DECENT WORK

EMPLOYMENT
AND
TRANSCULTURAL
NURSING
Noel S. Ayala, MSN,RN,FRIN
I. DEFINITION OF
TERMS
1. DECENT WORK

is employment that "respects the fundamental rights of

the human person as well as the rights of workers in terms
of conditions of work safety and remuneration. ... respect
for the physical and mental integrity of the worker in the
exercise of his/her employment.
1. DECENT WORK
Decent work sums up the aspirations of people in their working lives. It
involves opportunities for work that is productive and delivers a fair
income, security in the workplace and social protection for families, better
prospects for personal development and social integration, freedom for
people to express their concerns, organize and participate in the decisions
that affect their lives and equality of opportunity and treatment for all
women and men.
2. EMPLOYMENT

◦Employment is an agreement between an

individual and another entity that stipulates the
responsibilities, payment terms and
arrangement, rules of the workplace, and is
recognized by the government .
3. FIELDS OF
NURSING
ADVANCED PRACTICE REGISTERED
NURSING
advanced practice registered nurses have acquired more advanced skills
and knowledge through a master’s degree program, in addition to the
undergraduate degree to become a registered nurse.

This extended training distinguishes them from other nurses and they often
go on to work as a clinical nurse specialist (CNS), nurse practitioner (NP),
nurse anesthetist (CNA), or certified nurse-midwife.
AMBULATORY CARE NURSING

Ambulatory care nurses provide health services to patients

directly in an environment outside of a hospital, wherever it
is required. They are responsible for following treatment
plans for acute conditions, monitoring signs, communicating
with the patient and their family, and promoting overall
patient health.
CARDIAC NURSING

Cardiac nurses care for patients with cardiovascular disease

or health problems related to the heart and have specialized
knowledge in this area. They are responsible for monitoring
signs, treating symptoms, addressing clinical needs, and
providing relevant support and education to the patient and
their family.
CASE MANAGEMENT NURSE

Case management nurse care for patients who

require ongoing support and work to develop
and implement a treatment plan that aims to
stabilize health and minimize hospitalization.
CRITICAL CARE NURSING

Critical care nurses work with patients who are

critically ill or injured and require close monitoring
and care. They are responsible for looking after
patients with potentially fatal conditions and
following the treatment care plan for the best
outcomes.
DIALYSIS NURSING

Dialysis nurses care for patients who require dialysis as part

of their treatment plan, such as those with kidney disease.
They are responsible for monitoring signs and progress,
administering medications, and providing support and
advice to patients throughout the process. They may work in
a hospital, clinic, or provide in-home care.
GENETIC NURSING

Genetic nurses care for patients with a genetic disease and

have in-depth knowledge about the role of genetic in the
pathology of these conditions. They are responsible for
conducting family risk assessments, analyzing genetic data,
researching genetic diseases, and providing support to
affected individuals and families.
GERIATRIC NURSING

Geriatric nurses care for elderly patients and have a

thorough understanding of the health and treatment of
conditions that commonly affect the elderly. Geriatric
nurses often specialize further, to care for elderly patients
with a specific health condition.
MENTAL HEALTH NURSING

Mental health nurses, also known as psychiatric

nurses, care for patients with mental health,
psychiatric, or behavioral disorders. They help
to provide support to these patients and their
families while they recover.
NEONATAL NURSING

Neonatal nurses care for young infants in the

first few weeks of their life and have specialized
knowledge about how to take care of infants and
the conditions that may affect them.
ONCOLOGY NURSING

Oncology nurses care for patients who have

cancer. They help in the treatment and
monitoring of the disease, in addition to
providing support and education to patients and
their families.
PEDIATRIC NURSING

Pediatric nurses care for young children and their

families. They have specialized knowledge about the
function of young bodies and the health conditions
that may affect them and assist in the diagnosis,
treatment, and monitoring of these patients.
NURSE EDUCATORS

are registered nurses with advanced education who are also

teachers. Most work for several, if not many, years before
deciding to turn to a career teaching future nurses. Most
nurse educators have extensive clinical experience, and
many continue caring for patients after becoming educators.
 OTHER FIELDS OF NURSING
1. Gastroentorology Nursing
2. Anesthetic Nursing
3. OR Nursing
4. Holistic Nursing
5. Medical – Surgical Nursing
6. Midwifery Nursing
7. Neuroscience Nursing
8. Obstetrical Nursing
9. Occupational Health Nursing
10. Orthopedic Nursing
Other Field of Nursing ( Cont.)
11. Ostomy Nursing
13. Diabetes Nurse Educator
14. Dental Nursing
15. ER Nursing
4. NURSING AS A PROFESSION

Nursing is a profession within the health care sector

focused on the care of individuals, families, and
communities so they may attain, maintain, or recover
optimal health and quality of life. ... Nurses practice in
many specialties with differing levels of prescription
authority.
5. TRANSCULTURAL NURSING

Transcultural nursing means being sensitive to cultural

differences as you focus on individual patients, their
needs, and their preferences. Show your patients your
respect for their culture by asking them about it, their
beliefs, and related health care practices.
Different Fields of
Nursing
DECENT WORK EMPLOYMENT AND TRANSCULTURAL NURSING
OBJECTIVES:

Formulate concrete ideals on the ethical and moral values in the field of
nursing profession.

Foster the positive image of a professional nurse.

Plan individual career planning for the success of their nursing

profession.
A. CAREER PLANNING

Formulation of a program for one’s profession and

put it into action to attain the desired goal. It is
usually done by an individual after graduating their
basic course. It is also forecasting what you would
like to be of what you are in the future after
finishing a basic course.
B. GUIDELINES IN CHOOSING A
FIELD OF NURSING

Nurses who have to make their choices should think of

long-range goal so that they can build up a career-ladder in
nursing.

First consideration that nurses must make is SELF

EVALUATION. They need to consider the following:
1. their capacities
2. interests
3. qualifications
4. goals
FACTORS TO CONSIDER IN MAKING
SELF EVALUATION

1. Qualifications
2. Years of experience and training
3. Age and physical condition
4. Emotional stability and goals in life
C. FACTORS IN SELECTING A
FIELD OF NURSING

Kind of work to be performed

Availability of the work
Hours of work
Qualifications
Opportunities for advances
Method of entering
Earning
Fringe benefits
Other benefits
d. General Classification of
Fields OF Nursing

❖ Hospital or Institutional Nursing

❖ Public Health Nursing or Community Health Nursing
❖ Private Duty Nursing
❖ Industrial or Occupational Health Nursing
❖ Nursing Education
❖ Military Nursing
❖ School Nursing
❖ Clinic Nursing
❖ Independent Nursing Practice
 Institutional Nursing

Nursing in hospitals and related health facilities such as

extended care facilities, nursing homes, and neighborhood
clinics, comprises all of the basic components of comprehensive
patient care and family health. The concept of the modern
hospital as a community health center where in patient and out
patient are continuous describes the goal of medical care in
most general hospital
 Advantages of staff Nursing in
Hospital

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

2. Nurses are updated with new trends in medicine and in the nursing care of
patients.
3. They undergo rotation to different units and have a chance to determine
their special area of choice before they are assigned permanently in one
area.
4. They have an eight hour day and forty-hour week duty which provide for
two days of rest away from duty.
5. They have a chance to be promoted if they are qualified.
6. Salary increases are given periodically according to merit system
7. They are considered an important member of the health team
8. More staff development programs are available in the hospital.
 Disadvatages:

1. There is a great possibility of understaffing which

may require nurses to put in overtime work.
2. Because of the bulk of work, some nurses do not
find time to improve their skills through continuing
education programs.
3. Administrative problems and overwork may tend to
dissatisfy the staff nurse.
 Public Health Nursing or Community
Health Nursing

◼ The National Health Program of the Philippines gives as much

emphasis on the promotion of health and prevention of diseases
rather than care of the sick. It needs a deeper involvement and
close supervision with all members of the health team such as
physicians, nurses, epidemiologist, dentists, sanitary inspector,
sanitary engineers, nutritionist, health educators, social workers,
community and barangay leaders.
 Advantages of Public Health Nursing

1. The focus of nursing care is on family and community health rather than on an
individual basis.
2. It gives the nurse a better perspective of the health conditions of the community and
the health programs conceived by the government.
3. It maximizes efforts to improvise where there are no sufficient facilities, supplies and
equipment.
4. It enables the nurse to utilize various community resources and maximize
coordination with other members of the health team.
5. Focus of care is more on educational and preventive aspects.
6. Individuals, families and communities are motivated to assume responsibility for their
own health care.
 Disadvantage:

1. Cases found in public health nursing are limited mostly to chronic and
communicable diseases.
2. There are more hazards in public health than in hospital nursing.
3. There are no fixed hours of work.
4. Some claim that it is not as exciting nor as glamorous as hospital work.
5. Facilities for care of the sick are limited so that practice are also limited.
6. The PHN may not be immediately aware of changes or trends in the field
of nursing.
7. It is not a place for introverts.
8. There is no immediate supervisor to consult in case of emergency.
 Private Duty Nursing

Nurses in private practice are expected to be expert

clinicians as well as expert generalist in nursing. They
use the title Private Duty Nurse, Private Nurse
Practitioner, Special Duty Nurse or Private Duty Nurse
Specialist.
A registered nurse who undertakes to give
comprehensive nursing care to a client on a one on one
ratio.
 Two Categories:

1. General Private Duty Nurse- providing basic

nursing care to any type of patient.

2. Private Duty Nurse Specialist- skills in

complicated devices, interpreting, observing
signs and symptoms.
 Advantages:

1. Chance to see life as it really is, to study human nature and to

know close range interesting people of different nationalities.
2. The opportunity to make real friends
3. Chance to travel and see the world
4. The ability to own time, adjust work and private life, direct off
duty.
5. The chance to keep abreast with the new knowledge and
procedures.
6. The challenges of giving his best in providing care .
 Disadvantages:

1. Some patients become totally dependent on the nurse.

2. Many private duty nurses graduated so long ago and have not
upgraded their knowledge and skills.
3. There are not enough nurses for evening and night shift,
holiday, week-ends.
4. Little assistance is given by the Head Nurse when the patient
is critically ill.
5. There are no retirement, insurance and medicare benefits
unless he provide these for himself.
 Occupational Health Nursing or
Industrial Nursing

◼ Few nurses go into occupational health nursing. This is

because they often work alone, and must therefore
possess maturity, experience, and wise judgment.
◼ Occupational health nursing is the specialty practice that
provides and delivers health care services of workers.
The practice focuses on promotion, protection, and
supervision of workers health within the context of a
safe and healthy environment.
 Nursing Education

◼ Qualifications of the Faculty:

1. Be a registered nurse in the Philippines
2. Have at least three years of clinical practice in a field
of specialization
3. Be a member of good standing in the accredited
professional organization of nurses
4. Be a holder of masters degree in nursing
 Military Nursing

◼ Three broad areas:

1. To meet the nursing needs of today’s patient in AFP
medical facilities
2. To prepare each Nurse Corps Officer for future
assignments at a higher level of responsibility in the
different stations and general hospital in time of peace
and war
3. To teach and train enlisted personnel who perform
nursing functions under supervision.
 Qualification for Commission in the
Reserve Force Nurse Corps
1. Have a BSN from duly recognized university/college
2. Be licensed to practice nursing
3. Be a natural born Filipino citizen
4. Be single or has never been married
5. Be mentally and physically fit and cleared by appropriate security
agencies
6. Have a pleasing personality and good moral character
7. Be skillful in applying nursing process, communicating with
others, making sound/
8. rational judgment
9. Be interested and willing to work in both
peaceful and wartime conditions
10.Height requirements: for Males: minimum of 62 in.
for Females: minimum of 60 in.
 School Health Nursing

School health nurses often work alone, out of touch

with other nurse, the hospital and all professional
supports they have known. They are responsible for
the school activities in the areas of health service,
health education and environmental health and safety.
 Some responsibilities of the school nurse
are:

1. Organizing and implementing the school health

program
2. Coordinating school health programs
3. Undertaking functions directly related to pupils health
4. Evaluating school health program
5. Carrying out functions related to the health of school
personnel
 Advantages:

School nursing affords one the opportunity to watch

children advance from grade to grade in school health.
Hours are usually good and there is no shift duty.
Disadvantages:

Many school nurses do not update themselves

on the current issues in nursing making them
unaware of changes in the nursing practice.
 Clinic Nursing

Clinic nursing requires that a nurse possess general skills. Usually a

doctor has been in general practice for a number of years. It is with him
that the nurse acts as a receptionist, answers phone, does the billing,
takes x-rays, and ECG, change dressing, give injection and assist in
physical examination. Teaching patients and their families has become
an important function of the clinic nurse.
Nurses in this field must have excellent teaching and communication
skills, exhibit organizational and leadership ability, possess good
assessment skills, and have good insight in order to anticipate and
interpret the needs of their patient.
 Advantages:

1. Favorable working hours.

2. Efficient clinic nurses are trusted in their judgment and
share in planning the care of the patient.
 Independent Nursing Practice

As the term implies, “independent” means the nurse is

self employed and provides professional nursing services
to the clients and their families. While some independent
nursing practitioners set up their clinics near a hospital,
most of them are community based. The nurses reach out
and offer their services rather than expect clients to seek
their help.
 DIFFERENT FIELDS OF NURSING

CLASSIFICATION OF FIELDS OF NURSING IN GENERAL

The fields of nursing may be classified according to the following:

1.Hospital or Institutional Nursing

2.Public Health Nursing or Community Health Nursing

3.Private Duty or Special Duty Nursing

4.Industrial or Occupational Health Nursing

5.Nursing Education

6.Military Nursing

7.School Nursing

8.Clinic nursing

9.Independent Nursing Practice

INSTITUTIONAL NURSING
Nursing in hospital and related health facilities such as extended care facilities,

nursing homes, and neighborhood clinics, comprises all of the basis components of

comprehensive patient care and family health. The concept of the modern hospital as a

community health center where in-patient and out-patient care are continuous describes

the goal of medical care in most general hospitals.

The educational qualification for beginning practitioners is a Bachelor of Science in

Nursing degree. The nurse as a member of the health care team, participate in all

phases of patient care of the acutely ill, the convalescing and the ambulatory patient. The

nurse cares for the patient in the hospital or in the out-patient department and plants for

the nursing care needs of the patient about to be discharged. The nurse performs nursing

measure that will meet the patient’s physical, emotional, social, and spiritual health needs

while in the institution and helps him and his family plan for his further health care needs

when he returns home. The nurse’s function involve assessment of the patient’s needs for
 nursing and planning for giving or providing the care indicated whether this be personal

care, rehabilitation measures or health instructions. These function include participation

in the research and training carried on in the hospital, teaching auxiliary personnel and

assisting in teaching and supervision of nursing and/or midwifery students, if there are

affiliates in the said institution.

Advantages of Staff Nursing in Hospital’s

1.There is always a supervisor whom one can consult if problems exist.

2.Nurses updated with new trends in medicine and in nursing care of patients.
3.They undergo rotation of different units and have a chance to determine their

special area of choice before they are assigned permanently in one area such as Medicine,

pediatrics, surgery, ICU-CCU, Obstetrics, Operating Room, Delivery Room, etc.

4.They have an eight-hours day and a forty-hour week duty which provide for two days of

rest away from duty. They have provisions for sick leaves, holidays, and vacations with

ay according to personnel policies of the institution.

5.They have the chance to get promoted to higher positions if they are qualified.
6.Salary increases are given periodically according to merit system thereby

increased their initiative and best efforts.

7.They are considered an important member of the health team in providing care to the

patients.

8.More staff development programs are available in hospitals.

Disadvantage of Staff Nursing in Hospital’s

The disadvantages usually do not outweigh the advantages:

1. There is a great possibility of understaffing which may require nurses to put in

overtime work and sacrifice some of their plans. This is especially true in

hospitals where budget for personnel is limited.

 2. Because of the bulk of works, some staff nurses do not find time to improve their

skills through continuing education programs. Or, if the hospitals are far-flung, no

continuing education programs are provided.

3. Administrative problems and overwork may tend to dissatisfy the staff nurse.

Qualification of Nursing Service Administrators

Section 29 of RA 9173 specifies that a person occupying supervisory or

managerial positions requiring knowledge of nursing must:

a)Be a registered nurse in the Philippines;

b)Have at least two (2) years of experience in general nursing service

administration;

c)Possess a degree of Bachelor of Science in Nursing, with at least nine (9) units in

management and administration courses at the graduate level; and

d)Be a member of good standing of the accredited professional organization of

nurses.

It is provided, however, that a person occupying the position of chief nurse

or

director of nursing services, shall, in addition to the foregoing qualifications,

possess:
a) At least five (5) years of experience in a supervisory or managerial position

in nursing; and

b) A master’s degree major in Nursing.

It is further provided that for primary hospital, the minimum

academic qualifications and experiences for a chief nurse shall be as specified in

subsections (a), (b), and (c) of this section: Provided, furthermore, That for the chief

nurses in the public health agencies. Those who have a master’s degree in public health/

community health

nursing shall be given priority. Provided, even further, That for chief nurses in
military

hospitals, priority shall given to those who have finished a master’s degree in
completion of the General Staff Course (GSC): Provided finally, That those occupying

such positions before the effectively of this Act shall given a period of (5) years within

which to qualify.
A new trend in hospital nursing is clinical specialization. Nurses train n a special field of

nursing of their choice. Courses to prepare nurses desiring to perfect their clinical

opportunities are offered in universities, usually at the master’s level. These nurses must

have the experience required before applying for a position as an expert practitioner.

Memorandum Circular No. 2000-05, series of 2000 of the Professional Regulation

Commission, Board of Nursing, mandates the implementation of this provision of

the Philippines Nursing Act.

Nursing Specialty Certification

In this country, a Nursing Specialty Certification Program has been adopted by the

Board of Nursing through Resolution No. 14 series of 1999, and created a Nursing

Certification Council under it to oversee the administration of new programs by

the Specialty Certification Boards (refer to Appendices L and M).

SEC. 29. Comprehensive Nursing Specialty Program. – within ninety (90) days from

the effectively of this Act, the Board in coordination with the accredited

professional organization, recognize specialty organization and the Department of Health

is hereby mandated to formulate and develop a comprehensive nursing specialty program

that would upgrade the level of skills and competence of specialty nurse clinicians in the

country, such as not limited to the areas of critical care, oncology, renal and such other

areas as may be determined by the Boards.

The beneficiaries of this program are obliged to serve in any Philippine hospital for a

period of at least two (2) years of continuous service.

Sec. 33. Funding for the Comprehensive Nursing Specialty Program. – the annual

financial requirement needed to trait at least ten percent (10%) of the nursing staff of the

participating government hospital shall be chargeable against the income of

the
 Philippine Charity Sweepstakes Office and the Philippine Amusement and Gaming

Corporation, which shall equally share in the costs and shall be released to the

Department of Health subject to accounting and auditing procedures: Provided, That the

Department of Health shall set the criteria for the availment of this program.

Benefits of Certification
Certification offers advantage to the individual nurse, the nursing profession, and the

health delivery system.

1.Nurses certified above minimum standards improve the quality of patient care.

2.Certification measures expertise beyond that which measured in basic licensure.

3.Certification ensures continued in competence in the changing world of health care.

4.Certification is a means of confronting of the demands of health care.

5.It is a life long learning that advances nursing skills and knowledge to move the

profession forward.

6.It enhances the nurse’s self image and the public views of the profession.

What is the future of the hospital nursing? All indication point to the development of

additional in nursing specialization that will attract large numbers of nurses with varied

educational backgrounds and who have had many kind of clinical experiences such

as critical care nursing, neonatal care nursing, and rehabilitative nursing. Hospital

will

continue to be the principal employers of registered nurses in the foreseeable future.

PUBLIC HEALTH NURSING OR COMMUNITY HEALTH NURSING
Public health nursing is also called community health nursing. The National Health

Program of the Philippines gives as much emphasis on the promotion of health and

prevention of diseases rather than care of the sick. It needs a deeper involvement and

close cooperation with all members of the health team such as physicians, nurses,
 epidemiologists, dentists, sanitary inspector, sanitary engineers, nutritionist,
health

educators, social workers, the community, and the barangay leaders.

Effective coordination can be best achieved if all members have an understanding

of, and respect for, each other’s function.

Advantage of Public Health Nursing

1.The focus of nursing care is only on family and community health rather than on an

individual basis. Here, the nurse will be able to see the total picture of family and

community health.

2.It gives the nurse a better perspective of the health conditions of the community and

health programs conceived and implemented by the government, and to appreciate

the nurses’ role in national building.

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

equipment.

4.It enables the nurse to utilize various community resources and maximize

coordination with other members of the health team.

5.Focus of care is more on educational and preventive aspects. Thus, nurses have the

privilege of contributing to the program for healthy citizenry especially among the

rural poor.

6.Individuals, families and communities are motivated to assume responsibility for their

own health care.

Disadvantages of Public Health Nursing

1.Cases found in public health nursing are limited mostly to chronic and/ or

communicable diseases.

2.There are more hazards in public health than in hospital nursing, such as exposure to

elements (inclement weather, heat of sun, rain), dog or snake bites, accidents, etc.
 3. There are no fixed hours of work. The nurse may be called upon any time of the

day or night.

4. Some claim that public health nursing is not as exciting or as glamorous

as hospital work.

5. Facilities for care of the sick are limited so that practice or skills may also

be limited.

6. The public health nurse may not be immediately aware of changes or trends in

fields of medicine or nursing.

7. Public health nursing is not a place for introverts. A nurse has to be outgoing to

meet people.

8. There is no immediate supervisor to consult in case of emergency.

With the implementation of Primary Health Care, public health nurses are kept up-

to- date through various continuing education programs conducted by the Department of

Health and Regional Health Offices. The entry salary of a community health nurse is the

same as that of a Senior or Head Nurse in government hospital.

NURSES IN IN-SERVICE UDUCATION PROGRAMS

In-service education programs have been in existence for many years both in

hospitals and public health agencies. Many tertiary hospitals and public health agencies

have nursing staff in charge of staff development training and research.

Nurses in this field need:

1.Skills in nursing practice, therefore they must have experience of at least

two years in basic nursing practice;

2.Understanding of skills in teaching. Supervision, and consultation;

3.Understanding of the relationship of these person to these process of

administration and research;

 4. Understanding of the broad problems and desirable practices in patient-care

planning;

5. Understanding od and skills in the use of problem solving approach to

resolve every day problems in the practice of nursing and in-service of the

areas of concern;

6. Understanding of the role and functions of the revising personnel in this area of

in-service education;

7. Understanding of self and others involved in in-service education within the

various agencies in nursing; and

8. Ability to plan and implement programs for different kinds of nursing personnel.
Nursing coordinators for Staff Development need to have at least four years of

clinical practice and research and a Master’s Degree in Nursing. Nurse Instructors for in-

service training programs need at least two years of experience in clinical practice and

research and a master’s Degree in Nursing preferably with a clinical specialization.

With the advent of Quality Assurance Programs in health services, nurses may also be

employed as Quality Assurance Coordinators in agencies where this program is required.

Nurses in this field need experience in clinical nursing and research too.

PRIVATE DUTY NURSING

Nurses in private practice are expected to be expert clinicians as well as expert generalist

in nursing. They use the title Private Duty nurse, Private Nurse Practitioner, Special

Duty Nurse or Private Duty Nurse Specialist.

Definition of Private Duty Practitioner

A private duty nurse is a registered nurse who undertakes to give comprehensive

nursing care to a client on a one-to-one ratio. She/he is an independent contractor.

The patient may be provided care in the hospital or in the home.

 Private duty nurse practitioners are grouped into two categories.
1.General Private Duty Nurse. The general private duty nurse has a capabilities for

providing basic nursing care to any type of patient, among which are:

a. Assessment of the physical conditions and interpretation of the

significance of his/her finding as basis for planning the nursing care;

b. Identification of emotional and social factors and relating these to

signs and symptoms observed;

c. Application of scientific principles in the performance of nursing

techniques;

d. Working with patient’s family so that they gain understanding of his/her

illness and cooperate towards promoting early recovery of the patient;

e. Utilization of the laboratory and diagnostic test in promoting progress of

care and enhancing his/her own usefulness as a health teacher and

counselor;

f. Knowledge and recognition of pharmacology effects of drugs

and medications, their implications of nursing actions as needed; and

g. Interpretation of doctor’s orders concerning medicines and treatments and

communicating the same effectively to the patient and carrying them out promptly

and accurately with understanding of cause and effect.

2.Private Duty Nurse Specialist. In addition to the foregoing abilities expected of

the general nurse practitioner and as a result of his/her specialized preparation, a

private duty nurse specialist also demonstrates the following competencies:

b. Skills in handling, operating, and monitoring other complicated devices;

c. Skills interpreting data gathered from ECG, EEG, laboratory

diagnostic results and vital signs;

d. Skills in observing signs and symptoms and their favorable or untoward

significance in the progress of patient care; and

e. Promptness adeptness in instituting appropriate nursing measures.

Qualifications of a Private Nurse Practitioner

 A private nurse practitioner must:

1)Be a registered nurse in the Philippines;

2)Have the following documents for the current year:

a. Professional Tax Receipt (PTR)

b. Professional Regulation Commission Card (PRC), and

c. Residence Certificate
3)Have at least two (2) years of bedside nursing experience as a professional

nurse in general hospital immediately prior to application;

4)Be acceptable to the Director of Nursing Service as suitable for orientation

to do private duty nursing;

5)Be a full time private duty nurse;

6)Preferably have undergone a Critical Care Nursing Course; and

7)Be a certified I.V Nurse Therapist by the ANSAP (association of nursing

science administrator in the Philippines)

Requirements

A private nurse practitioner is required

1)To undergo orientation in the hospital as conducted by the Nursing Service

Office;

2)To have the complete paraphernalia, e.g., blood pressure apparatus, pen

light, bandage scissors, red and blue or black pen, and clip board;

3)To wear full white nurse’s uniform (cap, stoking, closed white shoes, I.D,

pin). Uniform blazers may be used if required by the hospital;

4)To have a medical certificate from a certified medical center or laboratory with

chest-x-ray result, CBC, urine and stool examination;

5)To give two (2) character references;

6)To acquired, for succeeding years, certificate of three (3) seminars or

continuing education programs attended; and

 7) To show certification as an I.V. Therapist by the ANSAP.
The private duty nurse is expected to follow the rule and regulations of

the hospital regarding nursing procedures, use and procurement of equipment

and supplies, system of medications, charting, diets, precaution techniques

and others. As in other fields of nursing, he/she is expected to adhere to the

code of ethics and practice.

General Guidelines
1)Although a private duty nurse is considered an independent contractor,

she/he is directly under the supervision of the nursing service in the

hospital, or of the Head Nurse in the unit. She/he is expected to make a

comprehensive verbal report to the chief nurse or supervisor when they

visit the patient and submit a written report to the head nurse at the close of

the shift.

2)The private duty nurse is responsible for the nursing care of the patient.
3)The private duty nurse shall endeavor to give complete nursing care before

going off-duty.

4)While the private duty nurse on house case is directly responsible to the
attending physician of the patient, a regular monthly service audit shall be

given to the Director of Nursing Services who referred her/him for

employment.

Policies and guidelines for nurses accompanying patients out of the country

1)Passport and other travel papers. The patient or his/her representative pays for all

expenses for fees and processing of visa and travel papers.

a. Passport, paid round trip ticket, and other papers should be in the

possession of the private duty nurse of all times.

b. A travel and accidental insurance in the amount of P50,

000.00 shall be provided for the private duty nurse and paid

for by the patient or his representative effective 72 hours

before departure
 and throughout the period of stay abroad while in the employment

of the patient.

c.The corresponding amount of salary computed at eight (8)

hours multiplied by two (2) shifts and the number of days the

patient plans to be out of the country should be left in the

Philippines for ready withdrawal by the private duty

nurse’s authorized representative on designated dates per

agreement of parties concerned.

d.A daily travel allowance in additional to the private duty nurse’s

regular salary while out of the country is negotiable with the

employer.

e.The female private duty nurse who is caring for a male

patient must be provided a separate room for rest periods.

f.All hotel, lodging and food expenses while out of town or out of

the country shall be paid for by the employer.

2)The private duty nurse is required to:

a. Leave with the Private Duty Nurses’ Association in the Philippines

her/his possible address of destination and tentative duration

of duty.

b. Report present to the nearest nursing organization in the area; and

c. Report to the Philippine Nurses Association his/her arrival in the

country.

Advantage of Private Duty Practice

Private duty practice gives the following advantages:

a.The chance to see life as it really is, to study human nature and to

know at close range interesting people of different nationalities,

culture, religion. And status;

b.The opportunity to make real friends through close association

with the patient and his family;

c.The chance to travel and see the world;

d. The ability to own time, adjust work and private life satisfactorily, and direct off-

duty time into enjoyable leisure;

e. The chance to keep abreast with new knowledge and procedures which provide an

exciting, stimulating experience, with infinite variety of problems to solve

and personal satisfaction to be gleaned; and

f. The challenge of giving his/her best in providing care and having the satisfaction

of seeing its result.

Disadvantages of Private Duty Practice

a. Some private duty nurses create in situation in which the patient is become totally

dependent on them.

b. Many private duty nurses are graduated so long ago and have not upgraded their

knowledge and skills.

c. There are not enough nurses for evening and night shifts, for holidays, weekends,

and vacation periods.

d. Being a lone practitioner minimized opportunity for developing good relationship

with other hospital personnel.

e. Some private duty nurse’s resent supervision by hospital staff.

f. Little assistance is given by the Head Nurse when the patient is critically ill and

the private duty nurse needs helps in giving treatment or in changing the position

of the patient. The private duty nurse sometimes goes without meals because the

Head nurse does not arrange for relief when the patient cannot be left alone.

g. Private duty nurses have a little or no participation in professional activities, if

they ever do; they do so on their own time and expense.

h. Nurses who are very experience and well qualified receive the same fees as the

new graduates.

i. Private duty nurses face problems in private practice being

independent contractors and there is greater needs for liability insurance.

j. There is no retirement, insurance and Medicare benefits unless the private duty

nurse provides these for himself or herself.

 The private duty nurses association of the Philippines defined the categories of the

private nursing practitioners in 1975. In February 1976. It submitted to the Philippines

Nurse Association the proposal to revise the rate from a twelve hours basis.

Standards rates for Private Duty Nursing was approved by the Board of Directors,

Philippines

Nurses Association in February 1976.

The rates to be changed for private duty are determined by the Private Duty Nurse

Association of the Philippines, anyone interested may verify from the Philippines Nurses

Association Headquarters or at the Nursing Service Office of Lourdes Hospital in

Mandaluyong City.

OCCUPATIONAL HEALTH NURSING OR INDUSTRIAL NURSING

Occupational Health Nursing was once called industrial nursing. In 1958,

industrial nurses in the United States is elected to call themselves occupational

health nurses to reflect the broader and changing scope of practice within the specialty.

Most of these nurses have experienced working in hospitals, in public health or some

other branch of the profession.

Few nurses go into occupational health nursing. This is because occupational health

nurses often work alone, and most therefore possess maturity, experience, and wise

judgment.

Occupational nursing is the specialty practice that provides and deliver health care

services to workers. The practice focuses on promotion, protection, and supervision

of workers’ health within the context of a safe and healthy work environment.

Occupational health nursing is autonomous and occupational health nurses make

independent nursing judgments in providing health services.

Since occupational health nurses work alone in situations where they may have to give

immediate care to patients with serious injuries, they need to be fully informed about their

legal responsibilities. The first consideration is the patient’s welfare. They must

make use of whatever first aid and nursing measures they judge necessary, bearing

in mind their professional limitations. Emergency or more extreme measures may be used
during life-and-death situations. Their actions will be judged against the yardsticks
of

reasonable, prudent nursing practice.

As in other fields of nursing, a Bachelor’s Degree in Nursing is required of

occupational health nurses. This field of nursing requires special skills. A

good preparation is a year or more in emergency nursing such as actual nursing

experience under the direction of a skillful nurse in this field. Helpful skills include

ability to take and read ECGs, eye screening, audiometer testing, laboratory tests, and

X-ray.

In addition, industrial nurses must know company policies on personnel,

insurance benefits, sick leave, pay rates, health programs, medical maters and

records. Since industrial nurses may have only part time or on-call medical direction, they

may find themselves custodian’s employees’ health records, counselors and advisers

of the workers, interpreters of company policies, health and safety teachers as well

as first aiders to the injured.

Most occupational nurses have to bargain individually for their salaries. Only few

employers hire enough nurses to make up a bargaining unit. This has hurt salaries

in industrial nursing to an extent and pay is probably less than in hospital work. But there

are compensations. Often, the industrial nurses works only during day hours. They are off

duty on weekends most of the time. Exception to these are nurses in large plants which

may require overtime work. These are usually seniority wage increases, pensions

and insurances.

Fortunately beginners in this fields have a wide variety of help available. Valuable

literature may be obtained from many sources. They may also seek support from

fellow practitioners through the Occupational Health Nurses Association of the

Philippines.

NURSING EDUCATION
Carrier opportunities in nursing education are better today than ever before. There is a

chronic teacher shortage in all nursing education programs. Nurses who likes to
 consider teaching as their field of expertise will have to consider the
following

qualifications (appendix K.)

Qualifications of the Faculty

A member of the faculty in a college of nursing teaching professional courses

must:

a.Be a registered nurses in the Philippines;

b.Have at least one (1) year of clinical practice in a field of specialization;

c.Be a member of good standing in the accredited professional organization of

nurses; and

d.Be a holder of a master’s degree in nursing, education, or other allied medical and health

sciences conferred by a college or university duly recognized by the government of

the Republic of the Philippines.

The practice of some school to hire as faculty members those under board nurses or

those without any experience contributes to the poor quality of nursing students who later

will become incompetent nurses themselves. This practice also subjects said nurses and

their employers to legal problems that may arise later.

Personal qualities and special abilities of faculty members include:

a. Capability to promote interest in the subject they teach; stimulate the mind of the

students. Arouse enthusiasm, quicken imagination, and awaken ambition;

b. Competence in the particular field they teach;

c. Resourcefulness with infinite patience, understanding, confidence and

perseverance. They must be able to inspire students to develop their fullest

potential; and
d. Expertise in providing nursing care in the chosen fields aside from the qualities

of good role models.

The career ladder in nursing education starts with a Clinical Instructor’s position

up to the Dean of a college of Nursing.

 A dean in a college of nursing should possess a Master’s Degree in Nursing and

must have at least five (5) years of experience in teaching and supervision as per R.A.

9173. Those teaching at the graduate Programs for Nurses must possess post- Master’s

Degree or a Doctoral Degree in Nursing.

Generally, salaries of those in the field of nursing education are higher than those

working in the hospitals. These vary according to the teachers’ experience, their fields of

specialization and their educational attainments.

Nursing education is an interesting, important, and challenging field and the

opportunities for well- prepared nursing educators are numerous.

MILITARY NURSING

The Nurse Corps

When the famed Tandang Sora led the nursing of the sick and wounded Katipunan

revolutionaries in 1980. Military nursing in the Philippine may be said to have begun.

However, the Nurse Corps we know today dates back more precisely about three decades

ago, shortly before the outbreak of World War II.

Commonwealth Act No. 1, commonly known as the National Defense Act, clearly for the

establishment of a medical service in the army of the Philippines. However, the

component corps were not specified. On September 5, 1938, the National Defense Act

was amended by Commonwealth Act. No. 385 whereby the different corps of the medical

service were explicitly spelled out, with the Nurse Corps being one of them. This is the

date celebrated by the Nurse Corps as its foundation day.

In spite of the legal basis for its existence, the Nurse Corps was not organized

until about mid-1940, when President Manuel L. Quezon issued Executive Order

No. 2167, dated April 25, 1940. This provided for the rules of the organization of

the Philippine Army Nurse Corps Reserve intended to be mobilized in the event

the Philippines would be involved in the impending war in the Far East. In accordance

with this new legislation, nurses begun to be commissioned early as July1940. At about

this
time in the U.S Army, the Army nurses were given only relative marks as

officers. Perhaps this was the reason why those who were first commissioned

under the Nurse Corps were only given relative ranks as second and third lieutenant

depending on their

age, education, and experience.

To emphasize the female composition of the Corps, them the Nurse Corps as

provided for in C.A. 385, was changed to the Female Nurse Corps pursuant to

commonwealth Act No. 569, dated June 7, 1940. By the end of 1941, there were about

200 nurse commission into the Nurse Corps. For some unknown reasons, the legal basis

of the Nurse Corps’ existence under the Philippine government became Executive Order

No. 267, the provision of which was very far from the benefits given by the USAFFE. To

prevent retrogression in the status of the military nurses, they began the long and tedious

fight because the military authorities were not very sympathetic with the plight of

the military nurses. With the aid of the Philippines Nurses Association, the military

nurses were able to lobby at the congress for the passage of a bill that would re-designate

the female nurses as a component of Medical Service. As Nurse Corps, the members

would be guaranteed the same rights and privileges as those granted the other

members the military. This resulted in the approval of Republic Act No. 203 on May12,

1948 by Pres. Elpidio Quirino, placing the Nurse Corps in proper perspective among the

other military organizations.

R.A. 479 of June 10,1950 amended R.A. 203, and gave credit to the service of the

military nurses during war. It also provided basis for determining the grade and

rank, seniority, and retirement of NC officers. In August 1952, the title Army

Nurse Corps, Medical Service, was change to Nurse Corps, AFP, Regular officers were

integrated in 1953.

Prior to 1973 the Chief Nurse was merely a staff of the office of the Surgeon

General and had to direct management and administrative functions in the AFP Nursing

Service. With the activation of the office of the Chief Nurse in the Armed Forces of the

Philippines and the designation of the Chief Nurse as Technical Staff of General

Headquarters on June 21,1973, the Chief Nurse has been afforded the prerogative

to decide on matters purely affecting the Nurse Corps and the nursing personnel in

the
 Armed Forces of the Philippines. This position now holds the rank of a Brigadier General.

The first military nurse to hold this rank was Brig. Gen. Elvegia R. Mendoza.

Function of the Nurse Corps, AFP

The AFP Nurse Corps provides comprehensive and quality nursing care to military

personnel, their dependents and authorized relatives.

The function of the AFP Nurse Corps may be grouped into three (3) broad areas:

a.To meet the nursing needs of today’s patients in AFP medical facilities;

b.To prepare each Nurse Corps officer (regular and reserve) for future
assignments at a higher level of responsibility in the different station and general hospital

in times of peace and war; and

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

Special emphasis is on enlisted members who function in

settings where there are no nurses.

Qualification of the Military Nurse

Principle. The nurse consciously and scientifically intervenes in the health and

illness environment for the purpose of ensuring that the soldier, his family and

other significant groups will have adequate personal care, maintenance, safety, and

comfort.

Rationale. The military nurse works at different health settings with various levels of

responsibilities. As such, he/she must have the professional, personal and other

qualifications commensurate with job responsibilities.

Criterion I- Qualification for Commission in the Reserve Force Nurse Corps

Anyone who wants to be commissioned in the Reserve Force Nurse Corps

must
a.Have a Bachelor Science in Nursing from a duly

recognized university/college;

b.Be licensed to practice nursing;

c.Be a natural born- Filipino citizen;

 d. Be single or has never been married for both male and female candidates.

Female applicants must not positively be found to have given birth to

a living or still born child;

e. Be mentally and physically fit for military services and cleared by

appropriate security agencies;

f. Have pleasing personality and a good moral character;

g. Be skillful in
i. Applying the nursing process in meeting health/nursing needs

of individuals/families/groups/communities;

ii. Communicating and relating with others

iii. Making sounds/ rational judgment in a given situation;

h. Be interested and willing to work in both peaceful and wartime conditions;

i. Not be more than thirty two (32) years of age at time of commission; and

j. Satisfy the following requirements

i. Minimum of sixty two (62) inches foe male, and a

ii. Minimum of sixty (60) inches for female.

Qualifications for Commission in the Regular Force, Nurse Corps

In addition to the requirements for commission in the Reserve Force, anyone who

wants to be commission in the Regular Force, Nurse Corps must

a.Successfully pass the rigid screening and battery test for the purpose;

b.Satisfy the height requirements of

i. Minimum od 64 inches for males; and a

ii. Minimum of 62 inches for a females; and

c.Not be more than 26 years of age at the time of regular commission.

Qualifications for Call to Active Duty (CAD)

Anyone who seeks to be qualified for CAD

a) Must be commissioned;
b) Must have at least one year nursing experience in a reputable health

agency;

c) Must have been cleared by appropriate security agency; and

d) Must have passed the physical and mental examinations conducted by the

appropriate authorities.

Qualification for General Duty Nurse

Anyone who desired to be qualified as General Duty Nurse

a) Must have the rank of Second Lieutenant;

b) Must adequate knowledge of a general nursing theory and practice,

including basic knowledge about biological, social, and medical sciences

and their application;

c) Must have knowledge of new development in the nursing field; and

d) Must demonstrate ability to perform comprehensive nursing care.

Characteristics of the Work

As in the other civilian hospitals, nursing service in military seeks to provide

the highest quality of nursing care to patient: in-patient in the hospital and

out-patient in the dispensaries, like in other hospitals, they also maintain

different section like the surgical intensive care unit, the Operating

Room and Anesthesia Sections, The recovery Ward, OB-Gyne,

Pediatric, Neuropsychiatry, Nuclear Medicine Sections and the

Family Planning Section manned by nurse specialists who have been

trained locally and abroad.

The medical corpsmen are highly trained enlisted personnel who help in the

care of patients, especially the males. Nursing attendants are unskilled

non-professionals, who assist nurses and doctors in the wards. In times of

emergency and as the exigency of the services to requires, the corpsmen

and attendants are authorize to do other medico- surgical procedures

like injection, giving medications, catheterizations, castings,

intravenous infusions, circumcisions, suturing of wounds, and other

duties as may be required of them.

 Enumerated below ate he benefits and privileges which military nurses are

entitled to received.

1. High salary rate allowance according to rank:

a. As second lieutenant, they will initially receive the same base pay as officers

of equivalent rank, incentive pay, subsistence allowance, quarters allowance,

clothing allowance, and others when applicable;

b. Flight pay for flight nurses which is 50% of base pay;

c. Hazard pay (radiation hazard pay) which is 20% of base pay;

d. Cold weather clothing allowance for those assigned in cold regions like PMA

I Baguio, or areas abroad; and

e. Overseas pay when detailed to foreign countries on schooling, or on missions;

2. Glamour and prestige of the uniform rank and position. All junior officers

and enlisted personnel will salute and accord them due military courtesy;

3. Hospitalization and free medication benefits for parents, dependents,

authorized relatives with specialist care;

4. Military schooling and basic training at the Armed Forces Medical Services

School ay the V. Luna Medical Center (VLMC);

5. Opportunity to meet people who hold key positions in the AFP and in the

government;

6. Opportunity to attend gala, social functions and parade; and

7. Opportunity to travel abroad.

Flight Nursing in the Philippines

One field of nursing that is considered peculiar only to the military and to the Air

Force is flight nursing or aero-space nursing. A flight nurse is responsible for patients,

military or otherwise, who have been evaluated from battle areas to the nearest

installation for treatment.

Air evacuation relieves congested areas, giving way to forward moving vehicles and

troops. It also reduces medical personnel and supply requirement of military

 operations. Furthermore, it prevents the possible loss of life due to shock or injuries

and cuts down permanent disability to the minimum. Early hospitalization and faster

relief pain bolster the morale of both patients and effective troops left in the battle

areas and places of assignment.

The aero-medical section of the different air base of the Philippines Air Force is

tasked with carrying out this mission in line with the overall objectives of the AFP

Medical Service, which is to conserve the fighting strength of the troops.

A flight nurse is a commissioned officer of the Nurse Corps in the active service,

usually assigned in the Philippines Air Force (PAF), and who as undergone special

training and instruction about flight nursing in the Philippines or abroad.

A great percentage of flight mission include evacuation of civilians, mostly

indigents, who come from areas not usually reached by commercial airlines. On such

mission, the flight is the most important member of the aeromedical team. More often

than not, medical missions are performed without a flight surgeon.

SCHOOL HEATH NURSING

School health nursing is very different from hospital nursing. School health nurse must

like children a lot. They often work alone, out of touch with other nurses, the

hospital and all professional supports they have known. They are responsible for

the school’s activities in the areas of health service, health education and

environmental health and safety.

The primary function of the school in education. The health program of each

school is geared toward making the students and faculty understand those

programs which emphasize health promotion, prevention of disease, and

follow-through of any findings that may indicate a need for medical care and treatment.

They perform a wide variety of services including basis screening for vision,

hearing, and risk factors that would interfere with the development of a healthy

lifestyle.
 For a school nurse, team relationship with other members of the school staff and

participation in their activities will depend on the size of the school, the community, the

health needs of the pupils, and availability of other personnel such as social worker or

guidance counselors.

Some responsibilities of the school nurse are:

1. Organizing and implementing the school health program;

2. Coordinating school health program

3. Undertaking functions directly related to pupil’s health;

4. Evaluating school health programs; and

5. Carrying out function related to the health of school personnel.

Advantages of School Nursing

School nursing affords one the opportunity to watch children advance from grade

in school health. Hours are usually good and there is no shift duty.

Disadvantages
Many school nurses di not update themselves on the current issues in

nursing making them unaware of changes in the nursing practice.

School nurses should enjoy working with children and should be able to

work trough, and with others to achieve their objectives. They should accept the

educational functions of the school and be committed to the promotion of health through

education.

CLINIC NURSING
Clinic nursing requires that a nurse possess general skills. Usually a doctor has been in

general practice for a number of years. It his with him that the nurse acts as a

receptionist, answers phone, does the billing, take x-ray and ECGs, changes

dressings, gives injections (such as BCG, DPT. Or measles vaccine), and assist in

physical examinations. The nurse may even do autoclaving of instruments, keep records,

order and store supplies, make follow up calls and referrals for patients. Teaching patient

and their families has become a important function of the clinic nurse. nurses in the field

must have
excellent teaching and communication skills, exhibits organizational and leadership

ability, possess good assessment skills, and good insight in order to anticipate and

interpret the needs of their patients.

The advantages of clinic nursing are affordable working hours, the satisfaction of

working with people they know and like and who know and like them in return. Efficient

clinic nurse are trusted in their judgment and share in planning the care of the patient.

Generally, and on the average, clinic nurses receive a slightly lower salary than hospital

nurses. A written contract setting forth the professional and personal

arrangements between the nurse and the employer can be mutually beneficial.

ADVANCE PRACTICE NURSING

This field of nursing is synonymous with specialization. Even specialization is a hallmark

of a mature discipline. The advance practice nurse is an umbrella terms for nurses

who have specialized education and experience beyond the basic nursing program. This

advance practice required the knowledge and skills and supervised skills obtained through

graduate study in nursing (either master’s or doctoral degree). This field covers the role of

the clinical nurse specialist.

The clinical nurse specialist is also known as a nurse specialist, nurse clinician or clinical

specialist. The clinical specialist is an expert practitioner within the specialized field of

nursing some may concentrate on cancer, rehabilitation, care of patients with

ostomies, neurological conditions, psychiatry, and many other subspecialists. These

nurses participate in a range of sub roles including. direct patient care, research , teaching,

consultation, and management.

INDEPENDENT NURSING PRACTICE

How would you like to hang at your gate or window a sign bearing your name and

the words “Independent Nurse Practitioner?” Here in the Philippines, there are
already
 few nursing clinics, a group of nursing specialists, and a project subsidized by the

Philippines Nurses Association, where in nurses do independent nurse practice.

As the term implies, “independent” means the nurse is self-employed and provides

professional nursing services to the client/patients and their families. While some

independent nursing practitioners set up their clinics near the hospital, most of them are

community-based. These nurses reach out and offer their services rather than expect

client to seek their help. They perform both independent and collaborative roles. Health

care assessment, formulating plants for health maintenance, prevention strategies of

supportive activities in critical and complex health problems are all within the scope of

nursing practice. They make referrals and collaborate with physicians and the other

disciplines as needed by the client or family.

Independent nurse practitioners are accountable for their decisions. Whether their role is

independent or collaborative, it is based in the fact that each health care discipline offers

an area of knowledge and expertise. Collaborative work is needed for effective,

efficient, an economical care. It is essential therefore that independent nurse practitioners

acquire working knowledge of the skills and expertise of other health workers.

Predicted Outcome of the New Role of Nurses as Independent Nurse Practitioners

The growing interest in independent nursing practice is expected to contribute

much to the improvement of health care in the country.

1.It will encourage professional nurses to extend their capabilities and assume greater

responsibilities for designated areas in generalized nursing practice.

2.The amount of health care will more increased and accessible to people.
3.The nurse’s involvement in the client’s family or community will increase the

nurse’s sensitivity and response to their clients needed.

4.Improvement of health services will help prevent serious illnesses and maintain positive

community health programs.

5.It will provide data for nursing education, to validate and legitimize extended role

practices for nurses.

Nursing as Profession
 Nursing definition:
•Virginia Henderson defined nursing in functional terms: "The
unique function of the nurse is to assist the individual, sick or
well, in the performance of those activities contributing to
health or its recovery (or to a 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."
BASIC NURSING PRINCIPLES :

SAFETY
THERAPEUTIC EFFECTIVENESS
COMFORT
USE OF RESOURSES
GOOD WORKMANSHIP
INDIVIDUALITY
 OBJECTIVES :

• Prepare nurses who will give expert bedside nursing

care
•Provide integration of health and social aspects theory &

practice

• Provide an adequate ,sound scientific foundation to

understand the functioning of body & mind in health
& disease
•Prepare to work cooperatively, develop sense of

responsibility

•Provide opportunity to develop skills& personality

•Upgrade nursing as a profession

 Concept of
nursing:
•The tasks of nursing are:
• (a) to promote health

• (b) to prevent disease

• (c) to help ill-person to healing (to assist healing)

• (d) to assist the dying patient to pass away with quietude, peace,
and dignity.(to ease suffering)

• (e) The client is a holistic human being, including

suffering person and healthy person.
 Concept of nursing
• 6) The working place is not only in the hospital, but also in
family, community and whole society.

• 7) Nursing is not only a science, but also an art.

• 8) The nursing science attaches importance to human being’s
living environment and the interrelation between human being
and its environment.

• 9) The nursing science is a gradually perfect and developing

science.
Philosoph
y
•The study of the fundamental nature of
knowledge, reality, and existence, especially when
considered as an academic discipline.

•A theory or attitude that acts as a guiding

principle for behavior.
 nursing
• Nursing is viewed as both an art and a science, reflecting upon the
concepts of the nursing. Nursing is an applied discipline which expresses
itself in practice, and has its foundation rooted in scientific/empirical
knowledge, theory, and research. Nursing is also expressed as a caring,
therapeutic and teaching discipline.

• The goal of nursing is optimum client wellness, and the maximum level of
functioning. The nursing interventions are evidence-based and stem from
their core knowledge.The professional nurse must appreciate the role of
informatics.
 nursing
Philosophy of nursing includes beliefs and values with regard to man
in general & specifically man as the learner ,teacher, nurse, client and
the beliefs about health, illness, society, nursing & learning etc..

It includes...
Spiritual : Religion should serve as the primary integrating factor.
Moral : Nurse has to develop right conscience.
Intellectual : to provide a systematic development & training& for
fulfilment of nursing function.
 cont....
Emotional needs : nurse must be able to function as a mature,
self – dependent & responsible individual & must be able to relate
well to other people.
Physical : to promote harmonious development, physical needs
to preserve essentials of health.
Social : nursing is linked with social culture ,in which nursing
activities are carried out.
 FUNCTIONS OF A
NURSE
•Caregiver
•The caregiver role has traditionally included those activities
that assist the client physically and psychologically while
preserving the client’s dignity. Caregiving encompasses the
physical, psychosocial, developmental, cultural and spiritual
levels.
• Communicator
• Communication is an integral to all nursing roles. Nurses
communicate with the client, support persons, other health
professionals, and people in the community. In the role of
communicator, nurses identify client problems and then
communicate these verbally or in writing to other members of
the health team. The quality of a nurse’s communication isan
important factor in nursing care.
•Teacher :
•As a teacher, the nurse helps clients learn about their
health and the health care procedures they need toperform
to restore or maintain their health. The nurse assesses the
client’s learning needs and readiness to learn, sets specific
learning goals in conjunction with the client, enacts teaching
strategies and measures learning.
•Client advocate
•Client advocate acts to protect the client. In this role
the nurse may represent the client’s needs and wishes
to other health professionals, such as relaying the
client’s wishes for information to the physician. They
also assist clients in exercising their rights and help
them speak up for themselves.
•Counselor
•Counseling is a process of helping a client to
recognize and cope with stressful psychologic
or
social problems, to developed improved
interpersonal relationships, and to promote personal
growth. It involves providing emotional, intellectual,
and psychologic support.
•Change agent
•The nurse acts as a change agent when assisting
others, that is, clients, to make modifications in their
own behavior. Nurses also often act to make changes
in a system such as clinical care, if it is not helping a
client return to health.

•Researcher ,rehabilitator,& critical thinker.

•Leader
•A leader influences others to work together toaccomplish a
specific goal. The leader role can beemployed at different
levels; individual client, family, groups of clients, colleagues,
or the community. Effective leadership is a learned process
requiring an understanding of the needs and goals that
motivate people, the knowledge to apply the leadership skills,
and the interpersonal skills to influence others.
• Manager
•The nurse manages the nursing care of individuals, families,
and communities. The nurse-manager also delegates nursing
activities to ancillary workers and other nurses, and
supervises and evaluates their performance.

• Case manager
•Nurse case managers work with the multidisciplinary health
care team to measure the effectiveness of the case
management plan and to monitor outcomes.
 :
• Caring nature:
• Nurses deal with the sick and injured and their families on a daily basis, and
must be able to show thatthey truly care about the situation.

• Empathic attitude
• Nurses must be able to put themselves in their patients’ shoes to
provide the quality care needed.

• Detail oriented
• Nurses must remember to make entries on patients’ charts and tobring
medications at the correct times.
•Emotionally stable
• Nurses feel the joy of seeing a new baby born as well as the pain of
losing a long-term patient. Emotional stability is crucial to deal
with the wide range of emotions nurses must endure.

•Adaptable
• People are unpredictable at the best of times, but become even
more so under stress, so a nurse’s typical workday will require
flexibility and adaptability.
•Hardworking :Nursing is a never ending job. It is unusual for a
hospital or medical center to be overstaffed, which of course
means more workload on each nurse in the unit.

•Quick thinker :
•When a nurse notices something is not right with a patient, they
must be able to make decisions quickly and put their plans into
action instantly, because a fraction of a second can mean the
difference between life and death.
•Physical endurance
•Nurses are on their feet all day, sometimes 12 or more
hours at a time, and are often required to assist patients
with activities that require physical strength.

•Good judgment
•A nurse must be able to look at a patient’s current state and
accurately assess what is needed, especially during
emergencies.
•Good communication skills
• Nurses must communicate with other nurses,
doctors, patients, and patients’ families clearly.

•Responsible
• Good nurses know how to perform all of their responsibilities
with the utmost accuracy and detail. They play a major role in
assessing and treating patients’ , and when dealing with the
health of another human being, so nurses must responsibly carry
out their duties at all times.
• N – Nobility, Knowledge
• U – Usefulness, Understanding
• R - Righteousness,
Responsibility
• S – Simplicity, Sympathy
• E – Efficiency , Equanimity
•Profession – is a calling that
requires special knowledge, skill
and preparation.

•An occupation with ethical components , that

is devoted to the promotion of human & social
welfare.
A profession is “ an occupation
or calling requiring advanced
training and experience in some
specific or specialized body of
knowledge which provides
service to society in that special
field.”
•Criteria of Profession:
•To provide a needed service to the society.
•To advance knowledge in its field.

•To protect its members and make it possible to practice

effectively.

Bixler and bixler criteria for profession:

•A profession is a form of employment especially one that is
respected in society as honourable and is possible only for an
educated person and after training in some special branch of
 •It has its own body of knowledge based on social & scientific principles.
•The members of this profession utilise this knowledge to identify & solve
problem

•Has a service aim as well as academic & theoretical aim.

•Constantly enlarges its body of knowledge through research inorder to
improve its services.

•It determines the qualifications necessary for those who enter into practice.
•It has a code of ethics
 Contd....
•Functions autonomously in the formation of professional policy
& in control of professional activities.
•It provides a freedom of action ,oppertunity for
continous professional growth & economic security.
•A profession recognises its responsibilities to develop
educational programmes in cooperation with institutions in order
to develop skills &to learn method of services
•Characteristics of a Profession:
•A basic profession requires an extended education of its
members, as well as a basic liberal foundation.
•A profession has a theoretical body of
specialised knowledge leading to defined skills,
abilities and norms.
•A profession provides a specific service.
•Members of a profession have autonomy
in decision-making and practice.
•The profession has a code of ethics for practice.
•Authority to control its work.
Contd.....
•Service to the society
•Extensive period of formal training
•Self – regulation
•Credentialing system to certify competence
•Legal reinforcement ofprofessional standards
•Ethical practice
•Creation of a collegial subculture
Nursing as a profession:

•NURSING >is a disciplined involved in the delivery

of health care to the society.
•>is a helping profession
•>is service-oriented to maintain health and
well- being of people.
•>is an art and a science.

•NURSE – originated from a Latin word NUTRIX,

to nourish.
• Characteristics of Nursing:
• Nursing is caring.
• Nursing involves close personal contact with the recipient of
care.
• Nursing is concerned with services that take humans into
account as physiological, psychological, and sociological
organisms.
• Nursing is committed to promoting individual, family,
community, and national health goals in its best manner
possible.
• Nursing is committed to personalized services for all
persons without regard to color, creed, social or economic
 ELEMENTS :
1. Accountability : service involves intellectual activities
,individual responsibilities
2. Autonomy : practitioners are relatively independent &
control their own policies & activities
3. Altruism : practitioners are motivated by service & consider
their work as an important component of their lives
4. Association :there is an organisation that encourages &
supports high standards of practice
Categories of nursing
personnel
• Staff nurse
• Senior staff nurse
• Nursing superintendent grade II
• Nursing superintendent grade I
• Nursing tutor/clinical
instructor
• Principal, school of nursing
• Lecturer, college of nursing
Categories of nursing personnel
• Assistant professor, college of nursing
• Professor, college of nursing
• Principal, college of nursing
• Senior assistant director of nursing
• Public health nurse- district family welfare
bureau
 VALUES
Freely chosen
Values underlie all moral dilemmas. though, not all values are moral
values (people values about work, family, religion, politics, money and
relationships.
IMPORTANT: Values influence decisions and actions, such as nurses’
ethical decision making.

Beliefs or attitudes about the worth of a person, object, idea, or action.

 Values and ethics
Values and ethics are inherent in all nursing acts.
A value is a strong personal belief; an ideal that a
person strives to uphold.
Your values reflect cultural and social influences,
relationships and personal needs. Vary among people
and develop and change over time.
 DEFINITION
Values are enduring beliefs or attitudes about the
worth of a person, idea or actions.
They are important because they influence decisions
and actions, including nurses ethical decision making.
 COMPONENTS
A value set is the small group of values held by an individual.
A value system is an organization of values in which each set of values are ranked along a
continuum from most important to least important.

value system are basic to a way of life, give direction to life & form the basis of
behaviour
ELEMENTS

BELIEFS:
Interpretations or conclusions that people accept a truth.
They are based more on faith than fact & may or may not be true.
ATTITUDE:
mental positions or feelings towards a person ,object or
idea.
oAn attitude lasts overtime ,where as a belief may last only briefly.
 BELIEFS ATTITUDES
VALUES
❑ FAITH than FACT. ❑ THINKING and BEHAVIORAL aspects.

❑ Last only briefly. ❑ Continuous overtime.

❑ Judged as bad or good,
❑ Judged as correct or incorrect.

positive or negative.
 TYPES
1. Societal values :
Values that are derived from society & the individual subgroups
These values are heavily influenced by a person’s socio cultural envt; i.e. By societal
traditions; by cultural, ethnic & religious groups; & by family & peer groups.

2. Personal values:
People internalize some or all of the societal values & perceive them as personal
values.

Personal values are needed to have a sense of individuality.

3. Professional values:
Acquired during socialization into a profession.
 Professional values..
They provide the foundation for nursing practice
& guide the nurses interaction with pts;
colleagues & public.
Nurses professional values are acquired from code of
ethics, experiences, teachers & peers.
ESSENTIAL NSG PROFESSIONAL VALUES

Altruism
Autonomy
Human dignity
Integrity
Social justice
Altruism: Its a concern for the welfare & well being of
others. In professional practice altruism is reflected by
the nurse’s concern for the welfare of pts, other nurses &
other health care practitioners.
Autonomy: Its the right to self determination. Professional practice reflects autonomy
when the nurse respects pts rights to make decisions about their health care.
Human dignity: Its the respect for the inherent worth & uniqueness of individuals &
populations. In professional practice, human dignity is reflected when the nurse values
& respects all pts & colleagues.
Integrity: Its acting in accordance with an appropriate code of ethics & accepted stds
of practice. Integrity is reflected in professional practice when the nurse is honest &
provides care based on an ethical frame work that is accepted within the profession.
Social justice: Its upholding moral, legal & humanistic principles. This value is
reflected in professional practice when the nurse works to assure equal treatment
under the law & equal access to quality health care.
 Essential Nursing Values and Behaviors

VALUES Professional Behaviors

Altruism •Understands cultures, beliefs, and perspectives of others.
Nurse’s concern for the welfare of patients, •Advocates for patients.
other nurses, and other health care •Take risks on behalf of patients and colleagues.
providers.
•Plans care in partnership with patients
Autonomy
Nurses respects patient’s right to make decisions about
their health care.
•Provides culturally competent and sensitive care.
Human Dignity •Protects patient’s privacy.
Nurses values and respects the inherent •Designs care with sensitivity to individual patient needs.
worth and uniqueness of all patients and •Provides honest information to patients and the public.
colleagues. •Document care honestly and accurately.
•Seeks to remedy errors made by self or others.
Integrity •Demonstrates accountability of own actions
Nurses acts honestly and provides care based on an ethical •Supports fairness and nondiscrimination in the delivery of care.
framework.

Social Justice
Nurse upholds moral, legal, and humanistic principles by
ensuring equal treatment under the law and equal access to
quality health care.
 Development of values/ value transmission

•An individual is not born with values, rather values are formed during a lifetime from
information gathered from the envt, family & culture.
•As children observe the actions of others, they quickly learn what has high & low
value for them.
Common modes of value transmission:

Modelling
Moralizing
Laissez- faire
Rewarding & punishing

Responsible choice
 Modelling

Through modelling, children learn what is of high or low

value by observing parents, peers & significant others. Thus
it leads to socially acceptable or unacceptable behaviour.
 Moralizing

In this mode of value transmission, children are taught a complete value system by parents or
an institution that allows little opportunity for them to weigh different values.
 Laissez-faire

In this approach, children are left to explore values on their

own & to develop a personal value system. In this no one
set of values is presented as best for all. This approach
often involves little or no guidance & can lead to confusion
& conflict.
 Rewarding & punishing

Children are rewarded for demonstrating values held

by parents & punished for demonstrating
unacceptable values.
 Responsible choice

In this mode, the caregivers encourage children to explore competing values and to weigh their

consequences. Support & guidance are offered as children develop a personal value system.
Value clarification
Process by which people come to understand their own values & value system.
Process of discovery & allows a person to discover through feelings & analysis of
behaviour

What choices to make ?

When alternatives are presented...
Identify whether or not these choices are rationally made...
 FROM?
VALUES TRANSMISSION VALUES CLARIFICATION
⚫ A process by which people identify, examine, and develop their own
⚫ Acquired through Observation and Experience.
individual values.
⚫ Affected by Socio-Cultural
environment (societal conditions, ⚫ It promotes personal growth (promotes awareness, empathy, and
family and peers)
insight)

⚫ It is an important step for nurses to take in dealing with

PERSONAL VALUES ethical problems.

⚫ Nurses should keep in mind the influences ⚫ No One set of values is right for everyone.
of Values on health.
⚫ People can retain or change the freely chosen values

⚫ CLARIFYING THE NURSES’

PROFESSIONAL VALUES VALUES
⚫ CLARIFYING CLIENT VALUES
 FROM?
Professional Clarifying Nurse’s Values
Values
⚫ Acquired during experience from code of ethics,
nursing, teachers, and peers. ⚫ Nurses and nursing
⚫ 5 VALUES ESSENTIAL FOR
students need to examine
PROFESSIONAL NURSE: the values they hold about
ALTRUISM
⚪

⚪ AUTONOMY
life, death, health and
⚪ HUMAN DIGNITY illness.
⚪ INTEGRITY
⚪ SOCIAL JUSTICE
Theory of Values Clarification (Raths, Harmin, and Simon, 1978)

Valuing Process
•Beliefs are freely chosen.

•Without outside pressure

Choosing Cognitive •After reflecting and considering consequences

or alternatives

•Chosen beliefs are cherished or prized

Prizing Affective

•Chosen beliefs are affirmed to others, incorporated

into one’s behavior and repeated consistently in
Acting Behavior one’s life.
 Clarifying Client Values
⚫ Is an intervention used by the nurse s when clients
experiences
unclear values that are harmful to their health.

Behavior Example
Ignoring a health professional’s A child client’s parent who values the
advice
Inconsistent communication behavior A n elderly who says she don’t want anymore to use cane when walking, but
won’t cooperate during her therapy.

Numerous admissions to a health A hypertensive client repeatedly seeks help for headache but does not take
the prescribed maintenance medicine.
agency for the same problem

Confusion about which course A pregnant woman who values her job to meet financial obligations, but also
needs to have complete bed rest for a safe labor and delivery.
of action to take
Clarifying Client Values
Process How?

List Alternatives Ask: “Are you considering other alternative courses of

actions?” “Tell me about them”

Examine possible Ask: “What do you think you will gain from doing that?”
consequences of choices

Choose freely Ask: “Did you have any say in that decision?”

Feel good about the choice Ask: “How do you feel about that decision?” “Some people feel
good after a decision is made; others feel bad. How do you
feel?”
Affirm the choice Ask: “What will you say to family or friends aboutthis?”

Act on the choice Ask: “Will it be difficult to tell your wife about this?” (it
determines the client’s preparedness to act in his
decision)
Act with a pattern Ask: “How many times have you done that before?” or
“Would you act that way again?”
Code of
ethics
 DEFINITION :
•Ethics refers to the moral code of nursing & is based on obligation to
service & respect for human life

Melanie & Evelyn

•A code of ethics is a set of ethical principles that are accepted by

all members of a profession.

Potter & Perry

❑Code of ethics is a guideline for performance & standards & personal
responsibilities.
 A code of ethics is a set of ethical principle that

A.) is shared by members of a group

B.) reflects their moral judgements over time

C. ) serves as a std for their professional actions

S:
Standards FOR THE BEHAVIOURS OF NURSE&
PROVIDE GENERAL GUIDELINES FOR
NURSING ACTION
Helps TO DISTINGUISH BETWEEN
RIGHT& WRONG

Enables A CORRECT DECISION

Protect THE RIGHTS OF INDIVIDUAL
 USES :
Acknowledge the rightful place of individual in health care delivery
system
Constitutes towards empowerment of individual to become responsible
for their health & wellbeing

Contributes to quality care

Identifies obligations in practice, research & relationship
Inform the individual, family, community & others professionals about
expectation of nurse
 FUNCTIONS :
▪To inform the public about the minimum stds of the
profession
▪To provide a sign of the profession’s commitment to the
public it serves

▪To outline the major ethical considerations of the profession

▪To provide general guidelines for professional behaviour
▪To guide the profession in self regulations
RESPECT & AUTONOMY
BENEFICENCE
JUSTICE
VERACITY(truth telling)
FIDELITY

CONFIDENTIALITY
ETHICAL ISSUES:

Practitioner –Assisted Suicide (PAS)

Refusal to treat
Genetic research
Right to refuse treatment

Do not resuscitate (DNR)

orders
Nursing Codes of Ethics
⚫ Purposes:
⚪ Inform the public about the minimum standards of the
profession
and help them understand professional nursing conduct.
⚪ Provide a sign of the profession’s commitment to the public
it serves.

⚪ Outline the major ethical considerations of the profession.

⚪ Provide standards for professional behaviors.
⚪ Remind nurses of special responsibility they assume
ETHICAL DILEMMA
Occurs when there is conflict between two
or more ethical principles.
No correct decision exists.
Nurse must choose b/w two alternatives that
are equally unsatisfactory.
Occurs as a result of difference in beliefs.
Ethical reasoning
 ETHICS
THE ICN CODE OF ETHICS FOR NURSES
An international code of ethics for nurses was first adopted by the
International Council of Nurses (ICN) in 1953. It has been revised and
reaffirmed at various times since, most recently with this review and
revision completed in 2005.

PREAMBLE
Nurses have four fundamental responsibilities: to promote health, to
prevent illness, to restore health and to alleviate suffering. The need for
nursing is universal.
Inherent in nursing is respect for human rights, including cultural
rights, the right to life and choice, to dignity and to be treated with
respect. Nursing care is respectful of and unrestricted by
considerations of age, colour, creed, culture, disability or illness,
gender, sexual orientation, nationality, politics, race or social
status.
Nurses render health services to the individual, the family and the
community and co-ordinate their services with those of related
The ICN Code of Ethics for Nurses has four principal elements that
outline the standards of ethical conduct.

1. NURSES AND PEOPLE

•The nurse’s primary professional responsibility is to people requiring
nursing care.
•In providing care, the nurse promotes an environment in which the
human rights, values, customs and spiritual beliefs of the
individual, family and community are respected.
•The nurse ensures that the individual receives sufficient information on which
to base consent for care and related treatment.
•The nurse holds in confidence personal information and uses judgement in

sharing this information.

•The nurse shares with society the responsibility for initiating and supporting

action to meet the health and social needs of the public, in particular those of

vulnerable populations.

•The nurse also shares responsibility to sustain and protect the natural

environment from depletion, pollution, degradation and destruction

 2. NURSES AND PRACTICE
•The nurse carries personal responsibility andaccountability for
nursing practice, and for maintaining competence by continual
learning.

•The nurse maintains a standard of personal health such that the

ability to provide care is not compromised.
•The nurse uses judgement regarding individual competence
when accepting and delegating responsibility.
•The nurse at all times maintains standards of personal
conduct which reflect well on the profession and enhance
public confidence.
•The nurse, in providing care, ensures that use of technology
and scientific advances are compatible with the safety, dignity
and rights of people
 3. NURSES AND THE PROFESSION
•The nurse assumes the major role in determining and implementing
acceptable standards of clinical nursing practice, management,
research and education.

•The nurse is active in developing a core of research- based

professional knowledge.

•The nurse, acting through the professional organisation, participates

in creating and maintaining safe, equitable social and economic
working conditions in nursing
 4. NURSES AND CO-WORKERS

The nurse sustains a co-operativerelationship with

co-workers in nursing and other fields.
The nurse takes appropriate action to safeguard
individuals, families and communities when their
health isendangered by a co- worker or any other
person.
5. NURSES AND SOCIETY
Participate and share responsibility with other citizens
&other health professionals.

Recognize and perform the duties of citizenship

Aware of laws and regulations which affect the
practice of medicine and nursing.
 INC CODE OFPROFESSIONALCONDUCT FOR
NURSESIN INDIA
1. Professional Responsibility and accountability
1. Appreciates sense of self-worth and nurtures it.
2.Maintains standards of personal conduct reflecting credit upon the profession.
3.Carries out responsibilities within the framework of the professional
boundaries.
4. Is accountable for maintaining practice standards set by Indian Nursing
Council
5. Is accountable for own decisions and actions
6. Is compassionate
7. Is responsible for continuous improvement of current practices
8. Provides adequate information to individuals that allows them informed choices
9. Practices healthful behavior
2. Nursing Practice

1. Provides care in accordance with set standards ofpractice

2. Treats all individuals and families with human dignity in providing physical,
psychological, emotional, social andspiritual aspects of care

3. Respects individual and families in thecontext of traditional

and cultural practices and discouraging harmful practices
4. Presents realistic picture truthfully in all situations for facilitating autonomous
decision-making by individualsand families
4.Promotes participation of individuals and significantothers in the care
5.Ensures safe practice
6.Consults, coordinates, collaborates and follows up
appropriately when individuals’ care needs exceed the nurse’s
competence
3. Communication and Interpersonal Relationships
1. Establishes and maintains effective interpersonal relationship with
individuals, families and communities
2. Upholds the dignity of team members and maintains effective
interpersonal relationship with them
3. Appreciates and nurtures professional role of team members
4. Cooperates with other health professionals to meet the needs of the
individuals, families and communities
 4. Valuing Human Being
1. Takes appropriate action to protect individuals

from harmful unethical practice

2. Consider relevant facts while taking conscience decisions

in the best interest of individuals
3. Encourage and support individuals in their right to speak
for themselves on issues affecting their health and
welfare
5. Management
1. Ensures appropriate allocation and utilization of available resources

2. Participates in supervision and education of students and other formal care

providers
3. Uses judgment in relation to individual competence while accepting and
delegating responsibility

4. Facilitates conducive work culture in order to achieve institutional

objectives Communicates effectively following appropriate channels of
communication

5. Participates in performance appraisal

7. Participates in policy decisions, following the principle of equity and accessibility of
services
8. Works with individuals to identify their needs and sensitizes policy makers and funding
agencies for resourceallocation

6. Professional Advancement

1. Ensures the protection of the human rights while pursuing the advancement of knowledge

2. Contributes to the development

3. Participates in determining and implementing quality care

4. Takes responsibility for updating own knowledge andcompetencies
5. Contributes to the core of professional knowledge
by conducting and
participating in research
 LEGAL CONSIDERATIONS
1st nursing law : Nursing registration- 1903
Indian nursing council act: enacted in 1947
Amended in 1957
LEGALIMPLICATIONS: (civil disputes)
Torts: Torts are when others interfere in individuals'privacy
Assault: Assault occurs when a person puts another person in fear of
a harmful or offensivecontact
Battery: It is an intentional touching of another's body without
the other's consent
Negligence: it is described as lack of proper care and
attention carelessness.
Malpractice: Failure to meet the standards of acceptable care which
results in harm to another person.

Fraud: It results from a deliberate deception intended to produce

unlawful gains.

False imprisonment: It occurs when a client is not allowed to leave a health

care facility when there is no legal justification to detain the client or when
restraining devices are used without an appropriate clinical need.

Invasion of privacy: It includes violating confidentiality intruding on private

client or family matters, and sharing client information with unauthorized
 Legal documents: it comprised:
a)Advance directive: Written document recognized by law that provides
directions concerning the provision of care when a person is unable to
make his or her own treatment choices.
b)Do not resuscitate orders: Written order by a physician when a client has
indicated a desire to be allowed to die if the client stops breathing or the
client's heart stops beating.
c)Informed consent: It is clients' approval [or that of the clients' legal
representative to have his or her body touched by a specific individual.
 NURSING LIABILITIES AND PREVENTIVE
MEASURES
o All nursing observations should be noted carefully,
describing accurately

Patients complaints should be recorded as accurately and

specifically

Nurse must report through proper channels

Authorities must be informed regarding any kind of equipment, materials or
supplies, which for any reasons less than safe for use in the patient's care

Insurance protection
 LEGAL RESPONSIBILITY
Registratio
n Licensing is a mandatory procedure for practice of nursing.
Registration aims at protecting patients byproviding qualified
nurses. The nurse is responsible to obtain registration in

the respective State Nursing Registration Council

Legal Liability/Act Of Negligence

License of a nurse can be suspended or cancelled for any act
of negligence or mal practice, following a specified procedure.

Medico — Legal case (M.L.C.)

Amedico legal case is a patient who is admitted to the hospital with some unnatural
Correct identity
A nurse/midwife is responsible to make sure that all babiesborn
in hospital are correctly labeled at birth and handed over to right
parent.
Unknown/unconscious patients must be labeled as soon as
their identity is known.
Patients who have to undergo surgery should be appropriately
identified and labeled.
Site of operation to be correctly marked particularly where
symmetrical sides or organs are there:
Operation theatre (O.T.): scrub nurse has to seeall theinstruments/
swabs are returned. She has to say OKAY' before closure by the surgeon
. LeftAgainst Medical Advice
(L.A.M.A.)
Inform medical officer in charge. Signatures of both
patients and witness to be taken as per institutional policy.
Patient's Property
Inform patient on admission that hospital does not take
responsibility of his belongings. If patient is unconscious/ orotherwise required
then a list of items must be made, counter checked by two staff nurses and kept
under safecustody.
Dying Declaration
Doctor or nurse should not involve themselves in dying
declaration, in case where police records the dying declaration. Dying declaration is
to be recorded by the magistrate. But if condition of patient becomes serious then
medical officer can record it along with two nurses it witness. Dying Declaration
can be recorded by the nursing staff with two nurses aswitness when medical
officer is not present. Then the declaration has to be sent immediately in a sealed
cover to themagistrate.
 Wills
For this, doctor has to be present there, he canrecode if
requested.
Examination of rape case
Female attendant/female nurse must be present during the
examination.
Artificial human insemination
❑ Written consent should be obtained from both donor and
recipient.
❑ Donor and recipient must have the same blood group. Donor
and recipient's identity should be kept confidential. .
❑ All related documents should be kept confidential & safe.
•Poison case
•Do not give either verbal or written opinion.
•Do not allow to take photos unless special permission
is granted by appropriate authority.
• Do not give any information to public or press.
• Preserve all evidence of poisoning.
•Collect and preserve all excreta, vomits and
them immediately
aspirates, seal and send forensic laboratory at
to earliest. the
.Consumer Protection
Consumer protection act was passed by parliament in 1986
Act(l986)
RIGHTS OF PATIENT:
 Nurses role to prevent
complications
1.Review nursing practice periodically. Update knowledge and improve skill by attending short term
courses, in- service education and continuing education programmes.

2.Should have complete knowledge of all rules and regulations of hospital and know their
descriptions

{duties and responsibilities).

3. Follow nursing practice

standards/protocols.

4. Be a keen observer.

5.Written instructions must have rules and code of practice laid down to ensure the safety and
well being of patients and nurses.
6. All hospitals must have rules, a code of practice laid down to
ensure the safety and well being of patients and nurses.

7. Maintain records and reports of the unit

properly.

8.Follow 6 Rights - right patient, right drug, right time and right
route with right technique and right of the patient lo know
about his/her disease condition.

9.Check the treatment order and use

professional judgment before
implementing.

10.Do not exceed the limits of nursing

procedure laid down by statutory
Nursing
•The nursing science is an independent applying
science that synthesizes natural and social
science.
•Nursing is a profession that helps human being
and serves for health of human being
•Nursing can assist individual to meet the basic
needs of human being and enforce the ability of
self-care.
Nature and scope of nursing
practice
• Nurses contribute to health care within a multidisciplinary
team. They are individually accountable for their actions
and practise within a statutory regulatory framework
established to protect the public and assure the quality of
nursing services.
• The role of the nurse is constantly changing and developing.
This means that nurses may add new functions to their
work. When deciding to do so, nurses must be sure that
patients will benefit and that they are competent for the
new role.
Nature and scope of nursing
practice
•Nursing is a service which:
• Helps individuals, families and communities to achieve
and maintain good health
• Supports, assists and cares for people during illness
or when their health is threatened
• Enhances people's ability to cope with the effects of
illness and disability
• Ensures, as far as possible, that death is dignified and
free from pain.
Nature and scope of nursing
practice
• Nursing achieves these goals by applying knowledge and skills gained
through education and training, updated and tested by research. It is
the combination of professional knowledge and skills, with the desire
to care for others, which provides the base of nursing. Nursing
practice includes:
• Assessing people's health, their health problems and the resources
they have to cope with them; deciding what nursing help is needed
and referring them to other sources of expertise when necessary
• Planning, giving and evaluating programmes of skilled nursing care
Nature and scope of nursing
practice
• Teaching individuals, families and communities about healthy
lifestyles. This involves helping them gain the knowledge and skills to
control their own health

• Teaching and enabling people to attain, maintain or recover

their independence
• Acting as the patient’s advocate and communicating the patient’s
needs
to others
• Co-ordinating care where other health care workers are involved
• Maintaining an environment conducive to health or recovery.
Nature and scope of nursing
practice
• Nursing is concerned, in particular, with:
• Situations in which people’s ability to maintain the normal
activities of life, such as breathing, feeding, elimination, mobility,
rest, sleep and personal cleanliness may be impaired
• Alleviating pain and discomfort
• Assessing physical and emotional responses to illness, trauma,
treatment and disability. These responses may include anxiety,
loss, loneliness and bereavement.
• Managing disordered intellectual responses, learning difficulties
and mental illness.
 CODE OF ETHICS
American Nurses Association
1.The nurse provides services with respect for human dignity and the uniqueness of
the client unrestricted by considerations of social or economic status, personal
attributes, or the nature of health problems.
2.The nurse safeguards the client’s right to privacy by judiciously protecting
information of a confidential nature.
3.The nurse acts to safeguard the client and the public when health care and safety are
affected by the incompetent, unethical, or illegal practice of any person.
4.The nurse assumes responsibility and accountability for individual nursing
judgments and actions.
5. The nurse maintains competence in nursing.
 CODE OF ETHICS
American Nurses Association
6.The nurse exercises informed judgment and uses individual competence and
qualifications as criteria in seeking consultation, accepting responsibilities, and
delegating nursing activities to others.
7.The nurse participates in activities that contribute to the ongoing development of the
profession’s body of knowledge.
8. The nurse participates in the profession’s efforts to implement and improve
standards of nursing.
9.The nurse participates in the profession’s efforts to establish and maintain conditions
of employment conducive to high-quality nursing care.
10.The nurse participates in the profession’s effort to protect the public from
misinformation and misrepresentation and to maintain the integrity of
nursing.
11.The nurse collaborates with members of the health professions and other citizens in
promoting community and national efforts to meet the health needs of the public.
TRENDS IN NURSING
•Basic nursing education in community colleges and
universities.

•A growing variety of employment settings.

•Growing emphasis on the aspects of nursing that

characterize it as a profession.

•Increasing political influence of nursing.

•Nursing influences on health care policy and practice.