University of Santo Tomas College of Nursing

Commission on Higher Education Center of Excellence in Nursing Education

Espana Boulevard Manila, Philippines

Course: Care of the Older Adult (NCM81020)

Title of Learning Activity: Ethico-legal Considerations in the Care of the Older Adult
Program Outcome:
1. Provide safe, appropriate, and holistic nursing care to individuals, families,
population groups and community utilizing nursing process in any healthcare
setting. (PO 2)
2. Practice nursing guided by Catholic / Thomasian core values taking into
consideration legal, ethical, and moral principles. (PO 4)
3. Function effectively as a conscientious Thomasian leader-manager and member
of the health care team in the delivery of client care. (PO 8)
4. Demonstrate responsible and engaged citizenship behaviors and pride of being a
Filipino Thomasian nurse in response to national and global issues. (PO 11)
5. Uphold the nursing core values in the practice of the profession. (PO 13)
6. Communicate effectively using culturally sensitive language and display
proficiency and responsibility in the use of information technology. (PO 5)
Course Outcome:
1. Perform safe, appropriate, and holistic care to older adults utilizing nursing
process. (CO 2)
2. Practice nursing in accordance with existing laws, legal, ethical, and moral
principles in the care of older adults. (CO 4)
3. Practice beginning management and leadership skills in the care of the older
adults using systems approach in the delivery of client care. (CO 8)
4. Demonstrate responsible citizenship and pride in being a Filipino. (CO 11)
5. Uphold the nursing core values in the practice of gerontology nursing. (CO 13)
6. Communicate effectively in speaking, writing, and presenting using culturally
appropriate language in the care of the older adults. (CO 5)
Learning Outcome/s:
1. Value ethico-legal considerations when providing safe and quality nursing care of
older adults.
2. Apply ethical reasoning and decision-making process to address situations of
ethical distress and moral dilemma
3. Discuss key principles , rights and benefits of the older adults under the
Philippine Nursing Law and other legal, regulatory, and institutional requirements
relevant to safe nursing practice.

Content:
 Laws Affecting Senior Citizens / Older Persons (RA 7432; RA 9257; RA 9994)
 Ethical Principles

Task designation: Individual reflective activity and group work (assigned group only)
Mode of implementation:
  Asynchronous- introduction of the concepts, evidence-based material readings,
development of performance tasks
 Synchronous: on-line classroom case-based discussion
Time Allotment: Asynchronous- 1 hours and Synchronous – 1 hour
Date of expected submission: Week 3

 Asynchronous activities
Individual task:
Read/View the following materials prior to the discussion of the topic
o Republic Act 9994 – Expanded Senior Citizens Act – link
https://www.officialgazette.gov.ph/downloads/2010/02feb/20100215-RA-
9994-GMA.pdf
o Economics of aging - https://www.youtube.com/watch?v=5gxBEY2c9YA
o Social Pension for older adults in the Philippines
https://www.youtube.com/watch?v=pfSgShvyeF0
o Benefits of senior citizens from Philhealth -
https://www.youtube.com/watch?v=vDADSv-mOu0

Assigned group:
o Interview at least 2 senior citizens (Rural and Urban) and ask them of the
usual benefits that they have received as senior citizens as from the
national government and local government (video will be a maximum of 5
minutes)

 Synchronous session:
o The video will be presented in class and the students are expected to share their
key insights identified from the readings and video materials
o Identify key ethical issues observed affecting the older person

Suggested Deliverables:
 Group work (Assigned RLE) – short video clip about a given case scenario
 Individual – Creative reflection on the topic in any format (short video blog,
illustration, essay, poem or any medium can be used) – provide a brief description
of the reflection for artistic works.

Evaluation: The creative reflection will be graded based on the following rubric:
Rubric for Creative Reflection
Criteria 3 2 1 Score
Understanding The work was The work was The work was
of the issue able to able to unable to
This reflects the highlight the highlight some highlight the
ability of the salient points of of the salient salient points of
proponent to the issue and points of the the issue, the
identify the exhaustive issue and issue identified
issue analysis was multiple was
conducted sources of data unsupported
was utilized and
inappropriate
Depth and Work is deeply Work is is The work
Clarity- the thoughtful. It thoughtful . It shows some
reflection was shows obvious shows a some depth of
well thought personal depth of thought and
and reflective awareness and thought and reflection but
of the a heightened reflection and with minimal
meaningful appreciation for some appreciation for
achievement of personal appreciation for personal
the learning reflection.  personal reflection.
outcomes reflection.
Message – the The message is The message The message
message is clear and was somewhat was confusing
clear and can be succinct to clear but there and does not
translated to the address the were some translate the
identified target target audience ambiguous proposed
audience concepts that advocacy
still need
refinement
Implications The output The output The output does
or conclusions strongly somewhat not support the
the work can supports the supports the nursing theories
contribute to nursing theories nursing theories and purely
the body of and can and can based on
knowledge in contribute to contribute to personal
the field of the body of the body of opinion and not
nursing knowledge knowledge grounded on
evidence
Organization – The report is The report is The report is
the ability to well organized,
somewhat disorganized
organize report and the organized and and there is
and present all thoughts are there were logical flow
relevant and presented in asome minor presented
pertinent very logical lapses in the
information manner manner it was
discussed
Synthesis – this The The The
reflects on the proponent/s has proponent/s has proponent/s
ability of the shown critical shown failed to exhibit
proponent to thought by somehow critical thought
synthesize the correctly critical thought by failing to
main learning synthesizing the but failed to establish main
points in the main issues in completely issues of the
activity the article synthesizing the article
main issues in
the article
Format – the The output is The output was The output is If applicable:
conformity to correctly somehow incorrectly
the provided formatted and correctly formatted and Done or Not
format APA citation formatted with failed to follow Done only
including was correctly some minor the appropriate
proper APA applied flaws in the citation format
citation in the APA citation
bibliography

Grade Equivalent:
SCORE GRADE SCORE GRADE
18 100 13 88
17 98 12 86
16 96 11 84
15 94 10 82
14 92 9 and below FAILED and must
repeat

Grade Equivalent: Performance task

Suggested References:
o Republic Act 9994 – Expanded Senior Citizens Act
o Meiner, S. E. & Lueckenotte, A. G. (2015). Gerontologic nursing. Elsevier:
Maryland Heights, Missouri. [RC954. G319 2015].
o Judson, K. (2016). Law & ethics for health professions. New York: McGraw-Hill.
[R725.5. J924a 2016].
o Westrick, S. (2014). Essentials of nursing law and ethics. 2nd ed. Burlington,
Massachusetts: Jones & Bartlett Learning. [RT85. W529 2014] MEB028807

Prepared by: Asst. Prof. Gian Carlo Torres PhD, RN

Ethico-legal Considerations in the Care of the Older Adult
CONTENT:
 Introduction/Background about the care of the elderly in the Philippines
 Laws Affecting Senior Citizens / Older Persons (RA 7432; RA 9257; RA 9994)
 Ethical Principles
 Include in the conclusion, Close family societal ties of Filipinos

inclusive

A hallmark of Filipino culture is how we treat our elderly with respect and utmost care,
but as people age and get older, their health becomes more vulnerable and complicated.

This entails a more focused health management and demands a more sensitive and
inclusive awareness. (Close up) Thus, through an effective awareness, we can create and
implement laws that can benefit the ageing population. (Close up) But wait, we already
have an existing law that do benefits the ageing population. (Pan out) So, let’s check it
out.

(Record voice) The RA 9994 or the Expanded Senior Citizens Act of 2010, which is the
most recent and prevailing law for senior citizens in the Philippines,

is where the indigent senior citizens aged 60 and above are entitled to (enumerate on
screen) 500 pesos monthly social pension, mandatory PhilHealth coverage, free
vaccination, social safety assistance, 20% discounts on medicines, medical services,
theaters, restaurants, transportation among others.

but the BIG JUICY question here, is this law effective enough to support and address the
needs of each member of the ageing population? My answer is No (close up).

(pan out) It was not holistically effective and was borderline selective and exclusive.
What I mean is that a study by the Coalition of Services of the Elderly pointed out that
more than half of the country’s senior citizens receive no pension at all. This is of serious
concern, as the increasing health risks of advanced age, combined with scarce
gerontologic services and fewer livelihood opportunities, leaves our senior citizens very
vulnerable.

In simpler terms, it is insufficient in addressing the needs, medical, social, and financial,
of the ageing population.

But this is not the only issue here, the issues concerning the elderly go beyond the
borders of legislative laws and mandated policies.
Issues also arise in the aspect of nursing care and health management of the elderly.

And one of it is in terms of the ethical challenges and ethico-legal issues concerning the
nursing care management of the elderly.

These include decision‐making and other challenges in end‐of‐life care, use of restraints,
lack of resources, autonomy and decision‐making capacity, communication and
cooperation between healthcare workers and the patients’ next of kin and the resident's
privacy and behavior. All of these affects how care to the elderly is being delivered and is
being accepted.

Members of the same family often express conflicting statements that contradict the
dying person’s self-determined choices and decisions.

In this type of conflicts, how can we, as nurses, make the autonomy and self-
determination of the competent dying person be upheld and preserved? We must
remember that our first duty is to our patients, to that dying person and family just comes
second.

How can we help families to respect and support the dying person’s wishes? As patient’s
advocates, we can advise, foster and facilitate early discussions about end-of-life issues,
thus helping these individuals make informed decisions.

While a principles-based approach to ethical dilemmas addresses basic elements to be

considered in decision making, the artificiality of a single decision-maker isolated from
the context of the family and care environment can lead to decisions that are sub-
optimal.

Aside from these, today’s healthcare environment is driven by discordant demands to

provide high quality and to manage costs with diminishing resources. The lack of
resources results in the difficulty of meeting the ethical standards of professional practice.
This preclude nurses from meeting many of their primary responsibilities in taking care
of the elderly.

There is a demand for systematic ethics work in nursing homes. In order to

establish a culture of care in nursing homes, the attention for everyday ethical
issues and the inclusion of ethics in everyday meetings and discussions have to
be more focused in the future. The implementation of special structures or places
for systematic ethics work must be based on sensitisation and awareness of
ethical aspects in everyday work and communication 32, 34.
as a nursing student, awareness is crucial in these topics

Truth be told, ethical challenges are already part of the nursing profession and for me,
these are unavoidable but what we can do, as we educate ourselves and expose
The nursing profession offers innumerable rewards, but let’s be honest, the work is
demanding
Nursing has been at the forefront in health care in commitment to health promotion

https://www.youtube.com/watch?v=pfSgShvyeF0
https://www.youtube.com/watch?v=vDADSv-mOu0
https://businessmirror.com.ph/2014/11/09/the-national-laws-for-senior-citizens/
https://opinion.inquirer.net/111086/misgivings-senior-citizen-law
https://www.researchgate.net/publication/331166618_Evaluation_of_the_Philippine_Exp
anded_Senior_Citizens_Act_RA_9994_on_Mandated_Privileges_for_the_Elderly
https://businessmirror.com.ph/2019/11/08/social-pension-and-our-senior-citizens/
https://opinion.inquirer.net/87612/senior-citizens-discount-on-water-power-use-clarified

For me, a law should not just be executed and implemented but also, it should be able to
address both the current struggles and challenges of a population and be able to
foreseeable ………….
and ultimately uplift the dignity of the individuals.

(Show pictures of the 2 old laws) We had the Republic Act 7432 or the Senior Citizens Act of 1991 and the
Republic Act 9257 or the Expanded Senior Citizen Act of 2003 which are the old amendments of the most
recent and prevailing law for senior citizens in the Philippines, the RA 9994 or the Expanded Senior
Citizens Act of 2010. It is where the indigent senior citizens aged 60 and above are entitled to (enumerate
on screen) 500 pesos monthly social pension, mandatory PhilHealth coverage, free vaccination, social
safety assistance, 20% discounts on medicines, medical services, theaters, restaurants, transportation among
others.

And one of it is in terms of Communication. Am I right (pan to the left, “huh?”,

“nevermind”.)

Effective Communication is vital in patient care as it has the ability to provide patients
with individualized care, result into positive outcomes, can make the patients disclose the
true extent of their feelings and interpersonal communication can satisfy the innate needs
of the patient
We, healthcare professionals,
a month to help them with their daily and medical needs.

As a nursing student…………
So in terms of the elderly care, I just want to remind you
old people wants to be recognized not by their “frailty and dependence” but by their
“value and importance”.

So that’s all for today’s topic guys, thank you for watching this vlog, see you again
next time.