PATIENT EDUCATION Teaching / Learning A planned interactional process that promotes intentional behavioral change.

Purposes of Patient Teaching Promotion of wellness

The Philippine Nursing Act of 2002 is the best guide the nurse can utilize as it defines the scope of nursing practice. Definition of a Professional Nurse A professional nurse is a person who has completed a basic nursing education program and is licensed in his/her country or state to practice professional nursing. Qualifications and Abilities of a Professional Nurse A. Professional Preparation The professional nurse must: 1. have a license to practice nursing in the country; 2. have a Bachelor of Science degree in Nursing; and 3. be physically and mentally fit. B. Personal Qualities and Professional Proficiencies The personal qualities and professional proficiencies of a nurse include 1. interest and willingness to work and learn with individuals/groups in a variety of settings; 2. a warm personality and concern for people; 3. resourcefulness and creativity as well as well-balanced emotional condition; 4. capacity and ability to work cooperatively with others; 5. initiative to improve self and service; 6. competence in performing work through the use of nursing process; 7. skill in decision-making, communicating, and relating with others and being research oriented; and 8. active participation in issues confronting nurses and nursing. Legal Aspects and the Nurse Professional Negligence The term negligence refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property. The elements of professional negligence are: (1) existence of a duty on the part of the person charged to use due care under circumstances (2) failure to meet the standard of due care (3) the foreseeability of harm resulting from failure to meet the standard, and (4) the fact that the breach of this standard resulted in an injury to the plaintiff. Specific Examples of Negligence 1. Failure to report observations to attending physicians. 2. Failure to exercise the degree of diligence which the circumstances of the particular case demands. 3. Mistaken identity. 4. Wrong medicine, wrong concentration. 5. Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients. 6. Errors due to family assistance. 7. Administration of medicine without a doctors prescription. The Doctrine of Res Ipsa Loquitor Res Ipsa Loquitor means the thing speaks for itself . This means that the injury could not have happened if someone was not negligent that no further proof is required. Three conditions are required to establish a defendants negligence without proving specific conduct. These are: 1. that the injury was of such nature that it would not normally occur unless there was a negligent act on the part of someone; 2. that the injury was caused by an agency within control of the defendant; and 3. that the plaintiff himself did not engage in any manner that would tend to bring about the injury. Examples Where No Further Proof is Required to Conclude that the Defendant is Negligent

Prevention of disease / injury Restoration of health Facilitation of coping abilities

Domains of Learning

Cognitive: Rational thought or thinking. Learning facts, reaching conclusions, solving problems , making decisions and using critical thinking skills. o Example: Patient can state the name and purpose of his / her medicines. Affective: Emotions or feelings. Changing beliefs, attitudes or values used in making judgments. Difficult to measure because it focuses on thoughts and feelings. o Example: Patient accepts that he / she has a chronic illness. Psychomotor: Physical application of knowledge. Muscular movements learned to perform a new skill or procedure. Easiest to measure because it can be physically demonstrated. o Example: A mother demonstrates proper breastfeeding techniques.

Learning Opportunities in Health Care Opportunity Admission Learning Needs Coming to know a new environment. Understanding specific treatment and their purpose. Opportunity Beginning of Each Shift Learning Needs Explaining new treatment or changes in plan of care.

Assessing patients need to know. Opportunity New Medications Learning Needs Knowing action of drug, dosage, side effects.

Demonstrating proper use and storage. Opportunity Diagnostic Procedure Learning Needs Knowing necessary preparation and what will happen. Opportunity Surgery Learning Needs Explaining pre operative routine and preparations
Practicing protocols such as leg exercises, coughing and deep breathing, log rolling, or getting out of bed in preparation for post operative period. Opportunity Discharge Learning needs Knowing any limitations on daily activities.

Demonstrating ability to care for self.

LEGAL RESPONSIBILITIES The nurse adheres to practice in accordance with the laws, policies and guidelines affecting nursing.

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A patient came in walking to the out patient clinic for injection. Upon administering the injection to his buttocks, the patient experienced extreme pain. His leg felt weak and he was subsequently paralyzed. His sciatic nerve was injured. The presence of sponges in the patients abdomen after an operation. Fracture on a newly delivered baby born by breech presentation.

Malpractice Malpractice in the usual sense implies the idea of improper or unskillful care of a patient by a nurse. Malpractice also denotes stepping beyond ones authority with serious consequences. An example of malpractice is the giving of anesthesia by a nurse or prescribing medicines. Under the Philippine Medical Act, this will be classified as within the purview of the medical practice. Doctrine of Force Majeure The term force majeure means an irresistible force, one that is unforeseen or inevitable. Under the Civil Code of the Philippines, no person shall be responsible for those events which cannot be foreseen, or which, though foreseen, are inevitable, except in cases expressly specified by law. Circumstances such as floods, fire, earthquakes and accidents fall under this doctrine and nurses who fail to render service during these circumstances are not held negligent. However, habitual tardiness due to heavy traffic is not considered an excuse for force majeure. Doctrine of Respondeat Superior The term means let the master answer for the acts of the subordinate. Under this doctrine, the liability is expanded to include the master as well as the employee and not a shift of liability from the subordinate to the master. Therefore, when a person, through his negligence, injures another, he remains fully responsible. This doctrine applies only to those actions performed by the employee within the scope of his employment. Examples: 1. The hospital will be held liable, if, in an effort to cut down on expenses, it decides to hire underboard nurses or midwives in place of professional nurses, and these persons prove to be incompetent. 2. The surgeon will be held responsible in case a laparatomy pack is left in a patients abdomen. Private duty nurses, however, are considered independent contractors. They are liable for their own negligent actions. Consent to Medical and Surgical Procedures CONSENT is defined as a free and rational act that presupposes knowledge of the thing to which consent is being given by a person who is legally capable to give consent. The consent signed by the patient or his authorized representative / legal guarding upon admission is for the initial diagnosis and treatment. Subsequent treatments / operations require individual, informed consent. It is only in case of emergency where the consent requirement does not apply. The physician should give as much information about a contemplated procedure and the patient should receive enough information to allow him to give an informed consent for such procedure or treatment . The intentional touching or unlawful beating of another person without authorization to do so is a legal wrong called battery. Nature of Consent Consent is an authorization, by a patient or a person authorized by law to give the consent on the patients behalf, that changes touching, for example, from non consensual to consensual. To substantiate the patients consent, a written authorization is needed as proof against any liability that may arise due to an alleged unlawful touching of a patient. Informed Consent Hayt and Hayt state that it is established principle of law that every human being of adult years and sound mind has the right to determine what shall be done with his own body. Explained: He may choose whether to be treated or not and to what extent, no matter how necessary the medical care, or how imminent the danger to his life or health if he fails to submit to treatment.

Essential Elements of Informed Consent Include: 1. the diagnosis and explanation of the condition 2. a fair explanation of the procedures to be done and used and the consequences 3. a description of alternative treatments or procedures 4. a description of the benefits to be expected 5. material rights if any 6. the prognosis, if the recommended care, procedure, is refused Proof of Consent A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of the procedure, the risks involved and the possible consequences. Consent of Minors Parents, or someone standing on their behalf, give the consent to medical or surgical treatment of a minor. Parental consent is not needed, however, if the minor is married or otherwise emancipated (from the parents). Consent of Mentally Ill A mentally incompetent person cannot legally consent to medical or surgical treatment. The consent must be taken from the parents or legal guardian. Emergency Situation When an emergency situation exists, no consent is necessary because inaction at such time may cause greater injury. Refusal to Consent A patient who is mentally and legally competent (sane mind and of legal age) has the right to refuse the touching of his body or to submit to a medical or surgical procedure no matter how necessary, nor how imminent the danger to his life or health if he fails to submit to treatment Ex: Patients who, because of their religious beliefs, may refuse BT as in the case of Jehovahs Witnesses. If after the explanation he still refuses to sign the consent form, he should be made to fill out the release form to protect the hospital and / or agency and its personnel from any liability that may result from his refusal. If he refuses to sign the release form, this should be noted in his chart. The competent person has a legal and ethical right to refuse TREATMENT, and this right is formally established. Consent for Sterilization Sterilization is the termination of the ability to produce offsprings. The husband and the wife must consent to the procedure if the operation is primarily to accomplish sterilization. When the sterilization is medically necessary and the sterilization is an incidental result such as in cases abruptio placenta, ectopic pregnancy or ruptured uterus, the patients consent alone is sufficient. CONTRACTS A contract is a promise or a set of promises which the law recognizes as a duty and when that duty is not performed, the law provides a remedy. When a nurse enters into a contract with an employer, it is usually an agreement to be paid a certain amount of money and be provided certain benefits in exchange for such services. Kinds of Contract Formal refers to an agreement among parties involved and is required to be in writing by some special laws. Informal one which concluded as the result of a written document or correspondence where the law does not require the same to be in writing, or as the result of oral and spoken discussion between the parties or conduct between the parties, evidence and intention to contract. Void one that is inexistent from the very beginning and therefore may not be enforced. Illegal one that is expressly prohibited by law. Examples: Those that are made in protection of the law. If a nurse proceeds to administer intravenous injection without special training and according to protocol established, she / he violates RA 9173, the Philippine Nursing Act of 2002.

Consent obtained by fraud. If a nurse obtained the consent of a patient or the family to be given services, through misinterpretation that she / he is licensed although she / he is not, such contract is illegal. Those obtained under duress. Duress means actual or threat of violence or imprisonment in order to obtain consent. A nurse may be forced to sign a contract under threat of dismissal. Those obtained under undue influence. If a nurse who has been taking care of an elderly patient uses her close relationship to acquire high salary or other options such as property, such contract is invalid as it is illegal. Those obtained through material misrepresentation. Aside from fraud, material misrepresentation may permit a person to avoid or cancel a contract. Suppose a midwife applied as nurse in an agency and was soon found not to be registered nurse, the contract that she signed becomes illegal because she misled the employer that she is a nurse.

Breach of Contract Failure to perform an agreement, whether expressed or implied, without cause. The following constitutes breach of contract for nursing services: 1. prevention of performance 2. failure to perform because of inconvenience or difficulty 3. failure of cooperation in performance 4. abandonment of duty (i.e., leaving unconscious patients, going off duty without endorsement, loafing while on duty 5. substitution of performance 6. failure to use due care Advantages of Written Contracts 1. A written contract is certain. It avoids the uncertainty of human memory. 2. It can specify a definite time within which it is binding so as to protect both sides against sudden changes without notice. 3. It sets a standard and relieves an individual professional person from haggling over compensation. 4. It is more likely to be open and well known so that the use of written contracts tends to establish minimum standards for professional practitioners and to protect them against discrimination in compensation. 5. It is definite an can be definite on many details which may otherwise stimulate favoritism or caprice even among professionals, such as hours of work, vacation allowances, holiday privileges, health and insurance provisions. 6. It can provide a definite procedure in case of complaints about substandard work, so that the employer has a clear course and the professional nurse has protection against arbitrary action. 7. It creates a minimum certainty and security for the professional employee so that he / she is free to concentrate on his / her work without concern for the details which the written contract has settled. ETHICO-MORAL RESPONSIBILITIES Responsibilities of Nurses to the Patients 1. The primary responsibility of the nurses to the patients is to give them the kind of care their condition needs regardless of their race, creed, color, nationality or status. 2. Nurses are advised to become familiar with the patients Bill of Rights and observe its provisions. 3. Because nurses are given compensation for their services, they should not accept tips or expensive gifts that may induce them to give more care to favored patients and neglect those who cannot give. 4. When nurses are engaged by patients or any agency, they shall complete said service on the length of time stipulated in the contract. They may not leave their patients or any agency without proper permission or resignation or without relief. 5. Nurses should commit themselves to the welfare of those entrusted to their care. Responsibilities of the Nurse to the Physician Section 28(a) of R.A. 9173 states that: 1. It shall be the duty of the nurse to:

(a) Provide nursing care to through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral, topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established. 1. Patients condition should be reported including results of therapies so that management of care can be properly monitored and modified as necessary. If any of the medical orders were not carried out for some reason (e.g., medications are unavailable, or a patient refuses to accept them), such shall not only be brought to the attention of the physician but also noted properly in the patients chart. Explore patients reason for refusal. Clarify misconceptions as needed. 1. Nurses shall familiarize themselves with the various routines, methods or idiosyncracies of physicians, so that smooth relationships can be maintained. In case the patient has a complaint against the physician, this shall be tactfully brought to the latters attention. Any case of illegal, incompetent or unethical practice by any member of the health team shall be brought to the attention of the appropriate authority through channels within the institutional or agency setting. 2. Nurses shall remember that any medical act relegated to them is illegal because it is specified in the Medical Law that any licensed nurse who does this, even if supervised, can be held for illegal practice of medicine. Responsibilities of Nurses to Their Colleagues 1. A mature person easily blends in any situation. Nurses shall adjust themselves to the organization and know its policies and procedures. They shall establish good working relationships with co-workers. 2. It is important that nurses know their place in the total organization so that they may cooperate, coordinate and maximize their work. Loyalty and consideration of others while at work will foster these relationships further. 3. Nurses who are cranky, too sensitive, who backbite, who do not see any good in their colleagues, are the type of nurses who will not be happy in their work. 4. Constructive criticism is always welcome but not fault- finding. Fault finders, gossipers, and whose who are fond of intrigues will surely resent it too if they become the target of their own practices. Responsibilities of Nurses to Themselves Just like any other professional, nurses are looked upon with respect in the community. They shall therefore endeavor to live a life that will uphold their self - respect. 1. When nurses are on duty, they shall try to look neat and attractive. Female nurses are advised to use light to moderate make up and have a neat hair style. They shall not wear uniforms that are neither too short nor tight fitting that will tend to restrict movement, nor expose unnecessarily any part of the body while giving care to the patients. Clean uniforms and clean bodies tend to enhance the image of nurses. Male nurses are likewise advised to be clean shaven, with hair clipped close to the nape instead of flowing to the shoulders. 2. The use of the uniform shall be specified in the policy of the hospital / agency. It shall be worn only when on duty. Dining in public, shopping or going to the market while in uniform is discouraged. 3. Nurses caps are worn only while on duty. These are either carried in bags or are left in their places of assignment. Jewelry such as earrings, necklaces or bracelets are not worn while on duty. However, wedding rings, school rings or school pins may be worn. 4. Nurses are looked upon by nursing students as their role models. Therefore, especially, while they are on duty, they must act in a manner that is worth emulating. Sincere and compassionate attitudes towards patients are caught by those around them. Confidentiality of Information Confidential information is also term as privileged communication because it is given based on trust. Patients and their families are entitled to know information or facts within the limits determined by the physician. If the patients insist on knowing their diagnosis, nurses may only repeat what doctors wish to disclose.

Any information gathered by nurses during the course of caring for their patients should always be treated confidential. This duty extends even after the patients death. Confidential information may be revealed only when: 1. patients themselves permit such revelation as in the case of claim for hospitalization, insurance benefits, among others; 2. the case is medico-legal such as attempted suicide, gunshot wounds which have to be reported to the local police; 3. the patients are ill of communicable disease and public safety may be jeopardized; and 4. given to members of the health team if information is relevant to his care. Moral Principles When a nurse is confronted with situations where moral judgment is necessary, the nurse may be guided by the following principles or rules: 1. The Golden Rule . Do unto others what you would like others do unto you. 2. 2. The Principle of Totality. The whole is greater than any of its parts. 3. Epikia . Exception to the general rule. 4. One who acts through an agent is himself responsible. 5. No one is obliged to betray himself / herself. 6. The end does not justify the means. 7. Defects of nature may be corrected. 8. A little more or less does not change the substance of an act. 9. The greatest good for the greatest number. 10. No one is held to the impossible. 11. Principle relating to the origin and destruction of life. Thou shall not kill. Example: Euthanasia or mercy killing Spiritual Commitment of Nurses 1. St. Pauls message to the Colossians is very apt for nurses. He said, You are the chosen people of God. He loves you and chose you for His own. So then, clothe yourselves with compassion, kindness, humility, gentleness, and patience. 2. The nurses ministry is reflected in Gods two great commandments: Love the Lord God with all your heart, and with all your soul and with all your mind and Love your neighbors as yourself. 3. There are times that the patient and / or his family may need the assistance of a nurse in calling a priest or minister of their faith. 4. The non Roman Catholic patient likewise looks up to his or her minister for spiritual guidance. A prudent nurse anticipates this need of the patient and makes arrangement that the minister or imam is contacted. In the absence of one, a nurse can read favorite passages from the Bible for the patient. The Lords Prayer may be recited for or with the patient. 5. Muslim nurses provide comfort and prayers to patients of the same faith by quoting passages from the Quran. References: The Quick Study for Nursing by Raines (2007) Professional Nursing in the Philippines, 11th Edition by Venson, et. al (2010)