NURSES

AND

CONTRACTS
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 which the law recognizes
as a duty and when that duty is not
performed the law provides a remedy
(Breach)
KINDS OF CONTRACT
Formal- refers to an agreement between
parties and is required to be in writing.
E.g. marriage contract ..
Informal- one in which the law does not
require the same to be in writing.
Express- the conditions and terms of
contract are given orally or in writing by the
parties concerned.
E.g. PDN under the doctrine of "facio ut
des" means I do that you may give.
Implied- one that is concluded as a
result of acts of conduct of the parties
into a contract.
Void- one that is inexistent from the
very beginning and therefore may not
be enforced.
Illegal- one that is expressly
prohibited by law
Those that are made In protection of the
law
Consent obtained by fraud; duress;
undue influence and material
misrepresentation
CONSENT
a free and rational act that
presupposes knowledge of the thing
to which consent is being given by a
person who is legally capable to give
consent

Informed Consent- 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
Nurse’s responsibility regarding
informed consent
(1) witness the exchange between
the client and the physician
(2) witnessing the client affix his
signature
(3) establishing that the client really
understood.
Characteristics of a Valid Consent

Voluntariness; free from coercion

Opportunities to ask questions
expalined
Treatment explained
Understood by the patient
Maturity of parties (physically and
mentally)
CRITERIA OF GOOD CONSENT

Eighteen years old and above

Mentally capacitated
Proxy consent- <18 and mentally
incapacitated
Parent
Guardian (in order)
Physician
Guardian ad litem
Exceptions to an Informed Consent
Married & mature minors
Emancipated minors
Emergency cases
Minors seeking birth control or pre-natal
treatment
Over specific age (12 years old & above
may give consent for STD, HIV testing,
AIDS treatment, drugs & alcohol
treatment without parents consent.
Sexually abused minors & adolescents
QUESTION

The nurse must see to it that the

written consent of mentally ill patients
must be taken from:
A. Doctor
B. Social worker
C. Parents or legal guardian
D. Law enforcement authorities
QUESTION
Imang is terminally ill, she speaks to you in
confidence. You now feel that Imang’s
family could be helpful if they knew what
Imang has told you. What should you do
first?
A. Tell the physician who in turn could tell
the family
B. Obtain her permission to share the
information in the family
C. Tell Imang that she has to tell her family
what she told you
D. Make an appointment to discuss the
situation with the family
QUESTION

Informed consent is necessary for the

treatment for involuntary clients.
When this cannot be obtained,
permission may be taken from the:
A. social worker
B. doctor
C. next of kin or guardian
D. chief nurse
QUESTION

The patient has a right to information

regarding the operation or other
invasive procedure and potential
effects. This right is achieved through:
A. informed consent
B. preoperative visit
C. charting
D. doctor’s rounds
QUESTION

A thumb mark of a comatose patient

in the informed consent is considered:

A. a misrepresentation
B. “nothing”
C. not a valid signature
D. a valid signature
QUESTION
Edward elaborated on the concept of informed
consent. He determines that the nurses need
more explanation if their response is one of the
following:
A. the consent should provide a description of
alternative treatments or procedures
B. the consent should offer a thorough explanation
of the procedures to be done and the
consequences of it.
C. the consent should include the medical
diagnosis and explanation of the patient’s
condition
D. the consent should describe the prognosis if the
recommended care is refused.
QUESTION

A nurse and a pregnant woman

agreed that the nurse will do home
delivery for a fee. What type of
contract?
A. Implied C. Void
B. Expressed D. Formal
LEGAL CONSIDERATIONS IN
CHARTING
PURPOSE OF THE PT’S. CHART
Communication and continuity
Assurance of quality care
Research
Legal document
Statistics of the disease

*The chart is owned by the hospital

DO’S & DONT’S IN CHARTING
DO’S
Full, factual and objectively accurate
Legible
Immediate
Personal
DON’T’S
Language or unacceptable words
Improper corrections
Spaces & skips
Abbreviation, not standard
Don’t tamper the medical record by:
Adding
Rewriting
Destroying original record

Observe agency’s standards on

documentation
Complete & Concise
Specific & Standard abbreviations
Writing an Incident Report
A tool used as a means of identifying
and improving client care. They are
usually made immediately after its
occurrence and validated immediately
by co-workers.
Purpose: to provide accurate
documentation of occurrences
affecting the client as to have basis
for its intervention.
The following are common situations
that require an incident report:
MOST OF THEM ARE NEGLIGENT ACTS
Falls , burns & medication error
Break in the aseptic technique
Incorrect sponge count during surgery
Failure to report the clients condition

Rules in Incident Report

Don’t use the word error or include lawful
judgment or inflammatory words
QUESTION
A main function of the patient’s
records is to:
A. prepare the nurse for the shift
worked
B. serve as a record of financial
charges
C. serve as a vehicle for
communication
D. ensure that the message is
received
QUESTION
When the nurse writes in the chart and
discovers an error has been made, which
is the BEST approach?
A. erase the erroneous material
B. carefully ink out the erroneous material
C. place an asterisk next to the statement,
then footnote it
D. draw a straight line through the error &
initial it.
QUESTION
Which of the following qualities are
relevant in documenting patients care?
1. accuracy and consciousness
2. thoroughness and currentness
3. systematic and orderly
4. legibly, properly dated and signed
5. use of locally accepted abbreviation

A. 1,3,4 & 5 C. 1,2,3 & 5

B. 2,3,4 & 5 D. 1,2,3,& 4
QUESTION
The patient’s medical record can work as a
double edged sword. When can the
medical record become the doctor’s/
nurse’s worst enemy?
A. When the record is voluminous
B. When a medical record is subpoenaed
in court
C. When it is missing
D. When the medical record is inaccurate,
incomplete, and inadequate
QUESTION
Disposal of medical records in government
hospitals/institutions must be done in close
coordination with what agency?
A. Department of Interior and Local
Government (DILG)
B. Metro Manila Development Authority
(MMDA)
C. Records Management Archives Office
(RMAO)
D. Department of Health (DOH)
QUESTION

In the hospital, when you need the

medical record of a discharged
patient for research you will request
permission through:
A. Doctor in charge
B. Hospital director
C. The nursing service
D. Medical records section
QUESTION

Legally, patient’s chart is:

A. Owned by the hospital
B. Owned by the doctor
C. Owned by the gov’t. cause it’s
a legal document
D. Owned by the patient
QUESTION
As a nurse, you can help improve the
effectiveness of communication
among healthcare givers by:
A. Use of reminders of ‘what to do’
B. Using standardized list of
abbreviations, acronyms, and
symbols
C. One-on-one oral endorsement
D. Text messaging and e-mail
QUESTION

Charting should be legible and

include only standard
abbreviations. Which of the
following is NOT a standard
abbreviation?
A. PRN C. NNO
B. OD D. NPO
NURSES AND WILLS, GIFTS,
ADVANCE DIRECTIVES
WILLS- legal declaration of a
person’s intentions upon death.
Called a testamentary document
because it takes effect after the death
of its maker
An act whereby a person is permitted
with the formalities prescribed by law,
to control a certain degree the
deposition of his estate, to take effect
after death.
Decedent – a person whose property is
transmitted through succession whether or not
he left a will
Testator – a person who left a will.
Testatrix – a woman who is making a will
Heir – a person called to succession either by
the provision of a will or by operation of law
Testate – a person who dies leaving a will
Intestate – a person who died without leaving a
will
Probate – validation of a will in court
Administrator – one who administers the
provision of the will
Estate – the interest a person has in lands or in
any other subject to property
Attestation Clause- means the clause wherein
the witness certifies that the instrument has been
executed before them, and the manner of the
same.
TYPES OF WILLS

Holographic will – a will is written,

dated and signed by the testator
Nuncupative will or
Nuncupation- an oral will
WHO CAN MAKE A WILL?
Sound mind
Eighteen years old & above
Not prohibited by law

WHO CAN WITNESS?

Sound mind
Eighteen years old & above
Able to read and write
Not blind, deaf or dumb
The Nurses obligation in the
Execution of a will
Note the soundness of the pt’s mind
Ensure there was freedom from fraud or
under influence
The pt should be above 18 years of age
Note the will was signed by the testator
and that the witnesses signed the will in
the presence of the testator
For protection, the nurse must make a
notation on the pt’s chart
 Gifts
Another way of disposing property

Four legal requirements for a gift:

gift must consist of personal property
Intention to make the gift
Indication of transfer of control over such
property
acceptance by the recipient

Gifts Causa Mortis or Donation Causa

Mortis – Gifts made by a person because
of anticipation of death or beliefs in
approaching death.
ADVANCE CARE
DIRECTIVE
a document written or completed by the
client and used by a facility or hospital to
provide care at a time when client cannot
make his own decision

SUBJ ECTS:
1. Show risk for early dementia
2. Show risk for stroke
3. Activities- severe head injuries
4. Severe and recurring psychiatric illness
5. Terminally ill
Characteristics of Advance
Directives

a. Allows clients to participate in

choosing health care providers
b. Allows also in choosing the type of
medical treatment the client
desires.
c. Allows clients to consent or refuse
treatments
 TYPES:
1. INSTRUCTIVE DIRECTIVE- specifies life-
sustaining treatment to be withheld or
withdrawn.
 LIVING WILL-legal document stating
person does not wish to have extra-
ordinary life saving measures when not
able to make decisions about his own care.
-applicable for life saving treatment only.
Example: DNR
2. PROXY OR DURABLE POWER
OF ATTORNEY
legal document giving designated
person authority to make health
care decisions on the client’s
behalf when the client is unable to
do so.
QUESTION
Mr. Martin felt better after 5 days but
recognizing the severity of his illness, he
executes a document authorizing the
wife to transact any form of business in
his behalf in addition to all decisions
relative to his confinement his document
is referred to as:
A. durable power of attorney
B. living will
C. informed consent
D. medical records
QUESTION
While in the ICU, a pt. executes the
document that list the medical treatment
he chooses to refuse in case his
condition becomes severe to a point that
he will be unable to make decisions for
himself. This document is:
A. living will
B. informed consent
C. last will and testament
D. power of attorney
Do not Resuscitate (DNR)

Factors in giving order of

resuscitation:
1. Client’s will and advance
directives
2. Disease prognosis such as
cancer or HIV
3. Client’s ability to cope
4. Whether CPR will be given or not
Reasons for refusing to perform
resuscitation

Epidemic or widespread disease or

debilitating condition & that CPR
is not beneficial
CPR will aggravate or prolong the
agony of the client against
cultural & religious suffering
Advance directives & Will
QUESTION

In medical and nursing practice,

code means a call for:

A. DNR state
B. call to order
C. clinical case
D. cardiopulmonary resuscitation
Organ Donation
REQUIREMENTS:
Any person 18 years of age or older may become
an organ donor by written consent.
Informed choice to donate an organ can take
place with the use of a written document signed
by the client prior to death, a will, or a donor card
or an advance directive.
In the absence of appropriate documentation, a
family member or legal guardian may authorize
donation on the descendant’s organs.
In case of newborns, they must be full term
already (more than 200 grams)
TYPES:
1. Autotransplantation- donor and recipient are
one and the same
Ex: skin and bones
2. Heterologous- donor and recipient are two
different individuals.
a. animal to human
b. human to human
c. cadaver donor
d. living donor

Types of organs used :

1. Those that regenerate
- bone marrow, skin
2. Those that come in pair
- kidneys, eyes
Religions that have different views
regarding organ donations
Russian Orthodox: permits all donations
EXCEPT THE HEART.
Jehovah’s Witness: DOES NOT ALLOW
organ donation and all organ to be
transplanted must be drained of blood first.
Judaism: They permit organ donation as
long as with RABBINICAL
CONSULTATION.
Islam: will NOT USE ORGAN STORED IN
ORGAN BANKS.
NURSING ETHICS
ETHICS
Came from the Greek word ETHOS
‘moral duty’
Studies how people make judgment in
regard to right or wrong

MORALITY
It is the right or wrong; good or evil;
proper or improper, cruel or
benevolent acts
Health Care ethics
Division of ethics that relates to
human health
Bioethics
Focuses on moral issues in the field
of health care

NURSING ETHICS
The examination of all ethical and
bio-ethical issues from the
prospective of nursing theory and
practice
PRINCIPLES IN
BIOETHICS
BENEFICENCE
means to do only what’s good
NON- MALEFICENCE
Principle of “do no harm”
AUTONOMY
the right to make one’s own decision;
self-determination
STEWARDSHIP
not harm our body because it is God’s
not ours
JUSTICE
The right to be treated fairly, justly and
equally
FIDELITY
refers to the obligation to be faithful to
the agreements, commitments and
responsibilities that one has made to
oneself and others
VERACITY
Truthfulness or honesty
RESPECT
treat all individuals as persons with
rights with or without abnormality.

INVIOLABILITY/ SANCTITY OF LIFE

 No one can violate or destroy life

SHARING OR ALLOCATION OF
RESOURCES
applies when resources are scanty or
very limited
Standards of Care

Guidelines for determining

whether nurses have performed
duties in an appropriate manner &
guidelines in which the nurse
should practice
QUESTION
Bioethics in caring for children capitalizes
on some important principles. You are
expected to know these by heart because
nurses care for children as well as adults.
What is the principle to hold on when
caring for children who have been
abandoned and abused?
a. consistent assurance
b. respect
c. allocation of resources
d. autonomy
QUESTION

The principle that tells children are to

be treated accordingly as persons is

a. beneficence
b. autonomy
c. non-maleficence
d. respect
QUESTION
When a nurse is providing care to
her/his patient, s/he must remember
that she is duty bound not to do any
action that will cause the patient harm.
This is the meaning of the bioethical
principle:
A. Non-maleficence
B. Beneficence
C. Justice
D. Solidarity
QUESTION

When the nurse triage patients to

render care accordingly, you are
using this particular principle
a. respect
b. allocation of resources
c. beneficence
d. autonomy
QUESTION

In choosing sharp intramuscular

needles for injection, you are
practicing this principle
a. beneficence
b. respect
c. justice
d. non-maleficence
QUESTION
In rendering care to a handicapped child,
the nurse has many responsibilities, most
of all the nurse should be ethical.
What principle should a nurse carry when
caring for a handicapped child?
a. respect
b. beneficence
c. non-maleficence
d. justice
QUESTION

Ensuring that there is an informed

consent on the part of the patient
before a surgery is done, illustrates
the bioethical principle of:
A. Beneficence
B. Autonomy
C. Veracity
D. Non-maleficence
QUESTION

In apportioning candies and other

nice goodies among children, what
bioethical principle should a nurse
observe?
a. respect
b. beneficence
c. non-maleficence
d. justice
QUESTION

This principle states that a person

has unconditional worth and has the
capacity to determine his own
destiny:

A. Bioethics C. Fidelity
B. Justice D. Autonomy
QUESTION

A handicapped child like any other

child should be loaded with
a. care
b. food
c. toys
d. love
QUESTION

What ethical consideration is

violated in human transplantation?
a. Principle of totality
b. Stewardship
c. Autonomy
d. Respect
PATIENT’S BILL OF
RIGHTS
1. Right to considerate and respectful
care
nurse avoids discriminating acts that
tends to bring the appearance of
favoritism
a “ tender loving care attitude”

2. Right to information about

diagnosis, treatment and prognosis
3. Right to informed consent
refers to the capacity of the patient to
accept or refuse treatment options
offered by the health care provider.

Elements:
 Voluntariness
 Informed
 Competent parties
 Knowledgable info. provided
 Signed prior to pre-op meds
4. Right to an advance care directive
5. Right to Privacy
6. Right to confidentiality
all records and communications held
in confidence
when to divulge information:
1. patient placed in serious danger
2. public welfare
3. legal proceeding
7. Right to go over records
8. Right to services and to transfer
Referral
9. Right to know relationship with other
health care and educational institutions
10. Right not to be subjects of research or
experimentation
11. Right to expect reasonable continuity
of care
follow up consultations
12. Right to know what hospital rules and
regulations apply to his conduct as a
patient
MORAL PRINCIPLES
The golden rule
Do unto others what you would like others
do unto you
The two fold effect
May have bad and good effect
Must be morally good
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
The Principle of Totality
The whole is greater than any of its parts
Epikia
Exception to the general rule
One who acts through an agent is
himself responsible
Ex. Nurse recommends patient to another
clinic for abortion but does not want to perform
No one is obliged to betray
himself/herself
No one can force any person to answer a
question if such will incriminate him/her
The end does not justify the means
Giving sleeping tablets to someone who has
chronic illness
Defects of nature may be corrected
Corrected by plastic surgery
If one is willing to cooperate in the
act, no injustice is done to him/her
With patient’s consent
A little more or less does not change
the substance of an act
Stealing
The greatest good for the greatest
number
Have more good effects for more people
than a smaller group
No one is held to the impossible
Do not promise impossible things
The morality of cooperation
Formal cooperation is an evil act and never
allowed
Principle relating to the origin and
destruction of life
Thou shall not kill
PATIENT’S
RESPONSIBILITIES
Providing information
Complying with instructions
Informing the physician of refusal to
treatment
Paying hospital charges
Following hospital rules and regulations
Showing respect and consideration
NURSES’ BILL OF RIGHTS
Registered nurses promote and
restore health
Prevent illness
Protect the people entrusted to their
care
Alleviate suffering
Provide services that maintain
respect for human dignity
QUESTION
The Patient’s Bill of rights helps
practitioners provide more effective patient
care. Which of the following should NOT be
included in the list?
A. be informed of administrative and
policies and practices
B. considerate and respectful care
C. confidentiality of communications and
records
D. relevant current and understandable
information concerning diagnosis,
treatment diagnosis, specific procedures
treatment and risks involved.
QUESTION
You inform the patient about his rights
which include the following EXCEPT:
A. Right to expect reasonable continuity of
care
B. Right to consent to or decline to
participate in research studies or
experiments
C. Right to obtain information about
another patient
D. Right to expect that the records about
his care will be treated as confidential
QUESTION

Which document addresses the

patient’s right to information, informed
consent and treatment refusal?
A. Code for Nurses
B. Nursing Practice Act
C. Patient’s Bill of Rights
D. Standard of Nursing Practice
 Board Resolution #
220

CODE OF ETHICS
FOR REGISTERED NURSES
Four basic ethical
principles:
1. Fundamental responsibility of the
nurse is four-fold
2. Nurse renders service regardless of
race, creed, nationality or political
belief.
3. Nurse protects life and respects the
dignity of man.
4. Nurse works in collaboration with
members of the health team
REGISTERED NURSES AND
PEOPLE
Ethical Principles:
Values, customs and spiritual beliefs
shall be respected
Individual freedom to make decisions
Personal information acquired must
be held in confidence
Guidelines to be observed:

a. individuality and totality of patients

b. respect
c. uphold the rights of individuals
d. take into consideration culture and
values

in the event of conflict, welfare and

safety take precedence
REGISTERED NURSES AND
PRACTICE
Ethical Principles
a.Human life is inviolable
b.Quality and excellence in the care of
patients
c.Accurate documentation- nursing
accountability
Guidelines to be observed:
a. know the definition and scope of nursing
practice
b. be aware of duties and responsibilities
c. acquire and develop competence in
knowledge, skills and attitude
d. optimum standard of safe nursing practice
e. be morally and legally responsible
f. patient’s records considered confidential
RN’S are aware that their actions have
professional, ethical, moral and legal
dimensions

Guidelines to be observed:
1. Duties in conformity with law
2. Not allow to be used in advertisements
that demean image of the profession
3. Decline any gift, favor or hospitality from
patient
4. Not demand and receive any commission,
fee for recommendations made
5. Avoid any abuse of relationship
REGISTERED NURSES AND THE
PROFESSION
Ethical Principles:
1. Maintain loyalty
2. Compliance with by laws of
accredited professional organizations
3. Commitment to continual learning
4. Contribute to the improvement of the
socio-economic conditions and
welfare of nurses
Guidelines to be observed:
a. Be a member of accredited prof
organization (PNA)
b. Strictly adhere to nursing
standards
c. Strive to secure equitable working
conditions through appropriate
legislation and other means
d. Assert for the implementation of
labor and work standards
QUESTION
Based on the Code of Ethics for Filipino
Nurses, what is regarded as the hallmark
of nursing responsibility and
accountability?
A. Human rights of clients, regardless of
creed and gender
B. The privilege of being a registered
professional nurses
C. Health, being a fundamental right of
every individual
D. Accurate documentation of actions and
outcomes
QUESTION

A basic structure against which

competent care is objectively
measured is which of the following?
a. principles
b. standards
c. laws
d. codes
QUESTION
Which of the following nurse’s behavior is
regarded as a violation of the Code of Ethics of
Filipino Nurses?
A. A nurse withholding harmful information to the
family members of a patient
B. A nurse declining commission sent by a doctor
for her referral
C. A nurse endorsing a person running for
congress.
D. Nurse Reviewers and/or nurse review center
managers who pays a considerable amount of
cash for reviewees who would memorize items
from the licensure exams and submit these to
them after the examination.
QUESTION
The purpose of having a nurses’ code of
ethics is:
A. Delineate the scope and areas of
nursing practice
B. Identify nursing action recommended
for specific health care situations
C. To help the public understand
professional conduct expected of nurses
D. To define the roles and functions of the
health care givers, nurses, clients
 -GET MOTIVATED!
-BELIEVE THAT YOU
WILL PASS!
-HAVE FAITH IN HIM!
God bless you!!!