Pentagon Professional Adjustment, Legal Management, Ethics & Research in

Nursing
NURSING RESEARCH
Nursing Research
Kerlinger - the systematic, empirical, controlled
and critical investigation o a hypothetical
proposition in relation to a nat!ral phenomena"
pro#lem
Cond!cted to a$rm or deny a hypothesis
Phenomenon%
everyday phenomenon that a&ects the n!rse 'eg% #acteria, dr!gs, physician(
)henomenon * hypothesis + research pro#lem
,'ed!cated g!ess"scienti-c" tentative ans.er(
/itho!t hypothesis there is no research pro#lem, only a pro#lem
Major Characteristics of a Good or Major Research
Systematic
o cond!ct research in a step #y step process or proced!re
Emirical
o o#0ective data sho!ld #e o#serva#le"meas!ra#le or readily collected !sing yo!r
senses
Controlled! maniulated
o 1ethods"tool o controlling is research design
Critical in"estigation!fact #nding in"estigation
o In order to ans.er the data is #y !sing acts%
o 2oo3ing or h!man #eings .ho can give !s acts
Purose of Research in Nursing Profession $%EE%&
%escriti"e
o o#serve, descri#e and record
o gain richer amiliarity regarding the phenomena
o 4556 3no.n to RN
E'loratory
o E7plore to those areas that are !n3no.n
o 8#serve more
o 956-956 '9563no.n to n!rses and 956 !n3no.n to the n!rses
E'erimental
o Active intervention, active manip!lation
o /ant to -nd o!t ca!se : e&ect
o ;one something #eore o#serving res!lts
%e"elomental
o <o improve the system o care or the yo!r patient%
o ;evelop and improve e7isting system
Conducting research is for the beneft the pt or patient care/pt focus
Ethics of a Researcher
S = Scienti#c ()jecti"e = cond!ctive research or a good p!rpose or o#0ect or yo!r pt
C = Cooeration and Consent% ;o not cond!ct data"e7periment ."o a consent 'legally
the patient o.ns the chart% Ho.ever the hospital o.ns the chart(
* = *ntegrity = .or3ed hard on the research
E = E+uita)le = ac3no.ledging .or3s or contri#!tion o others
N = No)ility = protect the rights o yo!r s!#0ects
o Right not to )e harmed
'physical, mental, moral harm( !s!ally done d!ring e7perimental research
Physical ,arm! Negligence - !ndeli#erate physical harm
1
Florence Nightingale
Birthplace Italy
Training Ground Germany
Greatest Contribution
environmental Theory, training
RNs in Crimean War
Commission = done o!tside the standard practice o n!rsing 'eg% !rinary
catheter placed on the nose o the pt(
(mission = rom the very start, yo! did not do something a#o!t it%
Moral ,arm
Assault = mental ear"threat .itho!t physical harm
-attery = physically yo! harm the pt
Restraint is never an independent n!rsing order
physical restraint = eg% >ac3et
chemical restraint = eg% !se o psychotropic dr!g
Moral harm
Slander = oral deamation
Li)el = p!#lished or placed in the ne.spaper
o Right to self.determination
o Right to ri"acy
Anonymity = identity o s!#0ect may not #e disclosed% )rivacy o the Inormant
'pt( eg% cond!ct a st!dy on HI? pt% #!t the pt .ants his name to #e .ritten in
the ne.spaper as 1r% @, 1r% A or 1r% /
Con#dentiality = inormation acB!ired m!st #e disclosed% )rivacy o the
inormation eg% cond!ct a st!dy on HI? pt% #!t the pt .ants the n!rse sho!ld
only 3no.
/ = /ruthfulness = p!t only the data yo! have collected
* = *mortance = importance to the n!rsing proession
0 = 0actual = acts or data
* = *deal 'ollo. the 44 steps o research(
C = Courage
Stes in Nursing Research Process
*denti#cation!formulation of research
o ro)lem - anything that reB!ires sol!tion thr! scientiic investigation%
o So!rces o pro#lem C
C = concepts 'Ca, )<D, 1I(
L = literat!re, essays, #oo3s, 0o!rnals
* = Iss!es
E = e7perience
N = N!rsing pro#lems
/ = theories
o Characteristics o a research pro#lem
G = general applica#ility and !se
Re = Researcha#le
0 = Eeasi#le and meas!ra#le
0 1 actors o a easi#le research C
time, money, e7perience o the researcher, instr!ments,
pop!lation
* = importance to n!rsing proession
N = novelty"originality
Plagiarism"illegal replication = !na!thoriFed !se o anotherGs
literary .or3 .itho!t any consent or permission
S = signi-cance to n!rsing
o 2 tyes of research according to use
)asic!ure research
only the research #ene-ts the research
It is only or yo!r personal necessity
Ans.ers yo!r o.n B!estion
Alied research
pro#lem solving
Solving the pro#lems o the patient%
o 3aria)le = s!#0ect to change
4inds of "aria)le
*ndeendent "aria)le
2
o !se this to stim!late a target pop!lation
%eendent "aria)le!E5ectual "aria)le
o res!lts o the e&ects o the st!dy
*nter"ening 3aria)le
o Comes #et.een dependent and independent
o E7ampleC orghanism varia#le, internal actor, se7,
gender, color
E'traneous 3aria)le
o E7ternal in!ences that can #e changed
o E7ampleC citiFenship, ed!cational stat!s
%ichotomous 3aria)le
o H choices" H res!lts
o E7ampleC 1ale" Eemale
Polychotomous 3aria)le
o 1!ltiple choices
o E7ampleC )reerred oods = Chinese, >apanese,
American% % % % %
E7amples
IA comparative St!dy in the Income o Eilipino N!rses
Employed in )%G%H% and N%A%G%H%J
Independent varia#le C )GH and NAGH 'place o .or3(
<arget pop!lation C Eilipino n!rses
;ependent varia#le C income
Research6
4% Identiy the )ro#lem
H% )!rpose = o#0ective !sing S1AR< 'Systematic, 1eas!ra#le, Attaina#le, Realistic, <ime
Do!nded(
K% ;e-ne <erms
a% Concept!al ;e-nition = dictionary de-nition
#% 8perational ;e-nition = de-ned in accordance on ho. the researcher !sed the
.ord
L% Revision o <erms
Re"ie7 of related literature
o Puroses 6
to have an !pdate regarding yo!r topic
to have a #asis o theoretical and concept!al rame.or3
o 1ain so!rces o literat!res
Concept!al
Eorm!lated
A!thors
Can #e sold
Doo3s = general !se
Research
Researcher
Research .or3s only
E!t!re research p!rpose only
0ormulation of concetual and theoretical frame7or8
o <hery = relationship #et.een concepts
o Concept!al rame.or3
diagrammatic and str!ct!ral presentation o the pro#lem hypothesis
o )aradigm
act!al str!ct!ral presentation o yo!r concept!al rame.or3
0ormulating hyothesis
o 9 tyes of hyothesis
Null!statistical hyothesis
sho.s no relationship or di&erence #et.een an independent
varia#le and dependent varia#le%
I; + ;?
3
Eg% I<here is no di&erence regarding proessional opport!nities
o Eilipino N!rses .or3ing in the )hilippines rom those .or3ing
in USA%J
Simle!(erational hyothesis!Alternati"e hyothesis
this sho.s relationship #et.een a single independent varia#le
rom single dependent varia#le%
Eg% IEilipinos N!rses .or3ing in USA has more proessional
opport!nities than those .or3ing in the )hilippines%
Comle' hyothesis
this sho.s a relationship #et.een t.o or more independent
varia#le rom t.o or more dependent varia#le%
Eg% IEilipino n!rses .ho .or3ed or 9yrs and passed the
CGENS, <8RE2, <SE, NC2E@ has greater opport!nities in NA as
compared to those in 1anila
%irectional hyothesis
speci-es the direction o the relationship #et.een varia#les
Eg% IEilipino N!rses .or3ing in the USA has more proessional
opport!nities than those .or3ing in the )hils%J
Non.directional
only predicts the relationship, #!t has no speci-c direction
#et.een varia#les%
Eg% I<here is a #ig di&erence #et.een a Eilipino N!rses .or3ing
in USA than those .or3ing in the )hils%J
Selecting research design
o Systematic controlled plan or -nding the ans.er to a pro#lem
o Roadmap, #l!eprint o the st!dy
o Sho!ld have a proper resign design
o I improper research design, there .ill #e improper collection o data
o Purose C 3ey or tool or proper collection o data
o /yes
According to Alication
-asic! Pure
o Eor personal 3no.ledge, c!riosity
Alied
o Dased on pro#lem solving approach
According to Methods
E'erimental
o perorming active manip!lation, o#serve and record
the res!lt%
o /yes of E'erimental Reseach
control
divide grp into H%
Gro!p a = control"comparison grp = .ill
!se the same soap everyday
Gro!p # = e7perimental grp = those
.ho .ill !se the sample soap
randomi:ation
!sing sample #y chance%
Choose randomly to avoid red!ndancy
o res!lt
Maniulation
)erorming intervention
3alidation
comparison o the e&ects
;uasi.e'erimental
alse e7periment%
No control sample%
Non.e'erimental
o No manip!lation is done% 8nly o#servation, descri#e
and record do.n the res!lt%
4
o /yes of non.e'erimental research design )ase
on time element
Retrosecti"e <E' Post 0acto=
Getting act!al e7perience
St!dies a gro!p o people ater its
occ!rrence, e7perience or acts%
E7perience o people in the past
%escriti"e
8#serve, descri#e : record%
St!dy o c!rrent events%
Prosecti"e
St!dy o research a#o!t !t!re
occ!rrence or !t!re events%
,istorical
)ast that is .ritten, doc!mented,
p!#lished and recorded
Primary %ata
o 8#serve
o 4
st
hand inormation
o person himsel
Secondary %ata
o H
nd
Hand Inormation
A#o!t the past !sing records, 0o!rnals,
#oo3s%
St!dy o the dead people thr! his
.ritten materials, acts
o according to data
+uantitati"e
data #ase on n!merical interpretation,
datas that are meas!ra#le, !sing yo!r
senses, data that are o#serva#le%
+ualitati"e
s!#0ective data, eelings, perception,
#elies, c!lt!re, attit!de
o Sur"ey Research %esign
Gro!p
Small
Eace to ace
2arge = not good res!lt
1ethods
1ailed s!rvey
Eace to ace
<elephone s!rvey
o According to /ime (rientation
Cross Sectional
Applica#le to H or more identical gro!p
Short term
Eor comparison
Longitudinal
4 gro!p only
.ith initial and ollo. !p s!rvey
long term st!dy
or developmental st!dy
Selecting your oulation and samles
o samle
part o pop!lation, data is collected%
<he recipient o the e7perimental treatment in e7perimental design or
the individ!als to #e o#served in a non-e7perimental design
o /yes of samling
Pro)a)ility - eB!al presentation" chances in the pop!lation%
5
Simle random techni+ue
o Used a single"identical gro!p%
o Eish #o.l techniB!e
Strati#ed random samling
o Ao! .ill -rst going to create a s!# pop!lation rom the
.hole pop!lation #eore doing randomiFation%
o 8ne pop!lation, yo! divide it%
Cluster random samling
o Ao! .ill -rst create a s!# area in a pop!lation #eore
doing the randomiFation% In one pop!lation, yo! ma3e
it smaller
Systematic random samling
o choosing a sample every nth name in the pop!lation%
o 1!ltiple o 455 names
o Samling frame = list o names appearing as yo!r
pop!lation
Non.ro)a)ility samling = yo! are not choosing #y chance%
Accidental! con"enience samling
o Dase on the accessi#ility"availa#ility o yo!r sample%
o K!ng sino pina3amalapit syo, y!n ang 3!3!nin mo%
Purosi"e!judgmental samling
o #ase on the common 3no.ledge or pop!lar 3no.ledge%
Sno7.)all samling
o get sampling #ase on last reerral
;uota Samling
o Setting criteria and getting samples -tting the criteria
Conducting ilot studies
Collecting data
o types C
B!estionnaires = !se o pen and paper method
dichotomo!s = divided into t.o% Eg% tr!e oralse% Aes or no
rating scale = poor 4, good H, #etter K, #est L
m!ltiple choice
Intervie. = !se o oral method o collection o data% Use o active
listening
Str!ct!red = .ith chec3list, ormal tal3, list o B!estion
Unstr!ct!red = inormal tal3, no pattern, anything goes
records = pre e7isting data
o#servation = !se o oc!lar method !sing yo!r senses
participant o#servation
non-participant o#servation
)ro#lems C
o Ha.thorneGs e&ects
<he data yo! get rom yo!r sample is not
acc!rate%
<he sample has a pro#lem
Sol!tion C do!#le #lind research = they sho!ld
not #e conscio!s that they are #eing st!died
o Halo e&ect
<he researcher has a pro#lem%
He is manip!lating the data collection%
It is a&ected #y special eelings"treatment
#et.een the researcher and the sample%
Analysis of %ata
o part o research .hen the researcher is orming a #ody o 3no.ledge o!t o
data collected or the p!rpose o a$rming or denying yo!r hypothesis
o Methods
Nominal method
get data #y means o categories%
eg% male, emale, income
6
(rdinal method = #ase on ran3 eg% mild, moderate, severe
*nter"al
#ase on the distance #et.een H n!merical val!es
eg% D) = 495"455 = 4H5"M5, .t, circ!merence, ht
ratio = KC45 children are malno!rish
*nterretation of %ata
o 2 Methods
+uantitati"e method = #ase on n!merical or graphical standards
+ualitati"e method = !se o narrative .ords
Communicating your conclusion
o E7plaining the res!lts o yo!r .or3 to the p!#lic
o Concl!sion = -nal ans.er to yo!r research
o Recommendation = s!ggestion to others
o ;issemination o Inormation
1ethods C
thesis"#oo3 = .ritten orm
symposia"symposi!m = oral presentation
p!#lish = a lot .ill #e a#le to read yo!r research
LEA%ERS,*P
Nursing Leadershi
Style or process .here#y a person is called #y a n!rse leader .as inN!ence o gro!p o
people called his ollo.ers or the p!rpose o attaining only one goal"o#0ective%
Princile for E5ecti"e Leadershi
>nity of Command = one gro!p given #y one leader
>nity of %irection = one gro!p sho!ld al.ays have one o#0ective
Su)ordination of your ersonal to your general interest = patient -rst policy
o R = resc!e yo!r patient
o A = alert the -re alarm
o C = con-ne the -re in one area #y closing the door
o E = e7ting!isher application
o Esprit dG corp"team spirit - Ea!lt o one is the a!lt o all
Resondeat Suerior!Command resonsi)ility
o let the master or the s!perior ans.er or the negligence o his s!#ordinates in
hal o his patient .ho s!&er rom in0!ry or death%
o yo! can delegate responsi#ility #!t not the acco!nta#ility
/heories of Nursing Leadershi
Great.Man theory = #orn as a leader
/rait theory = develop characteristics or #orn .ith the characteristics
o ? traits of a leader
P = ersonality 'adapta#ility, independence, creative"assertive,
advocate( a#ility to ad0!st to the need o the pt
* = intelligence 'proper 0!dgment, proper decision ma3ing, proper
comm!nication(
A = a)ility = 'inN!ence others, respect others, participate and
cooperate( )roper .ay to inN!ence is thr! health teaching
Charismatic theory = #ecomes a leader #eca!se o the charm
Situational theory!case to case )asis
o a person can #e a leader in one sit!ation #!t only a ollo.er in another
sit!ation% 'eg% #ecomes a leader in .here he specialiFes(
Leadershi styles
A!thocratic"A!thoritarian"dictatorial"JhardJ leader
o !nilateral style o leadership% 8nly the leader here perorms the decision
ma3ing .itho!t getting the inp!ts rom his mem#ers%
7
o 8ne sided style o leadership Dehavior C
A = apathy = insensitive to others
- 1 -oisterous seech
C 1 consistency
% 1 %ominating
E 1 E'loitati"e )eha"ior
0 1 ferocious )eha"ior, to coerce or compel the gro!p to ollo. him
o not a good style o leadership #!t only #est style d!ring emergency or
intensive crisis
Permissi"e, ultra.li)eral, laisse: faire, free.rein
o 2oose style o n!rsing leadership%
o Giving e7cess reedom or li#erality to.ards yo!r s!#ordinates i to lenient in
yo!r s!#ordinates, there .ill #e O control and po.er + P negligence
%emocratic!articiati"e
o #est style o leadership% 1!t!al style o n!rsing leadership
9 Po7er of a Good Leader
Legitimate! 0ormal! e'clusi"e Po7er
o E7ercise #eca!se yo! are appointed to a higher position
E'ert Po7er
o Ao! acB!ire e7tra = ordinary s3ills, talent or a#ility
Referent Po7er
o Charisma and charm
Re7ard Po7er
o * po.er or the part o the leader
o gives re.ards, #on!s, promotion, compensation
Coerci"e Po7er
o = po.er on the part o the leader
o reprimand, s!spend, terminate
A-C@s s8ills, +ualities and a)ilities
A 1 Authority
o #asis o the leader to delegate tas3s, responsi#ilities, 0o#s to #e perormed #y
his s!#ordinates
o 2 tyes of authority
Centrali:ed = top to #ottom or proper management
%ecentrali:ed = Dottom, to manage directly
- 1 -eha"ioral
o S = specialiFed #ody o 3no.ledge and s3ills to do sae care
o P = patient centered
o A = acco!nta#ility = lia#le or the res!lts o yo!r actions
o C = con-dentiality = n!rse-patient relationship
E7ceptions to con-dentiality o the contract C
P = patient consent, i there is
* = inorm"report to healthcare team or p!rpose o
preca!tionary meas!res
C = Comm!nica#le disease
o RA ?9A? 2a. on Noti-a#le ;isease
o HL = )olio" 1easle
o 4 /ee3 = SA;" HI?"<etan!s Neonat!rom
C 1 Crimes
o Child A#!se LM ho!rs, Daranggay, NG8
E = ethics
I? <HERA)IS<C 8ld RN, <raining, 95 Insertion, ANSA)
Ne. RN, <raining
C 1 Communication s8ill
o transer o inormation .ith !nderstanding
o Comm!nication #arriers"comm!nication #ac3log = eg% ;ialect di&erences,
noise, dea, high level o an7iety, hall!cinating
8
% 1 %ecision ma8ing s8ills
o Steps
identiy the pro#lem
identiy person a&ected
gather options"alternative
#rainstorming
delphitechniB!e = gathering sol!tions o!tside the gro!p 'eg%
specialiFed n!rse(
choose and implement
Eval!ation
E 1 Ethics
o Princiles
o Princile of Autonomy
independent 0!dgment or decision ma3ing
in all sit!ation the pt himsel is the one .ho sho!ld decide or his o.n
care
Consent
respect the decision o the pt
e7plain the ris3 to the patient"S8
.aiver - a legal doc .hen the pt re!se or treatment%
o Princile of 3eracity
telling the tr!th to the patient
Q4 the patient has the right to 3no. rom the )HASICIAN 'not the
n!rse(
o Princile of %ou)le E5ects
i the pt is made to choose #et.een H eB!al danger and he only needs
to choose one, choose the one that .ill prod!ce one good e&ect and
less evil e&ect%
o Princile of -ene#cence
doing good to the patient 'eg% providing therape!tic comm!nication,
providing privacy(
o Princile of Non.Male#cence
do no harm
K types o Harm
)hysical = negligence #y commission
1ental = assa!lt and #attery
1oral = slander and li#el
o Princile of Bustice
)rioritiFe the needs o the patient%
<o #e a#le to provide n!rsing care to the patient, provide the n!rsing
process%
N!rsing )rocess characteristics C
A = accepta#le !niversally
D - #ased patients assessment needs
C = client oc!sed
; = dynamics = #ase on the ever changing needs o the pt
E = eB!ita#le care
E = amiliarity"rapport to the patient
G = goal directed to.ards solving the assess needs o the
patient 'S1AR<(
o Princile of Resect!*n"iola)ility of life
S!icide and a#ortion is violation o this principle
0 1 0ace!sol"e ConCicts
o any clash o ideas res!lting to crisis
o Methods of resol"ing conCict
a"oidance = #y paying attention
smoothing = appealing to ones conscience and 3indness
unilateral action = !se o orced ear or threat
negotiation = #est method in resolving conNict% <he head n!rse
sho!ld o&er negotiation #et.een conNicting parties%
9
N>RS*NG MANAGEMEN/
N>RS*NG MANAGEMEN/
choosing the right person and giving them the appropriate tas3 or the p!rpose o
achieving their goal"o#0ective in achieving total care
0rederic8 /aylor@s Scienti#c Management /heory
Elements
o choosing the appropriate person '<A8(
o choosing the appropriate team
o choosing the appropriate training
o choosing the appropriate tools
,uman Relations theory
the #e a good manager, there sho!ld #e a good interpersonal relationship #et.een the
leader and ollo.er
%ouglas Mc Gregor@s Moti"ational theory
/heory D
o Negative .or3ers
o negligence, ine$cient, ine&ective .or3ers
/heory E
o )ositive .or3ers
o diligent, e&ective, e$cient .or3er
theory @ sho!ld #e given oc!s #eca!se they are prone to negligence and malpractice%
Ma' Fe)er@s -ureaucratic! authoritarian /heory
.hoever is on the top .o!ld perorm the management !nction
10
centraliFed
Elton Mayto@s -eha"ioral /heory
overtime pay, rest day, day o&
provide physical needs o the .or3ers
Ha.thorneGs E&ect
o I .or3ers 3no.s they are o#served they #ecome more e$cient
,enry 0ayol@s Princile of Management
>nity of Command = one leader, one command
>nity of %irection = one gro!p sho!ld al.ays have one goal
Remuneration of Personnel = patient -rst policy
Esrit de cors = team spirit
Command resonsi)ility!Resondeat Suerior = let the s!perior ans.er the a!lt
o his s!#ordinates even harm or death
Dalance #et.een centraliFation and decentraliFation
Sec!rity ten!re
;elegation o responsi#ility
Proer Comensation of 7or8ers
o RA A?G9 <Magna Carta La7= = salary grade 95 )4K,555"month
o ("ertime ay = additional o H96"hr
o Night %i5erential = additional o 456"hr
o Legal holiday = 7 H
o Philhealth - Dene-t o .or3er #oth related and non-related .or3 'aesthetic,
dental and cosmetics are not incl!ded(
o Maternity lea"e = R5days leave is NS;, SMdays i CS only to -rst L pregnancy
only to legitimate spo!se
o Paternity lea"e = Sday"4.ee3 leave
o Senior Citi:en@s Act = H56 disco!nt
9 stes in Management Process
Planning stage
o loo3ing ahead o time%
o Eorm!lating !t!re goals"o#0ective
o /yes of lan
Standard!(erational Plan <NCP=
plans or everyday or ordinary activities
Strategic!Contingency Plan
plan !sed d!ring s!dden or ac!te crisis
Long.range!future Plan
plans .hich yo! canGt eval!ated immediately%
Us!ally last months or yrs%
Used or chronic pt .hich reB!ires longer period o care%
o Stages of Planning Process
Mission = present reason .hen esta#lished yo!r organiFation
3ision - statement o yo!r !t!re p!rpose o yo!r !t!re organiFation
Philosohy = set o val!es and #elies o yo!r organiFation
Goal = general statement o yo!r p!rpose
()jecti"es = more speci-c statement o yo!r p!rpose
Policies 1 set o r!les and reg!lations in yo!r organiFation
Procedures
-udgeting = proper allocation o yo!r reso!rces
o ? tyes
Personnel
Compensation or salaries o .or3ers
(erational
everyday !se o eB!ipment and acilities
'gloves, .ater, electricity(
Caital
11
long term !se eB!ipment '1RI, C< Scan,
hospital #eds, hospital #!ildings(
(rganiFing
o H stages
(rgani:e your team RN Su)ordinates
;!ties o the RN
8nly assessment can perorm the n!rse
8nly the n!rse can perorm H<
8nly the n!rse sho!ld e7plain the proced!re to the patient
)reparation, administration, treatment o dr!gs to the patient
<he n!rse can only perorm eval!ation
<he n!rse can only do 0!dgment
%elegate /as8
<hey can only delegate to s!#ordinates the Ro!tinary tas3
'standard, !nchanging proced!re( eg% monitoring o I:8,
#athing, am#!lating, toileting, shampooing, transporting,
eeding, clothing, .iping
Sta#le patient - predicta#le o!tcome 'eg% postmortem care .ith
direct s!pervision o the n!rse only(
S!pervision = need g!idance
Sta5 Schedule! StaIng
Sched!les 'Ho. many ho!rs(
o <raditional = Mhrs a day"L5hrs".3
o <en ho!r shit"L days a .ee3
o Daylor plan = it consist o t.o shiting n!rses
traditional = mon-ri Mhrs
Hnd shit = 4Hhr shit d!ring .ee3ends
o )art-time .or3 = e.er .or3ing ho!rs per day and may
choose the day or .or3% 2ess than Mhrs 0o#
o 8n = call = d!ring shortage o n!rses"sta& #!t increase in
the n!m#er o patients%
Methods of Nursing care %eli"ery
%i5erent Methods
o Primary 1 2Hhrs a day
)rimary n!rse is the only n!rse .ho is responsi#le to
ma3e a care plan o the patient rom the moment o
admission till the moment o discharge% 'eg% private
d!ty n!rse or special n!rse(
o 0unctional Method
;8H ormat"government hospitals
Assign n!rse C
%!ty"tas3
(ne n!rse, one tas3
,ighly recommended d!ring a period o
shortage o n!rses and #!dget
poorest method o delivery #eca!se comm!nication
is hindered
o Case 1ethod"Case N!rsing
provide total care .ithin yo!r shit% Used in ICU
department
C = Case 1ethod
< = total care to the patient
8 = one is to one ratio
%irecting";elegation stage
o a 0o# or a tas3 is done or perormed #y another perorm or yo!
o /hat yo! cannot delegateC
yo! cannot delegate total control o the proced!re
yo! canGt delegate discipline o s!#ordinates or sta& mem#ers%
Con-dential tas3
12
<echnical tas3
1edical tas3 perorming s!rgical proced!re is done #y the doc not the
n!rse
Coordination"Colla#oration
o <he n!rse needs to colla#orate to other mem#ers o the health care team%
o 1!lti-interdisciplinary approach = to #e a#le to provide holistic approach to the
patient%
o /yes of Colla)oration
*nterersonal!*ntradeartmental
8ne patient, one !nit%
Colla#oration #et.een one n!rse to another healthcare team in
one !nit"department
Eg% 1I patient - n!rse, dietary, specialiFed in cardio
*nterdeartmental
L !nits in one hospital%
Coordination o the patients care #et.een H-more
!nits"departments #!t still !nder one same hospital or
instit!tion
Eg% patient d!e or appendectomy is transerred to the 8R
*nter Agency!*nstitutional
Coordination o patientGs care #et.een H or more
hospitals"health care instit!tion or the #ene-t o the patient
Eg% lying = in d!e or C"S and .as transerred to a hospital
Eval!ation"Controlling
o stage .herein yo! determine .hether or not yo!r plans or yo!r patient is met
or achieved
o Methods of e"aluating sta5 erformance
Chec8list
it is #eing eval!ated higher than yo!% 'eg% n!rse
manager"s!pervisor or head n!rse(
Nursing rounds
it is #eing eval!ated higher than yo!% 'eg% N!rse
manager"s!pervisor or head n!rse(
)sychiatric .ard is not done #y n!rsing ro!nds
Peer re"ie7
same ran3 or level is #eing eval!ated yo!
poor method
Performance araisal
the patient eval!ates yo!
#est method in eval!ation
PR(0ESS*(NAL A%B>S/MEN/ AN% N>RS*NG B>R*SPR>%ENCE
Professional
A calling in .hich its mem#ers proess to have acB!ired special val!es, 3no.ledge,
training or #y e7perience so that they may g!ide others in that special -eld%
Nursing is a rofession
Calling = service oriented
8thers = patients
Characteristics )y rofession
A = acco!nta#ility"lia#ility or the res!lt
C = caring proession Central Eoc!s
C = competent
E = ethics
S = service oriented
S = specialiFed scienti-c #ody o 3no.ledge and s3ills
PR(0ESS*(NAL %>/*ES (0 A N>RSE >N%ER RA JKA?
13
All are indeendent nursing actions
)romotive, preventive, c!rative and reha# care in all health care service
health ed!cation
!tiliFes n!rsing process
lin3 o patients in di&erent health care services
colla#oration o patientGs care or contin!ity o patient care
train n!rsing st!dents
s!pervision o s!#ordinates
acc!rate recording and reporting
e7ec!tion o valid doctorGs order 'the only one that is dependent n!rsing action(
)erennial S!t!ring ater training
)erorm IE i antenatal #leeding is a#sent and #eore !ll delivery
A doctors order is valid when giving medication is when it is put into writing and signed by the
physician. Whatever is not put into writing is considered not ordered by the physician.
Good Samaritan Act
;!ring emergency, national calamity, national epidemic there is no doctor aro!nd the
lie or the patient is in possi#le danger, then yo! can give dr!gs alone provided yo!
3no. the dr!gs or the patient%
RA L?HH = No deposit policy d!ring emergency cases only
Areas of Nursing Practice
KM *nstitutional Nursing
Hospital Dased ?en!e
; = ;!ties are ro!tinary and s!pervised
A = AcB!ired di&erent learning and technical s3ills
C- Coordination .ith HC<
S = SpecialiFed areas
o N!rse Generalist = comm!nity n!rse
o N!rse specialist = sta& n!rse
2M Pu)lic ,ealth Nursing
8nce a )!#lic n!rse in the comm!nity, yo! are oc!s on the preventive and promotive
o health #eca!se this is the mandate o )rimary Health Care 2a.%
Kst P,C
o ;ate C 4TSM
o )lace C Alma Ata
o Co!ntry C R!ssia
o 2ocal version o E% 1arcos ater 4yr o Alma Ata
o ConerenceC 2etter o Instr!ction TLT that mandates that all p!#lic .or3ers to
have a d!ty o promotive and preventive care or the patient%
Promotion of Pu)lic ,ealth
o P% LJAN = 1icron!trient S!pplement Act
?it% A, iron s!pplements, iodine
o P% L29 <En"ironmental sanitation la7 of the PhilsM=
It is cleanliness o the environment% 8!tside the instit!tion 'eg% proper
disposal o e7creta, proper drainage system(
o P% L9N <sanitation code of the PhilsM=
Involves proper sanitation o an instit!tion that engage in ood and
.ater s!pply% Inside the instit!tion% 'eg% canteen, mineral .ater store,
p!#lic mar3et, Se7 shop C A;8NIS, )EGASUS, CHIC8S( not applica#le to
private se7 practitioners%
Pre"ention of %isease
o P% JJN <EP* la7=
Comp!lsory Imm!niFation o children #elo. T y"o
Psychological and social adjustments )ecause you 7ill )e ta8ing care of
numerous clients
14
o RA AKNG <local go"ernment code=
decentraliFation or devol!tion o care% <he ;8H together .ith ;I2G and
local government !nits '#rgy, provincial( together .ith comm!nity
participation they made a local health #oard .hich is the 1AA8R%
)!rpose o local health #oard C it ma3es B!ality health care availa#le,
accessi#le and pro7imal or all
Particiation is maintained 7ith all mem)ers of the community, health care
team and family
?M (ccuation ,ealth Nursing
ind!strial or company health n!rse
%uties 6
o Curati"e!reha)ilitati"e
C = care or sic3"in0!red la#orers
R = Reerral
? = ?isit and &% !ps 'home visits(
o Promoti"e!Pre"enti"e
N = n!tritional
S = saety and sanitation
C = Co!nseling
HM Clinical *nstructor
o ;uali#cations 6
A = accredited n!rsing 8rg
M = 1AN in n!rsing or other health co!rses
( = 8ne yr clinical e7perience
R = R%N%
P,*L*PP*NE N>RSES ASS(C*A/*(N
o Fhen 7as PNA founded C 8ct% HH, 4THH '45-HH- HH(
o Fho is the founder PNA C Anastacia G% G!iron <!pas
o Puroses C
P = proessional .ell-#eing
> - !nity
P = promotes reciprocity even o!tside the )hils%
A = advancement o the 3no.ledge and s3ills o the n!rse
E = ethics prom!lgation
Proclamation (rder 9?J
;eclared #y )res% Garcia la. declaring the last .ee3 8ct as the o$cial n!rses .ee3%
School of Nursing in the Philiines

U)CN = 4
st

Schools originated in the )hil%

o Iloilo 1ission hospital
o )GH
o St% 2!3eGs
o 1ary >ohnston Hospital
o St% )a!l Hospital
o San >!an de ;ios
Contracts and Consents
Characteristics of a 3alid Consent
3 = vol!ntariness
( = 8pport!nities to as3 B!estion#e e7plained to pt
/ = treatment e7plained to the patient
> = !nderstood #y pt
M = mat!red #oth physically and mentally
Criteria of a good consent 6
15
4M y"o = a#ove
1entally capacitated 'a#sence o insanity and im#ecility(
I #elo. 4M y"o and mentally incapacitated a pro7y consent C in chronological order
o )arents
o G!ardian
o physician 'i parents and g!ardian are dead(
G!ardian Ad 2item = social .or3er or S!rgeon
Nurses and *llegal %etention
it happens i someone .ill limit the reedom o the patient to move or travel rom one
place to another%
HI? )atient = sho!ld #e 3ept in one room
o Eelacio = oral se7 = most astest mode o transer
o Cannaling!s = tong!e on clitoris
o Analing!s = tong!e on an!s = least mode o transer
Last Fill and /estament
Act .here#y a person is permitted #y the la. to have control in the manner o
disposing" giving his estate #!t .ill ta3e e&ect at the time o his death
<estate S!ccession = son or da!ghter .ill inherit the last .ill o the parents
Intestate S!ccession = .itho!t last .ill and testament
2 tyes of Last Fill and /estament
o Proerty
Notarial! (rdinary Fill
Chec3 28C
Chec3 proper location o the signat!re = end part o all the
pages at the side
N!rses can #e a .itness
,olograhic Fill
;!ring emergency cases
No .itness involved call a persdon .ho 3no.s and amiliar .ith
the hand.ritten o the testator
Entire last .ill and testament is hand .ritten dated and signed
#y the testator
o Life -ody
Ad"ance %irecti"es
Respect!l death
;irection" instr!ction o the patient in advance
;NR, donate organ, cremation
Medications and rescrition
only registered medical, dental and veterinary practitioners are a!thoriFed to prescri#e
dr!gs
K inormation
o name o the A1;, address o his clinic"hosp and )<RC license Q
o name o the pt, age, se7
o dr!g name, reB!ency, d!ration o the dr!g
RA NNA9 Generic Act
o all prescri#e dr!g m!st #e .ritten in generic and #rand name or generic name
#!t never the #rand name alone(
o )!rpose C or the pt to choose .hat #rand name they .ant
Remem#er the 45 RGs o medication
Right patient name #y chec3ing the pt .rist tag
?er#al or telephone = only done d!ring emergency
do!#ts or error = in case there is do!#t in medication, reer to the physician
I? dr!gs = in proper training
%ocumentation, recording and charting
Patient Chart = a#sol!tely legal
16
Purose of a atient Chart
o Comm!nication and conitin!ity o care
o Ass!rance o B!ality o care
o Research
o Legal doc!ment
o Statistics o disease
Su)oena = order coming rom the co!rt
o S!#poena ;!ces <ec!m = any doc!ments, o#0ects, papers, materials
o S!#poena Ad <esti-cand!m = person .ho .ill testiy '.itness(
%o@s in Charting
o 0 = !ll, act!al and o#0ectively acc!rate
o L = legi#le
o * = immediate
o P = )ersonal
Adendum = late entry"late doc!mentation
%on@ts in charting
o L = lang!age, 0argons or .ords .hich are !naccepta#le
o * = improper corrections
o S = Spaces and s3ips
o A##reviation
LEGAL %(C/R*NES *N N>RS*NG
Professional Negligence
Negligence
Eail!re to do something .hich is reasona#le and pr!dent n!rse sho!ld have done
something !nder a partic!lar sit!ation% 'eg% ail!re to raise side rales .hen the pt is
!nconscio!s(
? elements of negligence
o d!ty on part o the n!rse
o ail!re to do said d!ty
o in0!ry, harm, death = most important negligence
Malractice
in0!ry, harm or death is not important in malpractice
<he n!rse is allo.ed to perorm episiorrhapy
.ith proper training #!t not episiotomy
<he n!rse is allo.ed to perorm IE #!t .ith H conditions C
o etal a#erration" a#normal delivery
o prior to complete delivery
Crimes a5ecting nurses
<ypes o crime C
Manner of Commission
o %(L( = crimes committed .ith deceit% Crime .ith real criminal intention
o C>LPA = crimes committed !nder negligence% Crimes that are intentional
stages of e'ecution
o consummated
.hen the crime intended is totally committed or perected
o frustrated
the o&ended perorms everything to cons!mmate the crime #!t it did
not happen
o attemted
crime has not happened 'overt acts = acts merely sho.ing the
intention to commit the crime(
degree of articiation
o rincial
degree o participation is very important"indispensa#le #eca!se he is
the primary a!thor o the crime%% I no principle, there is no crime%
o accomlice
participation is merely dispensa#le%
17
Us!ally perorms #eore 'eg% reerral #y the n!rse o a a#ortionist to a
pregnant .omen( or d!ring the crime eg% 8D n!rse is to perorm
a#ortion% <he n!rse is loo3 o!t or police% <he n!rse is the accomplice%
o accessory
!s!ally perorms ater the crime 'eg% stole a ne#!liFer in the hospital%
Sold the ne#!liFer to an asthmatic pt( <his is an accessory #eca!se he
#ene-ted rom the crime
RA ALAA 1 Anti se'ual harassment la7
committed #y any person .ho e7ercises a!thority% 'eg% teacher to st!dent, head n!rse
to sta& n!rse(%
<hat person .ho is in a!thority is as3ing or a se7!al avor in an e7change o another
avor%
/yes of Rae
(rdinary rae
o a orci#le penetration o an organ or cop!lation to another organ or
cop!lation% 'eg% .omen are only the victim(
se'ual assault
o anything that is orci#le inserted to a #ody ori-ce .ith se7!al malice%
o Also orm o rape 'eg% hand or an o#0ect is #eing inserted in the anal%
Committed in #oth emale or male(
o Intervention C
S = saety 'emotional or physical saety(
R = report 'O 4M = report to #rgy%(
R = reerral 'i ather is the rapist, reer to ;S/;(
A)ortion
is the e7p!lsion or termination o a prod!ct o conception #eore the stage o via#ility%
'K-Rmonth"4H-HL.ee3s(
*nfanticide
3ill the person in less than Kdays or SHhrs o lie%
Parricide
3illing another person to .hom yo! have a relationship 'mother, ather, h!s#and(
,omicide
!nintentionally 3illing another person .itho!t any relationship 'eg% negligence in giving
meds(
Murder
intentionally 3illing another person .itho!t any relationship
Simulation of )irth
committed #y any person .ho shall s!#stit!te one child to another child or alter his
identities or the p!rpose o losing his civil stat!s% 'eg% the mid.ie ailed to report the
#irth o the #a#y, giving .rong inormation o the gender o the #a#y(
P% N9K <-irth registration act=
la. any person .ho assist in giving #irth to report .ithin K5 days to the 2ocal Civil
Registration 8$ce
La7 A5ecting Nurses
Act 2LGL <yrM KJKJ= = -rst tr!e n!rsing la.
o It removed rom the doctor the control o n!rses .ith K man team '4 chairman
and H mem#ers all n!rses(
KJ2G = 4st o$cial #oard e7am
Kst nursing school <Nmonths=
o Iloilo 1ission Hospital '4T5R(
o )GH School o N!rsing '4T5S(
o St% 2!3eGs school o n!rsing '4T5S(
o 1ary >ohnsonGs school o N!rsing '4T5S(
o St% )a!l Iloilo 4T5S(
o San >!an de ;ios '4T5S(
Kst college of nursing <Hyears= 1 >P
18
RA AKNH <KJJK=
RA JKA? <(ct 2K, 2GG2=
o -oard of Nursing
(ld
o 1 = 1AN
o A = Accredited N!rsing 8rg ')NA(
o E = -ve 1AN team '4 chairman, L mem#ers(
o S = R9 y"o = 4 year interim period
o N = Not convicted o any crime
o ) = )ec!niary interest 'A#sence(
o < = 45 years n!rsing practice
o C- CitiFen o R%)%
Ne7
o 1 = 1AN
o A = Accredited N!rsing 8rg ')NA(
o S = S 1AN team '4 chairman, Rmem#ers(
o I = immediately resigned !pon appt%
o N = Not convicted o any crime
o ) = )ec!niary interest 'A#sence(
o < = 45 years n!rsing practice #!t 9 yrs m!st #e in the )hils%
o C- CitiFen : resident o R%)%
Fho formulates the +uestion of the -oard E'amO = Doard o
N!rsing
In having a license it is a )rivilege not a Right
Doard o N!rsing iss!es the license
)RC iss!es the certi-cate o registration
CHE; are the ones .ho has the po.er to open and close a n!rsing
school
D8N 0!st inspects 9 consec!tive years o #elo. M56 passing rate, the
school .ill #e closed
Po7ers and 0unctions of -(N
o L = 2icens!re e7am
o * = Iss!e C8R
o M = 1onitor standards o n!rsing practice
o E = Ed!cation
o C = Code o ethics
o , = Hear and decides cases o negligence and malpractice
o A = Accredits di&erent organiFations
o G = G!ides N!rsing )ractice in the phils
o %ean
R%N%,1AN
9 years n!rsing e7perience
o Clinical *nstructor
A = allied in n!rsing or any allied health co!rses
1 = mem#er o )NA
8 = 4 yr e7perience
R = R%N%
o Nursing Administrator
Suer"isor!Manager , Community Military ,os
D = DSN RN
A = Accredited 8rg
N = T !nits
< = H yrs
Chie";irector
RN * 1AN *
9 yrs s!pervisor
e7perience
'N%D% i primary
Add only
masterGs in
)HN or
CHN
1AN *
GSC
'Gen%
Sta$ng
19
hosp( Co!rse(
o E'aminees
CG1 'Good 1oral Character(
)roos o ?alid Holder o Eilipino CitiFenship
)roos o valid holder o a DSN ;egree only rom schools .hose
c!rric!l!m is approved #y the CHE;
K docs s!# to )RC
R2E certi-cate
<8R .ith Scanned pict!re
2ist o cases
E7amination ee is )T55
2ast day Is C
8ther related la.s
P% 22? 1 PRC Act
RA KGLG = Civil Service e7am C!m 2a!de, Doard passer = eligi#le in ta3ing CSE
RA NH29 1 %angerous drugs Act
o unisha)le 7ith 2 chemical su)stances
Prohi)ited drugs
chemical s!#stance totally, a#os!ltely canGt #e cons!med #y
h!man #eing 'eg% Sha#!, 1ariana, Cocaine, 8pi!m(
Regulated drugs
yo! can !se this dr!g provided the pt has the prescription and
the A1; has appropriate license coming rom the DEA; or
;angero!s ;r!gs
RA ANGG 1 -a)y 0riendly ,ositalM
o Early #onding or mother is Early Rooming in and early #a#y #reast techniB!e
or early #onding Early #onding or ather is thr! c!ddling
EM(M 9K 1 Mil8 Code <-reast Mil8=
o Avoid man!act!red or orm!la mil3
,o7 to )e an RMNM under JKA?
o Have all B!ali-cations
o ta3e the e7am
o acB!ire the reB!ired ratings
o In order to pass the e7amination, an e7aminee m!st o#tain a general average
o at least S9 6 .ith a rating o not #elo. si7ty percent 'R56( in any s!#0ect
o An e7aminee .ho o#tains an average rating o S96 or higher #!t gets a rating
#elo. R56 in any s!#0ect m!st ta3e the e7amination again #!t only in the
s!#0ect or s!#0ects .here he"she !s treated #elo. R5 6 'R56(% In order to pass
the s!cceeding e7amination, an e7aminee m!st o#tain a rating o at least S96
in the s!#0ect or s!#0ects repeated%J
RA LJLK 1Moderni:ation ActM
Eor every 9,555, res!lts .ill #e released ater 9days
)RC rating NA1E
<e7t to HRK 'smart( HKK 'glo#e(
Fhat are the grounds for nurse not to )e registeredO
o % = ;ishonora#le cond!ct
o > = Unso!nd mind
o M = moral t!rpit!de
o * = Indecent immortal cond!ct
20