Professional adjustment/ Bioethics

NURSING JURISPRUDENCE- department of law which comprise all legal rules and principles affecting the practice of nursing.

NURSING LEGISLATION- the making of laws, or the body of laws already enacted affecting the practice of nursing.

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

LEGAL RIGHT- a claim which can be enforced by legal means against a person whose duty is to respect it.

COURT MECHANISM:

LAWSUIT- proceeding in court for a purpose.Purpose:

1. to enforce a right2. to redress a wrong

Civil case- Complainant/ defendantCriminal case- Plaintiff/ accused

STATUTE OF LIMITATIONS- the length of time following the event during which the plaintiff may file a lawsuit.Example: negligence- filed within 2-3 years from occurrence.

DUE PROCESS- is fair and orderly process which aims to protect and enforce a person’s right.Fundamental requirements of Due Process:

1. right to be informed2. right to remain silent3. right to have competent counsel4. no use of violence, threat, torture

TRIAL- facts are presented and determined; law is applied at the end

SUMMONS- is a writ commanding an authorized person to notify a party to appear in court to answer a complaint made against him.SUBPOENA- is an order that requires a person to attent at a specific time and place to testify as a witness.SUBPOENA DUCES TECUM- is a subpoena that requires a witness to bring documents/ papers in his possession.

WITNESS- person giving necessary details.

Nurses as witness:Could not divulge PRIVILEGED COMMUNICATION in a civil case- means that the nurse is incompetent to testify on the communications made to him by the patient, all the advice given and all information gathered by observation.

Duration of seal of secrecy except: 1. criminal case 2. with patient’s consent 3. patient sued doctor for damages

Testimonies of fact- factual information- no opinion unless an expert

witness.Perjury- is the willful telling of a lie under oath.Hearsay evidence- rumors not admissible in evidenceDying declaration- considered hearsay unless the dying person is a victim of a crime.

NURSES AND CRIMINAL LIABILTY

FELONIES- acts or omissions punishable by law.Elements:

1. deceit (dolo)- deliberate intent2. fault (culpa)- results from imprudence,

negligence, lack of foresight

Stages of crimes:1. Consummated2. frustrated3. attempted

Degree of crimes:1. Grave- capital punishment, or penalty of above 6 yrs

and one day, or fine of more than 6 thousand pesos.2. Less grave- penalty of 1 month and 1 day- 6 yrs, or

fine 0f not more than 6k but not less than 200 pesos.3. Light- penalty of 1day to 30 days, or fine of not more

than 200 pesos.

Classification of persons criminally liable:1. Principal

a. by direct participationb. by inducementc. by indispensable cooperation

2. Accomplice- “ accessory before the fact”3. Accessory- “ accessory after the fact”

a. profiting themselves or assisting others to profit

b. concealing/ destroying the evidence of the crime

c. harboring or assisting the escape of the principal

Circumstances affecting criminal liability:1. Justifying circumstance- not criminally liable

a. lawful self-defenseelements:

1. unlawful aggression2. reasonable necessity of the means employed

by the offender3. lack of sufficient provocation

b. obedience to an lawful order of superior2. Exempting circumstance- exempted from criminal

liabilitya. imbecile/ insane, except lucid intervalb. person below 9 years oldc. person above 9 and below 15 unless acted

with discernmentd. performance of a lawful act

3. Mitigating circumstance- reduces penaltya. below 18 y/o or over 70 y/ob. does not meet all requisite circumstancesc. offender is deaf, dumb, blind or with

physical defectd. voluntary surrendere. illness diminishing exercise of the will

power

4. Aggravating circumstance- increases liabilitya. take advantage of public positionb. committed with abuse of confidencec. on occasion of earthquake, epidemic,

calamityd. for price or rewarde. fire, poison, explosionf. evident premeditationg. craft, fraud or disguiseh. treachery

5. Alternative circumstances-

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a. relationshipb. intoxicationc. degree of instruction/ education

Crimes concerning nurses:1. Parricide2. homicide3. murder4. infanticide5. abortion6. illegal detention/ false imprisonment7. simulation of birth8. misdemeanor9. robbery10. theft11. assault12. battery13. invasion of privacy14. defamation- slander

- libel

Guidelines to prevent criminal liability:1. be familiar with Phil Nursing Law2. be familiar with laws affecting the nursing practice3. know agency rules, regulations, policies4. upgrade skills and competence5. develop good IPR6. consult superior as needed7. verify vague/ erroneous orders8. always keep doctor updated regarding patient9. ensure accurate recording and reporting10. informed consent

Legal considerations in charting:1. don’t tamper with medical records2. observe agency’s standards on documentation

- complete, concise, specific, use standard abbreviations

- telephone orders

Tips for avoiding legal pitfalls:1. Patient falls

- do proper assessment- appropriate assistance is given- use protective measures- document all nursing interventions

2. Medication error- observe 7 R’s of drug

administration- check dr’s order- consult drug handbook/ pharmacy- not exempt from liability for

following dr’s order

3. Equipment injuries- refuse to use a device not knopw

how to operate- report adverse events to superiors- monitor patient regularly

Nurses and Contracts/ Wills

Contract- agreement between atleast two parties which create an obligation recognized by law. There must be acceptance of the obligation.

Elements of a valid contract:1. given freely2. competent parties3. lawful object4. valid consideration

Types of contracts:1. Implied- terms are inferred from the actions of the

parties2. Expressed- verbal/ written, terms are specified

Breach of Contract: failure without legal excuse to perform any promise which forms the whole or part of the contract.

Will- an act whereby a person is permitted with formalities of law to control to a certain degree the disposition of a state to take effect after his death.

Decedent- person whose property is transmitted through successionTestator- a decedent who left a will

Two kinds of wills:1. Notarial2. Holographic

Nurse’s obligation in the execution of a will:1. Note the soundness of cliet’s mind2. that the will is signed by the testator3. that the witnesses shall be present at the time and

sign in the p-rese4nce of the testator.

Gifts Mortis Causa- disposing of gifts by a person in anticipation of death/ belief in approaching death.

- limited to personal properties- acceptance by the recipient- gifts are revocable and subject to

the claims of creditor’s without proof of intent of defrauding them.

NEGLIGENCE AND MALPRACTICENEGLIGENCE- Doing of that thing which a reasonably prudent person would not have done; or the failure to do that thing which a reasonably prudent person would have done in like or similar circumstances.

* 3 ESSENTIAL CONDITIONS FOR ACTIONABLE NEGLIGENCE:

1. Existence of a duty on the part of the person charged to protect the complaining party from the injury received.

2. Failure to perform that duty.3. Injury resulting from such failure.

Burden of Proof: complaining or injured party

* DOCTRINES UNDER NEGLIGENCE:1. Doctrine of “ Res ipsa Loquitur “- the thing speaks

for itself Three Conditions:

A) Accident must be of a kind which ordinarily does not occur in the absence of someone’s negligence;

B) The accident must be caused by an agency or instrumentality within the exclusive control of defendant;

C) Not have been due to any voluntary action or contribution on the part of injured party.

Examples of Cases:- Negligence resulting to injury to a

delirious patient Maki vs Murray Hospital

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- Liability for sponge left in the patient’s abdomen

Ales vs Ryan2. Doctrine of “ Respondeat Superior” – Let the

principal answer for the acts of his agent

Application: Failure of servant to use such care necessary in the course of employment.

- not applied if acting outside the legitimate scope of his authority.

Examples of Cases:

- Liability for burns due to hot water bag

Aderhold vs Bishop- Liability for death of infant due to

overdose of Digitalis Nortow vs Argonaut Ins. Company

3. Effect of “ Force Majeur”- Act of God; Irresistible or superior force

- Neither foresee or prevent; fortuitous event

Not answerable unless: A) Expressly specified by the law. B) Declared by stipulation. C) Nature of obligation requires assumption of risk.

* THE NURSE AND THE DOCTOR’S ORDERS - it is expected that nurses exercise reasonable judgment/ sound discretion in carrying out doctor’s orders.

- if life of patient is endangered, liable for criminal negligence or reckless imprudence

Somera Case

MALPRACTICE- Any professional misconduct, or any unreasonable lack of skill or fidelity in the performance of professional or fiduciary duties:

- Objectionable practice/ Contrary to established rules;

Example: Nurse giving out prescription of drugs

PHILIPPINE NURSING ACT ( RA 9173)

I. BOARD OF NURSING- composed of a chairperson and six members- appointment:- appointed by president of the republic of the

phils.

- qualification:a. natural born citizen and resident of the philsb. member of good standingc. be a registered nurse and holder of master’s

degree in nursing, education or other allied medical profession

d. ten years of continuous practice, last five years in the phils

e. no conviction of any offense involving moral turpitude

- Term of office:a. Appointed for 3 years/ reappointment for two years or two terms only

b. Appointment to vacancy shall be for the unexpired portion of the termc. proper oath of office

- Powers, functions and duties:a. conduct licensure exam for nursesb. issue, suspend or revoke certificates of

registration for the practice of nursingc. monitor and enforce quality standards of

nursing practiced. ensure quality nursing educatione. conduct hearings and investigations to

resolve complaints against nurse practitioners

f. promulgate a code of ethicsg. recognize nursing specialty organizationsh. prescribe, adopt, issue and promulgate

guidelines, regulations, measures and decisions as maybe necessary

- Grounds for Removal or suspension of a member:a. continued neglect of duty or incompetenceb. commission or tolerance of irregularities in

the licensure examinationc. unprofessional, immoral and dishonorable

conduct- Requirements upon qualification:

a. Immediately resign from any teaching position in any institution offering BSN and/or review program;

b. Immediately resign from any govt or private employment;

c. Not have pecuniary interest in, or administrative supervision in any istitution offering BSN or review classes.

II. EXAMINATION AND REGISTRATION

- Qualification for admission to the licensure exam:a. Citizen of the Philippines or by reciprocity;b. Good Moral Character;

Suspended by PRC Resolution No. 2004-192Reasons:1. Proliferation of enterprising

professionals victimizing examinees from the provinces;

2. Reports that pre-signed certificates of GMC are also allegedly being sold outside;

3. Additional expensesc. Holder of BSN Degree from a school duly

recognized- Ratings

a. General average of atleast 75% with a rating of not below 60% in any subject;

b. If above 75% but with a subject below 60%, must repeat that subject with a rating above 75%

- Oath taking- Issuance of Certificate of Reg/Prof License

a. Bearing – full name of the registrant; - serial number; - signature of the Chairperson and members of the Board;

- official seal of the Commission and the Board

b. PRC CARD – bears :- Date of Registration; - License Number;

- Date of Issuance and Expiration Date

- Renewal- Third year on birth month

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REGISTRATION BY RECIPROCITY:Conditions before nurses registered in a foreign country can practice in the phils:1. the requirements for registration in their country are

substantially the same in our country;2. Under their laws, Filipino nurses are granted the same

privileges and on the same basis as their citizens.

SPECIAL OR TEMPORARY PERMIT TO PRACTICE FOR LICENSED FOREIGN NURSES:1. well-known specialists or outstanding expert2. on a medical mission3. employed as exchange professors permit valid for the duration of the project, mission or

employment contract.

GROUNDS FOR REVOCATION AND SUSPENSION OF PROFESSIONAL LICENSE:1. Conviction by final judgment of any criminal offense

involving moral turpitude, immoral or dishonorable conduct, having unsound mind

2. Unprofessional or unethical conduct3. Gross incompetence or serious ignorance4. Malpractice or negligence5. Use of fraud, deceit or false statements in obtaining a cert

of registration6. Violation of RA 9173, Code of Ethics for nurses BR 220 7. Practicing profession during suspension

REQUIREMENTS FOR RE-ISSUANCE OF REVOKED CERTIFICATE OR REPLACEMENT OF LOSS CERTIFICATE:1. Expiration of a maximum of four years from date of

revocation2. Cause of revocation has disappeared or has been corrected3. Request is to replace lost, destroyed or mutilated cert/

license4. Proper application5. Payment of required fees

III. NURSING EDUCATION- Inactive nurses for a period of Five (5) Consecutive years can return to practice after one month didactic training and three months of practicum. The Board shall accredit hospitals to conduct said training.

- FACULTY OF NURSING- Qualifications:

a. registered nurseb. atleast one year clinical experiencec. member of good standingd. holder of master’s degree in nursing,

education or other allied medical and health sciences

- DEANS Qualifications:

a. Same with faculty; b. Atleast five years of experience in teaching and supervising a nursing education program

IV. NURSING PRACTICE

- SCOPE OF NURSING PRACTICE:1. singly or in collaboration with another, initiates and

performs nursing services to individuals,families and communities

2. provide nursing care from delivery up to old age3. as independent practitioner, primarily responsible for the

promotion of health and prevention of illness4. collaborates with other members of health team

- DUTIES OF NURSES:1. Provide nursing care2. Establish linkages with community resources 3. Provide health education4. Teach, guide and supervise students in nursing programs5. Undertake research and training, professional continuing

education6. Observe Code of Ethics

-QUALIFICATIONS OF NURSING ADMINISTRATORS

1. Supervisory or Managerial positions- Qualifications:

a. registered nurse in the Philippinesb. atleast two years experience in nursing

administrationc. with atleast nine units in management and

administrationd. member of good standing of accredited

professional org of nurses2. if the position is for chief nurse or director:

a. Same with supervisors;b. atleast five years of experience in a

supervisory or managerial positionc. a master’s degree major in nursing

3. Chief nurse for primary hospital:a. two years experience in general nursing

service administrationb. nine units management and

administration course

4. Chief nurse in public health agencies:a. master’s degree in public health/ CHN

be given priority

5. Chief nurse in military hospitals:a. master’s degree in nursing and

completion of the General Staff Course

V. Comprehensive Nursing Specialty Program- Beneficiaries are 1. Issued a Certificate of

Completion 2. Must serve in any Phil. Hospital for atleast two years of continuous service

Incentives and benefits: - limited to non-cash benefits such as: - free hospital care for nurses and their dependents;

- scholarship grants and others

VI. Penal and Miscellaneous Provisions

Prohibitions in the practice:Any person practicing nursing1. without a Cert of registration/ prof license and

PRC Card2. uses an invalid certificate;3. uses a suspended or revoked Certificate or

expired or cancelled permit4. gives false evidence to the Board5. falsely poses or advertises or conveys the

impression that he is a registered nurse6. who appends BSN, RN without authority7. who as aregistered nurse, assists illegal practice

of a non-qualified person

Penalties: a fine of not less than P50000. Nor more than

P100,000. Or imprisonment of not less than 1 year nor

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more than six years, or both, upon the discretion of the court.

LAWS AFFECTING NURSING PRACTICE

I. LAWS AFFECTING HEALTH/ STATUSRA 6675- GENERIC DRUG ACT OF 1988 Generic name- identification of drugs with scientifically and internationally recognized active ingredients. Brand name- propriety name given by manufacturer Essential drug list- list of drugs prepared by DOH on the basis of health conditions in the Phils as well as internationally accepted criteria.

Relevant provisions:- All government and private agencies and their

personnel shall use the generic terminologies for drug quality in all instances.

- The label of all drugs and medicines shall have the following: name, country of manufacture, date of manufacture and expiration

- Prescription should include generic and trade name of the drug, quantity, doctor’s signature, license number and PTR number

RA 953 – NARCOTIC DRUG ACT- registration and imposition of license on all

persons who deal in narcotic drugs and the control of the legal traffic in narcotic drugs.

- Narcotics- drugs which produces insensibility, stupor, melancholy or dullness of mind, habit forming

- Prohibited drugs- drugs with opium, coca leaf, heroine, morphine,LSD

- Regulated drugs- self-inducing sedatives, secobarbitals, hypnotic drugs

RA 6425- provision of S2- code of selected doctors who can prescribe narcotic drugs

PD 603- CHILD AND YOUTH WELFARE CODE- highlights the role of the nurse which include

immediate registration of births, child’s enjoyment of highest standard of health, uphold child’s freedom of expression, child’s inherent right to life, access to basic health services.

PD 996- provided for compulsory basic immunization for infants and children below 8 years oldPD 949- Primary health careRA 3573- an act providing for the prevention and suppression of dangerous communicable diseases

II. LAWS THAT PROMOTE THE WELFARE AND WELL BEING OF NURSESRA 7305- Magna Carta of Public Health Workers

- has provisions on the benefits, rights and responsibilities of public health workers

PD 442 – Labor Code of the PhilippinesPD 807- Civil Service Law- provides for recruitement and selection of employees in govt serviceRA 7877- Anti- Sexual Harassment Act

III. LAWS THAT PROVIDE THE RESPONSIBILITY OF THE EMPLOYEESRA 6713- Code of conduct and Ethical Standards for Public Officials and Employees

- public officials and employees shall at all times be accountable to the people and shall discharge their duties with utmost responsibility, integrity, competence and uphold public interest

RA 8344- An act penalizing the refusal of Hospitals and medical Clinics to administer appropriate initial treatment and support in emergency casesRA 7160- Local Government Code

- general features include decentralization and local autonomy

- the Local chief executive have the power over budgets for health, implementation of programs and appointment of personnel.

PROFESSIONAL ADJUSTMENT- growth of the individual and development of his

capacities- physical, mental, emotional, social and spiritual.

Characteristics of a profession:a. Altruism- work for the good of societyb. Autonomy- self- determinationc. Authority- based on knowledged. Accountability- answerable for their conduct and

responsible for their practice.e. Code of Ethics- relevance to social valuesf. Distinct identity

NURSING ETHICS

ETHICS- study of the norm of human acts as guided by human reason.

Theories:1. EGOISM- self-interest of the doer determines goodness

of the act.2. UTILITARIANISM- consequentialism Ethical if: - minimizes pain and suffering

- maximizes pleasure- seeks happiness of the majority

3. DEONTOLOGISM- legalistic view- “ what is legal is not necessarily

ethical4. RELATIVISM/ SUBJECTIVISM- standard of right or

wrong is relative to people, to time and to place.5. SITUATIONALISM- “ love theory’6. NATURAL LAW THEORY- work of creator

- if acts preserves life, it is good; if rejects life, it is bad.

Principles:1. BENEFICENCE- means to do good and not to do harm.2. NON- MALEFICENCE- one ought not to inflict evil or

harm.3. AUTONOMY- means self-determination4. JUSTICE- refers to the obligation to be fair to other

people.5. VERACITY- refers to telling the truth or not intentionally

deceiving or misleading patients6. STEWARDSHIP- not harm our body because it is God’s

not ours.

PATIENT’S BILL OF RIGHTS1. Right to considerate and respectful care- nurse avoids discriminating acts that tends to bring the appearance of favoritism- “ tender loving care attitude”2. Right to information about diagnosis, treatment and prognosis 3. Right to informed consent- refers to the capacity of the patient to accept or refuse treatment options offered by the health care provider.Elements:a. voluntarinessb. information

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c. capacity4. Right to refuse treatment- waiver signed5. Right to Privacy6. Right to confidentiality- all records and communications held in confidence- when to divulge information:a. patient placed in serious dangerb. public welfarec. legal proceeding7. Right to services and to transfer- referrals8. Right to know relationship with other health care and

educational institutions9. Right not to be subjects of research or

experimentation10. Right to expect reasonable continuity of care- follow up consultations11. Right to examine and receive an explanation of his bill12. Right to know what hospital rules and regulations

apply to his conduct as a patient

NURSING CODE OF ETHICS- BR # 220

Four basic ethical principles:a. Fundamental responsibility of the nurse is four foldb. Nurse renders service regardless of race, creed,

nationality or political belief.c. Nurse protects life and respects the dignity of man.d. Nurse works in collaboration with members of the health

team.

BIOETHICS- is the study of human conduct in the area of the life sciences and health care using moral values and principles.Examples: abortion, euthanasia, contraception, art. Insemination etc.

ETHICAL DILEMMAS

1) ARTIFICIAL INSEMINATION- is a procedure or process whereby the fertilization of an egg is the result of the sperm being introduced into the female reproductive system other than the natural, that is, other than the sexual act or intercourse.

Types: 1) Artificial Insemination by the Husband

(AIH) or Homologous Type2) Artificial Insemination by a Donor(AID) or

Heterologous Type

2) IN VITRO FERTILIZATION- Laboratory procedure whereby one or a few eggs are surgically taken from a woman’s ovary, fertilized with sperm in a petri dish, and transferred to and implanted in the woman’s uterus, hoping for a normal pregnancy to happen.

3) HUMAN CLONING- Refers to the production of one or more living human beings that are genetically identical to an original human being.

Types:1) Embryo Cloning- “ Artificial Twinning”2) Adult DNA Cloning3) Therapeutic Cloning ( Somatic Cell Nuclear

Transfer)

4) CONTRACEPTION- is any act done befor, during, or after the act of intercourse that purposely frustrates begetting of new life.

Types:1) Direct- deliberately intended

a) Artificial- Mechanical =

condom,diaphragm,cervical cup, IUD

- Chemical = cervical sponge, vaginal suppository, vaginal jelly

- Surgical = tubal ligation, vasectomy

b) Natural

2) Indirect

Argument that support contraception:- Woman’s autonomy or right- Situationalism ( Love Theory)- Utilitarianism (Sexual pleasure or

happiness)- Population “Time Bomb”

5) ABORTION- Termination of pregnancy, which begins at the moment of conception, when the sperm fertilizes the egg, and ends at the birth of the child.

Types:1) Spontaneous Abortion- miscarriage, kind

that occurs without medical or some other kind of intervention.

- Complete- all content in uterus expelled

- Incomplete- part or entire placent is retained

- Missed abortion- fetus is retained in the uterus for a period of time after its death.

2) Direct, induced or procured Abortion- elective or therapeutic abortion

- Early Uterine Evacuation or Vacuum aspiration- suctioning

- Dilatation and Evacuation, Dilatation and Curettage (D & C)

- Prostaglandin and Saline injection- through amniotic sac

- Hysterectomy

3) Indirect Abortion- necessary result of another medical procedure.

Right of the mother versus Right of the unborn/ fetus

Principle of Double Effect- refers to an act that causes two immediate effects: one,good,the other bad.

- Conditions:1) The act must either be

good or at least indifferent.

2) The intention is to achieve the good effect.

3) The expected good effect must be equal to or greater than the harmful effect that is expected.

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4) The good effect must follow from the action,or at least,must happen as immediately as the bad effect.

6) EUTHANASIA- “ MERCY KILLING”, is the intentional taking of the life of an ailing person, for any of the following reasons: Incurability of illness, Unbearable intensity of physical or emotional pain, unbearable financial burden arising from the illness.

Types:1) By Reason of the manner of attaining death

A) Active or Direct Euthanasia- the active taking of steps by the physician or the caregiver to end the life of the patient.

B) Passive or Indirect Euthanasia- the intentional omission or non-administration of medical treatmentto cause or hasten the death of the patient.

2) By reason of patient’s consentA) Voluntary Euthanasia- the patient

consciously and directly requests the health care provider to take the steps to put an end to the patient’s life.

B) Involuntary Euthanasia- the act of seeking the death of the patient is without the patient’s consent or knowledge.

Argument favoring Euthanasia:- compassion for the patient and

shortening the period of suffering of the patient

Argument disapproving Euthanasia:- it is intrinsically wrong since it

rejects life.

7. PHYSICIAN ASSISTED SUICIDE- the patient requests from the physician to provide the means to end his life.

8. HUMAN TRANSPLANTATION- surgiccal procedure whereby an organ or tissue is transferred from one part of the body to another or from one organism to another organism.

TYPES:1. Autotransplantation- donor and recipient are one and the

same Ex: skin and bones

2. Heterologous- donor and recipient are two different individuals.a. animal to humanb. human to human

cadaver donor living donor

Ethical considerations:1. Principle of totality

Body mutilation is ethical for the sake of saving the whole body or of preserving life.

ADVANCE CARE DIRECTIVE- makes known in writing the wishes or preferences of the patient when no longer able to speak for himself.

TYPES:1. INSTRUCTIVE DIRECTIVE- specifies life- sustaining

treatment to be withheld or withdrawn.

Ex: living will

2. PROXY OR DURABLE POWER OF ATTORNEY- assigns a surrogate if becomes unconscious or mentally incompetent

LEADERSHIP AND MANAGEMENT

Leadership: is a learned behavior involving influence and role modeling that inspires people to achieve personal and group goals.

Attributes of a good leader: Self awareness Self confidence Advocacy Accountability

Different leadership styles:Autocratic-leaders exert total control over members-focus is on productivityDemocratic-leader shares control with group membersLaisez-faire-leader relinguishes control to group members.-there is total freedom in a hihgly permissive atmosphere.Multi critic-leader utilizes varying styles depending on the situation.

Management-process of coordinating and supervising personnel and resources to accomplish organizational goals.

Attributes of an effective manager: Vision to plan for the future of the organization Increased trust Sound communication Increased decision making ability Organizational skills Neutral(ability to balance)

Nursing management functions:-Planning-organizingstaffingdirectingcontrolling

PLANNING:-forecasting of events, and based on which decisions are made, goals are set and prioritized and policies and standards are developed.Different types of planning:1. long range or strategic planning-extends from 3-5 years into the future 2. short range or operational planning-deals with day to day maintenance activities.Purposes of Planning:D-irects the organizationI-mproves efficiencyR-esources are maximizedE-fective for controllingC-ost effective measures are identifiedT-otal enhancement of communication and coordination

Phases of Planning:1. determining objectives2. collecting data3. developing a plan of action

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4. evaluating the plan

BUDGETING:-planning and controlling resources that affect the organization-involves examining resources, anticipating costs and predicting gains and shortfalls.

Purposes of Allocation of Budget:1. promotes proper allocation of resources 2. promotes smooth and efficient organizational operation3. serves as a tool for modification and changes in the

organization4. ensures availability or resources for the organizations

achievement of goals5. enables the management to control the organization by

allocating resources.

Two commonly used approaches to budgeting:1. Incremental Budgeting-budget is developed annually based on the previous years expenditure2. Zero-based Budgeting-each year the budget begins at zero.

Processes involved in Budgeting:1. planning2. preparation3. modification and approval4. monitoring

ORGANIZING:-structuring the agency to accomplish the tasks necessary to meet the agency goals.Different Functions of the Nurse in Organizing:-establishing objectives-establishing the structure to carry out plans-determining the most appropriate type of patient care delivery-grouping activities to meet unit goals-working with in the structure of the organization-understanding and using power and authorityMISSION:-describes and reflects an organizations core value.VISION:-provides an image of the desired future.PHILOSOPHY:-is a statement of belief that influences nursing practice

Different types of organizing client care1. Case Nursing-oldest approach-a nurse is responsible for all the care required for a particular patient-usually used in critical care units2. Functional Nursing–task-oriented–a nurse performs specific tasks and procedures according to schedule 3. Team Nursing-based on group approach-staff members work as a team4. Primary Nursing-involves comprehensive care of patients-the primary nurse has a 24-hour responsibility for the assigned patients.

STAFFING:-refers to the required number and mix of nursing personnel in a nursing unit with in a 4 hour period.Main purpose of Staffing:-to provide safe, quality care.Determinants of Staffing: Number of personnel Mix of personnel

Number of patients Type of patient care delivery system Classification of patients

Types of Staffing:1. centralized staffing:-assignment of personnel is made by the nurse manager at the organizational level.2. decentralized staffing-allocation of nursing personnel at the unit level.

DIRECTING:-Is the issuance of assignment, orders and instructions that permit the worker to understand what is expected of him or her and guidance and overseeing of the worker so that he or she can contribute effectively and efficiently to the attainment of organizational goals.POWER-the ability to impose the will of one person or group to bring about certain behaviors in other persons or groups.AUTHORITY-is the legitimate right to give commands.Different forms of Power:

NURSING RESEARCH

Nursing Research-scientific process that validate and refines existing knowledge and generate new knowledge that directly influence nursing practice.

-includes the study of all aspects, components, activities and phenomena relating to health and of interest to nurses.

Importance of Research In Nursing:So that we could: describe, explain, predict and control

Purpose:1. to generate new knowledge2. to develop new gadgets, techniques3. to evaluate a program or technique4. to validate theories

TYPES:1. According to motive or purpose

a. basic- for knowledge sakeb. applied- practical, knowledge generated

2. According to methodologya. descriptive- exploration and description of a

phenomena in real life situations- may use survey method- common methods used are

questionnaire, interview, observation

b. Correlation- examines linear relations between 2 or more variables

- determines the type ( + or - ) and degree of relationship

c. Quasi- experimental- examines cause and effect- done in partially controlled

situations- Quasi experiment may or may not

have control groups and random assignment may or may not be made.

d. experimental- examines cause and effect- done in highly controlled conditions- independent variable is manipulated

True experiment has three features: 1. subjects are randomly assigned2. experimental variable is manipulated3. with at least 2 groups-experimental and control.

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e. historical- study conducted regarding the past.

Limitations in Nursing research:1. Ethico- legal considerations2. Measurement problem

a. face validity- doing pretests by giving questionnaireb. contrast validity- done by giving the tool to group of

experts

Differences between the two Basic Types of Research:1. Qualitative- collection of narrative data

- undertaken to describe natural phenomena without controlling or manipulating variables

- examples: historical research,researches regarding beliefs and practices, experiences

2. Qualitative- collection of numerical data- statistical analysis, control research

conditions- examples: experimental studies,

extent of knowledge, effectiveness

Steps in the Research Process:1. Identify the problem2. Conduct literature review3. Identify theoretical/conceptual framework4. Formulate hypothesis5. Operationalize variables6. Select research design7. Ascertain and select sample8. Conduct a pilot study9. Collect data10. Analyze data11. Interpret results12. Disseminate information

Research Problem:Is a situation in need of description or quantification, solution, imrovement or alteration.You can evaluate these problems by using the following criteria:1. Significance of the problem2. Researchability of the problem3. Feasibility4. Interest to the researcher

Sources of problem:1. experience2. review of rel literature3. issues and popular concern4. replication studies5. intellectual curiosity

Purposes of a literature review:1. Search for research ideas/topics2. Be oriented on what is known3. Establish the conceptual context of our study4. Assess the feasibility of the study that we are planning5. Be informed on research approachSources of data:1. Primary data- provided directly by the subjects under

study, the most unbiased raw materialExample: letters, diaries, speeches, interview

2. Secondary data- involve someone who is not directly the source of informationEx: opinions, write ups

Data collected based on time orientation:1. retrospective- certain events in the present is linked to a

particular phenomenon in the past.

2. Cross-sectional- involves different age groups3. Longitudinal- one group is studied for a longer period of

time

Framework:Is an abstract logical structure of meaning that guides the development of the study and enables the researcher to link the findings to nursing body of knowledge.

A conceptual framework deals with abstractions that are put together because of their relevance to a common theme. Unlike a theoretical framework, it does not have a deductive system or propositions that assert a relationship between the concepts.

Hypothesis:-is a statement of the anticipated or expected relationship between the independent and dependent variables.Types:1. Null hypothesis- states no relationship between variables2. Research hypothesis- gives the predicted relationship

Complexity of Hypothesis:1. Simple- one independent and one dependent variable2. Complex or Multivariate- 2 or more independent or

dependent variable

Variable-Is any quality of a person, institution or situation that varies or takes on different values.

Independent vs dependent variables:An independent variable is the presumed “cause” while the dependent variable is the presumed “effect”. The variability in the dependent variable is presumed to be due to the variability in the independent variable.

Extraneous vs interveningExtraneous variables are other factors that affects the measurement of the IV or DV Example: knowledge, attitudeIntervening variables are any factor that are not directly observable in research situation but which maybe affecting the behavior of the subject.

Examples:1. Problems and coping strategies of COPD Patient.

IV- COPD, DV- Degree of seriousness, IV- problems and coping strategies

2. Difficulties of nursing students in doing nursing research: A basis for research enhancementIV- nsng research, DV- difficulties, EV- a basis for research enhancement

3. Transcultural care rendered by staff nurses to hypertensive patients.IV- transcultural care, DV-level of care

Operational Definition:Is a specification of the operations that researcher must perform to collect the required information.

Examples of data collection methods:-physiological/biological measures-observational methods-use of checklists and rating scales-interviews-use of questionnaires-psychological measures-content analysis-diaries

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Difference between validity and reliability:The validity of research tool is the extent to which the instrument actually reflects the construct or variable being examined.

External- applicability and generality of findingsInternal- truth value of findings

Reliability is concerned with how consistently the measurement technique measures the concept of interest.

Different levels of measurement in research:NOMINAL is used when data can be organized into categories of a defined property but the categories can not be compared.ORDINAL is used when data can be assigned to categories of an attribute that can be ranked.INTERVAL have equal numerical distances between intervals in the scale; there is no absolute zero point.RATIO is the highest form of measure; similar to interval except that it has an absolute zero point.

Difference between non-probability and probability sampling:In non-probability sampling, not every element of the population has an opportunity to be included. Examples: accidental/convenience, quota, purposive and network/snowballing.In probability sampling, every member of the population has a probability of being included in the sample. Examples: simple random sampling, stratified random sampling, cluster sampling and systematic sampling.

Data Summary and Analysis:Frequency tabulationsMeasure of central tendency-mean, median, mode

Difference between internal and external validity:Internal Validity: is the extent to which the results of the study can actually be attributed to the action of the independent variable, and not something else.

External Validity: is the degree to which the findings of the study are generalizable to the target population.

Ethical issues and considerations in research:Autonomy:The researcher should get the research participants/respondents’ informed consent. Informed consent implies that: 1. the participant received adequate information about the

research project2. the participant understood what he/she is expected to do

and the implications of his/her participation3. he/she participated voluntarily.

2. Right to privacy:The researcher should ensure the anonymity of the research participants and the confidentiality of the data/information collected from them.

3. Anonymity: Protection of participants in a study that even the researcher can not link them with the information they provided.

4. Confidentiality: Protection of the participants that their identities will not be linked to the information they provided and will never publicly divulged.

5. BeneficenceImplies the benefits of the research to the research subject/participants. This should be adequately explained to the participants.

6. Nonmaleficence-means avoidance of harm or reduction of risks to the research subject. The researcher should weigh the risks and the benefits of the study. The benefits should be far greater than the risks.

7. Social JusticeIncludes these issues:1. right to be represented in the sample2. right of equal access to knowledge3. right not to be discriminated againstThis ethical value is prominent in experimental studies, particularly those studies that have great promise to do good (e.g. drug that may cure a disease) to the participants.

Elements of an ethical research:1. protecting subjects’ rights2. balancing the benefits and risks in a study3. obtaining informed consent4. obtaining institutional approval for research

NUREMBERG CODE- guide researchers to conduct human experimentation – informed consent

DECLARATION OF HELSINSKI- experiment should not be done in violation of human rights.

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