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University of Santo Tomas

College of Nursing
MICHAEL JOHN VALLARIT
Professional Adjustment and Research Teresita I Barcelo, RN PhD

Nursing Law and Code of Ethics for Nursing

Elements of a TRUE Profession


1. Special body of knowledge and skill which can be obtained through formal education
2. More or less permanent membership
Nurses- biggest group of health professionals

3. Acceptance of service motive/ orientation

Justly compensated it is okay for nurses to charge patients for their service

4. Autonomy self governance

Code of Ethics
Nursing Law

RA 9173
o

Sections 3 Composition of the Board

7 member of the board

Section 4 Qualifications of the Board

Natural born citizen or resident of Philippines no foreigner can


be a board; not even a naturalized citizen

Member of good standing of accredited profession PNA

Registered nurse in the Philippines

Holder of masters degree in nursing, education or allied medical


profession; majority holders of MAN

Chairperson shall have a MAN

At least 10 years of continuous practice prior to application; 5


years of which shall be in the Philippines

Not convicted of any offense involving moral turpitude

Membership to the board shall represent the 3 areas of nursing:


Education, Service and Community health

Section 5 no conflict of interest

PNA agency that is tasked to nominate member of the board

For every vacancy 5 nominees

Immediately resign from any teaching position in any school or


university offering BSN and or review program for local boards

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Resign from any office or employment in the government

No pecuniary interest in or administrative supervision over any


institution offering BSN ---

Section 6

Term of office 3 years

More than 3 years allowed to be re-appointed once

Section 9 Powers of the board

Conduct the licensure exams

Issue, suspend or revoke the certificate of registration

Monitor and enforce quality standards of nursing practice to


ensure the maintenance of efficient ethical, moral, technical and
profession standards in the practice of nursing

Ensure the quality of nursing educational authority to open or


close nursing schools is vested with CHED upon recommendation
of BON

Investigate case of unethical or unprofessional conduct and


violation of this act

Promulgate the code of ethics

Recognize specialty organization

Not simple just generalist

-NAP

16 specialty organization

MCNAP, ORNAP, GNAP

Prescribe, adopt, issue and promulgate resolution, regulations,


measures and decision as maybe necessary for the improvement
of nursing practice and full enforcement of this Act.

3 Broad Powers of the Board

Quasi Legislative make laws; board resolution = law

Quasi Judicial investigate violation to issue and revoke


license

Executive implement the nursing law

Sec 11 causes for removal or suspension of BON

Continue neglect of duty or incompetence

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Commission or tolerance of irregularities in the licensure of the


exam

Sec 28 Scope of Nursing

Definition of practice of nursing a person, singly or in


collaboration with another, initiates and performs nursing services
to AFC in any health care setting. It includes but not limited to
nursing care during conception, labor, delivery, infancy, childhood,
toddler, preschool, school age, adolescence, adulthood and old
age.

RA 7164

- all stages of development; labor and delivery not

included

As an independent nurse practitioner, a nurse is primary


responsible for the promotion of health and prevention of illness.

Own private birthing clinic possible.

As member of health team, nurse shall collaborate with other


health

care

providers

for

the

curative,

preventive

and

rehabilitative aspects of care, restoration of health, alleviation of


suffering and when recovery is not possible, towards peaceful
death.

Hospice care for the dying

Duties of the nurse

Provide nursing care using the nursing process.


o

We are allowed to do IV by law

Establish

linkages

with

community

resources

and

coordination with the health team

Provide health education to IFC

Teach

guide

and

supervise

nursing

students;

administration of nursing services in varied settings such


as hospitals and clinics; undertake consultation services;
engage in such activities that require the utilization of
knowledge and decision making skills of a registered
nurse.

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Unprofessional, immoral and dishonorable conduct

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
o

If nursing functions supervised by other nurse,


not any other professional.

Undertake

nursing

and

health

human

resource

development training and research

This section does not apply to students who perform


nursing functions under the supervision of a qualified

In the practice of nursing, the nurse must observe the


Code of Ethics and uphold the standards of safe nursing
practice
o

COE Boards Resolution

The nurse is required to obtain competence


through continuing professional education provided
by recognized professional org; -----

RA 877 created the first board of nursing -2 nurses, 1 MD (chairperson)

RA 6704 amended RA 877 about the composition of the board 1966 5


members of the board (all nurses)

Code of Ethics

Guide to professional behavior of the nurse

Norms of conduct

BON Resolution 220 Series of 2004


o

Previous COE:

1984 simple adaption of the International Council of Nurses COE

1989 developed by PNA

Original version developed by BON

BON resolution 425 series 2003 Implementing rules and regulations (IRR) Rule V
the nurse while in practice of nursing in all settings is duty bound to observe
COE

Any violation revoke or suspension of license

4 basic ethical principles applied to nursing


o

The fundamental responsibility of the nurse is four-fold ; all are of equal


performance

To promote health

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faculty.

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

To prevent illness

To restore health a

To alleviate suffering

1st three = HEALTH is the primary goal of nursing

The nurse renders service regardless of race, creed, nationality or political


belief

We observe medical neutrality

The nurse protects life and respects the dignity of man

The nurse works in collaboration with the members of the team

Basic RIGHTS of the Patient


o

The right to information or to know about his or her condition

The right to make decisions about his or her own care or autonomy

Informed consent

The right to privacy and confidentiality

Privacy body

Confidentiality information

Privileged Communication all information personal to the patient


which must be kept secretly

Illness, diagnosis, prognosis

Not absolute;
o

Communicable disease it involves public welfare


and safety; inform only the proper authority DOH

Welfare and safety of the patient abuse

Domestic and child abuse

There is a court order in a criminal case with


written order with the court

o
-

With patients consent

The basis of a trusting relationship with the client

The right to quality care

Trends in Nursing Service


1. Automation

Nursing informatics

2. Independent/ Private Practice

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Entreprenurse

3. Specialization RA 9173 ***

Section 31 Comprehensive Nursing Specialty Program

The BON in coordination with the PNA, recognized specialty organization and the
DOH shall formulate and develop a comprehensive nursing specialty program

The purpose of the comprehensive specialty programs to upgrade the level of


areas of critical care ----

Beneficiaries of the program are obliged to serve in any Philippine Hospital for a
period of at least 2 years of continuous service

Section 33 Funding for the Nursing Specialty Program

DOH shall set the criteria for the availment of this program

Train at least 10% of the nursing staff annually of the participating government
hospital

Funds shall be given by the PCSO and PAGCOR to be released by DOH

4. Primary Nurse

PDN

The nurse is responsible and accountable for total nursing care of the patient from
admission to discharge, 24 hours a day

Attending nurse of the patient

First, assessment >> then NCP

Kardex contains the NCP

5. Holistic Nursing
6. Hospice care care of the terminally ill clients
-

Trends in Nursing Education


1. Ladder- Type Curriculum every step in the ladder is a terminal course you get a degree
each step

Step is the foundation to the next step

2. Post graduate education


3. Team teaching
4. Distance Education
-

National Nurses Organization


1. Only registered nurses can be members of PNA

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skill and competence of specialty nurse clinicians such as but not limited to the

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
2. PRC accredited professional organization for nursing PNA

That organization is the official representative of the profession accreditation

3. Code of Ethics Article VI section 17 states that registered nurses must be members of the
accredited professional organization

Accreditation lasts for only 3 years

4. To be part is not a legal obligation; ethical obligation, as stated in the COE


official function
6. May get benefits from PNA

Member of ICN Indirectly

Complimentary copy of the Philippine Journals for Nursing two times per year

Upon death, family will get a fund

Fields of Practice
1. Hospital Nursing
2. CHN
3. Nursing Education
4. Private Practice
5. Nursing Research

Qualifications in various fields


1. Hospital Nursing

Staff nurse > RN

Head Nurse

Educational no requirement

Experience of at least 1 year experience

Supervisor / Nursing Service Administrators

Section 29
o

Nurse Supervisor

RN

At least 23 years experience in general nursing service


administration at least 2 years head nurse

BSN with at least 9 units in management and administration


courses at the graduate level

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5. LOI 1000 gives priority to members of PNA when they are going to hire or select delegates to

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Member of good standing of accredited professional organization


of nurses

Chief nurses
o

Must posses

At least 5 years of being a supervisor or managerial position in nursing

MA in nursing

For primary hospitals, the maximum academic qualifications and


experiences for a chief nurse is the same as that of nursing supervisor

PH less than 50 beds

For chief nurse in public health agency, priority is given to one a masters
degree in public health or CHN

For chief nurse in military hospital, priority shall be given to those with
MAN and have completed the General Staff course

2. CHN

PHN RN only; apply at the local health department of own place

Chief Nurse

Categories

PHN in DOH

Military nurse RN; board rating not more than 80%; single for women only
for three years

Occupational Health Nursing

3. Nursing Education

Qualifications

Faculty members
o

RN

At least 1 year clinical practice in a field of specialization

Member of PNA

MA in Nursing, education or allied medical health sciences; including MD

Dean Section 27
o

MA in Nursing

5 years experience in teaching and supervising a nursing education


program

Member of PNA

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
4. Private Practice

Various areas hospital PDN, home care, private practice

PDN > RN with affiliation with the hospitals

Private practice breathing center, day care center for children or elderly,
hospice care, ostomy care nurse, diabetes education center

How to obtain a license to practice


1. By examination

RA 9173 Sec 13 qualifications for admission to licensure exam

Graduate RLE and TOR

Filipino citizen and resident in the Philippines birth certificate; resident


certificate - cedula

Good moral character no document to check

Sec 15 GA of 75 with nor rating below 60 in any subject

If GWA is 75 or higher but gets a rating below 60 in any subject must take exam
again in the subjects rated below 60; to pass examinee must obtain at least 75
in the repeated subjects

Removal exam shall be taken within 2 years after the last failed exam (BON Res.
425 s 2003 IRR)

2. By reciprocity for foreigners

Section 20 of RA 9173

Conditions:
o

Requirements for registration or licensing nurses in said country is


substantially the same.

The laws of said country grants the same privileges to Filipino nurses as
their own citizens.

3. By special permit

Section 21 Special or temporary permit

Granted to:
o

Licensed foreign nurses whose service is either for a fee or fee if


internationally known specialist or outstanding experts

Licensed foreign nurses on FREE medical mission

Licensed foreign nurses employed by school or colleges of nursing as


exchange professors

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Very specific and temporary time, place or mission; no renewal if expired

4. Mutual Recognition Agreement agreement among ASEAN

Indonesia, HK, Thailand, Brunei, Vietnam, Myanmar

RA 9173 Section 16 OATH


1. Successful examinee must take oath of the profession before the Board or authorized

Only if the mass oath taking is done

To register and get license where you took the Board Examination

RA 9173 Section 17 Issuance of certificate of registration/ professional license and ID


1. Certificate of registration or professional license shall be issued to a successful examinee upon
payment of prescribed fee (permanent)

Renewal of ID every 3 years at birth month; PRC office

Revocation and suspension of certificate of registration Section 23


1. Causes

Unprofessional and unethical conduct

Gross incompetence or serious ignorance

Malpractice or negligence in the practice of nursing

Use of fraud, deceit or false statement in obtaining license

Violation of provisions of this act

Negligence within your scope

Malpractice beyond the scope

RA 9173 Section 24 Re-issuance of revoked certificate


1. The BON may re-issue with the following conditions:

After at least 4 years from date of revocation

When the cause of revocation has been removed or corrected

Sec 26- Requirements for inactive nurses returning to practice


1. Nurses who have not actively practiced the profession for 5 consecutive years are required to
undergo 1 month of didactic training and 3 months practicum
2. BON shall accredit hospitals to conduct said training

ONLY PGH is accredited.

Obtaining Filipino Citizenship


1. Ways

By birth natural born Jus sanguinis based on the citizenship of parents

10

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government official prior to entering the practice

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

By naturalization foreigners

Legal process >> court >> apply >> 10 years of residence

RA 9225 Citizenship Retention and Re-acquisition Act of 2003 natural born Filipinos
doo not lose citizenship when they become naturalized in another country provided they
make the oath of allegiance so they can vote, run for office, or practice profession with
proper authority.

Duties of a Filipino Citizen


1. Pay Taxes

Income tax

Professional Tax 50 pesos every year, not later than January 31.

PTR, Privilege Tax, Occupational Tax

Where to pay: BIR

Government officials are

free from paying PT Magna Carta for Health

Professionals
2. Show love of country or Allegiance to the country
-

Working Contract
1. Contract is an agreement between at least 2 parties which creates an obligation recognized by
law.
2. Elements of a VALID working contract

TRUE Consent

COMPETENT PARTIES

Sound mind

Major age 18 years old

LAWFUL object

True means it is voluntary, freely given, no coercion, no pressure

Object or subject must be something within the bounds of law

VALID consideration something of value

Compensation

Service with no compensation cannot be sued for liability that have occurred

3. At least 2 witnesses NOT AN ELEMENT


4. Written > Verbal; with witness; better but not essential

If with breech of contract there is a proof

5. TYPES

11

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

According to form

Formal written and signed; follows the legal format

Informal either verbal or format; does not follow the legal format

According to terms of contract

Expressed either verbal or written the terms of the contract period of validity,
salary and benefits

Implied terms are not specified but the actions will tell the terms of contract

Last Will and Testament


1. Is the will an action or document? Action
2. Document testament
3. The will is an act allowed by law whereby a person makes a decision about the distribution of
ones estate and the decision will be carried out upon his death.
4. Not compelled
5. Qualifications of a testator who makes the testament

Major age

Competent or sound mind

6. Qualifications of a witness

Sound mind

Legal age

Can read and write

Acceptable form of last will and testament WRITTEN

Not under the influence of alcohol

Not convicted of perjury

Not deaf or dumb

Not a beneficiary prevent of conflict of interests

7. Types

Holographic will hand written entirely by the testator

From the date to the content to the signature

No need for witnesses

Authenticated Will dictated by the testator but written by somebody else.

With witnesses at least 2 witnesses

It is not the duty of the nurse to act as a witness in the making of the will. Only out of
willingness or voluntariness of the nurse

12

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
-

Lawsuit
1. It is a proceeding in court for a purpose
2. Possible purposes

To redress a wrong done to a person

To enforce a right

Complainant or plaintiff the one who files the case

Defendant or the respondent object of the lawsuit

4. Summons respondent

Written court order asking the defendant to appear in court

5. Subpoena witness

Written court order

Subpoena duces tecum = witness + documents

CRIMES
1. Violation of law
2. An act or an omission punishable by law which may be committed with deceit or by fault
3. Commission or omission
4. Deceit is present if the person committed the crime with full knowledge and understanding of
the gravity of the act and with full consent.
5. Fault ignorance of the law
6. Conspiracy when a crime is committed by a group of people who agree to commit a crime
together

Roles in conspiracy

Principal
o

Mastermind

Actually performing the act

Assisted in the commission of the crime>> act is essential to the


commission of the crime

Accessory or accessory after the act


o

Ways:

Destroying the evidence of a crime

Planting evidence in a crime

Assisting principal to escape or hiding the principal

13

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3. The 2 parties involved in a lawsuit

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Assisting the principal to benefit or you yourself benefits from the


effects of the crime

Accomplice or accessory before the act


o

Accomplice the person refers someone so that a crime can be done

7. Types
According to punishment

Grave minimum imprisonment is 6 years and 1 day; Php 6,001 and above

Less grave maximum is 6 years; 1 month and 1 day minimum; Php 201 to
6000

Light 30 days maximum ; Php 200 or less

According to degree of execution

Consummated objective of the crime is achieved

Frustrated completed all actions but objectives are not achieved

Attempted did not achieve object because you did not finish all actions

8. Forms of punishment

Imprisonment

Fine

9. Circumstances affecting liability in a crime

Justifying no liability

Exempting the law excuses the person who commits the crime; the action carries a
liability but the person who commits the act is exempted

Mitigating reduces liability

Aggravating increases liability

Alternating may decease or increase liability depending on the situation

10. Examples of justifying circumstances

In defense of ones self

In defense of ones property

Conditions for self- defense to be justified:

The unlawful aggression was started by the offended party

No provocation on part of the offender

Reasonable means employed to repel or prevent the aggression

11. Examples of Exempting circumstance

Offender is below 9 years old no full capacity on the gravity of his actions

14

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Offender is between 9-15 years old but acted without discernment (full understanding)

Mentally retarded or insane

Doing the act under the compulsion of an irresistible force or force majeure

When the person is doing the lawful act, with due care, causes injury by mere accident,
there was neither fault nor intention to commit the crime.

12. Examples of Mitigating Circumstance


Offender is a minor or above 70 years old minor(below 18 not fully accountable with
the action)

There was no intention to commit such a grave offence.

Voluntary surrender so that measures can be done to counteract the problem

Offender committed the act under the compulsion of a very strong emotion or passion.

When the offender is deaf, dumb or blind- seen in Penal Code; with limitations

13. Examples of aggravating circumstance

Offender committed the crime in abuse of power or confidence: incest

Offender committed the crime during a calamity or conflagration

Offender fire or sabotage- big destruction of property which is uncontrolled

Offender uses fraud or deceit in the commission of the crime

Offender gets paid or reward to do the crime

Crimes done with pre-meditation planning and intention

14. Examples of alternating circumstance

Intoxication of alcohol

Level of education

Definition of Crimes
1. Infanticides killing of infant less than 3 days old, regardless of relationship
2. Parricide- killing an immediate member of family spouse, child, parent
3. Murder with pre-meditation
4. Homicide- no intention
5. Assault- attempting to harm others VS. Battery with physical contact

Always get informed consent- invasive procedure and admission

6. Illegal distention or false imprisonment

Sign a waiver

Some crimes
1. Substitution of a child with another

15

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
2. Simulation of a birth
3. Child abuse

First to do: Report to medico-legal MD if diagnosis is confirmed, report to DSWD


(Child Welfare) and Police (crime)

4. Abandonment of a child left alone but not harmed


5. Slander defamation false statement given in public intended to destroy reputation of a
6. Libel written
-

Neligence
1. It is doing an act which a prudent nurse would not do; or not doing an act which a prudent
nurse would have done in the same situation
2. Imprudence does not know when or when not to do things
3. Voluntary, causes harm RECKLESS IMPRUDENCE doing an act voluntarily and causing
injury without the intention to cause such
4. Doctrine affecting liability; even no doctrine applies there is still a liability

Res ipsa loquitor

Injury that was caused is the proof the there was a negligent act

Example: patient got burned in application of hot water bath; left sponge in the
abdomen circulating nurse

3 conditions for the doctrine to apply: - all three must be present


o

Injury would have not occurred in the absence of someones negligence

There is voluntary control on the part of the nurse of the instrumentality


that caused the injury

There is lack of voluntary participation on the part of the patient to the


occurrence of the injury

Respondeat superior

Superior is ALSO accountable for the action of the subordinates

When does it apply?


o

When the subordinate committed the error while on duty because there is
an active employer- employee relationship

When do you consider that the order is legal? written and signed by a licensed
MD

16

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person - verbal

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Telephone orders to be countersigned by the MD within 24 hours to make it


legal
o

When ACCEPTABLE? If there is an emergency; what exempts to the


liability: the emergency

Strategies to protect superior from being accountable for subordinates error


o

Hire only qualified nurses

Orient the staff nurses properly and adequately

Issue memoranda, policies, bulletins, circulars to remind the staff nurses


of their duty

Force majeure

Irresistible force or an act of God

Key element: it cant be predicted or it cant be controlled

5. Analysis to determine liability in a negligent act

First Question: Is there a duty to protect the injured party from the injury received?

IF yes, proceed to second question

Good Samaritan Act: Nurse does not have the obligation to help the person,
thus, if client got more injured
o

Second question: was there a failure to do the duty?

Third: Did an injury result from the failure?

All 3 questions must be answered with a yes to have a criminal liability.

Some situations where negligence will likely to occur:

Admission: consent on admission (covers routine procedure); orientation

Surgery OR consent

RN makes sure that the patient signs the consent

Should come from a legitimate person

Invasive procedure needs written consent every time


o

In NY- does not recognize the GSA

Key element in IC: explain at the level of the patients understanding

Discharge instructions

Charting - What is not written was not done; erasures in charting

Laws affecting the Practice of Nursing

RA 9173 Nursing Act (other provisions)

Section 32 salary: salary of the beginning nurse must be salary grade 15 Php15000

17

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Section 34- Incentives and Benefits depend on the hospital ; free hospitalization,
scholarships, fellowship

Section 35- Prohibitions in the practice of nursing

In 7164 less penalty

PD 651 Compulsory Birth Registration register the birth within 30 days from the date of
birth the one who assisted the delivery office of the local civil registrar
RA 9255 An act allowing illegitimate children to use the surname of the father amending
Article 176 of E0 209 Family Code- provide that father acknowledge the child signs the back
of the birth certificate

PD 825 Garbage Disposal

RA 8749 Clean Air Act of 2000

RA 9003- Solid Waste Management Act of 2000

Zero Waste Management

Reuse, Reduce, Recycle

RA 6675 Generics Act

If there is an impending epidemic, parents cannot refuse for their child to be immunized

Needs parental consent EPI no impending epidemic

RA 6972 Establishment of Barangay Day Care Center


Your services should go beyond what the barangay can give

RA 7600 Rooming In and Breastfeeding Act

Baby Friendly hospital practices rooming in and BF

Promotion of these services

EO 51 Milk Code

We should only promote generic drugs

PD 996 Compulsory immunization Law

Incinerations of hospital waste is prohibited

Health professionals are inhibited in endorsing commercially prepared formula

RA 9231 Special Protection of Children against child abuse, exploitation and discrimination

Previously, RA 603

RA 7170 Organ Donation Act

RA 9211 Tobacco Regulation Act

Prohibited to smoke in close public places, hospitals and schools

RA 9251- Expanded Senior Citizen acct

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

20% discount on diagnostic procedure, PF, hospitalizations, transportations, domestic


and basic requirements

RA 8423 Creation of the Institution of Traditional and alternative Health Care

Alternative modes of treatment have been legitimized

Herbs, massage

RA 8172 Salt Iodization Law

Hyperthyroidism is endemic; due to iodine deficiency

Requiring that all processed foods use iodized salts

RA 8344 Prohibitions of hospitals to refuse care in emergencies

Health is a right of a citizen

RA 8505 Establishment of rape crisis center in hospitals and other suitable agencies

RA 3573 Requirement to report all communicable diseases

RA 9262 An act defining violence against women and their children providing for protective
measures for victims

RA 9288 National system for ensuring NB screening

Health practitioners are obliged to inform parents of availability or newborn screening


test

RA 1054 requires owner or lessee of any industrial, commercial or agricultural establishments to


provide free emergency medical and dental services to his employers or laborers

At least 100 employees- regularly employed RN

RA 9165- Comprehensive Danger Drugs Act of 2002 possession of 5 grams of prohibited drugs
is punishable by 12-20 years of imprisonment and 500,000 1M fine

Kinds of Dangerous Drugs

Prohibited

Regulated medical purposes


o

Morphine pain

Demerol

Codeine

Specifies who can handle them

Where to keep: cabinet with lock; key hang a key on the chain, where
it on your neck (principle: key should only be accessible to authorized
people)

RA 8976 Food Fortification Act of 2000

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Foods should have Vit A,D, B

RA 9502 Universally Accessible Cheaper and Quality Medicine Act of 2008

RA 1080 Civil Service Eligibility Law

RA 7875 Amended National Health Insurance Law Philhealth

Once employed, automatically a member of Philhealth

Hospital benefits for 45 days per year

Covers outpatient cases cataract, breast cyst, sterilization

With benefits Normal delivery

First delivery with episiotomy (surgical procedure)

At least 60 years old and not employed and single dependent - single

Married: spouse (not employed) , children below 21 (unemployed)

RA 6713 Code and Conduct and Ethical Standards for Public Officials and Employees

RA 6809 major age lowered to 18 years old

RA 7160 Local Government Code (devolution of DOH)

Health services is no longer the responsibility of DOH, not a responsibility of Local


Health Department

RA 7305 Magna Carta for Public Health Workers

Benefites and incentives:

Exempted from paying professional tax

RA 7877 Anti Sexual Harassment at work and Education

PD 442 Labor Code private employers

Permanent status if you work continuously for 6 months - regular

Cannot be removed unless there is a valid cause

Contractual or regular no benefits

Overtime pay more than regular

Regular: +25% of hourly rate

Holiday:
o

Special: +30% of hourly rate

Legal: according to law: +100% of hourly rate or double pay

Night differential pay:

10PM -6AM

10% night DFP

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Exemptions from CS Exam can work in government as a permanent employee

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Regular day : Any eight hour work

Regular week: any 40 hours

Sick Leave: 15 days paid leave

Maternity leave

PD 626 Employee Compensation and State Insurance Fund

Injury, illness or death work related compensable

Private sector: SSS

Public: GSIS

RA 8981- PRC modernization Act

Computerization of Board Exam

LOI 1000 Government agencies to give preference to members of accredited professional


organization when hiring or when selecting official delegates to official functions

RA 8187 Paternity Leave

7 days 4 pregnancies also

Only for legal spouse

RA 9225

BON Res 112 Series 2005- Core Competencies standard for nursing practice

Presidential Proclamation 539 proclamation declaring nurses week every last week of October
(promulgated October 1958)

RA 1612 Payment of privilege tax/ professional tax for professionals

BON Res 4595 series 2002 MCN standard of practice

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60 days 4 pregnancies

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
NURSING RESEARCH
-

Definition: scientific process that validates and refines existing knowledge and generates new
knowledge that directly and indirectly influences nursing care.

Primary Goal:

To develop scientific knowledge base for nursing practice. The knowledge generated through
research is essential for description, explanation, prediction and control of nursing phenomena

Specific Purposes

Generate new knowledge

Develop new gadgets and techniques

Evaluate a program or technique

Generate or validate theory (tentative explanation of a phenomenon event that is not fully
understood)

Scientific Law - explanation is universally accepted as correct

Types of Quantitative Research

According to Purpose:

Basic or Pure

Knowledge for knowledge sake

Applied

Purpose is to solve problems, to make decisions, to predict or control outcomes


in the real world

First researcher- Florence Nightingale

Limitations of Nursing Research

Ethico-legal considerations

Measurement Problems

Validity measures what you intend to measure.

Reliability yield the same result even repeatedly used

Control Problem

Ethics of research

Nuremberg Code of Ethics informed consent

Germany

Made Jews human guinea pigs

Belmont Report

Articulated 3 primary ethical principles

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Beneficence significance of the study

Respect for human dignity

Justice

Vulnerable groups for research unable to protect themselves

Children

Mentally or emotionally disabled persons

Physically disabled

Prisoners

Hospitalized persons (may feel pressured to participate)

Pregnant women (fetus)

Steps in Quantitative Research

The Conceptual Phase

Formulating and Delimiting the Problem

Reviewing the Literature

Developing a Theoretical Framework

Design and Planning Phase (RESEARCH PROPOSAL)

Selecting an appropriate research design

Specifying the Population

Specifying the Methods

Designing the plan for selecting the sample

Finalizing and reviewing all aspects of the research plan

Conducting a Pilot Study and making revisions mini research / whole research

Objective: run a study and look for possible areas of problems and gaps to be
revised

Empirical Phase

Collecting the Research Data

Preparing the Data for Analysis

Analytic Phase

Analyzing through appropriate quantitative or qualitative methods the research data

Interpreting the results of the analyses

Dissemination Phase

Communicating the findings through written or oral presentations

Undertaking steps to utilize the findings or to promote their utilization

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
-

First Step in the research Process: To find a topic for Research

Where do you search for research topics:

Own thoughts, observations and experiences

Review of literature

Theories concepts e.g. Role theory, sick role, the nurses role, the interaction between the
patients role and the nurses role

Testing assessment and intervention strategies

Criteria for Selecting a Research Topic

Relevance and Significance

Avoidance of duplication

Feasibility personnel time, equipment, money, availability of student participants

Political acceptability getting the permission of authorities involved

Ethical acceptability

Capability of researcher

3 levels of Research questions

Level I Exploratory in nature

Answers provide a complete description of the topic

Level II Descriptive level

Focus on relationships between 2 or more variable previously studied but never studied
together before

Level III Experimental level require considerable knowledge of the topic

Tests predictive hypothesis about the variables

Causal relationship

Hypothesis

Formal statement of the expected relationship between 2 or more variables in a specified


population

Translates the research problem and objectives into clear explanation or prediction of the
expected results of outcomes of the study

Hypothesis differs from objectives and research questions by predicting the outcomes of a study
and the researcher indicates the rejection or non rejection or support or nonsupport of each
hypothesis.

Uses:

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Indicates the variable (trait, property or characteristic of the population being studied)
to be manipulated and the variable to be measured

Identifies the population to be studied

Directs the conduct of the study by indicating the type of research

It influences the study design, sampling technique, data collection and analysis methods
and the interpretation of the results.

Types of variables

Research variables main focus of the study

Independent variables variable that is manipulated by researcher

Dependent variables- variable that you observe and measure; shows the result of
the manipulation

Extraneous Variables / Confounding variables

Variables present in the population but is not the main interest can affect the
result

May not be recognized or uncontrolled

Maybe recognized but cant be controlled

As control decreases, the potential influence of recognized and unrecognized


confounding variables increase

Characteristics of a Hypothesis

Statement of anticipated relationship causal or non causal

Testability

There is a predicted relationship

Variables are observable or quantifiable definition of variables (operational


definitions)

Hypothesis that involves moral, ethical, or value laden issues are not testable

Justifiability Theoretical Framework

Maybe deduced from theory if there is

If new area being investigated, maybe based on logical reasoning or personal


experience

Consistent with existing body of research findings

Types of Hypothesis according to complexity

Simple one independent and one dependent variable

Complex or multivariable 2 or more IV and or 2 or more DV

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
Types

Research or alternate hypothesis

Statistical. null hypothesis

Statement of expected relationship


Statement of no relationship

Predicted relationship of alternate hypothesis

Directional direction is specified

Non Directional

Example:

There is no difference in the nutritional status of children given nutribun with those given a liter
of milk daily.

IV type of food

DV nutritional

Null, simple, non directional

The incidence of nosocomial infection can be reduced by 50% when using the new technique of
HW than when using the traditional HW technique

Research Framework

Brief explanation of a theory or those portions of a theory to be tested

Every study has a framework

Must identify and define the concepts and the relational statements being studied

Design and Planning Phase

Elements of a good quantitative research

Appropriate to the purpose of the study

Cause and effect- experimental design; quasi-experimental design

Feasible given realistic constraints

Effective in reducing threats to validity

Concepts important in choosing design

Causality

Bias

Means to slant away from the true or expected result/ situation

The sources of bias need to be eliminated to arrive at valid and reliable results

If present unreliable results

Sources:

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College of Nursing
MICHAEL JOHN VALLARIT
Researcher

Measurement Tools

Individual study subjects

Sample

Data sources- definitions maybe different

Possible sources of bias during data collection


o

Defective instruments

Questionnaires with:

Fixed or closed question on topics about which little is


known yes/no ; with choices

Open ended questions without guidelines on how to


ask/answer them

Vaguely phrased questions

Questions placed in an illogical manner

Mechanical devices that are not standardized

The source of bias in the instrument can be prevented by:

Carefully planning the data collection process

Pre-testing the data collection tools groups of experts


sample population

Observer bias

Halo effect with pre conceived idea about the sample

Hawthorne effect- knowing that the samples are being observed,


they will act artificially

This can be prevented by:

Having training of the observers

Supervising them during the data collection

Effect of observer on the subjects (hawthorne effect)

Prevented by:

Prolong the observation time HE is usually observed in


the early stage of data collection and diminishes over time

Observer must try to maintain the naturalness of the


situation and be as unobtrusive as possible

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

How the observer should behave and relate with the


subject during the observation must be included in the

Manipulation

Control

Having the power to direct or manipulate factor to achieve a desired outcome

In uncontrolled confounding variables increases effect

The greater amount of control the research has of the study situation, the more
credible the findings

The purpose of a research design is to maximize control factors in the study


situation

Controlling of treatment strategies:


o

Make a detailed description of the treatment.

Be consistent in implementing the treatment. Variation in the treatment


reduces effect size.

Controlling of measurement
o

Measures must have documented validity and reliability test

Data collectors must be observed for consistency of measurement

Strategies of control
o

Controlling the environment- consistent for all subjects

Controlling equivalence of subjects and groups

Equal number in E and C group to say that they are the same
in the beginning

Define selection criteria

Random sampling (how you choose the sample) followed by


random assignment (control and experimental)

Examine the extent of equivalence by measuring and comparing


characteristics for which the groups must be equivalent. This
comparison is usually reported in the description of the sample.

Controlling extraneous variables

Design strategies used to control extraneous variables:

Random sampling

Random assignment

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training

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Homogeneity

Heterogeneity obtain subject with a wide variety


(heterogenous) to reduce the risk of biases. This is
designed to increase generalizability.

Stratification involves even distribution of the subjects


throughout the sample

Matching

Validity - Study validity is the measure of the truth or accuracy of the claim.

Internal the extent to which the effects detected in the study are a true
reflection of reality rather than the result of extraneous variables

External extent to which study findings can be generalized beyond the study
group

Factor that can affect internal validity:


o

History an event that is not related to the planned study but occurs
during the time of the study.

Maturation described as growing older, wiser, hungrier, more tired,


stronger, or more experienced during the study

Testing effect- effect being measured can be due to the number of times
the subjects responses have been tested.

Instrumentation effects can be due to changes in the measurement


instruments between pretest and posttest; when observer or data
collectors become more experienced between pre-test and post test, thus
altering in some way the data to collect

Selection a selection threat is more likely to occur when randomization


is not employed

Volunteer group least acceptable; with acknowledge biased

Mortality due to the subjects who drop out before the completion of the
study

Problem: if more loss on one group over the other unequal


number of participants per group

Diffusion or imitation of treatments the control group may gain access


to the treatment intended for the experimental group (diffusion) or a
similar treatment available from another source (imitation).

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Threats to External Validity

Interaction of selection and treatment If a large number of subjects


approached declined to participate, they tend to be volunteers or do-gooders

Quantitative research design

Non Experimental

Descriptive design

Typical descriptive design used to examine characteristics of a single sample

Comparative descriptive- examines and describes differences in variable in two


or more groups that occur naturally -----

According to time dimension


o

Longitudinal designs examines changes in the same subjects over an


extended period

Long period of time one sample

Limitation: expensive and greater danger of mortality of subjects

Cross sectional different sample, representing each stages

Examines groups of subjects in various stages of development


simultaneously

The assumption is the stages are part of a process that will


progress over time.

Limitations:

Many extraneous variables that may affect result

Correlation studies

Examines relationships between variables

A representative sample must be selected for the study

No attempt is made to control or manipulate the situation simply observe the


relationship

Types
o

Case control method begins with effect and looks for a cause;
retrospective

No way of ensuring individual characteristics

Weak when establishing cause and effect

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Hawthorne effect on sample

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT
o

Cohort design begins with cause and wait for effect ; prospective
design

Ensured of comparable characteristics

Good form of testing causal relationship in a natural setting

Good for determining relationship in natural setting

Experimental Designs

True Experiment

Features of True Experiment:


o

Manipulation of IV

Control of extraneous variables

Randomization

Quasi Experimental Design

When randomization or control of major extraneous variables is not possible or


cannot be done.

Criteria to establish causality

Co-variation between presumed cause and effect

Causal direction- X must precede the Y

Non spuriousness of results the effect or results were the intended results;
how? After repeating the procedure same results

Phases in the Qualitative Design the researchers are learners from their sample

Orientation and overview

To get a handle on what is salient about the phenomenon of interest

Focused exploration more focused scrutiny and in=depth exploration of those aspects
of the phenomenon that are judges to be salient

Confirmation and closure goes back to participant to validate results

In this final phase, the researcher undertake efforts to establish that their
findings are trustworthy, often by going back and discussion their understanding
with study subjects

There 3 phases are nor discrete events; they may overlap

Different research designs

Ethnography

Provides a framework for studying the meaning, patterns, and experiences of a


defined cultural group in a holistic fashion

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MICHAEL JOHN VALLARIT
o

How do they think, how they express themselves specific culture

The aim is to learn from (rather than study) members of the cultural group to
understand their world view as they define it.

Phenomenology

It is concerned with the lived experience of humans

Question asked: What is the essence of this phenomenon as experienced by

Grounded Theory

Primary purpose: to generate comprehensive explanation of phenomena that are


grounded in reality

It seeks to describe and understand the social psychological and structural


processes that occur in a social setting.

Case Study

In depth investigation of a single entity or small series of entities eg individual,


family, institution

It determines the dynamics of why individuals think, behave or develop in a


particular manner rather than what his or her status, progress, actions or
thoughts

Limitations: lack of generalizability small group

Historical Research

Systematic collection and critical evaluation of data coming from past events/
occurrences

It is undertaken to answer questions concerning causes, effects or trends


relating to past events that may shed light to present behaviors or practices.

Sources of data
o

Primary interview of an eyewitness, birth certificate, autobiography

Secondary biography

Evaluation of historical data


o

External criticism authenticity and genuineness of data

Internal criticism the evaluation of the worth and accuracy of the


evidence

Methods of Data Collection

Observation

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these people?

University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Degree of investigators involvement

Participant (bias) or non participant (Hawthorne) observation

Degree of structure

Self report:

Questionnaire (respondent writes the answer) or interview (interviewer writes the


answer)

Available or existing data

Degree of structure open or close ended questions

Problem: incomplete or inaccurate existing data

Physiologic measure or Biomedical instrumentation

Differentiation between data collection techniques and data collection tools


Data Collection technique

Data Collection Tools

Using available info

Checklist, data compilation form


Eyes and other senses, pen and paper, watch, scales,

Observing

checklist
Interview schedule tool used (questionnaire),

Interviewing

checklist rating scale, tape recorder

Administering written questionnaire


-

Questionnaire

Sampling

A process of selecting a subset from a population to obtain info about the phenomenon in a
way that represents the population

Population aggregate of elements which share common characteristics:

Sample subset selected of population of interest

Element a unit of the population of interest

Purpose of sampling

Achieve representativeness

Minimize cost

Sampling strategies

Probability sampling

Every element known every element can be selected

Non zero probability of being included

Involve random procedures

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

Allow estimate population characteristics

Can estimate sampling error

Permits use of inferential statistics

Types of probability sampling

Simple random fish bowl technique; homogenous population

Stratified / modified simple random heterogenous population; smaller more

Cluster/ Multi stage element for sampling: cluster

Systematic with random start: arranged in some kind of order, seating


arrangement, alphabetical order

Non probability sampling

Population enumeration not possible

Enumeration expensive, inconvenient

Rarity / unpredictability of phenomenon

Types: common: convenience

Convenience

Quota

Purposive

Snowball

General Guidelines in Estimating Sample Size

The larger the sample (n), the more reliable the estimate

Purpose of the study

Homogeneity of phenomenon in population

Univariate Analyses use only descriptive statistics

Know or understand DV

Characteristics of sample

Determine characteristics of IV preparatory to further analyses

Bi variate / multi variate analyses

What relationship exist, what do they look alike, how strong are they

Alternative hypothesis to be ruled out

Statistics Key Concept

A tool / aid

organizing summarizing data

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homogenous groups apply simple random

University of Santo Tomas


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MICHAEL JOHN VALLARIT

meaningful communication of findings

Factors that affect statistical analysis

making inferences

Levels of measurement

How the number are used to measure

4 levels

Nominal 2 nominal: chi square

Ordinal

Interval

Ratio

3 major parts of a research report

Preliminary pages

Title page

Table of contents

Body of the report

Research problem hypothesis, definition, framework

RRL

Methodology- methods, stools, sampling, statistical test, design

Presentation, analysis and interpretation of findings

Summary, conclusion and recommendations

Supplementary pages

Bibliography / References

Appendices

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University of Santo Tomas


College of Nursing
MICHAEL JOHN VALLARIT

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