Nursing Study: NCM 105

PROFESSIONAL NURSING

Definition of Nursing

1. ICN Definition – Nursing, as Integral part of the health care system, encompasses the promotion of health, the prevention of illness, and care of the physically ill, mentally ill, and disabled people of all ages, in all health care and other disabled people of all ages, in all health care and other community settings.  Within this broad spectrum of health care, the phenomena of particular concern to nurses are individual family and group responses to actual or potential health problems.  These human responses range broadly from health restoring reactions to an individual episode of illness to the development of policy in promoting in promoting the long term health of population.

2. WHO Definition – The mission of nursing in society is to help individuals, families and group to determine and achieve their physical, mental and social potential, and to do so within the challenging context of the environment in which they live and work.  This requires nurses to develop and perform functions that relate to the promotion and maintenance of health as well as to the prevention of ill health.  Nursing also includes the planning and implementation of care during illness and rehabilitation, and encompasses the physical, mental and social aspects of life as they affect health, illness, disability and dying.  Nursing is the provision of care of individuals, families and groups throughout the entire lifespan – from conception to death.  Nursing is both an art and a science that requires the understanding and application of the knowledge  and skills specific to the discipline. It also draws on knowledge and techniques derived from the humanities and the physical, social, medical and biological sciences.

3. WHO Definition on the Function of the nurse – (1) providing and managing direct practical nursing, (2) teaching patients, clients and health care personnel, (3) developing nursing practice based on critical thinking and research

4. American Nurses Association – Nursing is the diagnosis and treatment of human responses to actual or potential health problems

Major Nurse Theorist Definition of Nursing

1. Florence Nightingale (1859) – The goal of nursing is to put the patient in the best condition for nature to act upon him, primarily by altering his environment

2. Hildegard Peplau (1952) – Nursing is viewed as an interpersonal process  involving interaction between two or more individuals that has its common goal assisting the individual who is sick or in need of health care

3. Faye Abdellah – (1960) – Nursing is a service to individuals, families and society based on an art and science  that molds the attitudes intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people with their health care needs, and is focused around twenty one nursing problem

4. Ernestine Wedenbach (1964) – Nursing is a helping, nurturing, and caring service rendered with compassion, skill and understanding in which sensitivity is the key to assisting the nurse in identifying problems.

5. Virginia Henderson (1966) – Nursling’s role is to assist the individual (sick or well) to carry out those activities he would perform unaided if he had the necessary strength, will or knowledge

6. Myra Lavine (1969) – Nursing means the nurse interposes her skill and knowledge into the course of events that affect the patient. When influencing adaptation favorably, the nurse is acting in a therapeutic sense.  When the nursing intervention cannot alter the course of adaptation, the nurse is acting in a supportive sense.

7. Ida Jean Orlando (1972) – Nursling’s unique and independent role concerns itself with an individual’s need for help in an immediate situation for the purpose of avoiding, relieving, diminishing, or curing that individual’s sense of helplessness

8. Dorothea Orem (1980) – Nursing is concerned with the individual’s need for self care action, which is the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health and well being

9. Dorothy E. Johnson (1980) – Nursing is an external category force that acts to preserve the organization and integration of the patient’s behavior with optimal level under those conditions in social health , or in which illness is found

10. Imogene King (1981) – The focus of nursing is the care of human beings resulting in the health of individuals and health care of groups, who are viewed as open system in constant interaction with their environment.

11. Betty Neuman (1982) – Nursing respond to individuals, groups and communities who are in constant interaction with the environmental stressors that create disequilibrium.  A critical element id the client’s ability to react to stress and factors that assist with reconstitution or adaptation.

12. Sister Callista Roy (1984) – The goal of Nursing is the promotion of adaptive response (those things that positively influence health) that are affected by the person’s ability to respond to stimuli.  Nursing involves manipulating stimuli to promote adaptive responses.

13. Martha E. Rogers (1984) – Nursing is an art and science that is humanistic and humanitarian directed towards the unitary human, and corrected with the nature and direction of human development. (Ellis 2001)

Legal Definition of Nursing Practice

Philippine Nursing Act of 2000 defines nursing practice

Sec 28 Scope of Nursing
• A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infant, childhood, toddler, preschool, school age, adolescence, adulthood and old age.  As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness.  As members of the health team, nurses shall collaborates 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 a peaceful death.  It shall be the duty of the nurse to:
- Provide nursing care 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, essential primary health care, 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
- Establish linkages with community resources and coordination with the health team
- Provide health education to individuals, families and communities
- Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied setting 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; and
- Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice
• Provided, that this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty. Provided, further, that in the practice of nursing in all settings,
- The nurse is duty bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice
- The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, That the program and activity for the continuing professional education shall be submitted to and approved by the Board.

Philippine Laws Relating to Nursing

1. Act No. 2493 – approved on February 5, 1915; the first law affecting nursing; entitled “An Act to Amend Act No. 310, Regulating the Practice in the Philippine Islands of Medicine and Surgery in all their Branches, To repeal section 1 of Act No. 1632 and Registration of Nurses in the Philippine Island
2. Act No. 2808 – approved on March 1, 1919; An Act Regulating the practice of nursing profession in the Philippine Island;” otherwise known as “The Nurses Law”
3. Act No. 3025 – approved on March 8, 1922; amended some sections of Act 2808
4. Act No. 3438 – approved on November 28, 1928; amended Act No. 2035
5. Act No. 4007 – approved Dec 5, 1932 and became effective on Jan 1, 1933; known as the “Reorganization Law of 1932”
6. Republic act No. 465 – approved on June 1950; standardized the examination and registration fees charged by the then Examining Board
7. Republic Act 546 – approved on June 1950; reorganized the Board of Examiners and placed them under the direct supervision of the President of the Philippines
8. Republic Act No. 877 – took effect on June 19, 1953; otherwise known as “The Philippine Nursing Law;” repealed all the provisions of the above mentioned laws that are consistent with its provisions on nursing education and practice
9. Republic Act No. 4704 – approved on June 18, 1966; amended RA 877
10. Republic Act No. 6136 – approved on August 31, 1970; amended RA 877 and RA 4704; expressly authorized registered nurses to administer intravenous and other injections as long as the administration is under the direction of and in the presence of a physician
11. Republic Act No. 6511 – took effect on July 1, 1972; amended RA 465
12. Republic Act No. 9173 – approved October 21, 2002; known as “The Philippine Nursing act of 2002;” repealed RA 7164; repeals, amends or modifies all other laws that are inconsistent with it
13. Republic Act No. 6758 – otherwise known as the “Compensation and Classification act of 1989,” prescribing the salary of professional nurses in public health institutions
14. Republic Act No. 7164 – approved on November 21, 1991; entitled “The Philippine Nursing Act of 1991;” repealed, modified all existing laws that are inconsistent with it.
15. Executive order No. 496 – entitled “Instituting Procedures and Criteria for the Selection and the Recommendation of Nominees for Appointment to Vacant Positions in the Professional Regulation Boards under the Supervision of the Professional Regulation Commission”
16. Republic Act No. 8981 – “The PRC Modernization Act of 2000;” provides for the power, function and responsibility of the Professional Regulation Commission (PRC) to recommend nominees for appointment by the President to the Board of Nursing.

Health Policies and Laws

1. Republic Acts  - Laws (RA's) created by the Congress and signed by the President.
2. Administrative Orders - Prescribed policies, rules, and regulations and procedures (AO's) individuals and organizations outside of the DOH.
3. Executive Orders - Executive legislations (EO's) that are health-related.
4. Presidential Decrees - Executive decrees (PD's) that are health-related.

Republic Act
1. Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening
2. Republic Act 9257 - Expanded Senior Citizens Act of 2003
An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes"
3. Republic Act 9211 - Tobacco Regulation Act of 2003
An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes
4. Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995
An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes.
5. Republic Act 8203 - Special Law on Counterfeit Drugs"
An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof
6. Republic Act 6425 - Dangerous Drugs Act of 1972
This Act shall be known and cited as "The Dangerous
Drugs Act of 1972."
7. Republic Act 6675 - Generics Act of 1988
An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs
And Medicines Identified By Their Generic Names
8. Republic Act 4226 - Hospital Licensure Act
An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency
9. Republic Act No. 7876 - Senior Citizens Center Act of the Philippines
An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges
10. Republic Act 7305 - Magna Carta of Public Health Workers
Magna Carta of Public Health Workers (Republic Act No. 7305)
11. Republic Act 7719 - National Blood Services Act of 1994
An Act Promoting Voluntary Blood Donation, Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof
12. Republic Act 7875 - National Health Insurance Act of 1995
An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose
13. Republic Act 7432 - Senior Citizen Act of 1992)
An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges
14. Amendment to RA 7170 - Organ Donation Act of 1991
An Act To Advance Corneal Transplantation In The Philippines, Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991
15. Republic Act 8504 - Prevention and Control of 1988
Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids
Monitoring System, Strengthening The Philippine National Aids Council, And For Other Purposes
16. Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997)
An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes
17. Republic Act 8749 - Philippine Clean Air Act of 1999
An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes
18. Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments
An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases
19. Republic Act 5921
An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes
20. Republic Act 9165 - An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes
21. Republic Act 7394
The Consumer Act Of The Philippines
22. Republic Act 8976
Philippine Food Fortification Act of 2000
Administrative Orders
2007
1. Administrative Order No. 2007-0029 - Revised Guidelines on Management of Animal Bite Patients
2. Administrative Order No. 2007-0028 - Implementing Guidelines of EO No. 663 "Implementing the National Commitment for Bakuna ang Una sa Sanggol at Ina", Attaining the WHO's Goal to Eliminate Measles and Neonatal Tetanus, Eradicate Polio, Control Hep B and Other Vaccine Preventable Diseases..
3. Administrative Order No. 2007-0027 - Revised Rules and Regulations Governing the Licensure and Regulation of Clinical Laboratories in the Philippines
4. Administrative Order No. 2007-0025 - Revised Guidelines for Conducting Medical Fitness Examination for Seafarers
(download related documents and requirements)
5. Administrative Order No. 2007-0024- Guidelines for the Licensure of Department of Health Hospitals
6. Administrative Order No. 2007-0023 - Schedule of Fees for the One-Stop Shop Licensure System for Hospitals
7. Administrative Order No. 2007-0022- Violations under the One-Stop Shop Licensure System for Hospitals
8. Administrative Order No. 2007-0021- Harmonization and Streamlining of the Licensure System for Hospitals
9. Administrative Order No. 2007-0017- Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations
10. Administrative Order No. 2007-0015-A - Amendment to AO No. 0015 "Revised Guidelines in the Management and Prevention of Schistosomiasis
11. Administrative Order No. 2007-0015 - Revised Guidelines in the Management and Prevention of Schistosomiasis
12. Administrative Order No. 2007-0011 - Repeal of A.O. 118-B s.1992 entitled "Rules and Regulations Governing the Accreditation of Clinical Laboratories for the Training of Medical Technology Interns"
13. Administrative Order No. 2007-0019 - Guidelines for the Implementation of the Quality Assurance System on Direct Sputum Smear Microscopy (DSSM)
14. Administrative Order No. 2007-0012 - Philippine National Standards for Drinking Water 2007
15. Administrative Order No. 2007-0014 - Guidelines on the Issuance of Certificate of Product Registration for Equipment or Devices Used for Treating Sharps, Pathological and Infectious Waste
16. Administrative Order No. 2007-0033-A Amendment to Administrative Order No. 2006-0033 entitled "Guidelines for the DOH-PITC Expanded Drug Access Pilot Program Using Convenience Stores as BNB Express Outlets"
17. Administrative Order No. 2007-0007 - Guidelines in the Implementation of Oral Health Program for Public Health Services
18. Administrative Order No. 2007-0004-A - Amendment to Administrative Order No. 2006-0004: Guidelines for the Issuance of Certificate of Need to Establish a New Hospital
19. Administrative Order No. 2007 - 0003 - Policies and Guidelines Governing the Registration and Licensing of Establishments Dealing with Medical Devices
20. Administrative Order No. 2007-0001 - Revised Schedule of Fees for Certain Services Rendered by the Bureau of Health Facilities and Services and Centers for Health Development in Relation to the Regulation of Health Facilities and Services and Validity Period of License to Operate, Accreditation, Authority to Operate, and Clearance to Operate for Certain Health Facilities and Services
2006
1. Administrative Order No. 2006-0039 - Amended Policies and Guidelines for the Institutionalization and Decentralization of the Department of Health Drug Consignment System
2. Administrative Order No. 2006-0038 - Amendment to Administrative Order No. 1 s. 2003 dated January 2, 2003 re: Operational Guidelines in the Conduct of Pre-employment Medical Examination of Overseas Workers and Seafarers
3. Administrative Order No. 2006-0037 - Amendment To Administrative Order No. 163 s. 2004; Rules And Regulations Governing The Registration, Licensure And Operation of Dialysis Clinics in the Philippiines
4. Administrative Order No. 2006-0036 - Schedule of Fees for Certain Services Rendered by the Centers for Health Development in Relation to Presidential Decree No. 856 Code on Sanitation in the Philippines"
5. Administrative Order No. 2006-0033 - Guidelines for the DOH - PITC Expanded Drug Access Pilot Program Using Convenience Stores as BNB Express Outlets
6. Administrative Order No. 2006 - 0029 - Guidelines for Rationalizing the Health Care Delivery System based on Health Needs
7. Administrative Order No. 2006 - 0026 - Implementing Guidelines in the Conduct of the National TB Control Program - Directly Observed Treatment Short-Course (NTP-DOTS) Certification
8. Administrative Order No. 2006-0024 - Rules and Regulations Governing the Accreditation of Laboratories for Drinking Water Analysis
9. Administrative Order No. 2006 - 0023 - Implementing Guidelines on Financing Fourmula One for Health (F1) Investments and Budget Reforms
10. Administrative Order No. 2006 - 0020 - Guidelines for Evaluation of Consumer Participation Strategies in Fourmula One for Health
11. Administrative Order No. 2006 - 0018 - Implementing Guidelines for the Philippine National Drug Formulary System
12. Administrative Order No. 2006 - 0015 - Implementing Guidelines on Hepatitis B Immunization for Infants
13. Administrative Order No. 2006-0008 - Guidelines on Public-Private Collaboration in Delivery of Health Services Including Family Planning for Women of Reproductive Age
14. Administrative Order No. 2006 -0012 - Revised Implementing Rules and Regulations of Executive Order No. 51, Otherwise Known as the "Milk Code", Relevant International Agreements, Penalizing Violations Thereof, and for Other Purposes
15. Administrative Order No. 2006-0010 - Revision of Fees and Charges Imposed by the Bureau of Quarantine in Accordance with RA 9271, Repealing Such Orders Inconsistent Therewith, and for Other Purposes
16. Administrative Order No. 2006-0009 - Guidelines Institutionalizing and Strengthening the Essential Drug Price Monitoring System (EDPMS)
17. Administrative Order No. 2006-0007 - Guidelines in Establishing Governing Boards for Augmenting Management Capacity of Public Hospitals
18. Administrative Order No. 2006-0007-A - Supplementary Guidelines to AO No. 2006-0007 to Cover Guidelines for Establishment of Governing Boards for Selected Department of Health (DOH) Hospitals
19. Administrative Order No. 2005-0003-B - Amendment to Administrative Order No. 2005-0003 dated January 11, 2005 re: Guidelines on the Issuance of Certificate of Product Registration for Water Purification Equipment and Device
20. Administrative Order No. 2006-0003 - Strategic Framework and Operational Guidelines for the Implementation of Health Programs for Persons with Disabilities (PWDs)
21. Administrative Order No. 2006-0004 - Guidelines for the Issuance of Certificate of Need to Establish a New Hospital
22. Administrative Order No. 2006-0001- Operational Guidelines for Parasitologic Screening of Food Handlers
2005
1. Administrative Order No. 0029s. 2005 - Amendment to Administrative Order No. 147, s. 2004
2. Administrative Order No. 183 s. 2005 - Rules and Regulations Governing the Licensure and Regulation of Ambulatory Surgical Clinics
3. Administrative Order No. 0029 s. 2005 - Amendment to Administrative Order No. 147 s. 2004: Amending Administrative Order No. 70-A series 2002 re: Revised Rules and Regulations Governing the Registration, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines.
2004
1. Administrative Order No. 181 s. 2004 - Revised Rules and Regulations governing Accreditation of Medical Facilities for Overseas Workers and Seafarers
2. Administrative Order No. 163 s. 2004 - Revised Rules and Regulations Governing Registration, Licensure and Operation of Dialysis Clinics in the Philippines
3. Administrative Order No. 147 s. 2004 - Amending Administrative Order No. 70-A, series 2002 re: Revised Rules and Regulations Governing the Registration, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines
2003
1. Administrative Order No. 114 s. 2003 - Suspension of the Implementation of Administrative Order NO. 70-A, s. 2002
2. Administrative Order No. 105 s. 2003 - Revised Rules and Regulations Governing the Registration and Licensure of Dental Laboratories in the Philippines
3. Administrative Order No. 101-A, s. 2003 - Rules and Regulations Governing Authorization of Blood Collection Unit and Blood Station
4. Administrative Order No. 81, s. 2003 - Rules and Regulations Governing Accreditation of Hospitals Engaged in the Conduct of Kidney Transplantation
5. Administrative Order No. 48 s. 2003 - Classification of Clinical Laboratories Based on Institutional Character
6. Administrative Order No. 28, s.2003 - Revised Rules and Regulations Governing the Registration and Licensure of Dental Laboratories in the Philippines
7. Administrative Order No. 1, s. 2003 - Operational Guidelines in the Conduct of Pre-Employment Medical Examination of Overseas Workers and Seafarers
2002
1. Administrative Order No. 127, s. 2002 - Amendment to Administrative Order No. 70-A, s. 2002 "Revised Rules and Regulations Governing the Registration, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines
2. Administrative Order No. 118, s. 2002 - Schedule of Fees for Certain Services Rendered by the Bureau of Health Facilities and Services
3. Administrative Order No. 102, s. 2002 - Schedule of Fees for Certain Services Rendered by the Bureau of Health Facilities and Services
4. Administrative Order No. 70-A, s. 2002 - Revised Rules and Regulations Governing the Regulation, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines."
2001
1. Administrative Order No. 59, s. 2001 - Rules and Regulations Governing the Establishment, Operation and Maintenance of Clinical Laboratories in the Philippines.
2000
1. Administrative Order No. 176 s. 2000 - Standard Guidelines for Conducting Medical Fitness Examinations for Filipino Seafarers.
2. Administrative Order No. 51-A, s. 2000 - Implementing Guidelines on Patients and on Availment of Medical Social Services in Government Hospitals.
1996
1. Administrative Order No. 5-A, s. 1996 - Revised policies, procedures and guidelines governing affiliation and training of students in the DOH hospitals and other government health facilities

Executive Order
1. Executive Order No. 663
Implementing the National Commitment for "Bakuna ang Una Sa Sanggol At Ina", Attaining World Health Organization's goals to Eliminate Measles and Neonatal Tetanus, Eradicate Polio, Control Hepatitis B and Other Vaccine-Preventable Diseases
2. Executive Order No. 637
Providing the Basis for the Computation of the Incentive Benefits of Personnel who may be Affected by the Implementation of the Rationalization Program under Executive Order No. 366s. 2004
3. Executive Order No. 611
Authorizing Compensation Adjustments to Government Personnel
4. Executive Order No. 567
Devolving the Taguig-Pateros District Hospital from the Department of Health to the City of Taguig
5. Executive Order No. 452
Directing the Enrollment of 2.5 Million Indigent Families Pursuant to Executive Order No. 276s. 2004 also known as the Enhanced PCSO Greater Medicare Access Program and for other Purposes
6. Executive Order No. 441
Delegating to the Secretary of Department Health (DOH) the Power to Exercise Oversight Function over the Philippine Sports Commission (PSC)
7. Executive Order No. 442
Designating the Philippine International Trading Corporation as the Lead Coordinating Agency to Make Quality Medicines Available, Affordable and Accessible to the greater masses of Filipinos
8. Executive Order No. 417
Directing the implementation of the Economic Independence Program for Person with Disabilities
9. Executive Order No. 392
Amending Executive Order No. 182 dated February 14, 2003, Entitled " Transferring the Medicare Functions of the Overseas Workers Welfare Administration to the Philippine Health Insurance Corporation
10. Executive Order No. 102
Redirecting the Functions and Operations of the Department of Health.
11. Executive Order No. 51
Adopting a National Code of Marketing of Breastmilk Supplements and related products, penalizing violations thereof, and for other purposes.
12. Executive Order No. 247
Prescribing Guidelines and Establishing a Regulatory Framework for the Prospecting of Biological ang Genetic Resources, their By-Products and Derivatives, for Scientific and Commercial Purposes; and for other Purposes
13. Executive Order No. 455
Transferring the Supervision and Control of the Philippine Charity Sweepstakes from the Department of Social Welfare and Development to the Department of Health, and for other Purposes
14. Executive Order No. 472
Transferring the National Nutrition Council from the Department of Agriculture to the Department of Health

Presidential Decree
1. Presidential Decree 881
January 30, 1976
Empowering the Secretary of Health to regulate the labeling, sale and distribution of hazardous substances
2. Presidential Decree No. 856
Code on Sanitation of the Philippines
(with Implementing Rules and Regulations)
3. Presidential Decree No. 522
Prescribing Sanitation Requirements for the Operation of Establishments and Facilities for the Protection and Convenience of the Traveling Public
4. Presidential Decree No. 651
Requiring the Registration of Births and Deaths in the Philippines which occurred from January 1, 1974 and thereafter
5. Presidential Decree No. 996
Providing for Compulsory Basic Immunization for Infants and children below eight years of age
6. Presidential Decree No. 498
Amending sections two, three, four, seven, eight, eleven, thirteen, sixteen, seventeen, twenty-one and twenty-nine of Republic Act No. 5527, also known as the Philippine Medical Technology Act of 1969
7. Presidential Decree No. 965
A Decree Requiring Applicant for Marriage License to Receive Instructions on Family Planning and Responsible Parenthood
8. Presidential Decree No. 1631
Creating the Lunsod ng Kabataan
9. Presidential Decree No. 1823
Creating the Lung Center of the Philippines
10. Presidential Decree No. 384
Amending Republic Act Numbered 4073, entitled an An Act Further LIberalizing the Treatment of Leprosy by Amending and Repealing certain Sections of the REvised Administrative Code
11. Presidential Decree No. 1832
Creating National Kidney Foundation of the Philippines
12. Presidential Decree No. 893
Reconstituting the National Schistosomiasis Control Commission into the Schistosomiasis Control Council and for other
Purposes
13. Presidential Decree No. 79
Revising the Population Act of Nineteen Hundred and Seventy-one
DEPARTMENT OF HEALTH CALENDAR OF ACTIVITIES
January 2007
> National Cancer Consciousness Week - January 15 -21
February 2007
> Leprosy Prevention and Control Week (19-25)
> Healthy Lifestyle Month
> Oral Health Month
March 2007
> Women's Health Day (8)
> World Tuberculosis Day (24)
> Burn Injury Prevention Month
> Rabies Awareness Month
> Women's Health Month
April 2007
> World Health Day (7)
> Bright Garantisadong Pambata Week (16-22) (Round) - Garantisadong Pambata - April 11-17
May 2007
> World Asthma Day(2)
> AIDS Candlelight Memorial Day((21)
> World No Tobacco Day (31)
> Safe Motherhood Week (9-15)
> Natural Family Planning Month
June 2007
> World Environment Day (5)
> World Blood Donor Day (14)
> DOH 109th Anniversary (23)
> Safe Kids Week (18-24)
> Dengue Awareness Month
> National Kidney Month
July 2007
> National Diabetes Awareness Week (16-22)
> National Disability Prevention and Rehabilitation Week (16-22)
> National Blood Donors Month
> National Disaster Consciousness Month
> Nutrition Month
August 2007
> Family Planning Day (1)
> National Tuberculosis Awareness Day (19)
> World Breastfeeding Week (1-7)
> National Hospital Week (5-11)
> National Lung Month
> Sight-Saving Month
September 2007
> World Heart Day (26)
> Generics Awareness Month
October 2007
> World Mental Health Day (10)
> World Sight Day (10)
> Elderly Filipino Week (1-7)
> National Health Education Week (1-7)
> National Mental Health Week (8-14)
> Garantisadong Pambata Week (15-21) (Round 2)
November 2007
> National Food Fortification Day - November 7
> World Diabetes Day (14)
> Substance Abuse Prevention Week (7-13)
> Filariasis Awareness Month
> Malaria Awareness Month
> Traditional and Alternative Health Care Month
December 2007
> World Aids Day (1)
> Health Emergency Week (2-8)
> Firecracker Injury Prevention Month


 THE PHILIPPINE NURSING ACT OF 2002
Republic Act No. 9173

- the law that principally governs the Nursing Profession in the Philippines
- October 8, 2002 – was approved by the House of Senate as Senate Bill No. 2292
- October 15, 2002 – was approved by the House of Representative as House Bill No. 1084
- October 21, 2002, was signed into law by Pres. Gloria Macapagal Arroyo as RA 9173
- Resolution No. 425, series of 2003 of the Board of Nursing – the rules and regulations implementing the Phil Nursing Act of 2002

Article 3 Sec 3
- Creation and Composition of the Board – chairperson and six (6) members.  Shall be appointed by the President of the Philippines from among the two recommendees, per vacancy, of the PRC, chosen and rank from the list of 3 nominees

Section 4 of RA 9173
- Qualifications of the Chairperson and Members of the Board – The Chairperson and members of the Board shall, at the time of their appointment, possess the following qualifications:
o Be a natural born citizen and resident of the Philippines
o Be a member of good standing of the accredited professional organization of nurses
o Be registered nurse and holder of a master’s degree in nursing, education or allied medical profession conferred by a college or university duly recognized by the Government: Provided, that the majority of the Members of the Board shall be holders of  a master’s degree in nursing: Provided, further, that the Chairperson shall be a holder of master’s degree in nursing
o Have at least ten years of continuous practice of the profession prior to appointment: Provided, however, that the last five (5) years of which shall be in the Philippines and
o Not have been convicted of any offense involving moral turpitude;
-  Provided, that the members of the Board shall represent the three (3) areas of nursing, namely: nursing education, nursing service and community health nursing.

Section 5 of RA 9173
- Requirements upon Qualification as Member of the Board of Nursing – any person appointed as Chairperson or Member of the Board shall immediately resign from any teaching position in any school, college, university or institution offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations or in any office or employment in the government or any subdivision, agency or instrumentality thereof, including government owned or controlled corporations or their subsidiaries as well those employed in the private sector.  He/she shall not have any pecuniary interest in or administrative supervision over any institution offering Bachelor of Science in Nursing including review classes.

Section 7 of RA 9173
- Compensation of Board Members – The Chairperson and Members of the Board shall received compensation and shall receive compensation and allowance comparable to the compensation and allowances received by the Chairperson and members of other professional regulatory boards.

Section 8 of RA 9173
- Administrative Supervision of the Board, Custodian of its Records, Secretariat and Support Services – The board shall be under the administrative supervision of the Commission.  All records of the Board, including applications for examination, administrative and other investigative cases conducted by the Board shall be under the custody of the commission. The commission shall designate the Secretary of the Board and shall provide the secretariat and other support services to implement the provisions of this Act.

Sec 9 of RA 9173
- Powers and duties of the Board – The Board shall supervise and regulate the practice of the nursing profession and shall have the following powers, duties and functions:
o Conduct the licensure examination for nurses
o Issue, suspend or revoke certificate of registration for the practice of nursing
o Monitor and enforce quality standards of nursing practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation
o Ensure the quality of nursing education by examining the prescribed facilities of universities or colleges of nursing or departments of nursing education and those seeking permission to open nursing courses to ensure that standards of nursing are properly complied with and maintained at all times.  The authority to open and close colleges of nursing and/or nursing education programs shall be vested on the Commission on Higher Education upon the written recommendation of the Board
o Conduct hearings and investigations to resolve complaints against nurse practitioners for unethical and unprofessional conduct and violations of this Act, or its rules and regulations and in connection therewith, issue subpoena and testificandum and subpoena duces tecum to secure the appearance of respondents and witnesses and the production of documents and punish with contempt persons obstructing, impending and/or otherwise interfering with the conduct of such proceedings, upon application with the court;
o Promulgate a Code of Ethics in coordination and consultation with the accredited professional organization of nurses within one (1) year from the affectivity of this Act
o Recognize nursing specialty organizations in coordination with the accredited professional organization and
o Prescribed, adopt, issue and promulgate guidelines, regulations, measures and decisions as may be necessary for the improvement of eth nursing practice, advancement of this Act subject to the review and approval by the Commission

Sec 10 of RA 9173
- Annual Report – The Board shall at the close of its calendar year submit annual report to the president of the Philippines through the commission giving a detailed account of its proceedings and the accomplishments during the year and making recommendations for the adoption of measures that will upgrade and improve the conditions affecting the practice of the nursing profession

Sec 11 of RA 9173
- Removal of Suspension of Board Members – The President may remove or suspend any member of the Board after having been given the opportunity to defend himself/herself in a proper administrative investigation, on the following grounds:
o Continued neglect of duty or incompetence
o Commission or toleration of irregularities in the licensure examination and
o Unprofessional, immoral or dishonorable conduct

Sec 12 of RA 9173
- Licensure Examination – All applicants for license to practice nursing shall be required to pass a written examination, which shall be given by the Board in such places and dates as may be designed by the Commission; Provided, that it shall be in accordance with Republic Act No. 8981, otherwise known as “PRC Modernization Act”

Sec 13 of RA 9173
- Qualifications for Admission to the Licensure Examination – In order to be admitted to the Examination for nurses, an applicant must, at the time of filling his/her application, establish to the satisfaction of the Board that:
o He/She is a citizen of the Philippines, or a citizen or subject of a country which permits Filipino nurses to practice within its territorial limits on the same basis as the subject or citizen of such country; Provided, That the requirements for the registration or licensing of nurses in said country are substantially the same as those prescribed in this Act;
o He/she is of good moral character; and
o He/she is a holder of a Bachelor’s Degree in Nursing from a College or University that complies with the standards of nursing education duly recognized by the proper government agency.

Sec 14 of RA 9173
- Scope of Examination – The scope of the examination for the practice of nursing in the Philippines shall be determined by the Board.  The Board shall take into consideration the objectives of the nursing curriculum, the broad areas of nursing, and other related disciplines and competencies in determining the subjects of examinations.

Sec 15 of RA 9173
- Ratings – In order to pass the examination, the examinee must obtain a general average of at least 75% with a rating of not below 60% in any subject.  As examinee who obtain an average rating of 75% or higher but gets a rating below 60% in any subject must take the examination again but only in the subject or subjects where he/she is rated below 60%.  In order to pass the succeeding examination, an examinee must obtain a rating of at least 75% in the subjects or subjects repeated.

Sec 16 of RA 9173
- Oath – All successful candidates in the examination shall be required to take an oath of profession before the Board or any government official authorized to administer oaths prior to entering upon the nursing practice

Sec 17 of RA 9173
- Issuance of Certificate of Registration/Professional License and Professional Identification Card – A certificate of registration/professional license as a nurse shall be issued to an applicant who passes the examination upon payment of the prescribed fees.  Every certificate of registration/professional license shall show the full name of the registrant, the serial number, the signature of eth Chairperson of the Commission and of the Members of the Board, and the official seal of the Commission
- A professional identification card duly signed by the Chairperson of eth Commission, bearing the date of registration, license number, and the date of issuance and expiration thereof shall likewise be issued to every registrant upon payment of the required fees.

Sec 19 of RA 9173
- Automatic Registration of nurses – All nurses whose name appears at the roster of nurses shall be automatically or ipso facto registered nurses under this Act upon its effectivity

Sec 20 of RA 9173
- Registration by Reciprocity – A certificate of registration/professional license may be issued without examination to nurses registered under the law of foreign  state or country: Provided, that the requirements for registration  or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided further, That the laws of such sate or country grant the same privileges to registered nurses of the Philippines on the same basis as the subjects or citizens of such foreign state or country.

Sec 21 of RA 9173
- Practice Through Special/Temporary Permit – A special/temporary permit may be issued by the Board to the following persons subject to the approval of the Commission and upon payment of the prescribed fees:
o Licensed nurses from foreign countries/state whose service are either for a fee or free if they are internationally well known specialist or outstanding experts in any branch or specialty of nursing;
o Licensed nurses from foreign countries/states on medical mission whose services shall be free in a particular hospital, center or clinic; and
o Licensed nurses from foreign countries/states employed by schools/colleges of nursing as exchange professors in a branch or specialty of nursing
- Provided however, that the special/temporary permit shall be effective only for the duration of eth project, medical mission or employment contract

Sec 22 of RA 9173
- Non registration and Non-issuance of Certificate of Registration/Professional License or Special/Temporary Permit – No person convicted by final judgment of any criminal offense involving moral turpitude or any person guilty of immoral or dishonorable conduct or any person declared by the court to be of unsound mind shall be registered and be issued a certificate of registration/professional license or a special/temporary permit.
- The Board shall furnish the applicant a written statement setting forth the reasons for its actions, which shall be incorporated in the records of the Board.

Sec 23 of RA 9173
- Revocation and Suspension of Certificate of Registration/Professional License and Cancellation of Special/Temporary Permit – The Board shall have the power to revoke or suspend the certificate of registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds
o For any of the causes mentioned in the preceding section
o For unprofessional and unethical conduct
o For gross incompetence or serious ignorance
o For malpractice or negligence in the practice of nursing
o For the use of fraud, deceit or false statements  in obtaining a certificate of registration/professional license or a temporary/special permit
o For violation of this Act, the rules and regulation, Code of Ethics for nurses and technical standards for nursing  practice, policies of the Board and the Commission, or the conditions and limitations for the issuance of the temporary/special permit or
o For practicing his/her profession during his/her suspension from such practice
- Provided however, That the suspension of the certificate of registration/professional license shall be for a period not to exceed four years

Sec 24 of RA 9173
- Re-issuance of Revoked Certificates and Replacement of Lost Certificates – The Board may, after the expiration of a maximum of four (4) years from the date of revocation of  certificate, for reasons of equity and justice and when the cause for revocation has disappeared or has been cured and corrected, upon proper application thereof and the payment of the required fees, issue another copy of the certificate of registration/professional license.
- A new certificate of registration/professional license to replace the certificate that has been lost, destroyed or mutilated may be issued, subject to the rules of the Board.

Sec 25 of RA 9173
- Nursing Education Program -  The nursing education program shall provide sound general and professional foundation of the practice of nursing.
- The learning experiences shall strictly adhere strictly to specific requirements embodied in the prescribed curriculum as promulgated by the Commission on Higher Education’s policies and standards of nursing education

Sec 26 of RA 9173
- Requirement of Inactive Nurses Returning to Practice – Nurses who have not actively practiced the profession for five (5) consecutive years are required to undergo one (1) month of didactic training and three (3) months of practicum.  The board shall accredit hospitals to conduct the said training program.

Sec 27 of RA 9173
- Qualifications of the Faculty – A member of the Faculty in a college of nursing teaching professional courses must:
o Be a registered nurse in the Philippines
o Have at least one (1) year of clinical practice in a field of specialization
o Be a member of good standing in the accredited professional organization of nurses; and
o Be a holder of a master’s degree in nursing , education, or allied medical and health services conferred by a college or university duly recognized by the Government of the Republic of the Philippines
- In addition to the aforementioned qualification, the dean of college must have a master’s degree in nursing.  He/she must have at least five (5) years of experience in nursing

Sec 28 of RA 9173
- Nursing Practice – A person shall be deemed  to be practicing nursing within the meaning of this Act when he/she  singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities  in any health care setting.  It includes, but not limited to , nursing care  during conception, labor, delivery, infancy, childhood and old age.  As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. As members of the health team, nurses 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 a peaceful death.  It shall be the duty of the nurse to:
o Provide nursing care 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, essential primary health care, 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;
o Establish linkages with community resources and coordination with the health team;
o Provide health education to individuals, families and communities;
o Teach, guide and supervise students in nursing education programs including the 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, and;
o Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice;
- Provided, That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided, further, That in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice.  The nurse is required to maintain competence  by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, that the program activity for the continuing professional education shall be submitted to and approved by the Board.

Sec 29 of RA 9173
- Qualification of Nursing Service Administrators – A person occupying supervisory or managerial positions requiring knowledge of nursing must:
o Be a registered nurse in the Philippines
o Have at lest tow (2) years experience in general nursing service administrations;
o Posses a degree of Bachelor of Science in Nursing , with at least nine (9) units in Management and administration courses at the graduate level; and
o Be a member of good standing of the accredited professional organization of nurses;
- Provided, further, That for primary hospitals, the maximum academic qualifications and experience for a chief nurse shall be as specified in subsections (a), (b), and (c) of this section: provided, furthermore, That for a chief nurses in the public health agencies, those who have master’s degree in public health/community health nursing shall be given priority.  Provided, even further, that for chief nurses in military hospitals, priority shall be given to those who have finished a master’s degree in nursing and the completion of the General Staff Course (GSC): Provided; finally, That those occupying such positions before the effectivity of this Act shall be given a period of five (5) years within which to qualify

Sec 30 of RA 9173
- Studies for Nursing Manpower Needs, Production, Utilization, and Development – The Board, in coordination with the accredited professional organization and appropriate government or private agencies hall initiate, undertake and conduct studies on health human resource production, utilization and development.

Sec 31 of RA 9173
- Comprehensive Nursing Specialty Program – Within 90 days from the effectivity of this Act, the Board in coordination with the accredited professional organization, recognized specialty organizations and the Department of Health is thereby mandated to formulate and develop a comprehensive nursing specialty program that would upgrade the level of skill and competence of specialty nurse clinicians in the country, such as but nor limited to the areas of critical care, oncology, renal and such areas as may be determined by the Board.
- The beneficiaries of this program are obliged to serve in any Philippine hospital for a period of at least 2 years of continuous service.

Sec 32 of 9173
- Salary – In order to enhance the general welfare, commitment to service and professionalism of nurses, the minimum base pay of nurses working in the public health institution shall not be lower than salary grade 15 prescribed under Republic act no. 6758, otherwise known as the “Compensation and Classification Act of 1989:” Provided, that for nurses working in local government units, adjustments to their salaries shall be in accordance with Section of said Law

Sec 33 of RA 9173
- Funding for the Comprehensive Nursing Specialty Program – The annual financial requirement needed to train at least the percent (10%) of the nursing staff of the participating government hospital shall be chargeable against the income of the Philippine Charity Sweepstakes Office and the Philippine Amusement and Gaming Corporation, which shall equally share in the costs and shall be released to the Department of Health subject to the accounting and auditing procedures: Provided, That the Department of Health shall set criteria for the availment of the program.

Sec 34 of RA 9173
- Incentives and Benefits – The board of Nursing, in coordination with the Department of Health and other concerned government agencies, association of hospitals and the accredited professional organization shall established an incentive and benefit system in the form of free hospital care for nurses and their dependents, scholarship grants and other non-cash benefits . The government and private hospitals are hereby mandated to maintain the standard of nurse-patient ratio set by the Department of Health.

Sec 35 of RA 9173
- Prohibitions in the Practice of Nursing – A fine of not less than fifty thousand Pesos (P50,000.00) not more than One Hundred Thousand Pesos (P100,000.00) or imprisonment of not less than 1 year nor more than six (6) years, or both , upon the discretion of the court shall be imposed upon:
o Any person practicing nursing in the Philippines within the meaning of this Act
 Without a certificate of registration/professional license and professional identification card or special temporary permit or without having been declared exempt from examination in accordance with the provision of this Act; or
 Who uses as his/her own certificate  of registration/professional license and professional identification card or special temporary permit of another, or
 Who uses as invalid certificate of registration/professional license, a suspended or revoked certificate of registration/professional license, or an expired or cancelled special/temporary permit; or
 Who gives any false evidence to the Board in order to obtain a certificate of registration/professional license, a professional identification card or special permit; or
 Who falsely poses or advertises as a registered and licensed nurse or uses any other means that tend to convey the impression that he/she is a registered and licensed nurse; or
 Who appends BSN/RN (Bachelor of Science in Nursing/Registered Nurse) or any similar appendage to his/her name without having been conferred said degree or registration; or
 Who, as a registered nurse and license nurse, abets or assists the illegal practice of a person who is not lawfully qualified to practice nursing
o Any person or the chief executive officer of a judicial entity who undertakes in-service educational programs or who conducts review classes for both local and foreign examination without permit/clearance from the Board of the Commission; or
o Any person or employer of nurses who violate the minimum base pay of nurses and the incentives and benefits that should be accorded them as prescribed in Sections 32 and 34; or
o Any person of eth chief executive officer of a judicial entity violating any provision of this Act and its rules and regulations

Sec 36 of RA 9173
- Enforcement of this Act – It shall be the primary duty of the Commission and the Board to effectively implement this Act. Any duly law of enforcement agencies and officers of  national, provincial, city or municipal governments shall, upon the call or request of the Commission or the Board, render assistance in enforcing the provisions of this Act to prosecute any persons violating the same.

Sec 37 of RA 9173
- Appropriations – The Chairperson of the Professional Regulation Commission shall immediately include in its program and issue such rules and regulations to implement the provisions of this Act, funding of which shall be included in the Annual General Appropriations Act.

Sec 38 of RA 9173
- Rules and Regulations – Within 90 days after the affectivity of this Act, the Board and the Commission, in coordination with the accredited professional organization, the Department of Health, the Department of Budget and Management and other concerned government agencies, shall formulate such rules and regulations necessary to carry out the provisions of this Act.  The implementing rules and regulations shall be published in the Official Gazette or in any newspaper of general circulation.

Sec 39 of RA 9173
- Separability Clause – If any part of this act is declared unconstitutional, the remaining parts not affected thereby shall continue to be valid and operational.

Sec 40 of RA 9173
- Repealing Clause – Republic Act No. 7164, otherwise known as the “Philippine Nursing Act of 1991” is hereby repealed.  All other laws, decrees, orders, circulars, issuances, rules and regulations and parts thereof which are inconsistent with this Act as hereby repealed, amended or modified accordingly.

Scope of Nursing Practice

A. Independent Nursing Functions
a. Licensed to initiate based on knowledge and skills
b. Physical care
c. Gathering health information
d. Support and comfort
e. Teaching, counseling
f. Environmental support
g. Referrals
B. Dependent/Collaborative Nursing Functions
a. Under physician orders
b. Under protocols
c. Decision under parameters
d. Student reports to faculty member

Areas of Nursing Practice
A. Nursing Education
B. Nursing Services
C. Community Health Nursing

Levels of Nursing Practice

A. Novice -  this stage is attributed to nursing students who have no background knowledge and therefore, needs rules, facts and direct instruction to guide their actions and to perform nursing safely
B. Advanced Beginner – this stage is attributed to a new graduate who ahs developed a greater self awareness as a nurse and has become less reliant on rules, facts and direct instruction and is more contexts free in her practice.  A practitioner at this level begins to grasp situations, has marginally acceptable performance, has previous experience but still cannot recognize situations based on those experiences.  They are aware of there limitations and seek the assistance and guidance of a mentor such as her supervisor.
C. Competent – a practitioner at this level of practice is characterized by a sense of role mastery. Practice at this level is planned and evolves on the basis of long term goals and prioritization.  This nurse has wider knowledge base, plans and anticipates, functions by relying on previous experiences, and therefore works with increases level of efficiency.
D. Proficient – a nurse at this level based on holistic and deep understanding of the situation, which means that she sees the total picture of  a situation and understands it.  The nurse functions with an intuitive grasp, a skill that can be attained only by seeing and comparing many similar and distinct clinical situations that she has been exposed to over time.  Therefore, this nurse has many meaningful clinical experiences that have provided her with valuable lessons and insights on how to act on a particular situation she encounters in her present practice.  The hallmarks of proficient practice are increased perceptual acuity and responsiveness to particular situations.
E. Expert – the nurse at this level is characterized by an intuitive grasp of the most salient aspect of each situation with the minimum number of cues.  Unlike the proficient level, there is no detached decision making, hesitation , deliberation or consideration of  a wide range of possibilities instead she instantaneously  zeros in on the problem and takes action.  Clinical grasp is inextricably linked with clinical response.  This ability requires an enormous background and vast experiences.  Expert practice represents the essence of clinical judgment and is the pinnacle of clinical performance from the most knowledgeable members of the profession

Careers in Nursing

Hospital Setting Non Hospital Setting
Critical Care/ICU
Emergency Nurse
Maternal/Child Care
Medical: Cardiology, Diabetes
Gastroenterology, Gerontology
Nephrology, Neurology, Oncology
Pulmonary, Rehabilitation, Renal
Rheumatology, Urology
Operating Room/Recovery Room
Pediatrics
Psychiatric/Mental Health
Surgical: Burn, Cardiovascular
Ear/Nose/Throat, Gastroenterology
Orthopedics, Plastic Reconstructive
Transplant Public/Community Health
Mental Health Agencies
Home Health Care/Private Duty
Health Maintenance Organization and
Managed Care Companies
Occupational Health
Research Centers
Extended Care Facilities
Clinics
Rehabilitation Centers
Hospices/Nursing Homes
School Nursing
Day Care Centers
Military Branches

A. Institutional Nursing practice – refers to nursing employment in a health care setting, whether in an in-patient or out-patient setting and providing nursing care to the individual, the family or the community.  This includes nurses working as staff nurse, occupational nurses, clinic nurses, school nurses, nurses in nursing homes, rehabilitation centers and other extended health care facilities.
B. Public Health Nurse/Community Health Nurse – synthesis of nursing theory and public health practice applied to promoting and preserving the health of the populations, This includes the ambulatory health clinics, home health care, industrial sites, nursing centers, outpatient surgery centers (derma clinics), prenatal and well baby clinics, school, rural health nurse and city health offices.
C. Occupational Health Nurse – concerned with the health and safety of  people at work, their families and the general community.  The nurse is responsible in the promotion and preservation of the health of the working population.
D. School Nurse – working in the school setting whose focus is to strengthen and facilitate the educational process by promoting normal development; promoting health  and safety and interfering with actual and potential health problems  of the students.
E. Hospital staff Nurse – provides direct care to patients with a wide variety of conditions and at different ages; teaches patients and families regarding self care, administer medications, IV therapy, and treatments; performs assessment; plans, implements, evaluates and documents care; serves as advocates of the patient and the family and supervises nursing aids.
F. Private Duty Nurse – who contracts independently to render full time comprehensive nursing care to patients on a one to one ratio in the hospital or in the patient’s home environment.
G. Nurse Midwife – is nurse who is both a registered nurse and a registered midwife.  Provides care for women during pregnancy and childbirth which includes services to women and their babies in the areas of prenatal care, labor and delivery management, post partum care, normal newborn care, well women gynecology and family planning.
H. Military Nurse – provides all aspects of traditional nursing care and practice both peace and war time settings through various branches of military service to military personnel and their dependents.
I. Office/Clinic Nurse – facilitates delivery of primary care to patients in settings such as physicians, offices, surgicenters, and medical office buildings.
J. Flight Nurse – provide continuous and often intensive nursing care while transporting critical patients by helicopter, airplane or ambulance from one medical facility to another and from emergency or trauma scenes and brief medical providers at the receiving medical facility  on the patient’s status.
K. Nursing homes – capable of caring for individuals with a wide range of medical conditions, not only the elderly.
L. Nurse Educators – responsible for providing quality educational experiences that prepare future generation of nurses to provide quality patient care, at the same time ensuring competence and advancement of practicing nurse.

Nurses with Post Graduate Education and Specialization

A. Master’s Degree – MAN, MSN
B. Doctoral Degree – PhD
C. Post Doctoral Programs

LAW AND THE NURSE

I. Definition of Law
a. Law in the Broadest sense – any rule of action or norm of conduct applicable to all kinds of action and to all objects of creation.
b. Law in the Strict Legal Sense – is rule of conduct, just and obligatory, promulgated by competent authority for common observance and benefit.

II. Classification of Law
a. Natural Laws – derive their authority and force from God.  They are superior to other laws and binding to the whole world.  Also known as Eternal Law
i. Physical Laws – universal law of action that govern the conduct and movement of material things. Also know as law of nature, e.g. gravity
ii. Moral laws – set rules that establish what is right and what is wrong as dictated by human conscience and inspired by eternal law.
b. Positive Laws – promulgated expressly and directly
i. Divine Positive Law – laws that are promulgated expressly by God Himself.  They are made known to man through revelation. Ex. Ten commandments
ii. Divine Human Positive Law – promulgated by God’s representatives on Earth under His Divine Inspiration. Ex. Ecclesiastical Law
iii. Human Positive Law – positive laws promulgated by man
1. Public Law – human positive law that govern the relationship between the Sate and its citizens (and also between states). May be classified as follows:
a. Constitutional Law – refers to the Constitution which is the supreme and fundamental law of the state. It defines the power of the state and the right of the citizens
b. Criminal Law – defines crimes, treats of their nature, and provides for their punishment
c. Administrative Law – governs the organizations, competence and functions of government administrative authorities
d. Law of Public Officers – governs the conduct of those who hold and exercise public offices and functions
e. Election Law – governs the exercise of the right to suffrage, especially in the selection of eth representatives of the citizens in the government
f. International Law – governs the relationship between and among states or nations
2. Private Law – laws that govern relationships between members of the society among the citizens of a state, classified into:
a. Civil Law – regulate the relations that exist among members of the society for the protection of private interest. E.g. Law of succession
b. Commercial Law – regulate the commercial or business relations among members of eth society
c. Remedial Law – laws that prescribe the methods of enforcing rights or of obtaining redness for their invasion.  It refers to the means and methods of setting the courts in motion, making the facts known to them, and effectuating their judgments.
III. Sources of Law
a. Constitution – supreme fundamental law of the land.  It is the law to which all other laws must conform
b. Legislation – enacted by the Legislative Branch of the Government. It include the ordinances enacted by the local government.
c. Administrative or Executive Orders, Regulations and Rulings – issued by administrative officials under authority by law.  Intended to clarify or explain the law and carry into effect its general provisions. They are valid only when they are not contrary to the laws and the Constitution.
d. Precedents – refer to the judicial decisions or jurisprudence.  The decisions of the court, especially the Supreme Court, that apply or interpret the law of the constitution form part of the legal system of the Philippines
e. Custom – habits and practices which, through long and uninterrupted usage, have become acknowledged and approved by the society as binding rules of conduct.  As long as they are not contrary to law, public order or public policy, customs may be applied in the absence of law that is exactly applicable to the point in controversy.
f. Supplementary Sources of Law – refer to those sources of law which the courts may resort in the absence of all other sources.  They include the principle of justice and equity, decisions of foreign tribunals, opinions of authors and religion.

Meaning, Elements and Inherent Powers of the State

I. Meaning of State – a community of persons with a definite territory, government of their own, and sovereignty.
II. Elements of State
a. People – mass of population permanently inhabiting the territory of state
b. Territory – definite and fixed portion of the earth permanently inhabited by the people of the state.
c. Government – agency through which the will of the people of the state is being formulated, expressed and finally realized
d. Sovereignty – the supreme and uncontrollable power by which the state is governed, e.g. sovereignty resides in the people and all government authority emanates from them
III. Inherent Power of the State
a. Police Power – power of the state to regulate rights, privileges and property for the promotion of general welfare
b. Power of the Eminent Domain – power of the state to take private property for public use upon payment of just compensation
c. Power of Taxation – power of the state to demand contributions from the people in exchange for the protection and services it provides to them.
IV. Three Branches of the Government
a. Legislative Branch – refers to the Congress of the Philippines, made up of the Senate and House of Representatives.  The Constitution vests this branch with legislative powers (powers to make laws)
b. Executive Branch – executive departments and headed by the President of the Republic of the Philippines, also known as the Chief Executive.  The executive departments are headed by the respective secretaries who are considered as the alter egos of the president.  The Constitution vests the President with executive powers – the power to execute or implement the laws of the lands
c. Judicial Branch – refers to the Judiciary, which is the Supreme Court of eth Philippines and the other Courts established by Law.  The Constitution vests the Judiciary with judicial powers – the power to apply, or to interpret and apply, the laws

Criminal Law and the Nurse

Criminal Law and Crimes
I. Definition of Criminal Law – is that branch of law which defines crimes, treats of their nature, and provides for their punishment.
II. Three Characteristics of Philippine Criminal Law
a. Generality – penal laws are binding on all persons who live or sojourn in Philippine Territory
b. Territoriality – as a general rule, criminal law undertakes to punish crimes committed within Philippine territory
c. Prospectivity – penal laws punish only those crimes committed during (and not before) their effectivity.
i. Exception to Prospectivity – penal law shall have retroactive effect if it is favorable to the accused
ii. Exceptions to the Exception – even if favorable to the accused, a penal law shall have no retroactive application in the following instances:
1. when the law itself so provide; or
2. when the offender is a habitual criminal
III. Meaning of Crime – an act or an omission that is punishable by law
IV. Two Sources of Philippine Criminal Law
a. The Revised Penal Code of the Philippines (Act 3815) and its amendments; and
b. Special Penal Laws – laws that are passed by the legislature of the Republic of the Philippines, that are penal in nature, and that are not included in the Revised Penal Code of the Philippines
V. Two Kinds of Crimes According o the Law Punishing Them
a. Felonies – crimes punished by the Revised Penal Code of the Philippines
b. Offenses – crimes punished by a special penal law

Felonies
I. Elements of  a Felony
a. There must be an act or an omission
i. Act – is a bodily movement tending to produce some effect in the external world
ii. Omission – is an inaction or the failure to perform a positive duty which one is bound to do
b. The act or omission must be punishable by the Revised Penal Code of the Philippines
i. The rule is – there is no crime when there is no law punishing the act – “Nullum crimen, nulla poena sine lege”
c. The act is performed or the omission is incurred by means of either malice or fault
i. Malice – refers to criminal intent or the deliberate intent to do an injury to another, his property or his right
ii. Requisites of Malice (“Dolo” or Criminal Intent)
1. Freedom
2. Intelligence
3. Intent
iii. Fault (Culpa) – refers to imprudence or negligence.  Imprudence indicates a deficiency of action and usually involves luck of skill.  Negligence indicates deficiency of perception and usually involves lack of foresight.
iv. Requisites of Fault
1. Freedom
2. Intelligence
3. Imprudence or Negligence
II. Two kinds of Felonies According to the Manner of Commission
a. Intentional Felonies – committed by means of malice or criminal intent
b. Culpable Felonies – committed by means of fault
III. Three Kinds of Felonies According to the Stages of Acts of Execution
a. Attempted Felony when
i. The offender commenced the commission of felony directly by overt acts;
ii. The offender did not perform all the acts of execution which should have produced the felony;
iii. The non performance of all acts of execution was due some cause or accident; and
iv. The cause or accident must be other than the offender’s spontaneous desistance
      If a person does not perform all the acts of execution because of his own
      spontaneous desistance, there is no attempted felony.
b. Frustrated Felony when
i. That the offender performs all acts of execution;
ii. That the acts would have produced the felony as a consequence;
iii. That the felony is not produced
iv. That the non-production of eth felony is by reason of some cause/s; and
v. That the cause/s is independent of the will of the perpetrator
c. Consummated Felony
i. When all the elements necessary for its execution and accomplishment are present
IV. Three Kinds of Felonies According to Their Gravity
a. Grave Felonies – which the law punishes with capital punishment (death penalty) or with nay of the afflictive penalties (reclusion perpetua – imprisonment from 20 years and 1 day to 40 years; reclusion temporal – imprisonment from 12 years and 1 day to 20 years; prision mayor – imprisonment from 6 months and 1 day to 6 years)
b. Less Grave Felonies – which the law punishes with any of the correctional penalties (prision correccional – imprisonment from 6 months and one day to 6 years; destierro – restriction of freedom from 6 months and one day to 6 years; arresto mayor – an imprisonment from 1 month and 1 day to 6 months
c. Light Felonies – are those which are punished by law with arresto mayor (light penalty consist of imprisonment or deprivation of freedom from 1 day to 30 days) or with fine not exceeding P 200.00, or both such imprisonment and fine.

Persons Who Shall Incur Criminal Liability

1. Any person who commits a Felony – is criminally liable for all the consequences resulting from his felonious act. And these consequences are the wrongful acts done to the aggrieved party, which may be:
a. The wrong intended by him; or
b. The wrong not intended by him, but is the direct, natural and logical consequence of his felonious act
2. Any person who commits an impossible crime – an act which is performed with criminal intent and which would be an offense against persons or property where it not either:
a. For the inherent impossibility of its accomplishment; or
b. On account of the employment of inadequate or ineffectual means

Conspiracy

1. Meaning of Conspiracy – exist when two or more persons come to am agreement concerning the commission of  a felony and decide to do it.
2. Two kinds of Conspiracy
a. Conspiracy as a Felony: “Conspiracy to Commit Felony”
i. A conspiracy to commit a felony is punishable only in the cases in which the law especially provides a penalty therefore.
ii. However, generally (that is, when no law specially punishes it),  a conspiracy to commit felony is not punishable.
iii. Examples of punishable conspiracies to commit felony
i. Conspiracy to commit treason
ii. Conspiracy to commit rebellion
b. Conspiracy as a Manner of Incurring Criminal Liability
i. When the conspiracy relates to a felony that is actually committed, that conspiracy is not a felony but is merely a manner of incurring criminal liability.  This results in making the act of any of the conspirators the act of all. Thus the rule, “where there is conspiracy, the act of one is the act of all”/
ii. From the legal view point, conspiracy exists if, at the time of the commission of the offense, all of the (two or more) perpetrators had the same purpose and were united in its execution.


Persons Who Are Criminally Liable For Felonies

I. Persons Who Are Criminally Liable For Felonies
a. For grave felonies and for less grave felonies, the following are criminally liable
i. The principals
ii. The accomplices and
iii. The accessories
b. However, for light felonies, only the principals and the accomplices are criminally liable; the accessories are not liable
II. The principals
a. Principals by Direct Participation
i. Those who take a direct part in the execution of the felony
ii. When only one persons commits a felony, he is necessarily a principal by direct participation. However, when two or more persons commit the felony, they are principals by direct participation if there is a conspiracy and they personally took part in executing their criminal design
b. Principals by Induction
i. Are those who directly force or induce others to commit the felony
ii. The principals by induction has two ways of directly forcing another to commit a felony, namely
1. by using irresistible force
2. by causing uncontrollable fear
3. the principal by induction also has two ways of directly inducing another to commit a felony, namely
a. by giving price, or ordering reward or promise
b. by using words of command
iii. Principals by Indispensable Co-operation
1. Are those who cooperate in the commission of the felony by another act without which it would not have been accomplished.
2. for  a person to become a principal by indispensable cooperation, it is necessary that:
a. a conspiracy exists between him and the principal by direct participation
b. he cooperates in the commission of the felony by performing another act, that is, an act different from the act of the principal by direct participation
c. His cooperation must be indispensable, that is, without it the commission of the felony would not have been accomplished
III. The Accomplices
a. Accomplices are those persons who are not principals but who cooperate in the execution of the felony by previous or simultaneous acts
b. For a person to be considered an accomplice, it is required
i. That there is community of design (this means that, knowing the criminal design of eth principal by direct participation, he concurs with the latter in his purpose)
ii. That he cooperates in the execution of the offense by previous or simultaneous acts (with the intention of supplying material or moral aid in the execution of the crime in an efficacious way)
iii. That there is a relation between his acts and those done by the principal.
IV. The Accessories
a. Accessories – are those who, having knowledge of the commission of the felony, and without having participated therein (either as principals or accomplices), take part after the felony was committed.
b. Specific Acts of Accessories
i. By profiting himself by the effects of the felony
ii. By assisting the offender to profit by the effects of the felony
iii. By concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery
iv. By harboring, concealing, or assisting in the escape of the principal who is guilty of treason, parricide, murder or on an attempt to take the life of the Chief Executive, or is known to be habitually guilty of some other crime
v. If he is a public officer, by harboring, concealing, or assisting in the escape of the principal who is guilty of any (grave or less grave) felony, provided he (the accessory) acts with abuse of his public function.
c. Accessories exempted from Criminal Liability
i. An accessory is exempted from criminal liability when the principal of the felony is his or her spouse, ascendant, descendant, brother, sister, or relative by affinity within the same degree
ii. However, this exemption does not apply if the necessary profited by the effects of the felony or if he assisted the principal to profit by the effects of the felony.

Circumstances Affecting Criminal Liability

I. The Circumstances Affecting Criminal Liability
a. Justifying circumstances – which make the act of a person to be legal and not criminal, so that he is deemed not to have violated the law and is free from both criminal and civil liability. When there is a justifying circumstances, no crime exist; consequently, no criminal and civil liability are incurred.
b. Exempting Circumstances – circumstances which make the act of a person to be lacking in nay of the conditions that would make it intentional or culpable (such as intelligence, freedom, intent, or negligence). When there is an exempting circumstances, the actor (or perpetrator of the act) is exempt from criminal liability.
c. Mitigating Circumstance – or those circumstances which, if present in the commission of the felony, do not entirely free the actor from criminal liability but serve only to reduce the penalty
d. Aggravating Circumstances – those circumstances which, if present in the commission of the felony, serve to increase the penalty (without exceeding the maximum of the penalty provided by law for the felony)
e. Alternative Circumstances – those circumstance which must be considered either as aggravating or mitigating depending upon the nature and effects of eth felony and the other conditions attending its commissions.
II. Justifying circumstances
a. Self Defense – the justifying circumstance of self defense exists when a person acts in defense of his person or rights and the following requires concur
i. Unlawful aggression
ii. Reasonable necessity of the means employed to prevent or repel such aggression
iii. Lack of sufficient provocation on the part of the person defending himself
b. Defense of Relatives – there is defense of relatives when a person acts in defense of the person or rights of his relatives, and the following requisites are present:
i. Unlawful aggression
ii. Reasonable necessity of the means employed to prevent or repel such aggressions
iii. In case the provocation was given by the person attacked, the one making had no part therein
iv. The term relative – refers to the spouse, ascendants, descendants, brothers, sisters, relatives by affinity in the same degree, and relatives by consanguinity within the fourth civil degree.
c. Defense of Strangers – exists when a person acts in defense of the person or rights of a stranger, provided that the following requisites are present:
i. Unlawful aggressions
ii. Reasonable necessity of the means employed to prevent or repel such aggression
iii. That the person depending be not induced by revenge, resentment, or other evil motive
iv. The term strangers – refers to those persons who are not included in the enumeration of relatives in the justifying circumstances of defense of relatives
d. Avoidance of greater Evil or Injury – exists when a person, in order to avoid an evil or injury, does an act which causes injury to another person or damage to the latter’s property, provided that the following requisites are present:
i. The evil sought to be avoided actually exists
ii. The injury feared is greater than done to avoid it, and
iii. There is no practical and less harmful means of preventing it
e. Fulfillment of Duty, or Lawful Exercise of Right or Office – exists when a person acts in the fulfillment of a duty or a lawful exercise of a right or office
f. Obedience To a Lawful Order – exists when a person acts in obedience to an order issued by a superior for some lawful purpose.
III. Exempting Circumstances
a. Imbecility or Insanity -  exist when the person acting is either
i. An imbecile or
ii. An insane (who has not acted during his lucid interval)
iii. Effects of Insanity
1. insanity of the time of the commission of the offense: exempting
2. insanity after the commission and during the trial: The court shall suspend the proceedings and order the confinement of the accused in a hospital until he recovers his reasons
3. Insanity after final sentence or while serving his sentence: The execution of the sentence will be suspended with regard to the personal penalty only, (like death or imprisonment) nut not with regard to civil or pecuniary liability.
iv. Being Nine Years or Less of Age – this exempting circumstance is present when the actor, at the very moment be perpetrated the act, nine years or less of age
v. Being Over Nine and Under Fifteen Years of age – is present when the actor, at the very moment be perpetrated the act, is over nine (9) but under 15 years of age and has not acted with discernment.
1. Discernment – refers to the mental capacity of a  minor (between 9 and 15 years old) to understand the difference between right and wrong, that is, to fully appreciate the consequences of his unlawful acts
vi. Accident – exists when a person, while performing a lawful act with due care, causes an injury by mere accident without fault or intention of causing it
1. an accident – is something that happens outside the sway of human will and whose consequences are not humanely foreseeable.
vii. Irresistible Force – is present when a person acts under the compulsion of an irresistible (physical) force (coming from a third person)
viii. Uncontrollable Fear – exists when a person acts under the impulse of an uncontrollable fear of an equal or greater injury. (The fear referred to in this circumstance is brought about by the intimidation or threat employed by a third person)
ix. Insuperable Cause – is attendant when a person fails to perform an act required by law because he is prevented by some lawful or insuperable cause.
IV. Mitigating Circumstances
a. Incomplete Justifying or Exempting Circumstance – exist when all the requisites necessary to justify the act or to exempt from criminal liability, in respective cases, are not attendant
b. Being Under Eighteen or Over Seventy Years of Age – present when the offender is under 18 or over 70 years of age.  This circumstance covers and offender who is over 9 but under 18 years of age who acted with discernment
c. No Intention to Commit So Grave A Wrong – exist when the offender , at the time of the commission  of the felony, had no intention to commit so grave a wrong as that committed.
d. Provocation or Treat – present when sufficient provocation or threat on the part of (or originating from) the offended party immediately preceded the act)
e. Vindication of A Grave – exist when the act committed in the vindication of a grave offense to the one committing the felony (or to his spouse, ascendants, descendants, brothers, sisters, or relatives by affinity within the same degrees)
f. Passion or Obfuscation – attendant when the offender acted upon an impulse so powerful as naturally to have produced passion or obfuscation.
g. Surrender or Confession of Guilt – voluntary surrender when the offender, without having been actually arrested, voluntarily surrendered to a person in authority or his agents. Voluntary Confession of Guilt – the offender had voluntarily confessed his guilt before the competent court prior to the presentation of evidence of the prosecution. Known also as Voluntarily Flea of Guilty
h. Physical defect – present when the offender is deaf and dumb, blind or otherwise suffering from some physical defect which thus restrict his means of action, defense, or communication with his fellow human beings.
i. Illness of the Offender – exist when the offender is suffering from such illness as would diminish the exercise of his will power without however depriving him of consciousness of his back.
j. Similar and Analogous Circumstances – circumstances of a similar nature and analogous to those mitigating circumstances mentioned above may also be considered, such as
i. Impulse of jealousy – as similar to passion and obfuscation
ii. Extreme poverty and necessity – as similar to incomplete justification and based on state of necessity or avoidance of greater evil or injury.
V. Aggravating Circumstances
a. Taking Advantage of Public Position – exist when the offender, in order to commit the felony, took advantage of (or abused) his public position.
b. Contempt or Insult to Public Authorities – present when the felony was committed in contempt of or with insult to the public authorities.
c. Disregard of Rank, Age or Sex – present when felony was committed with insult or in disregard of the respect due to the offended party on account of his rank, age or sex
d. Dwelling of the Offended Party – exists when the felony was committed in the dwelling of the offended party, if the latter has not given provocation
e. Abuse of Confidence – present when the offender committed the felony with abuse of the confidence or trust given to him by the offended party, and such abuse of confidence facilitated the commission of the felony
f. Obvious Ungratefulness – present when the offender committed the felony with obvious ungratefulness
g. Palace of the Chief Executive – present when the offender committed the felony inside the Malacañang Palace
h. In the Presence of the Chief Executive – present when the offender committed the felony in the president of the Republic of the Philippines
i. Where Public Authorities Are Engaged in the Discharge of their Duties – present when the offender committed the felony in a place where public authorities are engaged in the discharge of their duties
j. Place Dedicated to Religious Worship – exists when the offender committed the felony in a place dedicated to religious worship.
k. Nighttime – present when the offender committed the felony in the nighttime. (nighttime refers to the period of darkness beginning at the end of dusk and ending of dawn.  Nights are from sunrise to sunset.)
l. Uninhabited Place – exists when the offender committed the felony in an uninhabited place
m. By A Hand – aggravating circumstance is present when the felony was committed by a band. (A band or cuadricilla is a group of more than three armed malefactors who are acting together in the commission of a felony)
i. To be aggravating, Nighttime, Uninhabited Place, or By a Band
1. Must have facilitated the commission of the felony or
2. must have been especially sought by the offender to insure the commission of the felony or for the purpose of impunity
3. must have been taken advantage of (by the offender), for the purpose of impunity
ii. On the Occasion of Calamity or Misfortune – exists when the offender committed the felony on the occasion of (and taking advantage of) a conflagration, shipwreck, earthquake, epidemic, or other calamity or misfortune.
iii. With the Aid of armed Men – exists when the offender committed the felony with the aid of armed men or persons who insure or afford impunity.
iv. Recidivism – present when the offender is a recidivist. ( a recidivist – is one who, at the time of his trial for one crime, shall have been previously convicted by final judgment of another crime embraced in the same title of the Revised Penal Code)
v. Habituality – present when the offender has been previously punished either;
1. for  a felony which is punished with an equal or greater penalty
2. for 2 or more felonies punished with a lighter penalty
vi. Price, Reward or promise – exists when the offender committed the felony in consideration of a price, reward or promise
vii. Inundation, Fire, Poison, Explosion, Etc. – exists when the offender committed the felony with evident premeditation. (There is evident premeditation when there is evidence showing that between the time when he actually perpetrated it, he meditated and reflected on his intention and the consequences of his act).
viii. Craft, Fraud or Disguise – present when the offender, in committing the felony, employed craft, fraud or disguise. (Craft involves intellectual trickery and cunning on the part of the offender. Fraud – involves insidious words or machinations used to induce the victim to act in a manner which would enable the offender to carry out his designs. Disguise involves resorting to any devise to conceal identity)
ix. Superior Strength – exists when the offender took advantage of his superior strength, that is, when the offender  used purposely excessive force out of proportion to the means of defense available to the person attacked.
x. Treachery – present when the offender committed the offense with treachery. (There is treachery when the offender commits any of the crime against the person, employing means, methods or forms in the execution there of which tend directly and specially to insure its execution, without risk to himself arising from the defense which the offended party might make).
xi. Ignominy – present when the offender, in committing the felony, employed means (or brought about circumstances) which ass ignominy to the natural effects of the felony. (To add ignominy means to make the effects of eth felony more humiliating or to put the offended party to shame).
xii. Unlawful entry – exists when the offender committed the felony after unlawful entry
xiii. Breaking of Wall, etc. – exists when the offender broke a wall, roof, floor, door, or window, as a means to the commission of eth felony
xiv. With Aid of Minors or by Means of Motor Vehicles – exist when the offender committed with the aid of person under 15 years of age, or by means of motor vehicles, airships, or other similar means
xv. Cruelty – is present when the offender, in committing the felony, deliberately augmented the wrong (or injury) done by causing other wrong not necessary for its commission.
VI. Alternative Circumstance
a. Relationship – refers to the circumstance wherein the offended party is a relative of the offender (that is, the offended party is the spouse, or an ascendant, or a descendant, or a brother, or a sister, or a relative by affinity in the same degree, of the offender)
i. Some Rules of Relationship
1. Relationship is mitigating in crimes against property such as in robbery or arson
2. Relationship is aggravating in crimes against person if the offended party if a relative of a higher degree than the offender or when the offender and offended part are of the same levels, such as rape, murder, homicide or serious physical injuries
3. Relationship is aggravating – in crimes against chastity, such as Acts of Lasciviousness
ii. Intoxication or drunkenness
1. Intoxication is mitigating in the following instances
a. If it is not habitual
b. If it is not intentional (or subsequent to the plan to commit a felony)
2. Intoxicating is Aggravating
a. If it is habitual
b. If its is intentional (or subsequent to the plan to commit a felony)
iii. Degree of Instruction and Education
1. Low degree of instruction and education or the lack of it is generally mitigating (except in crimes against property and in crimes against chastity)
2. High degree of instruction and education is aggravating if the offender availed himself of his learning (or took advantage of it) in committing the felony.

Penalties

I. Meaning of Penalty – is the suffering that is being inflicted by the State for the commission of the crime
II. Theories Justifying Penalty
a. Prevention – penalty prevents the danger to society that may arise from crimes
b. Self Defense – penalty is measure of self defense intended to protect society from the threat and wrong inflicted by the criminal
c. Reformation – penalty is intended to correct and reform the offender
d. Exemplarity – the criminal is penalized as an example to deter other from committing crimes
e. Justice – penalty is imposed as an act of retributive justice, a vindication of right and moral law violated by the criminal
III. Causes of Total Extinction of Criminal Liability
a. Death of the Convict – one of the judicial conditions of penalty is that it is personal.  However, the death of the offended party does not extinguish the criminal liability of the offender. Reason – the crime is committed against the state
b. Service of Sentence – reason – crime is but a debt incurred by the offender as a consequence of his wrongful act and the penalty is but the amount of his debt.  When payment is made, the debt is necessarily extinguished.
c. Amnesty – which is general pardon of  a class of persons who are guilty of high political crimes (such as Treason)
d. Absolute Pardon – which is an act of grace (coming from the President) which exempts the convict from the punishment of the crime without any condition
e. Prescription of the Crime – which is the forfeiture or loss of the right of the state to prosecute the offender after the lapse of  a certain time
f. Prescription of the Penalty – which is the forfeiture or loss of the right of the State to execute the final sentence after the lapse of  a certain time
g. Marriage of the Offended Woman – or the marriage of the offender, in good faith, with the offended woman after the commission of eth crime of rape, acts of lasciviousness, seduction or abduction.  Also extinguished by this marriage are the criminals liabilities of the co-principals, accomplices and accessories of the crime involved.

Civil Liability for Crimes

I. Two Classes of Injuries By a Crime
a. Social Injury – which is produced by the disturbance and alarm which are the outcome of the crime.  And this is sought to be repaired through the imposition of the corresponding penalty and
b. Personal Injury – which is caused to the victim of the crime who may have suffered damage, either to his person, to his property, to his honor, or to her chastity.  It is sought to be repaired through indemnity, which is civil in nature.
II. Rule on Civil Liability Arising from Crimes
a. Article 100 of the Revised Penal Code of eth Philippines provides that “every person criminally liable for a felony is also civilly liable”
III. No Damage, No Civil Liability – while every person criminally liable for a felony is also civilly liable, however, it is necessary that the commission of the felony caused damage to another; otherwise, the offender would not be civilly liable even if he is criminally liable for the felony committed
IV. Who are Civilly Liable for Felonies Committed by Imbecile or Insane Persons – an imbecile or an insane person is exempt from criminal liability.  However, the civil liability for eth offense he has committed shall be borne by:
a. The persons having legal authority or control over them, if they are at fault or negligent; or
b. The imbecile or the insane (shall answer with his own property), in the following instances
c. If the said persons having legal authority or control are not at fault or negligent; or
d. If the said persons, though at fault, are insolvent; or
e. If there are no such persons having legal authority or control
V. What Civil Liability Includes
a. Restriction – which involves the restoration by the convict of the thing itself to the offended party, with allowance for any deterioration or diminution.
b. Reparation of the Damaged Cause – which is payment by the convict of the amount of damage, taking into consideration the price of the thing and its special sentimental value to the injured party
c. Indemnification for Consequential Damages – which is the indemnification not only for the damages caused the injured party, but also for those suffered by his family or by a third person by reason of the offense.

Some Crimes or Felonies

Some Crimes Against Person

1. Parricide – is the unlawful killing by a person of “his father, mother, or child, whether legitimate or illegitimate, or any of his ascendants, or descendants, or his spouse” (Penalty – reclusion perpetua to death)
2. Murder – the unlawful killing by a person of another, which killing is not Parricide and which is committed with any of the qualifying circumstances. (Penalty – reclusion perpetua to death)
a. Some of the circumstance that may qualify killing into Murder are: treachery, price, reward, or promise; inundation, fire, poison, etc.; earthquake, epidemic, or other calamity; evident premeditation; cruelty, or outraging at the person or corpse of the victim
3. Homicide – unlawful killing by a person of another, which killing is not parricide and which is committed without the attendance of any of the circumstances that qualifies it to murder (penalty – reclusion temporal)
4. Giving assistance to Suicide – is giving by a person of means or of whatever manner of positive and direct cooperation to another who wish to end his life.
a. The penalties for giving assistance to suicide are as follows: if he does not do the killing himself, prision mayor
b. If he does the killing himself – reclusion temporal
c. If the suicide is not consummated, arresto mayor in its medium and maximum periods
5. Infanticide – the unlawful killing by a person of any child less than 3 days of age
a. Penalties – if the offender is related to the victim within the degree of relationship indicated to the victim within the degree of relationship indicated in Parricide, then the penalty will correspond to that of Parricide
b. If the offender is a stranger, then that corresponding to murder
c. If the offense was committed by the mother for the purpose of concealing her dishonor, then the penalty is prision correccional in its medium and maximum periods;
d. If committed by the maternal grandparents for the same purpose, then the penalty is prision mayor.
6. Abortion – is the expulsion of the fetus from the womb before it is capable of sustaining life (outside the womb), which expulsion results in its death.
a. Intentional abortion – or that kind of abortion which is intentionally caused by the offender, punishable by
a. Reclusion temporal – used violence against the pregnant woman
b. Prision mayor – if without violence, he acted without her consent;
c. Prision correccional – in its medium and maximum periods, if she should have consented
b. Unintentional Abortion – or that kind of abortion committed by a person who, without intending the abortion, however, voluntarily employs physical violence upon a pregnant woman, which violence causes her to abort. Penalty – prision correccional in its minimum and medium periods
c. Abortion Practiced by the Woman Upon Herself or with Her Consent, punished by
a. Prision correccional – in its medium and maximum periods
b. If committed for the purpose of concealing her dishonor, prision correccional in its minimum and medium periods
d. Abortion Practiced by the Parents of the Woman With Her Consent – punished by prision correccional in its medium and maximum periods
e. Abortion Practiced by A Physician or Midwife – taking advantage of their scientific knowledge or skill, shall cause an abortion or assist in causing the same, shall suffer the same penalties as those imposed for Intentional abortion.
7. Dispensing of Abortive s- felony of dispensing abortives is the unlawful dispensing of any abortive by any pharmacist without the proper prescription from a physician – penalty – arresto mayor and fine of P 1,000.00
8. Mutilation – committed by a person who shall intentionally mutilate another by depriving him, either totally or partially, of some essential organs of reproduction
9. Physical Injuries
a. Serious Physical Injury – is the crime committed by any person who wounds, beats, or assaults another, if the physical injuries result, among others, (and generally) in the illness or incapacity for labor of the injured person for more than 30 days
b. Less Serious Physical Injury – crime committed by any person who shall inflict upon another physical injuries (not described in art. 263 but) which incapacitates the offended party for labor for ten days or more (but less than 31 days) or shall require medical attendance for the same period
c. Slight Physical injury – the crime committed by any person who inflict physical injuries which either
a. Incapacitates the offended party for labor from one to nine days, or shall require medical attendance during the same period; or
b. Does not prevent the offended party from engaging in his habitual work nor require medical attendance
10. Rape
a. Rape by a Man of a woman – committed by a man who has carnal knowledge of a woman under any of the following circumstances
a. Through force, threat or intimidation
b. When the offended party is deprived of reason or otherwise unconscious
c. By means of fraudulent machination or grave abuse of authority or
d. When the offended party is under 12 years of age or is demented, even though none of the circumstances mentioned above are present
b. Rape by any Person of another Person – committed by any person who commits an act of sexual assault either
a. By inserting his penis into another person’s mouth or anal orifice or
b. By inserting any instrument or object into the genital or anal orifice of another person
Under any of the following circumstances
a. Through force, threat or intimidation
b. When the offended party is deprived of reason or otherwise unconscious
c. By means of fraudulent machination or grave abuse of authority or
d. When the offended party is under twelve years of age or is demented, even though none of the circumstances mentioned above are present
c. Penalties for rape
i. Ordinarily – rape by a man of a woman – reclusion perpetua; rape by any person of another person – prision mayor
ii. Rape by a man of a woman – reclusion perpetua to death, while Rape by any Person of another Person – prision mayor to reclusion temporal in the following occasion
1. if the rape is committed with a deadly weapon
2. if rape was committed by 2 or more persons
iii. Rape by a Man of a Woman – punished by reclusion perpetua to death, while Rape by any person of another person is punished by reclusion temporal, when by reason or on the occasion of the rape, the victim has become insane
iv. Rape By a Man of A Woman is punished by reclusion perpetua to death, while Rape By Any Person of Another Person is punished by reclusion temporal to reclusion perpetua, when the rape is attempted and a homicide by reason or on the occasion thereof;
v. Rape By A Man of A Woman is punished by death, while Rape By Any Person of Another Person is punished by reclusion perpetua, when by reason or on the occasion of the rape, homicide is committed.
vi. Rape By A Man A Woman is punished by death, while Rape BY Any Person of Another Person is punished by reclusion temporal, if the rape is committed with any of eth following aggravating or qualifying circumstances:
1. when the victim is under 18 years of age and the offender is a parent, ascendant, step-parent, guardian, relative by consanguinity or affinity within the third civil degree, or the common law spouse of the parent of the victim;
2. When the victim is under the custody of the police or military authorities or any law enforcement or penal institution;
3. when the rape is committed in full view of the spouse, parent, and of the children or other relatives within the third civil degree of consanguinity;
4. When the victim is a religious engaged in legitimate religious vocation or calling and is personally known to be such by the offender before or at the time of the commission of the crime;
5. when the victim is a child below 7 years old;
6. when the offender knows that he is afflicted with HIV/AIDS or any other sexually transmitted disease and the virus or disease is transmitted to the victim;
7. when committed by any member of the Armed Forces of the Philippines or para-military units there-of of the Philippine National Police or any law enforcement agency or penal institution, when the offender took advantage of his position to facilitate the commission of eth crime;
8. when by reason or on the occasion of the rape, the victim has suffered permanent physical mutilation or disability;
9. when the offender knew of the pregnancy of the offended party at the time of the commission of eth crime; and
10. when the offender knew of the mental disability, emotional disorder and/or physical handicap of the offended party at the time of the commission of the crime

Some Crimes Against Personal Property
1. Kidnapping – (or illegal detention) is the crime committed by any person who kidnaps or detains another, or in any other manner deprives him of his liberty.
2. Abandonment of Persons in Danger – is the crime committed by anyone who fails to render assistance to any person whom he finds in an uninhabited place wounded or in danger of dying, when he can render assistance without detriment to himself.
a. Under the revised penal code, a person who finds an abandoned child under 7 years old shall be penalized (with the same penalty of arresto mayor) if he fails to deliver the said child to the authorities or to his family, or if fails to take him to a safe place.
3. Abandonment of One’s Own Victim – crime committed by anyone who fails to help or render assistance to another whom he has accidentally wounded or injured.
4. Threats
a. Grave Threats – crime committed by any person who shall threaten another with the infliction upon the person, honor, or property of the latter or of hid family, of any wrong amounting to a crime. If threat is to commit a wrong not amounting to a crime, the crime committed is only Light Threat
5. Grave Coercion – is the crime committed by any person who, without authority of law, (by means of violence, threat, or intimidation) either
a. Prevents another from doing something not prohibited by law, or
b. Compels him to do something against his will, whether it be right or wrong

Some Crimes Against Property

1. Robbery – is the crime committed by any person who, with the intent to gain, takes any personal property belonging to another, by means of violence against or intimidation of any person, or using force upon anything.
2. Theft – crime committed by any person who, with intent to gain, but without violence against, or intimidation of, persons nor force upon things, takes personal property of another without the latter’s consent.
3. Swindling or Estafa – crime committed by any person who defrauds another
4. Destructive Arson – is the crime committed by any person who burns a building, train, ship, airplane, etc.
5. Malicious Mischief – crime committed by any person who deliberately causes to the property of another any other damage (id est, not falling within the terms of arson and Other crimes involving destructions)

Some Crimes Against Chastity

1. Adultery – crime committed by any married woman who has sexual intercourse with a man not her husband and by the man who has carnal knowledge of her.
2. Concubinage – committed by any husband (married man) who either
a. Keeps a mistress in the conjugal dwelling
b. Has sexual intercourse, under scandalous circumstances, with a woman who is not his wife; or
c. Cohabits with a woman not his wife in any other place
3. Acts of Lasciviousness – refers to an act or conduct that is lewd or lascivious or lewd emotions; and the term “lasciviousness” comprises all acts of lasciviousness performed upon a person of either sex short of lying with a woman and anything leading up to it, independently of the intention of the wrongdoer.
4. Seduction – withdrawing a person from the path of rectitude; it is a leading astray.  As a felony, it may be simple or qualified:
a. Simple Seduction – refers to a seduction of (or the unlawful intercourse with) a woman who is single or a widow of good reputation, over twelve but under 18 years of age, committed by means of deceit.
b. Qualified seduction – seduction of a “doncella” (or virgin) over twelve years and under 18, committed by any of the following: Any person in public authority; priest; home servant; domestic; guardian; teacher; any person who, in any capacity, shall be entrusted with the education or custody of the woman seduced.
c. Qualified Seduction – is also committed by any person who seduces his sister or descendants, whether or not she is a virgin or over eighteen years of age.
5. Abduction  - is the kidnapping of  a woman by removing her from her home, or from whatever place she may be, to take her to some place, with the intent to marry or corrupt her (“libidinis causa”). It may be forcible or consented:
a. Forcible Abduction – as a felony, is the abduction of any woman against her will and with lewd designs.
b. Consented Abduction – as a felony, is the abduction of  a virgin over 12 and under 18 years of age, carried out with her consent and with lewd designs.

Some Crimes Against the Civil Status of Person
- the revised penal code of the Philippines also penalizes crimes against the civil status of persons, some of which are as follows:
1. Simulation of Birth
2. Substitution of One Child for Another
3. Concealment or Abandonment of  a legitimate child
4. Usurpation of (Another’s) Civil Status
5. Bigamy – or the contracting of  a second or subsequent marriage either:
a. Before the former marriage has been legally dissolved, or;
b. Before the absent spouse has been judicially declared presumptively dead
6. Marriage Contracted Against Provisions of Law – or the crime committed by a person who contracts marriage knowing
a. That the requirements of the law have not been complied with; or
b. That the marriage is in disregard of a legal impediments

Crimes Against Honor

1. Libel, Slander, and Slander by Deed
a. Libel – is  a public and malicious imputation of  a crime, or a vice or defect, real or imaginary, or any act, omission, condition, status, or circumstance tending to cause the dishonor, discredit or contempt of a natural or judicial person, or to blacken the memory of one who is dead.
b. Slander – is oral defamation
c. Slander by deed is the crime committed by any person who performs an act, not being an oral or written defamation, which casts dishonor, discredit or contempt upon another person.

Criminal Negligence

1. The third element of felony is that “The act is performed or the omission is incurred by means of either malice or fault.” Malice refers to criminal intent, while fault refers to imprudence or negligence
2. Thus, under Article 365 of the Revised Penal Code of the Philippines, any person who, either by reckless imprudence or by simple imprudence or negligence, shall commit any act which, had it been intentional, would constitute a (grave, less grave, or light) felony, shall suffer the penalty mentioned in the said article.
3. In other words, the commission, either by reckless imprudence or by simple imprudence or negligence, shall commit any act, which if intentional, would be  an offense, is punishable
4. Imprudence, indicates a deficiency of action and usually involves lack of skill, while negligence indicates the deficiency of perception and usually involves lack of foresight.
5. Reckless imprudence – consist in voluntary, but without malice, doing or failing to do an act from which material damage results by reason of inexcusable lack of precaution on the part of the person performing or failing to perform such act, taking into consideration his
a. Employment and occupation
b. Degree of intelligence
c. Physical condition and
d. Other circumstance regarding persons, time and place
6. Simple Imprudence – contains in the lack of precaution displayed in those case which:
a. The damage impending to be caused is not immediate or
b. The danger is not clearly manifest
7. Any person found guilty of committing an offense by imprudence or negligence is also criminally and civilly liable.
a.

Patients Bill of Rights

- Senate Bill 588 entitled “Magna Carta for Patient’s Rights” – passed into law, aims to “recognize and promote patients rights, among which are:

1. Right to Medical Care and Humane Treatment
a. Every Person has the right to health and medical care corresponding to his state of health, without any discrimination and within the limits of the resources available for health and medical care at the relevant time
b. He has the right to health and medical care of good quality.  In the course of such care, his human dignity, convictions and integrity shall be respected. His individual needs and culture shall be like wise respected.
c. If any person, cannot immediately be given treatment that is medically necessary he shall, depending on his state of health – (1) directed to wait for care, (2) referred or sent for treatment elsewhere, (3) he shall be informed of the reason for the delay and the estimated waiting time
d. Patient in emergency who are in danger of dying and/or may have suffered serious physical injuries shall be extended immediate medical care and treatment without any deposit, pledge, or mortgage or any form of advance payment
2. Right to Informed Consent
a. The patient has right to clear explanation, in lay person’s terms, all proposed procedures, whether diagnostic or therapeutic, including identity of the person who will perform the said procedure, possibilities of any risk or mortality of serious side effects, problems related to recuperation, and probability of risk involved, and he will not be subjected to any procedure without his informed consent.  Provided, that in case of emergency, when the patient is unconscious and/or incapable of giving consent and there is no one who can give consent in his behalf, then the physician can perform any diagnostic or treatment procedure as good practice of medicine dictates without such consent
b. Informed consent shall be obtained from a patient concerned if he is legal age and of sound mind, from the next of kin in the case the patient is incapable of giving consent, or from the parents or legal guardian in the case of minor or mentally incapacitated individual. Provided, that if his parents or legal guardian refused to give consent to a medical or surgical procedure necessary to save his life, the court upon petition of the physician or any person interested in the welfare of the child, may issue an order giving such consent
3. The right of Privacy
a. The patient has the right to be left alone when this will not prejudice the provision of necessary medical care
b. The patient ahs the right to be free from unwarranted publicity, except in the following cases;
i. When  his mental of physical conditions is in controversy and the appropriate court in its discretion orders him to submit to a physical or mental examination by a physician;
ii. When the public health and safety so demanded; and
iii. When the patient waived his right
4. Right to Information
a. The patient has the right to clear, complete, and accurate evaluation of the nature and extent of his disease , the contemplated medical treatment and surgical procedure including the medicines to be administered and their genetic counterparts and its probable outcome, economic costs, impact of lifestyle and work including side effects and after effects of eth treatment, possible complications and other pertinent facts regarding his illness.  However, if the disclosure of the information to the patient will cause mental suffering and further impair in his health, or cause the patient not to submit to medically necessary treatment, such disclosure may be withheld or deferred to some future opportune time upon consultation with the patients next of kin
b. The patient has the right to know the name and credentials of the physicians responsible for his care or for coordinating such care.  He may likewise request for similarly relevant data about any other health care provider directly involved in his care.
c. The patient ha the right to examine and be given an itemized bill for services rendered in the facility or by his physician and by other health care providers, regardless of the manner and source of payment.  He entitled to a thorough explanation of such bill should be find this incomprehensible
5. Right of Privileged Communication
a. The patient ahs the right to demand that all information, communication and records pertaining to his care be treated as confidential.  A physician is not authorized to divulge any information to a third party who has no concern with the care and welfare of the patient, except:
i. When such disclosure will benefit public health and safety
ii. When it is the interest of justice; and
iii. When the patients waives the confidential nature of such information
6. Right to Choose Physician
a. The patient is free to choose the physician to serve him except when:
i. He is confined in the charity ward; and
ii. He has entered into a contract with a health maintenance organization or any other health insurance organization which stipulates that the patient can only be served by a physician affiliated with the organization.
7. Right to self determination
a. The patient has the right to refuse diagnostic and treatment procedures. Provided, that
i. He is of age and sound mind
ii. He is informed of eth medical consequences of his refusal;
iii. He releases those involved in his care from any obligation relative to the consequences of his decision; and
iv. His refusal will not jeopardize public health and safety
b. An adult with sound mind may execute an advance directive for physicians not to put him on prolonged life support if, in the future, his condition is such that there is little or no hope of reasonable recovery.
8. The Right to Religious belief
a. The patient has the right to refuse medical treatment which may be contrary to his religious belief, subject to the limitations described in the preceding subsection.  Provided that such a right shall not be imposed by parents upon their children who have not reached not reached the age of legal discretion.
9. Right to Medical Records
a. The patient is entitled to a summary of his medical history condition which shall be accomplished by the attending physician.  He ahs the right to view the content of his medical records with the attending physician explaining contents thereof.
b. The health care institution shall issue medical certificate, free of integrity and authenticity of then medical records
c. The health care institution shall issue medical certificate, free of charge, to the patient upon discharge from the institution. Any other document that the patient may require for insurance claims shall also be made available to him within reasonable period of time.
10. The Right to Leave
a. The patient has the right to leave the hospital or any other health care institution regardless of his physical condition.
b. No patient shall be detained against his will in any health care institution on the sole basis of his failure to fully settle his financial obligations with the physician or the health care institution.
11. The Right to Refuse Participation in Medical Research
a. The patient has right to be advised if the health care provider plans to involve him in medical research, including but not limited to human experimentation that may affects his care or treatment.  Such human experimentation may be performed only with the written informed consent of the patient.
12. The Right to Correspondence and Received Visitor
a. The patient has the right to communicate with relatives and other persons and to received visitors subject to reasonable limits prescribed the rules and regulations of the health care institutions.
13. The Right to Express Grievances
a. The patient ahs the right to express the grievances about the care and service s received.  The Secretary of Health, in consultation with health care providers, consumer groups and other concerned agencies, shall established a grievance system wherein patient may seek redress of their grievances.  Such a system shall afford all parties concerned with the opportunity to settle amicable all grievances.
14. Right to be Informed of His Rights and Obligations as a Patient
a. Every person has the right to be informed of his rights and obligations as a patient. The Department of Health,  in coordination with health care providers, professionals and civic groups, the media, health insurance corporations, people’s organizations, local government units and other government agencies, and NGO’s, shall launch and sustain nationwide information and education campaign to make people their rights as patients.

Nurse’s Bill of Rights
• the following Nurses Bill of Rights was adopted by the ANA Board of Director on Jun6, 2001
1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.
2. Nurses have the right to practice environments that allow them to act in accordance with professional standards and legally authorized scopes and practice.
3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretive statements.
4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and their patients.
7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.
• The following additional rights are posted by “The Nurse’s Lounge” website
8. Nurses have the right not to be abuse in any form by physicians, pharmacists, administrators or nursing directors. Any abuse that occurs should be dealt with in a professional and in partial manner by the nurse’s employer.
9. Nurses have right not to be exploited and abused by being floated to areas of practice that they are not familiar with.
10. Nurses have the right to refuse any assignment that they feel is unsafe.  Such as when a nurse is assigned a patient load he/she feels is unsafe.  A nurse is assigned to work in an area of nursing in which he/she is not familiar.  A nurse knows that equipment/supplies are inadequate or not available.

Bills of Rights and Responsibilities for Students of Nursing

The following bill of rights of student nurses was adopted by the National Student Nurse’s Association (NSNA) of America in 1991

1. Students should be encouraged to develop the capacity for critical judgment and engage in a sustained and independent search for truth.
2. The freedom to teach and the freedom to learn the inseparable facets of academic freedom: students should exercise their freedom in a responsible manner.
3. Each institution has a duty to develop policies and procedures which provide and safeguard the student’s freedom to learn.
4. Under no circumstance should a student be barred from admission to a particular institution on the basis of race, creed, sex, color, national origin, handicap, or marital status.
5. Students should be free to take reasoned exception to the data or views offered in any course of study and to reserve judgment about matters of opinion, but they are responsible for learning the content of any course of study for which they are enrolled.
6. Students should have protection through orderly procedures against prejudiced or capricious academic evaluation, but they are responsible for maintaining standards of academic performance established for each course in which they are enrolled.
7. Information about student views, belief, political ideation, or sexual orientation which instructors acquire in the course of their work or otherwise, should be considered confidential and not released without knowledge or consent of the students, and should not be used as a basis for evaluation.
8. The student should have the right to have responsible voice in eth determination of his/her curriculum
9. Instructions should have a carefully considered policy as to the information which should be a part of a student’s permanent educational record and to the conditions of this disclosure.
10. Students and student organizations should be free to examine and discuss all questions of interest to them, and to express opinions publicly and privately.
11. Students should be allowed to invite and to hear any person of their won choosing within the institution’s acceptable realm, thereby taking the responsibility of furthering their education
12. The student body should have clearly defined means to participate in the formulation and application of institutional policy affecting academic and student affairs.
13. The institution has an obligation to clarify those standards of behavior which it considers essential to its educational mission, its community life, or its objectives and philosophy
14. Disciplinary proceedings should be instituted only for violations of standards of conduct formulated with significant student participation and published in advance through such means as a student handbook or  a generally available set of institutional regulations.  It is the responsibility of the student to know these regulations.  Grievance procedures should be available for every student.
15. As citizens and members of an academic community, students are subject to the obligations which accrue to them by virtue of this membership and should enjoy the same freedom of citizenship.
16. Students have the right to belong or refuse to belong to any organization of their choice.
17. Students have the right to personal privacy in their living space to the extent that the welfare and property of others are respected.
18. Adequate safety precautions should be provided by nursing programs, for example, adequate street lighting locks, and others safety measures deemed necessary by the environment.
19. Dress code, if present in school, should be established with student input in conjunction with the school director and faculty, so the highest professional standards are maintained, but also taking into consideration points of comfort and practicality for eth student.
20. Grading systems should be carefully reviewed periodically with students and faculty for clarification and better student-faculty understanding.
21. Students should have a clear mechanism for input into the evaluation of nursing faculty.

NURSING ETHICS

Nursing Ethics
1. The study of the historical and contemporary foundations of professional nursing action in order to understand the “good” or the benefit that nursing provides for individuals and society.
2. an analysis of potential or actual professional nursing actions (individual or disciplinary) for the ability of these to facilitate the “good” proposed and
3. a critique of both (1) and (2) with regard to the promotion of this “good.”

The following definition of nursing ethics has been provided:
1. The ideas, customs and habits associated with the general characteristics of a nurse (Aikens, 1916)
2. The rules of conducts followed by a nurse while attending to the sick (Robb, 1921)
3. Doing one’s duty with skill and moral perfection (Gladwin, 1930)
4. A specialized field of inquiry born of eth practice of nursing (Johnstone, 1989)
5. What guides the activity of nursing on behalf of the presumed good (Bandman & Bandman, 1995)
6. The ethical norms (i.e., values, virtues and principles) that guide the moral behavior of nurses (Yeo, 1996)
7. A filed or discipline in which the ethical norms that guide the moral behavior of nurses are explored and analyzed (Yeo, 1996)
8. A field that is a subcategory of biomedical ethics; the analysis of ethical judgments made by nurses (Fry & Veatch, 2000)
9. is concerned with the principles of right conduct as they apply to the nursing profession… deals with the fourfold responsibility of nurses: nursling’s universality, the scope of services rendered by the nurses, their responsibilities to the people, to their practice, to society, to their co-workers, and to their profession (Venzon, 2003)

The Code of Ethics of Filipino Nurses
• The PNA Special Committee develop a code of ethics for Filipino Nurse in 1982 that was approved by the House of Delegates of the PNA
• In 1984 – the Board of nursing officially adopted the ICN’s Code of Ethics and added a fifth commitment which is “promotion of spiritual environment” when it passed Board Resolution no. 633
• In 1989, the PRC approved the amended Code of Ethics and it was approved by the general assembly of the PNA during a convention held in 1990
• In 2002, the Philippine Nursing Act of 2002 (RA 9173) was enacted, empowered and ordered the Board of Nursing to promulgate a Code of Ethics for Registered Nurses in coordination and consultation with the accredited professional organizations.

CODE OF ETHICS FOR REGISTERED NURSES

Article I
Preamble

Section 1
Health is a fundamental right of every individual.  The Filipino registered nurse, believing in the worth and dignity of each human being recognizes the primary responsibility to preserve health at all cost.  This responsibility encompasses promotion of health, prevention of illness, alleviation of suffering, and restoration of health.  However, when the foregoing is not possible, assistance towards a peaceful death shall be hi/her obligation.

Section 2
To assume this responsibility, registered nurses have to gain knowledge and understanding of man’s cultural, social, spiritual, physiological, psychological, and ecological aspects of illness, utilizing the therapeutic process.  Cultural diversity and political and socio-economic status are inherent factors to effective nursing care.

Section 3
The desire for the respect and confidence of clientele, colleagues, co-workers, and the members of the community provides the incentive to attain and maintain the highest degree of ethical conduct.

Article II
Registered Nurses and People

Section 4
Ethical Principles
1. Values, customs, and spiritual belief held by individuals shall be respected.
2. Individual freedom to make rational and unconstrained decisions shall be respected.
3. Personal information acquired in the process of giving nursing care shall be held in strict confidence.

Section 5
Guidelines to be observed: Registered Nurses must
1. Consider the individuality and totality of patients when they administer care
2. Respect the spiritual belief and practices of patients regarding diet and treatment
3. Uphold the rights of individuals
4. take into consideration the culture and values of patients in providing care. However, in the event of conflicts, their welfare and safety must take precedence.

Article III
Registered Nurses and Practice

Section 6
Ethical Principle
1. Human life is inviolable
2. Quality and excellence in eth care of the patients are the goals of nursing practice
3. Accurate documentation of actions and outcomes of delivered case is the hallmark of nursing accountability

Section 7
Guidelines to be Observed: Registered Nurses must
1. Know the definition and scope of Nursing practice which are in eth provision of RA No. 9173, known as the “Philippine Nursing act of 2002” and Board Resolution No. 425, Series of 2003, the “Rules and Regulations Implementing the Philippine Nursing Act of 2002”, the IRR
2. Be aware of their duties and responsibilities in the practice of their profession as defined in the “Philippine Nursing Act of 2002” and the IRR
3. Acquire and develop the necessary competence in knowledge, skills and attitudes to effectively render appropriate nursing services through varied learning situations.
4. If they are administrators, be responsible in providing favorable environment for the growth and developments of Registered nurses in their charge
5. Be cognizant that professional programs for specialty certification by the BON are accredited through the Nursing Specialty Certification Council (NSCC)
6. See to it that quality nursing care and practice meet the optimum standard of safe nursing practice.
7. Ensure that modification or practice shall consider the principles of safe nursing practice.
8. If in position of authority in a work environment, be normally and legally responsible for devising a system of minimizing occurrences of ineffective and unlawful nursing practice.
9. Ensure that patients’ records shall be available only if they are to be issued to those who are professionally and directly involved in their care when they are required by law.

Section 8
Ethical Principle – Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and privileges.

Guideline to be observed: Registered Nurses must
1. Respect the “Patients’ Bill of Rights” in the delivery of nursing care.
2. Provide the patients or their families with all pertinent information except those which may be deemed harmful to their well being
3. uphold the patients rights when conflicts arises regarding management of care

Section 10
Ethical Principle – Registered Nurses are aware that their actions have professional, ethical, moral, and legal dimensions.  They strive to perform their work in the best interest of all concerned

Section 11
Guidelines to be Observed:  Registered Nurses must
1. Perform their professional duties in conformity with existing laws, rules, regulations. Measures, and generally accepted principles of moral conduct and proper decorum
2. Not allow themselves to be used in advertisement that should demean the image of eth profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.)
3. Decline any gift, favor or hospitality which might be interpreted as capitalizing on patient.
4. Not demand and receive any commission, fee or emolument for recommending or referring a patient to a physician, a co-nurse or another health care worker; not to pay any commission, fee or other compensation to the one referring or recommending a patient to them for nursing care.
5. Avoid any abuse of the privilege relationship which exist with patients and of the privilege access allowed to their property, residence or workplace.

Article IV
Registered Nurses and Co-Workers

Section 12
Ethical Principles
1. The registered Nurse is in solidarity with other members of the health care team in working for the patient’s best interest.
2. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and other health care provider.

Section 13
Guidelines to be observed:  Registered Nurse must
1. Maintain their professional role/identity while working with other members of the health team.
2. Conform to group activities as those of a health team should be based on acceptable , ethico – legal standards.
3. Contribute to the professional growth and development of other members of the health team.
4. Actively participate in professional organizations.
5. Not act in any manner prejudicial to other professions.
6. Honor and safeguard the reputation and dignity of the members of nursing and other professions; refrain from making unfair and unwarranted comments or criticism on their competence, conduct, and procedure; or not do anything that will bring discredit to a colleague and to any member of other professions.
7. respect the right of their co-workers.

Article V
Registered Nurses, Society and Environment

Section 14
Ethical Principles
1. The preservation of life, respect for human rights, and promotion of health environment shall be a commitment of a Registered Nurse.
2. The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of eth people as a contributing members of society is a noble concern of Registered Nurse.

Section 15
Guidelines to be observed: Registered Nurses must
1. Be conscious of their obligations as citizens, as such, be involved in community concerns.
2. Be equipped with knowledge of health resources within the community, and take active roles in primary health care.
3. Actively participate in programs, projects, and activities that respond to the problems of society.
4. Lead their lives in conformity with the principles of right conduct and proper decorum.
5. Project and image that will uplift the nursing profession at all times.

Article VI
Registered Nurses and the Profession

Section 16
Ethical Principles
1. Maintenance of loyalty to the nursing profession and preservation of its integrity as ideal.
2. Compliance with the by laws of the accredited professional organization (PNA) and other professional organizations of which the Registered Nurse is a member is a lofty duty.
3. Commitment to continual learning and active participation in the development and growth of the profession are commendable obligations.
4. Contribution to the improvement of the socio-economic conditions and general welfare of nurses through appropriate legislation is a practice and visionary mission.

Section 17
Guidelines to be observed : Registered Nurses must
1. Be members of the Accredited Professional Organization.
2. Strictly adhere to the nursing standards
3. Participate actively in the growth and development of the nursing profession.
4. Strive to secure equitable socio-economic and work condition in nursing through appropriate legislation and other means
5. Assert for the implementation of labor and work standards.

Article VII
Administrative Penalties, Repealing Clause and Effectivity

Section 18
The certificate of Registered Nurse shall either be revoked or suspended for violation of any provision of this Code pursuant to Sec. 23 (f), Art. IV of RA No. 9173 and Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR.

Section 19
The Amended Code of Ethics promulgated pursuant to RA No. 877 and PD NO. 223 is accordingly repealed or superseded by the herein code.

Section 20
This Code of Ethics for Nurses shall take effect fifteen (15) days from its full and complete publication in the Official Gazette or in any newspapers of general circulation.

Some Nursing Definitions on Nursing Ethics

1. Moral Turpitude – refers to the act of baseness, vileness or the depravity in private and social duties which man owes to his fellow man, or to society in general, contrary to accepted and customary rule of right and duty between man and man. It refers to the quality of  a crime involving a great infringement of the moral sentiment of the community as distinguished from statutory mala prohibita
2. Mala Prohibita – are acts or omissions which are made criminal by law but which, of themselves, are not criminal. This term may be distinguished from mal in se which refers to acts that are wrongs in themselves
3. Neglect of duty – refers to the omission or refusal, without sufficient excuse, to perform an act or duty, which was the officer’s legal obligation to perform; the failure to give due attention to the performance of a duty
4. Incompetency – is defined as manifest lack of adequate ability and fitness for the satisfactory performance of official duties by reason of one’s vice or vicious habits; the lack of any physical, moral or intellectual quality which substantially incapacitates one to perform his duties
5. Unprofessional Conduct – defined as that conduct which by general opinion considered to be unprofessional because immoral, unethical or dishonorable.  It refers to such conduct which violates ethical code or rule of profession; or to such conduct which is unbecoming a member of  a profession
6. Immoral Conduct – refers to that conduct which is willful, flagrant, or shameless, and which shows a moral indifference to the opinion of the good and respectable members of the community.  It is not confined to sexual matters, but includes conduct inconsistent with rectitude, or indicative of corruption, indecency, depravity, and dissoluteness
7. Dishonorable conduct – defined as not honorable, not upright characterized by principles of honor.
8. Honor is defined as honest or integrity in one’s beliefs and actions.
9. Character – refers to the aggregate of the moral qualities which belong to and distinguish an individual person; that moral predisposition or habit, or aggregate of ethical qualities, which is believed to attach to a person, on the strength of the common opinion and report concerning him
10. Moral – pertains or relates to the conscience or moral sense or to the general principles of right conduct
11. Good – may mean unobjectionable, sufficient in law, valid



THE EMERGENCE OF LEADERSHIP THEORIES IN NURSING

Definition, Nature, Scope of Leadership

Leadership
a. is the process of persuasion and example by which an individual (leadership team) induces a group to take action that is in accord with the leader’s purposes of all (Gardner, 1986)
b. is a process in which a person inspires a group of constituents to work together using appropriate means to achieve a common mission and common goals.  They are influenced to do willingly and cooperatively, with zeal and confidence and to their greatest potential (Holoman, 1986)
c. is the process of directing and influencing and task related activities of group members (Stoner, 1978)
d. is asocial transaction in which person influences others.  Persons in authority do not necessarily exert leadership.  Rather, effective people in authoritative positions combine authority and leadership to assist an organization to achieve its goals (Merton, 1969)
           Flores (1989) provided definitions of leadership such as:
e. can be describe as a process of influence on a group in a particular situation, at a given point in time, and a specific set of circumstances that stimulate people to strive willingly to attain, organizational objectives, giving them the experience to attain the common objectives and satisfaction with the type of leadership provided.
f. Is the knacks of getting other people to follow you and do willingly the things you want them to do.  It is the ability to motivate subordinates and other employees toward the achievement of company objectives.
g. Must be based on the insight into present realities.  Leaders who succeed are those who can get inside their people and motivate them.  A leader gets inside people so as to energize them.


Fundamental Considerations for Effective Leadership

- according to Merton (1969), effective leadership has to satisfy the following considerations:

1. A person receiving a communication understands it
2. This person has the resources to do what is being asked in the communication
3. This person believes the behavior being asked is consistent with personal interest and values.
4. This person believes it is consistent with the purposes and values of the organizations

Major Variables in Leadership

- McGregor (1960) stipulated that four major variables are significant in leadership. These are:

1. (personality of the leaders) - The characteristics of a leader
2. (personality of the group) -The attitudes, needs, and other personal characteristics of the followers
3. (situation in which leadership is exercised) - The characteristics of the organizations, such as its purpose, its structure, the nature of the task to be performed, and
4. (organizational factors) - the social, economic, and political milieu.  The personal characteristics required for effective performance of a leader vary, depending on the other factors

- leadership is considered as a dynamic and interactive process involving three dimensions: the leader, the follower, and the situation.  It is a result of the relationship between the environment, the organizational structure, the group members, and the leader

Theories of Leadership

1. Trait Theory – basic assumptions that leaders are born, not made.
a. Traits that are related to leadership effectiveness according to Swansburg (1993) are as follows:
a. Intelligence Traits – judgment, decisiveness, knowledge, and fluency of speech are intelligence traits that a nurse manager is perceived to possess.  Having them enables the nurse manager to relate well and inspire subordinates to perform well.
b. Personality Traits – adaptability, alertness, creativity, cooperativeness, personal integrity, self confidence, emotional balance and control and independence (nonconformity) are the perceived personality traits of a nurse manager.  These traits facilitate the leadership capability of a nurse manager as he or she is able to motivate the people so that the goals of the organization as achieved.
c. Ability Traits – ability to enlist cooperation, popularity and prestige, sociability (interpersonal skills), social participation, tact, and diplomacy fall under ability traits of  a leader.  Collective unity among members of the system should be focus of a leader to achieve its goals.  This could only be possible when the leader possess the aforementioned ability traits.

2. Behavioral Theory – underscores the significance of understanding human behavior.
a. The nurse manager must understand human beings as the behavior of people is at the core of leadership and management in nursing.
b. The nurse leader should have a more valid and strong foundation in psychology and sociology that are necessary as an adequate preparation in human anatomy and physiology.  The study of nursing leadership and management depends so much on the study of man.

3. Situation Theory
a. McGregor (1966) explicitly stated that research findings to date suggest that it is more fruitful to consider leadership as a relationship between the leader and the situation that as a universal pattern of characteristics possessed by certain people.
b. This implies that leadership study has now taken on a situational approach (Pilar and Rodriguez, 1981).  This approach based its main point from the popular terms expressed by Uris (1953) as he advised the would be leaders in the following manner: “The skill with which you apply the three basic tools of leadership – autocratic, democratic, and free-rein techniques” – determines your personal success as a leader.

4. Situational Leadership
a. It means that there is no one best leadership style and maintains that effective leadership is matching the appropriate leadership style to the individual’s group’s level of task-relevant readiness (Heidental, 2003)
b. Situational leadership assumes that a leader should help followers grow in their readiness to perform new tasks as long as they are able and willing to go.
c. The five levels or stages of Benner’s model are as follows: novice, advanced beginner, competent, proficient, expert nurses

5. Motivational Theory
a. Maslow’s theory of motivation is one of the theories of leadership in nursing.  His theory is a positive one that is based on holistic-dynamic theory
b. (1) basic physiologic needs – human basic needs, food, clothing, shelter (2) safety needs – security, protection, stability, etc (3) Belongingness Needs – love, affection, acceptance, etc. (4) Esteem needs - strength, competence, freedom, esteem for others, attention, appreciation (5) self actualization – self accomplishment

6. Interactional Theory
a. Signifies an interaction between the person and situation.  It maintains that in simple reflex types of behavior the stimulus acts on the organism and elicits the response, and the organism plays no active part in the selection of interpretation of behavior
b. Interaction occurs between stimulus and organism because the condition or nature of the organism may influence the stimulus as well as be influenced by it.

The Managerial Grid
Description
Leaders may be concerned for their people and they also must also have some concern for the work to be done. The question is, how much attention to they pay to one or the other? This is a model defined by Blake and Mouton in the early 1960s.
 Concern for People High Country Club management Team management
Medium Middle of the road management
Low Impoverished management Authority-compliance
  Low Medium High
Concern for Production (Task)
 Impoverished management
Minimum effort to get the work done. A basically lazy approach that avoids as much work as possible.
Authority-compliance
Strong focus on task, but with little concern for people. Focus on efficiency, including the elimination of people wherever possible.
Country Club management
Care and concern for the people, with a comfortable and friendly environment and collegial style. But a low focus on task may give questionable results.
Middle of the road management
A weak balance of focus on both people and the work. Doing enough to get things done, but not pushing the boundaries of what may be possible.
Team management
Firing on all cylinders: people are committed to task and leader is committed to people (as well as task).
The Managerial Grid was the original name. It later changed to the Leadership Grid.
Lewin's leadership styles

Description
Kurt Lewin and colleagues did leadership decision experiments in 1939 and identified three different styles of leadership, in particular around decision-making.
Autocratic
In the autocratic style, the leader takes decisions without consulting with others. The decision is made without any form of consultation. In Lewin's experiments, he found that this caused the most level of discontent.
An autocratic style works when there is no need for input on the decision, where the decision would not change as a result of input, and where the motivation of people to carry out subsequent actions would not be affected whether they were or were not involved in the decision-making.
Democratic
In the democratic style, the leader involves the people in the decision-making, although the process for the final decision may vary from the leader having the final say to them facilitating consensus in the group.
Democratic decision-making is usually appreciated by the people, especially if they have been used to autocratic decisions with which they disagreed. It can be problematic when there are a wide range of opinions and there is no clear way of reaching an equitable final decision.
Laissez-Faire
The laissez-faire style is to minimize the leader's involvement in decision-making, and hence allowing people to make their own decisions, although they may still be responsible for the outcome.
Laissez-faire works best when people are capable and motivated in making their own decisions, and where there is no requirement for a central coordination, for example in sharing resources across a range of different people and groups.
Discussion
In Lewin et al's experiments, he discovered that the most effective style was Democratic. Excessive autocratic styles led to revolution, whilst under a Laissez-faire approach, people were not coherent in their work and did not put in the energy that they did when being actively led.
Servant Leadership

Servant Leadership – is life and leadership in the service of the Lord.  Nurse leaders should use their gifts from God according to the grace given to them.

Servant leadership in nursing is selfless commitment and devotion to duty.  It recognizes the necessity of providing holistic care to the patient – physically and spiritually.  Nurse leaders are duty bound in the promotion of spiritual environment for their patients.

Servant Leadership in the Christian world is based on the Good Samaritan Act from the new testament.

1.
NURSING MANAGEMENT

Nursing Management – as a process of coordinating actions and allocating resources to achieve organization goals of the healthcare delivery system.

General Principles of Nursing Management

1. Nursing management is planning
2. Nursing management is the effective use of time
3. Nursing management is decision making
4. Meeting patient’s nursing care needs is the business of the nurse manager
5. Nursing management is the formulation and achievement of social goals
6. Nursing management is organizing
7. Nursing management denotes a function, social position or rank, a discipline and a field of study.
8. Nursing management is the active organ of the division of nursing , of the organization, and of the society in which it functions
9. Organizational cultures reflect values and beliefs
10. Nursing management is efficient communication
11. Nursing management is controlling or evaluating (Swansburg 1993)

Levels of Skills Management in Nursing

A.  Conceptual Skills

1. It refer to an individual’s mental ability to coordinate a variety of interest and activities.
2. The nurse manager should have the ability to think in the abstract, analyze lots of information and make connections between the data.
3. Someone who could create a vision
4. She thinks critically and able to conceptualize how things could be

B.  Interpersonal Skills

1. Provide individuals a unique flair in their speech, determine the amount of empathy heard in their words of consolation, and rule their desires to examine what is said.
2. It influence the individuals’ preferred ways of using language, the degree to which they listens, and their ways on responding to others.
3. This also refers to interpersonal styles which means the ways in which individuals react and communicate with others.

C.  Technical Skills

1. Are the tools, procedures, and techniques that are unique to the nurse manager’s specialized situation.  There is a need for the nurse manager to master the job in an attempt to be viewed as a source of help – an expert.

Management
Management comprises directing and controlling a group of one or more people or entities for the purpose of coordinating and harmonizing that group towards accomplishing a goal. Management often encompasses the deployment and manipulation of human resources, financial resources, technological resources, and natural resources. Management can also refer to the person or people who perform the act(s) of management.
The verb manage comes from the Italian maneggiare (to handle — especially a horse), which in turn derives from the Latin manus (hand). The French word mesnagement (later ménagement) influenced the development in meaning of the English word management in the 17th and 18th centuries
Management has to do with power by position, whereas leadership involves power by influence.
Functions of management
Management operates through various functions, often classified as planning, organizing, leading/motivating and controlling.
• Planning: deciding what needs to happen in the future (today, next week, next month, next year, over the next five years, etc.) and generating plans for action.
• Organizing: making optimum use of the resources required to enable the successful carrying out of plans.
• Leading/Motivating: exhibiting skills in these areas for getting others to play an effective part in achieving plans.
• Controlling: monitoring — checking progress against plans, which may need modification based on feedback.
Management Theories

5. Scientific Management Defined
a. Type of management that is characterized and guided by the application of scientific approaches to solve managerial problems in business and industry.
b. It seeks to find out that particular management procedure that is applicable in a given situation through a careful examination of the job, determining what is to be done and eventually designing the tools and methods to accomplish the task.
c. Principles of Scientific Management
i. There is a necessity to apply science in the development of each job, to replace the old rule-of-thumb method
ii. There should be scientific selection, training, and development of workmen in order to achieve optimum efficiency
iii. There should be adequate compensation of the workmen according to his accomplishment and friendly cooperation between management and workers to make sure that the work being done is in conformity with sound principles of scientific management and human relations.
iv. There should be equitable division of work and responsibilities between management and workmen, giving everyone the functions for which he is best suited, and as such, preserving his own individuality in the exercise of his initiative.

6. Bureaucracy
a. Refers to a highly structured from of administration and usually includes no participation by the governed.    A termed coined by Max Weber, it involves a clear cut division of integrated activities which are regarded as duties inherent in the office.
b. Advantages of Bureaucratic Management
i. Competent and responsible employees are produced
ii. Employees perform by uniform rules and conventions
iii. Employees are accountable to one manager who is an authority
iv. They maintain social distance with supervisors and clients
v. Favoritism is reduced and impersonality is promoted
vi. Rewards and other incentives are provided to employees based on technical qualifications, seniority, and achievement
c. Disadvantages
ii. Complaints about red tape frequently heard and experienced
iii. Procedural delays are observable
iv. Genera frustrations among employees and clients are inevitable
d. Characteristics of Bureaucracy
i. Formality
ii. Low autonomy
iii. A climate of rules and conventionality
iv. Division of labor
v. Specialization
vi. Standardized procedures
vii. Written specifications
viii. Memoranda and minutes
ix. Centralization
x. Controls and
xi. Emphasis on high level of efficiency and production (Swansburg, 1990)

3. Human Relations – job efficiency spells better production.  Attaining both is having harmonious relationship among employees.  To get a job done in the most acceptable manner is for every employee to work together in a most pleasing manner.
a. It refers to the integration of people into a work situation in a way that motivates them to work productively, cooperatively, and with economic, psychological and social satisfaction. (Andres, 1989)
b. It signifies the individual worker as the source of control, motivation, and productivity in organization (Heidenthal, 2003)

4. Theory of Motivation – Hygiene
a. The Motivation to Work was written in 1959 by Herzberg together with Mausner and Synderman. It expressed a challenged to the tenets of scientific management and aimed at giving sound foundation to the more humanistic schools.  Motivational factors like good working conditions, status, job security, and salary as hygienic were noted by Herzbergy as necessary so that employees would perform adequately of the job.
b. Herzberg also viewed other factors such as recognition for achievement, responsibility, the nature of the work itself, and possibility for growth as motivators.  He believed that they should ideally be provided for eth employees to perform in a more than adequate manner.

5. Theory X and Y – the Human side of the Enterprise by McGregor (1960) advanced the concepts of Theory X, the traditional view of direction and control, and Theory Y, the integration of individual and operational goals.
a. Theory X Manager
i.   He assumes that: (1) the average person has an inherent dislike for work and will avoid it if possible; (b) must be coerced, controlled, directed, and threatened with punishment to get the work done, and (c) prefers to be directed, wishes to avoid responsibility, has relatively little ambition, and wants security above all.
ii. The manager performs on the assumption that organizational requirements take precedence over the needs of individual members.  This manager coercively, autocratically, and arbitrarily uses authority to obtain the commitment of staff members to the organization’s objectives, orders staff members on what to do, evaluates their performance and rewards of punishes them on the basis  of how well they perform their assignment.  The effectiveness of authority depends largely upon the manager’s ability to enforce it through the use of punishment.
b. Theory Y Manager – manages based on an entirely different set of assumptions about human behavior
i. The expenditure of physical and mental effort in work is as natural as play or rest.
ii. External control and the threat of punishment are not the only means for bringing about effort toward organizational objectives. Man will exercise self direction and self control in the service of objectives to which he is committed.
iii. Commitment to objectives is a function of the rewards associated with their achievement.
iv. The average human being learns under proper conditions, not only to accept but to seek responsibility.
v. The capacity to exercise a relatively high degree of imagination, ingenuity, and creativity in the solutions of organizational problems is widely, not narrowly, distributed in the population.
vi. Under the conditions of modern industrial life, the intellectual potentialities of the average human being are only partially utilized.
vii. The central principle which derives from Theory Y is that of integration: the creation of conditions such that members of the organization can achieve their own goals best by directing their efforts towards the success of the enterprise.

6. Theory M for Management
a. It was reported in 1973 that Allen made a study of McGregor’s X and Y types of behavior wherein he suggested that most managers avoid extremes in their beliefs about people.
b. Theory M for management which stated that people are motivated to work by highly complex factors that may be biological, psychological, social, or economic, to name only a few possibilities.  Sych factors vary in relative importance according to conditions at the time.
c. It was further reiterated that some people dislike responsibility and prefer to be led, other are ambitious and want to be leaders, the majority fall somewhere in between
d. 2 points in relation to administration (1) X and Y type managers represent only the extremes and the majority of the managers are somewhere between the extremes, and (2) the successful manager recognizes that no two persons nor problems are the same, therefore, different types of behavior are necessary at different time in order to best help the work group to achieve team goals.

7. Theory Z – Participative Management – based on the Japanese concept of organization.  The characteristic of type Z organizations are as follows:
a. Long term (lifetime) employment
b. Slowed down rates of evaluation and promotion
c. More implicit and less formalized control systems
d. Personal concern for the employee
e. Cross functional rotation
f. Some degree of participative consensual decision making, and
g. Emphasis on individual responsibility

8. TQM (Total Quality Management)
a. Is a quality revolution taking place in both business and the public sector as pointed out by the Saskin and Kiser in 1991.  It was inspired by a small group of quality experts, wherein the late W.Edwards Deming  was considered the most prominent.
b. Deming emphasized that a well managed organization was one in which statistical control reduced variability and resulted in uniform quality and predictable quantity of output.
c. The foundation of TQM
i. Focus on the customer
ii. Continuous improvement – very good is not enough. Quality can always be improved.
iii. Improve the quality of everything the organization does
iv. Measures accurately – uses statistical techniques to measure every critical variable in the organization’s operations
v. Involve employees – involves the people on the line in the improvement process. Teams are widely used for finding and solving problems.


Approaches on Management

2. The System Approach
a. Is where the manager consciously attempts to understand the relationship among various parts of the organization and the role of each part in supporting the overall performance of the organization.
b. It is based on the firm belief that before the implementation of any functional change, its ultimate effect on the entire system must be properly examined,

3. The Contingency Approach
a. It recommends the use of different principles from different sources to solve a given problem at hand.
b. Hellriegel and Slocum (1974), informed that there is no single approach which provides an adequate umbrella for the varied management situations and problems.  This is where common sense attempts to bridge the gap between theory and practice to bridge the gap between theory and practice.

4. Contingency Approach – is ellectic
a. The manager who applies this approach uses those theories and principles from various sources that are deemed necessary to solve those problems at hand.



10 Basic Managerial Roles – according to Mintzberg (1975), there are ten basic management roles that highlight actual managerial functions.

Leadership Roles
• the figurehead role

• the leader role

• the liaison role
Performance of ceremonial duties

Direct involvement to approve decisions and choose a managerial team

Dealing with outside people
Information Roles
• the monitor role

• the dissemination role

• the spokesman role
Receipt and sending of information for control purposes

Sharing of information, collected as monitor, with subordinate

Speaks for his department
Decisional Roles
• the entrepreneurial role

• the disturbance handler role

• the resource allocator role

• the negotiator role
Involvement with constant addition or deletion of new projects

Attention to problems arising out of strikes bankruptcies, and interference

Allocation of budgets, time and information

Ranges from negotiation of an argument to negotiation of a labor contract

Principles of Management
Henry Fayol's Principles of Administrative Management
2. DIVISION OF LABOR
Work specializations can result in efficiencies
3. AUTHORITY
Managers have the right to give orders, but with authority comes responsibility
4. DISCIPLINE
Discipline is necessary to develop obedience, diligence, energy and respect
5. UNITY OF COMMAND
An employee should receive orders from one supervisor only
6. SUBORDINATION OF INDIVIDUAL INTERESTS TO GENERAL INTERESTS
The interests of one employee or group of employees should not take precedence over the needs of the organization
7. REMUNERATION
Compensation should be fair for employee and employer
8. SCALAR CHAIN (HIERARCHICAL)
A clear line of authority should extend from the highest to lowest levels
9. EQUITY
In return for their obedience, employees should expect justice
10. STABILITY OF PERSONNEL TENURE
Because time is required to become effective, high turnover should be prevented
11. INITIATIVE
Managers should encourage and develop employee initiative
ESPRIT DE CORPS
Harmony and union build organizational strength
THE PLANNING PROCESS

Planning
1. Refers to a process beginning with objectives, defining strategies, policies, and detailed plans to achieve them, achieving an organization to implement decisions, and including a review of performance and feedback to introduce  a new planning style (Steiner, 1969)
2. Is deciding in advance what to do, how to do it, when to do it and who do it (Alexander, 1978)
3. The process of analyzing and understanding a system, formulating its goals and objectives, assessing its capabilities, designing alternative courses of action or plans for the purpose of achieving these goals and objectives, evaluating the effectiveness of these plans, choosing the referred plan, initiating necessary actions for its implementation, and engaging in continuous surveillance of the system in order to arrive at an optimal relationship between the plan and the system (lewey and Loomba, 1984)

Purposes of Planning

1. Planning leads to success in achieving goals and objectives
2. Planning gives meaning to work
3. Planning provides for effective use of available personnel and facilities
4. Planning helps in coping with crisis situations
5. Planning is cost effective
6. Planning is based on past and future, thus helping reduce the elements of change
7. Planning can be used to discover the need for change
8. Planning is needed for effective control

Characteristic of Planning

1. Planning is purposeful – its is deliberate, rational and objective process. Analyzes of both internal and external factors to determine the organization’s environment require tools and models to be used.
2. Planning is process oriented – it is a continuous process. The organization accelerates to a desired state due to repetitions and modifications of the planning cycle.
3. Planning is hierarchical in nature – a system of plans is developed by an organization.  Different plans are generated by and for certain components of nature.
4. Planning is future directed – the future is dealt with through planning and  therefore requires forecast of economic variable, the needs and demands of patients, health services utilization, social environment, and direction of political forces.
5. Planning is multi dimensional – the key dimensions are – (1) Time – short range or less than 1 year, medium range or less than 5 years and long range or over 5 years, (2) Organizational level – regional, hospital wide or departmental, (3) Functional Area – identified by the departmental organization, like patient, services, finance, maintenance, (4) Scope – comprehensive plan, strategic plans, tactical plans, implementation plan and so forth

Elements of Planning

1. Written statement of mission and purpose
2. Philosophy
3. objectives and
4. detailed management or operational plan – the blueprints by which the purpose, philosophy, and objectives are put into action.

Types of Planning

1. Strategic or Long Range Planning – it determines where an organization is going over the next year or more, how it is going to get there and how it will know if it got there or not.  The focus is usually on the entire organization, while the focus of a business plan is usually on  a particular product, service, or program.  It is futuristic in approach.
a. Strategic Analysis – includes the conduct of some sort of scan, or review, of the organization’s environment, e.g. the political, social, economic, and technical environment.  Planners also consider the various SWOT – strengths, weaknesses, opportunities, and threats.  Also known as Situational Analysis
b. Setting Strategic Direction – planners carefully come to conclusions about what the organization must do as a result of the major issues and opportunities facing the organization.  Goals should be designed as S (specific) M (measurable) A (attainable) R (realistic) T (timely) E (extending the capabilities of those working) R (rewarding).
i. Mission Statements – brief written descriptions of the purpose of the organization. This includes the values and vision statement
ii. Vision Statement – usually a compelling description of how the organization will or should operate at some point in the future and of how customers or clients are benefiting from the products and services of the organization.
iii. Values Statements – includes the overall priorities in how the organization will operate. Some people focus the values statement on moral values. Moral values are values that suggest overall priorities in how people ought to act in the world.
c. Action Planning – the process of laying out how the strategic goals will be accomplished carefully. Objectives or specified results are often included in action planning, with each strategic goal.
d. Strategic Planning benefits
i. Clearly defines the purpose of the organization and establishes realistic goals and objectives
ii. Communicates those goals and objectives to the organization’s constituents
iii. Develops a sense of ownership of the plan
iv. Ensures the most effective use is made of the organization’s resources by focusing the resources on key priorities.
v. Provides a base from which progress can be measured and establishes a mechanism for informed change when needed.
vi. Brings together of everyone’s best and most reasoned efforts have important value in building a consensus about where an organization is going.
vii. Provides clearer focus of organization, producing more efficiency and effectiveness
viii. Bridges staff and board of directors
ix. Provides the glue that keeps the board together
x. Produces great satisfaction among planners around a common vision
xi. Increases productivity from increased efficiency and effectiveness
xii. Solves major problems
e. Guidelines for strategic planning
i. It should be done when an organization is just getting started
ii. Should be done in preparation for a new major venture
iii. Should be conducted at least once a year in order to be ready for the coming fiscal year
iv. Each year, action plans should always be updated
v. Note that during implementation of the plan, the progress of the implementation should be reviewed at least on a quarterly basis by the Board.
f. Budgets – specify money needed for the resources that are necessary to implement the annual plan
i. Operating Budgets – usually associated with major activities over coming year, including wages, salaries, and compensation both permanent and temporary or casual employees
ii. Project Budgets – associated with major projects, for example, constructing a building, developing a new program or product line, etc.
iii. Cash budgets – budgets depict where cash will be spent over  some near term, for example, over the next three months
iv. Capital budgets – these budgets are associated with operating some major asset, for example, a building, automobiles, furniture, computers, etc
g. Human Resource Planning – this is essential to retention of outstanding professional talent.  It decides how the full spectrum of human resources will affect the strategic and operational plans. If the human resources do not fit the strategic plan the nurse manager decides what action to take.  This can include locating new people with special skills or upgrading the skills of senior people
i. Systematic Forecasting of Manpower Needs – business conditions and forecast
ii. Performance Management – analyzing, improving and monitoring performance
iii. Career Management – determining, planning and monitoring the career aspirations
iv. Management development  - assessing and determining the developmental needs of managers for succession
2. Operational or Short Range Planning



Human Resource Planning and Corporate Planning
Business Planning Human Resource Planning
Long Range Planning Strategic Planning

Corporate Philosophy
Organizational Mission
Strengths and Weaknesses Environmental Scanning

Labor Supply Analysis
Labor Force Composition
Social/Cultural Composition
Demographic Changes
Legal and Regulatory Agency Changes
Middle Range Planning Operational Planning

Organizational Goals and Objectives Forecasting

Projected Personnel Needs by Job Category
Attrition
Productivity Changes
Short Range Planning Budgeting

Budgets
Economic Forecast
Performance Goals
Annual Operating Plans Projected Staffing Requirements

Surplus or deficit of personnel
Staffing authorization
Succession Planning
Promotions and Transfers
Training and Development


ORGANIZING DEFINED

Organizing
1. The process of forming a system into an organic whole, giving it an orderly structure, framing, and making arrangements for its working  order.  It involves cooperation.
2. This process establishes formal authority which includes the organizational structure set up; groupings, roles, and relationship identification
3. As a process, it also determines the need for staff through staffing patterns development, maintenance and distribution in the different areas as necessary.
4. This is a process where personnel job description, qualifications and functions are distinctly defined and specified work efficiency in the organization.

Organization
1. A system of interrelated resources, including environment, materials, supplies and behavior of people, that performs a task which has been differentiated into several distinct subsystem performing a part of the task, and the efforts of each being integrated to achieve effective  performance of the total system (Kraegel, et al 1974)
2. Is a planned grouping of people to accomplish a specific purpose (DeCenzo and Silhanek, 2002)
3. An organized body, system, or society where members harmoniously work together to achieve organizational goals.

Characteristics of Organizations
1. Goals – every organization has a specific purpose expressed in terms of  a goal or set of goals.
2. People – organization consist of people; they are grouped and worked together in a distinct way.
3. Structure – defines and limits the behavior of the organizational members.  Rules and regulations in the structure are created in order to identify some members as supervisors to give them authority over other employees, and do explicitly describe every member’s job to eliminate confusion on what is to be expected.
4. Culture – organizations are like people who have personality.  It reflects the values, symbols, rituals, myths, and work practices that are common to every organization.
5. Job – the kind of job that every employee performs plays a very significant part in influencing behavior at work.
6. Supervision – it employs the supervisor who is responsible for establishing the work environment.

Organizational Types of Authorities
1. Line authority
a. Authority that entitles a supervisor to direct and individual’s work.  Employee authority emanates from the top of the organization to the worker population, following what is called the chain of command.
2. Staff Authority
a. Is the authority in positions created to support, assist, recommend, and generally reduces the supervisors’ informational responsibilities.

Staffing
1. Refers to the process of determining and providing the acceptable number and mix of nursing personnel to produce the desired level of care to satisfy the patients’ demand for care (Rowland and Rowland, 1992)

Staffing Methodology – it should satisfy the following criteria
1. It should be observed in an orderly manner.
2. It should follow a systematic process.
3. It should be based upon sound rationale
4. It should be applied to determine the number and kind of nursing personnel required to provide nursing care of  a predetermined standard to a group of patients in a particular setting (Aydelotte)

Staffing Formula

        Average census x Nursing Hours x 1.4 x 1.14
=      -----------------------------------------------------------
                                   7.5
1. 1.4 figure stands for 1.4 work weeks of 5 days to cover a 7 days week; 1.14 figure stands for the built in holidays, sick leave, annual leave,  and 7.5 figure stands for 7.5 productive hours on an 8 hour shift.
2. More comprehensive staffing formula

a. Categorize the number of patients according to the levels of care needed.
i. The total number of patients multiplied by the percent of patients at each level of care, either minimal, intermediate, intensive or highly specialized.
b. Find the total number of nursing hours needed by the patients per day at each categorized level.
ii. Number of patients at each level by the average number of nursing care hours needed per day.
iii. Get the sum of the nursing care hours needed at the various levels
c.       Find the actual number of nursing care hours needed by these given number of patients per year
                           i.   The total nursing care hours needed per day multiplied by the total number of days (365) in a year
       d.    Find the actual number of working hours rendered by each nursing personnel per year
            i.  Number of hours on duty per day multiplied by the actual working days per year
        e.    Find the total number of nursing personnel needed.
i. Divide the total number of nursing care needed by the given number of patients per year by the actual number of working hours rendered by an employee per year
ii. Find the number of relievers – multiply the number of nursing personnel needed by 0.15 (for those working 40 hours per week) or by 0.12 (for those working  48 hours per week)
iii. Add the number of relievers to the number of needed nursing personnel’s.
         f.  Categorize into professional  and professionals
             i.  Multiply the number of nursing personnel according to the number/ratio of professionals to non professionals

Scheduling
1. I defined as a time table indicating planned work days and shifts of nursing personnel.  A schedule indicates the working days and off days to the nursing personnel.  A schedule indicates the working days and off days to the nursing personnel in order to assure adequate patient care and achieve a desirable distribution of duties.

Types of Scheduling
2. Centralized scheduling – it is the chief nurse or her designate that usually does the assignment of the nursing personnel to the various hospital areas which includes the shifts of duties and off duties.
3. Decentralized scheduling – it is the Chief nurse or her designate that usually does the assignment of the nursing personnel to the various nursing areas.  Arrangement of shifts of duty and off duties are done by the Supervising nurse or head nurse or senior nurse of the particular units or areas.
4. Cyclic Scheduling – type of scheduling observes an established basic time pattern for a certain number of weeks and is repeated thereafter.  It conforms to the requirements of fair distribution of hours of work and time off for staff.

Types of Patient Assignment
1. Case Method – is where a nurse is assigned to a patient for total patient care.  This is one on one scheme.
2. Primary Method – the focus of primary care system is the patient, rather than the task.  In this method, the primary nurse personally does the assessment of the patient’s health status or needs of care, develops and administers the nursing  care plan which includes health teaching and pre discharge planning, and evaluates the outcomes of acre for adjustment as needed.
3. Functional method – system of providing care  for the patient is based on the concept of division of labor as nurses and other care givers perform specific  tasks in eth delivery of nursing care.  One registered nurse may be assigned as medication nurse, admission and discharges, nursing attendants and other nursing procedures.
4. Team Method – a kind of nursing modality, professional, technical and ancillary nursing personnel are grouped as a team to provide total care to a selected group of patients.
5. Case Management – a system of patient care delivery, it focuses on the attainment of outcomes within effective and appropriate time frames and resources.  The case managers direct care provisions for the patient as it focuses on an entire episode of illness, crossing all settings wherein the patients received care.

DIRECTING

Directing Defined
1. Getting work done through others
2. in nursing – giving orders and directions to others to attain quality patient care.  This function of  a nursing manager is administrative in nature which involves two major aspects, namely: the human and technical aspects.
3. it is generally considered that directing the human component in an organization is the most important and the most difficult.

Communication on Management
1. It is viewed as a process of symbol using, understanding, interaction, reduction of uncertainty, transference, and transmission of information (Bornmann, 1980)
2. It functions in linking the individual to the environment, establishing commonality, exercising power, time binding and replicating memories.

Flow of Information
1. Downward communication – may come in forms of policies, manuals and guidelines for information and compliance of everyone in eth organization.
2. Upward communication – usually comes from subordinates on top management.  It is done in the form of feedback informing the administration as to the effect of the downward communication – the extent to which it ahs been received and acted upon. Grievances procedures, incident or situational report, and other forms of written reports are forms of upward communication.
3. Lateral or sideward communication – is being observed between employees, personnel, units or department on similar level.  It comes out in various forms like endorsements betweens shifts, nursing rounds, conferences or meeting or in making referrals between service departments.

DECISION MAKING

Decision making – as the most important administrative activity since it is involved in the other processes of administration such as planning, organizing, coordinating, directing, controlling and evaluating.

Categories of Decision
1. Personal Decision – those which every staff member does in discharging duties.  These duties are related to every nurse’s assessment of eth patient’s needs, planning and implementing care, and evaluating of outcomes.
2. Organizational decisions – relate to the operations of a unit or department or the entire system and they are concern to all members of the aforementioned organizational group.

Decision Making Process and Problem Solving
1. Recognize, define, and limit the problem;
2. Analyze and evaluate the problem
3. Establish criteria or standards by which the solution will be evaluated or judged as acceptable and adequate to the need;
4. Collect the necessary data and information;
5. Formulate and select the preferred solutions or actions.  Test them in advance, and
6. Put into effect the selected or preferred solution;
a. Programming the solution
b. Controlling the activities in the program; and
c. Evaluating the results and the process

Management Conflict – usually attributed to the customary ideas about what a manager performs – planning, organizing, directing or leading and controlling compared with the traditional role of the worker – doing manual labor (Myers 1970)

Nature and Causes of Management Conflict
1. Traditional organizations have conflicting views regarding role relationships between managers and workers.  Organizational managers are the ones who have been presumed to possess the maturity, knowledge, ability, and responsibility to plan, direct, and control the workers activities.
2. Labor impacts have impact in formalizing and widening the gap between the employer and the employees.

Directing More Meaningful Work Model

Planning and Organizing
• Problem Solving / Decision Making
• Setting Standards of Work
• Use of Resources: Human Resources, System, etc.

Doing
• Plan of Implementation

Controlling
• Standards of control
• Measurement of performance against set standards
• Correcting Deviations from Standards and plans

CONTROLLING

Controlling
• is the critical function of management that measures and evaluates whether the strategies set and plans made are carried out. Wherever necessary, corrective action or plan modifications takes place to ensure that organizational goals are accomplished.
• Refers to the process of evaluating, measuring, and feedback function.
• This is the link between doing and re-planning
• It is the looking back technique and looking ahead technique in management
Functions of Controlling
1. It involves setting standard for evaluation purposes at carefully selected strategic control points
2. It aims to check and make reports on the performance compared with standards
3. it seeks to take corrective actions as indicated and if conditions warrant
4. it measures performance results periodically against plans through the appraisal of departmental and unit results against objectives and observes performance reviews by comparing individual results with criteria for satisfactory performance and specific objectives.
5. It includes result interpretation which allows the modification or expansion of existing plans to achieve revised objectives
6. It feedback aspect necessitates  the rise of a suitable performance evaluation procedure so that people may know how they are doing thereby enabling them to plan the desirable changes for the future.

Characteristic of Good Control
1. Control is future oriented
2. Control is multidimensional
3. The assessment of whether good performance assurance has been achieved is difficult and subjective
4. Better control is not always economically feasible, the control tools are costly and should be implemented only if the expected benefits exceed the costs.

Principles of Control
1. The principle of “setting the fox to watch the henhouse” – requires employees to supply their superiors with the needed information
2. The principle of “measured behavior” driving out the “unmeasured behavior” – giving of feedback to an employee
3. The principle of “paradox of control” – emphasizes that any attempts of an individual to control others may impose on them new requirements.

Performance Appraisal – refer to the method by which, through observation by the appraiser, the individual worker’s efficiency in performing his duties and responsibilities during a given period is evaluated on the basis of pre-determined performance standards or established goals set by the employee and his supervisor.

Purposes of Performance Appraisal
1. Providing feedback or employee performance
2. Basis for personnel action, transfer, demotion, layoff, discharge and increase in salary
3. Management guide in employee counseling and discipline
4. Promotion of better employee-employer relations
5. Improvement of supervision by making the supervisor better aware of his duties.
6. Development of employees and supervisors
7. Motivating employees to become agents of prime movers change.
8. Identification of training needs and management development.
9. Facilitate organizational diagnosis and development

Discipline – refers to the action taken by a superior to enforce the organization’s standards and regulations.  It generally follows a typical sequence of four steps: verbal warning (temporary record of reprimand), written warning (written record of reprimand), suspension (time off without pay) and dismissal (removal from one’s job).

21ST CENTURY CHALLENGES IN NURSING

Documentation in Nursing

Forms
1. Nursing Health History and Assessment Worksheet – being completed when patient is admitted
2. Graphic Flow Sheets – to provide an efficient and timesaving way to record information that must be obtained repeatedly at regular and/or short intervals of time.
3. Medicine and Treatment Records – show all medicines and treatments provided on repeated basis
4. Nursing Kardex – flip over card usually kept in portable file at the Nurses station.  It has two part information – activity and treatment section and nursing care plan section.  In kardex – info about basic demographic data, primary medical diagnosis, current orders of the physician to be carried out by the nurse, written nursing care plan, nursing orders, scheduled test and procedures, safety precautions in patient care and factors related to daily living activities.
5. Discharge Summary – it includes the direct result of planning for discharge that starts soon after the person is admitted to a healthcare institution.

SOAP Charting

S- subjective information
O – objective information
A – Assessment
P – plan of action
I – intervention
E – evaluation
R - revision

Using the SOAP Format

The following skills are required in using SOAP format:
1. listening and observing
2. data analysis
3. knowledge of clinical information and proper terminology
4. planning and organizing information
5. appropriate action

 Nursing Audit
1. Is part of the nursing quality program
2. it is both evaluating and planning functions of nursing management
3. refers to the method of assuring documentation of the quality of nursing care in keeping with the standards of the organization, the nursing department, the professional, governmental and/or nongovernmental, and the accrediting group

MANAGEMENT-LABOR RELATIONS

Labor Relations – generally refers to the relationship between the employees and management in an organization.  It also applies to the relationship between management and labor unions.

Labor union – consists of group of workers, who act together, seeks to promote and protect the mutual interest of every member through the collective bargaining.

Declaration of State Policy in Relation to Labor Unions
1. It is the policy of the state
a. To promote the primacy of free collective bargaining
b. To promote free trade unionism
c. To foster the free and voluntary organization of  strong and unified labor movement
d. To provide an adequate administrative machinery for the expeditious settlement of labor or industrial disputes
e. To ensure stable but dynamic and just industrial peace
f. To ensure the participation of workers in deciding and policy making processes affecting their rights, duties and welfare

Labor Rights

As embodied in the New Constitution of the Philippines

1. Right to protection by the state
2. Right to full employment
3. Right to equal work opportunities, regardless of sex, race or creed
4. Right to self organization
5. Right to collective bargaining and negotiations
6. Right to security of tenure
7. Right to just and humane conditions of work
8. Right to peaceful concerted activities including right to strike
9. Right to participate in policy and decision making processes affecting their rights and benefits
10. Right to compulsory arbitration as may be provided by law

As embodied in the Labor Code of the Philippines

1. Right to certain hours of work and weekly rest periods
2. Right to overtime and premium pay
3. Right to living wage
4. Right to protection of working women and minors
5. Right to emergency, medical and dental treatments
6. Right to protection under safety and health standards
7. Right to employee’s compensation in case of injury or illness in line of duty and
8. Right to social security and medical care

Collective Bargaining – is  a process through which the management and the union meet, discuss and decide terms and conditions of employment which will determine and govern the conduct of their relationship during the effectivity of eth agreement.

Strikes and Lockouts

Strike – as concerted work stoppages, characterized by slowdowns, mass leaves, sit downs, attempt to damage, destroy or sabotage, plant equipment and facilities and similar activities

Lockout – includes shutdowns or the suspension or cessation of business operations as a result of a deadlock in eth collective bargaining negotiations or a labor dispute.

Causes of Strikes and lockouts – higher wages, overtime, premiums, differential pay, shorter working hours, wage adjustments and better working conditions.

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