse treatment if he decides so
o The person making the decision must be deemed competent, intellectual capacity, legal age
 Veracity

7. o Health care providers are bound to tell the truth
 Beneficence
o Promotes the doing acts of kindness and mercy that directly benefit the patient
 PATIENT’s BILL OF RIGHTS
o Considerate and respectful care
o Relevant, current and understandable information
o Make decisions regarding his care plan
o Have advance directive (living will)
o Every consideration of his privacy
o Confidentiality of communications and records
o Review his records concerning his medical care
o Be informed of business relationship among the hospital educational institution
o Consent or decline to participate experimental research affecting his care
o Reasonable continuity of care when appropriate and be informed of other care options
o Be informed of hospital polices and practices
 NONMALEFICENCE-
o To do no harm
o Not assisting in or performing abortion
o Not to assist people to commit suicide
o Be involved in mercy killing

8.  JUSTICE
o The right to demand to be treated justly, fairly and equally
 NURSES’ BILL OF RIGHTS
o Registered nurses promote and restore health
o Prevent illness
o Protect the people entrusted to their care
o Alleviate suffering
o Provide services that maintain respect for human dignity
 LVING WILLS OR ADVANCE DIRECTIVE
o Accept or refuse any treatment, service or procedure used to diagnose or treat physical or mental condition
o Decision to provide or withhold life-sustaining measures
o This living will is signed by the patient
o Witnessed by two other persons who is not designated as the person’s health care representative
o Directive has force of law
 MORAL PRINCIPLES
o The golden rule
 Do unto others what you would like others do unto you
o The two fold effect
 May have bad and good effect
 Must be morally good

9.  Good effect must be willed and the bad effect merely allowed
 Good effect must not come from an evil action
 Good effect must be greater than the bad effect
o The Principle of Totality
 The whole is greater than any of its parts
o Epikia
 Exception to the general rule
o One who acts through an agent is himself responsible
 Ex. Nurse recommends patient to another clinic for abortion but does not want to perform
o No one is obliged to betray himself/herself
 No one can force any person to answer a question if such will incriminate him/her
o The end does not justify the means
 Giving sleeping tablets to someone who has chronic illness
o Defects of nature may be corrected
 Corrected by plastic surgery
o If one is willing to cooperate in the act, no injustice is done to him/her
 With patient’s consent
o A little more or less does not change the substance of an act
 Stealing
o The greatest good for the greatest number

10.  Have more good effects for more people than a smaller group
o No one is held to the impossible
 Do not promise impossible things
o The morality of cooperation
 Formal cooperation is an evil act and never allowed
o Principle relating to the origin and destruction of life
 Thou shall not kill
GOOD SAMARITAN LAW
• A nurse who renders first aid or treatment at the scene of an emergency and who does so within the standard of care, acting in good faith,
is relieved of the consequences
CODE OF GOOD GOVERNANCE
• Service to others
o Commitment to a life of sacrifice and genuine selflessness in carrying out their professional duties
• Integrity and Objectivity
o Perform their responsibilities with the highest sense of integrity
• Professional Competence
o Knowledge, technical skills, attitudes and experience
• Solidarity and teamwork
o Maintain and support one professional organization
• Social and Civic Responsibility

11. o Shall always carry out their professional duties with due consideration of the broader interest of the public
• Global Competitiveness
o Shall remain open to challenges of a more dynamic and interconnected world
• Equality of All professions
o Shall treat their colleagues with respect and strive to be fair in their dealings with one another
AMENDED CODE OF ETHICS FOR NURSES
• Section 3 Republic Act No. 877 known as the Philippine Nursing Law and Section 6 of P.D No. 223 the amended Code of Ethics of Nurses
• Article I
o Preamble- health is a fundamental right of every individual
• Article II
o Values, customs and spiritual beliefs held by individual shall be represented
o Consider the individuality and totality of patients when they administer care
• Article III
o Human life is inviolable
o Quality and excellence in the care of patients are the goals of the nursing practice
o Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability
• Article IV
o The registered nurse is in solidarity with other members of the healthcare team in working for the patient’s best interest
• Article V
o Preservation of life, respect for human rights and promotion of healthy environment

12. o Promotion in local, national, and international efforts to meet health and social needs of the people
• Article VI
o Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal
• Article VII
o The certification of registration of the registered nurse shall either be revoked or suspended for violation of any provisions of this
code.
DEFINITION AND MEANING OF LAW
• The sum total of rules and regulations by which society is governed
• Man mad regulates social conduct in a formal and binding way
• Rule of conduct pronounced by controlling authority and which may be enforced
o Authority or right to declare that the rule exists
o Rule is pronounced or expressed
o Source can be defined
o A right to enforce the same must be provided
• Controlling authority in our system is the government
• Fundaments law of the government is the constitution
• Principal sources of pronouncements
o Constitution
o Statutes or legislations
o Executive branch

13. o Case decision/judicial opinions
o Presidential decrees
o Letters of instructions
RESONSIBILITY AND ACCOUNTABILITY FOR THE PRACTICE OF PROFESSIONAL NURSING
• Professional Negligence
o Commission or omission of an act, pursuant to a duty
 Existence of a duty on the part of the person charged to use due care under circumstances
 Failure to meet the standard of due care
 The foresee ability of harm resulting from failure to meet the standard
 The fact that the breach of this standard resulted in an injury to the plaintiff
• Article 19 of the civil code
o One shall act with justice, give every man his due, observe honest and good faith
• Article 20
o Those who in the performance of their obligations through negligence causes any injury to another, are liable for damages
• Common acts of negligence
o Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath
o Objects left inside the patient’s body; sponges suction tips, loose dentures lodged in the patient’s trachea
o Falls of the elderly; confused, unconscious, sedated patients
o Falls of children whose bed rails were not pulled up and locked
o Failure to observe and take appropriate action

14. o Failure to report observations to attending physicians
o Failure to exercise the degree of diligence which the circumstances of the particular case demands
o Mistaken identity- drug given to the wrong patient
o Wrong medicine, wrong concentration, wrong route, wrong dose
o Defects in the equipment
o Errors due to family assistance
o Administration of medicine without a doctors prescritption
THE DOCTRINE OF RES IPSA LOQUITUR
• Injury was of such nature that it would not normally occur unless there was negligent act
• Injury was caused by an agency within control of the defendant
• Plaintiff himself did not engage in any manner that would tend to bring about the injury
MALPRACTICE
• The idea of improper or unskilful care of a patient by a nurse
• Stepping beyond one’s authority with serious consequences
• Carelessness of professional personnel
• LESNIK- negligent act committed in the course of professional performance
DOCTRINE OF FORCE MAJEURE
• Irresistible force; unforeseen or inevitable
• No person shall be responsible for those events which cannot be foreseen
• Floods fire, earthquakes

15. DOCTRINE OF RESPONDEAT SUPERIOR
• Let the master answer for the acts of the subordinate
• The liability is expanded to include the master as well as the employee
INCOMPETENCE
• Lack of ability, legal qualifications or fitness to discharge the required duty
CONSENT TO MEDICAL AND SURGICAL PROCEDURES
• Consent
o Free and rational act that presupposes knowledge of teh thing to which consent is being given by a person who is legally capable to
give consent
o Signed by the patient or authorized representative/legal guardian
o An authorization by a patient or a person authorized by law to give the consent on the patient’s behalf
o Nurse secures the consent of the patient upon admission
• Informed Consent
o Established principle law that every human being of adult years and sound mind has the right to determine what shall be done with
his own body
o May choose whether to be treated or not
• Proof of Consent
o A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature
of the procedure
TORTS
• A legal wrong, committed against a person or property

16. • Assault and Battery
o Imminent threat of harmful or offensive bodily contact
o Unjustifiable to tough another person or to threaten to do so
• Battery
o An intentional, unconsented touching of another person
• False Imprisonment of Illegal Detention
o Unjustifiable detention of a person without a legal warrant within boundaries
• Invasion of Right to Privacy and breach of confidentiality
o Right to privacy is the right to be left alone
o Right to be free from unwarranted publicity
o Exposure to public view
o Divulge information from patient’s chart to improper sources or unauthorized person
• Defamation
o Character assassination
o Slander-oral defamation
o Libel-written words
o There must be a third person who hears or read the comment before it can be considered defamation
CRIMES, MISDEMEANORS, AND FELONIES

17. CRIME
• An act committed or omitted in violation of the law
• Two elements
o Criminal act
o Evil/criminal intent
• Conspiracy to commit a crime
o Two or more persons agree to commit a felony
 Principals- who take a direct plan/part
 Accomplices- cooperate in the execution
 Accessories- having knowledge of the commission of the crime
• Criminal Actions
o Acts or offenses against public welfare
• Criminal negligence
o Reckless imprudence- person does an act or fails to do it voluntarily but without malice
o Simple imprudence- did not use precaution and the damage was not immediate or the impending danger was not evident or
manifest
• Criminal Intent
o States of mind of a person at the time the criminal act is committed that he/she knows that an act is not lawful and still
decide to do it anyway
WILLS

18. • A legal declaration of a person’s intentions upon death
• Testamentary document takes effect after the death of its maker
• Decedent- person whose property is transmitted through the succession whether or not he left a will
• If he left a will he is called a testator
• Woman is testatrix
• Heir- called to succession either by the provision of a will or by operation of law
• A person who dies leaving a will is said t have died testate
• One who dies without will is said to have died intestate
• Validation of the will in a court is known as probate
• A will which is written, dated and signed by the testator is called holographic will
• An oral will is called nuncupative will or nuncupation- made during the person’s last illness, that it be done in the place in which he died,
one or more witnesses to the will
• Testator must have the expressed intention of making a will
• Must be right of age
• Under 18 cannot make a will
• Required to have sound mind
• Think clearly ability at the time of its execution
NURSES OBLIGATIONS IN THE EXECUTION OF A WILL
• The nurse should note the soundness of the patient’s mind
• There was freedom from fraud or undue influence

19. • Make a notation on the patient’s chart of the apparent mental and physical condition of the patient at the time of making the will