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LEGAL ASPECTS OF NURSING
Responsibility and Accountability
When nurses undertake to practice
their profession, they are held responsibleand accountable for the quality ofperformance of their duties.
Professional Negligence
Refers to the commission or omissionof an act, pursuant to a duty, that areasonably prudent person in the same or
similar circumstance would or would not
do, and acting or the non-acting of whichis the proximate cause of injury to anotherperson or his property.
Elements of negligence1. existence of a duty on the part of
the person charged to use due careunder circumstances.
2. failure to meet the standard ofcare.
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3. the foreseeability of harm resultingfrom failure to meet the standard
4. the fact that the breach of this
standard resulted in an injury tothe plaintiff.
Examples of Negligence1. Failure to report observations to
attending physicians.
2. Failure to exercise the degree ofdiligence, which the circumstancesof the particular case demands.
3. Mistaken identity4. Wrong medicine, wrong
concentration, wrong route, wrong
dose.5. Defects in the equipment such asstretchers and wheelchair that canlead to falls.
6. Administration of medicine withoutdoctors prescription.
Doctrine of Res Ipsa Loquitor The ThingSpeaks for Itself
Examples
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1. Wrong site injection leading tosciatic nerve paralysis
2. Burn area due to spilled hot water
bag or improvised hot water bag
Malpractice
Refers to improper or unskillful care ofa patient by a nurse.
Examples1. Insertion of urinary catheter
causing damage to urinary sphincter2. Failure to properly monitor patient,
resulting in aspiration pneumonia
and death3. Fall during transfer of patient
Doctrine of Force Majeure
Means an irresistible force, one that isunforeseen or inevitable.
Nurses who fail to render serviceduring floods, fire, earthquakes andaccidents are not held negligent.
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Doctrine of Respondeat Superior. Let theMaster answer for the acts of the
subordinate.
The liability is expanded to include thesuperior (doctors, hospitals, chief,head) as well as the nurse performingthe negligent act.
Examples1. The hospital will be held liable, if,
in an effort to cut down onexpenses decides to hire
underboard nurses or any non-
registered health care providers.2. The surgeon will be heldresponsible in a case wherevisceral pack or an instruments is leftin a patients abdomen.
Incompetence
It is the lack of ability, legalqualifications or fitness to discharge therequired duty.
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Liability of Nurses for the Work of NursingAides
Nurses should not delegate theirfunctions to nursing aides since thePhilippine Nursing Act specifies thescope of nursing practice of professionalnurses.
Liability for the Work of Nursing Students
Under the Philippine Nursing Act of2002 RA 9173, nursing students do
not perform professional nursing
duties.
They are to be supervised by theirclinical instructors, in order that theerrors committed by nursing students willbe avoided, the following measuresshould be taken:
1. Nursing students should always beunder the supervision of theirclinical instructors.
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2. They should be given assignmentsthat are at their level of training,experience, and competency.
3. They should be closely supervisedif they are performing proceduresfor the first time.
4. They should be oriented to thepolicies of the nursing unit.
5. Their performance should be
assessed frequently to determinetheir strengths and weaknesses.
6. Frequent conferences with thestudents will reveal their problemswhich they may want to bring to
the attention of their C.I. or vice
versa.
Intravenous Therapy and LegalImplications
Based on the Philippine Nursing Act of1991 Section 28 which states that inthe administration of intravenousinjections, special training shall berequired according to protocol
established.
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Therefore nurses have to undertake acertified training IV Therapy as
developed by ANSAP.Telephone Orders
Telephone orders should be done inemergency cases only.
The nurse should read back such orderto the physician to make certain the orderhas been correctly written.
Such order should be signed by the
physician on his next visit within 24hours.
The nurse should sign the name of thephysician per her own and note the timethe order was received.
Charting Done by Nursing Students
When a nurse or a clinical instructorcountersigns the charting of a nursing
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student he attests that he has personalknowledge of information and that such isaccurate and authentic.
Tort: A legal Wrong
1. Assault - is the imminent threatof harmful or offensive bodilycontact.
Battery - is an intentional,unconsented
touching of anotherperson.
A patient refuses an injectionand the nurse gives it anyway,the nurse can be charged for
battery.
A patient who gets injuredwhile being restrained maycause the nurse to be liable forassault and battery.
2. False Imprisonment or IllegalDetention - the unjustifiable
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Crimes, Misdemeanors, and Felonies
Crimes. It is an act committed oromitted in
violation of the law.
Felony. It is committed with deceitand fault. A
deceit exists when the actis
performed with deliberateintent and
there is fault when the
wrongful acts
result from imprudence, orlack ofskill or foresight.
Examples: rape, murder,drug-related
crimes, theft
Criminal negligence may beclassified into
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reckless imprudence and simpleimprudence.
Reckless imprudence occurswhen a person does an actor fails to do it voluntarily butwithout malice, from which materialdamage results immediately.
Simple imprudence occurswhen the person or nurse didnot use precaution and thedamage was not immediate or
impending danger was not evident or
manifested.
Criminal intent is the state of mindof a
person at the time the criminal actis
committed, that is he knows thatan act is not lawful and stilldecided to do it anyway.
Misdemeanor. Is a general name forcriminal
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offense which does not in law amountto
felony. Punishment is usually fine or
imprisonment of less than one year.
Conspiracy to commit a crime: Whentwo or more persons agree to commita felony and decide to do it. Personswho commit felonies are either
principals, accomplices or accessories.
Principals - are those who take adirect part in
the execution of the act.
Accomplices - are those persons whocooperate inthe execution of the offense
Accessories - are those who, havingknowledge
of the commission ofthe crime,
take part or assistingthe crime
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by concealing thecrime.
Classes of Felonies1. According to the degree of the acts ofexecution
1.1consummated, when the elements(time, place, how) of felony arewell-planned prior to its
execution.1.2 frustrated, when the elements are
present however its executionfailed.
1.3attempted, when the offender
commences the act but does not
perform all the acts whichshall produce the felony by reasonof some cause or accident.
2. According to the degree of punishment2.1grave felonies, are those to which
the law attaches the capitalpunishment (death,
imprisonment from 6 years and 1 day,fine of not exceeding 6,000
pesos).
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2.2 less grave felonies, are those towhich
the law punishes with correctional
imprisonment from 1 day to 6years and, fine of not exceeding6,000 pesos but not less than 200pesos.
2.3 light felonies, are punishable onlywhen they have been
consummated.
Circumstances affecting criminalliability.
1. Justifying Circumstances.
1.1 when one acts in defense of
his life or rights.
2. Exempting Circumstances.2.1 insane person2.2 person under 15 years old2.3 any person who acts under
irresistible force, anduncontrollable fear
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3. Mitigating Circumstances (asituation which lessens theoffense)
3.1no intention3.2the offender is under 18 or over
70years old
3.3presence of provocation orthreat
3.4the offender is suffering fromsevere illness
4. Aggravating Circumstances (asituation / act making the crime
worse)
4.1 taking advantage of his publicposition4.2 when the crime is committed
with insult to publicauthorities
4.3 the crime is committed in aplace of worship
4.4 when the crime is committedduring misfortune andcalamities
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4.5 premeditated crime or after anunlawful entry
4.6 fraud or disguise
5. Alternative Circumstances, arethose which must be taken intoconsideration as
aggravating or mitigating accordingto the offenders relation to
complainant, degree of instructionand education.
Lack of education is not mitigatingin: rape, abduction, arson,
treason, seduction, acts of
lasciviousness (lying on top of thecomplainant, embracingand kissing her, mashing herbreasts, inserting his hand
inside her panty and touching hersexual organ) and heinouscrimes.
Moral TurpitudeIt is the gross disregarding of moral
standards expected of a human being
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while doing some activity or crime.Example: raping a person in front ofher parents or husband.
Murder. Unlawful killing of a person.
Examples:* Death resulting from
abortion
* Euthanasia
Abortion. Expulsion of the fetusbefore the age
of viability.
Infanticide. Killing of a child lessthan 3 daysold.
Parricide. Killing ones father, motheror child whetherlegitimate or illegitimate or any
of his descendants.
Robbery. Taking of the property fromanother person.
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Points to Observe in Order to AvoidCriminal Liability
1. Be familiar with the Philippine NursingLaw.2. At the start of employment, get a copyof your job description, agency rules,regulations and policies.3. Upgrade your skills and competence.
4. Accept only such responsibility that iswithin the scope of your employment andyour job description.5. Do not delegate your responsibility toothers.
6. Determine whether your subordinates
are competent in the work you areassigning them.7. Consult for problems.8. Verify orders that are not clear.9. Keep the value and necessity ofkeeping accurate and adequaterecords.10.Patients are entitled to an informedconsent.
Sources of Law
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Law- ordinance of reason promulgated forthe common good by one whohas legitimate authority. It
consists of enforced rules underwhich a society is governed.
Types of Law1. Public Law - a bill or jointresolution (other than for
amendments to the Constitution)passed by both Houses of Congress
and approved by the President.
Branches1.1Felonies
1.2Misdemeanor
2. Private/Civil Law - a body of lawsregulating relations betweenindividuals or between individualsand corporations concerning
property rights, personal dignity
and freedom, and personal injury.
3. Contract Law - that branch of jurisprudence that studies the
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rights and obligations of partiesentering into contracts.
4. Tort - court cases that seekcompensation for damages..
Criminal LawInvolves the state imposing
sanctions for crimes
committed by individuals so thatsociety can achieve justice and a
peaceable social order.
Administrative LawRefers to the body of law which
regulates bureaucratic managerialprocedures and defines thepowers of administrative
agencies.
Characteristics of a Law1. Authority or the right to declare
that the rule exists.2. The rule is pronounced or
expressed and that its source canbe identified.
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3. A right to enforce the same mustbe provided.
The Controlling Authority of a Law:The
Government
Pronouncement of the Law: Must bedeclared in writing
Good Samaritan LawA rule that exempts from liability a
person (such as an off-dutyphysician/nurse) who voluntarily
renders aid to another in imminent
danger but negligently causes injurywhile rendering theaid.
This rule is to protect those who cometo the aid of others for no other reasonthan kindness.
Nurse-Attorney Relationship
Licensure (discussed in RA 9173)
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Laws, Resolutions, Proclamations andExecutive
Orders Affecting the Practice ofNursing in the Philippines
RA 877 An act regulating the practiceof nursing profession in thePhilippines
RA 4704 June 18, 1966An act amending certain
sections of RA 877 also known asthe Philippine Nursing Law.
RA 6136 August 31, 1970An act amending subparagraphseven of RA 877 (application andexecution of legal orders).
RA 7164 Philippine Nursing Act of 1991
RA 6511 An act amending RA 465 whichstandardized the examination andregistration fees chargedby the various Board of Examiners.
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PRC Memorandum No. 90 11. DatedAugust 20, 1990, provided the new
rates for examination and registration.
LOI No. 1000 March 20, 1980 Pres.Ferdinand Marcos
required that members ofaccredited professional
organizations shall be givenpriority in the hiring of employees in
the government service andin the engagementof professional services.
RA 1612 Privilege Tax Law ProfessionalTaxPayment
RA 7392 June 18, 1960Amended RA 2644 known as
Midwifery Law
RA 2382 The Philippine Medical Act
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RA 5181 This act prescribes permanentresidence and reciprocity asqualifications for any
examination or registration for thepractice of any profession in thePhilippines
RA 6425 Dangerous Drug Act
RA 3573 in 1929 declared that allcommunicable diseases shallbe reported to the nearest
health station and that any personmay be inoculated, administered
or injected with prophylactic
preparations.
RA 1082 Approved on June 1954 andamended by RA 1891 on June 22,1957 provides for the
creation of RHUs.
RA 1891 an act amending someprovisions in RA 1082
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PD791 the revised Population Act.
PD 166 amending PD 791 which
strengthens family planningprograms through participation of
private organizations and individuals inthe formulation andimplementation of the
program planning policies.
General Order No. 18 enjoins allcitizens of the Philippines topromote the concept of family
welfare, responsible parenthood and
family planning.
LOI No. 47 directs all schools ofmedicine, nursing, midwiferyand allied medical professions
and social work to prepare, plan andimplement the
integration of familyplanning in their curricula.
Dept of Labor Order No. 7 requires allindustrial establishments to
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provide familyplanning services.
PD 48 limits paid maternity leaveprivileges to four children.
PD 69 limits the number of children tofour for tax exemption purposes.
PD 965 requires that couples intendingto get married must firstundergo a family planning andresponsible parenthood instruction prior
to the issuance of a marriage
license.
RA 1054 requires the owner, lessee oroperator of any company andestablishment to furnish freeemergency, medical and dental
attendance to his workers.
RA 4226 Hospital Licensure Act
PD 442 Labor Code of the Philippines
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PD 603 Child and Youth Welfare Code
PD 651 decrees the registration of birth
of a child within 30 days with theCivil Registrar
ILO Convention149 provides for theimprovement of lifeand work conditions of nursing
personnel.
PD 1519 gives Medicare benefits to allgovernment employeesregardless of status of
appointment.
PD 1636 requires compulsorymembership in the GSIS orSSS Retirement Plan
PD 626 Employee Compensation andState
Insurance Fund
RA 6675 Generic Act of 1988
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RA 6758 standardizes the salaries ofgovernment employees whichinclude the nursing
personnel
RA 7160 The Local Government Code
RA 7305 The Magna Carta for HealthWorkers
RA 7600 Rooming-in and BreastfeedingAct
RA 7432 Senior Citizens Act
PD 223 creating the ProfessionalRegulation Commission(Board of Nursing) and
prescribing its powers and functions.
PD 541 allows former Filipinoprofessionals to practicetheir respective profession in the
Philippines. Balikbayans may practicetheir profession during the periodof their stay in the country.
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PronouncementsNurses Week - Last week of
October
National CancerConsciousnessWeek - Second week
of January
InternationalWomens Day - March 8
World Health Day - April 7
Earth Day - April 2
National HealthWorkers Day - May 7
World Red CrossDay - May 8
International NursesDay - May 12
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World Diabetes Day - June 27
World AIDS Day - December 1
World BreastfeedingDay - August 1
International DayFor Drug Abuse
and Child Trafficking - January 2