Nursing Research, Leadership and Mgmt[1].

NURSING REASEARCH, LEADERSHIP AND MANAGEMENT

I. Nursing research

a. Definition of termsb. Characteristicsc. Purposed. Ethics of Scientific Researche. Steps in Nursing Research

II. Nursing Leadership

a. Definition of Termsb. Elements of Leadershipc. Nursing Leadershipd. Reasons for the Study of Nursing Leadershipe. Theories of Leadershipf. Leadership Styleg. Powers of a Leaderh. Skills and qualities of a Leader

III. Nursing Management

a. Definition of Termsb. Theories of Managementc. Manager/ Typesd. Management Processe. Sample Questions or Post-test** CBQ : Common Board Question

I. Nursing Research :

Definition : according to Kerlinger, nursing research is the :a. systematicb. empiricalc. controlled, andd. critical investigationof a hypothetical proposition in relation with a phenomenon.

* First thing to do in nursing research is to choose a problem related to a phenomenon.

Nursing problem : is anything that influences the human lives / existence.

Ex. : diseases, infections, pollution etc

Example of a problem : Tuberculosis1. You need to apply a hypothetical proposition.Hypothesis : represents not the final answer to the nursing

problem being studied BUT is :a. an educated guessb. a scientific guessc. a tentative answer only.* IS a big question mark in the researcher’s mind.2. Hypothesis for the problem of TB :“ Environmental pollution in Manila increases the cases of TB at

San LazaroGeneral Hospital”.

Four Major Characteristics of a Scientific Research :1. Systematic : the study must follow a step-by-step

process/procedure.(**CBQ)2. Empirical/ Empiricism : the study should be dealt with

objectivity : the data related tothe problem should be readily observable or gathered through

the senses.3. Controlled/ Appropriate Research Design : study should be

directed, designed ormanipulated by appropriate system, method or process to control

all variables ofthe study.4. Based on a Critical investigation : the study should be a fact-

finding investigation on apopulation or human beings to gather data to answer the

hypothesis.

Four Basic Purposes of Nursing Research :1.Descriptive purpose : 100 % knowledge on the subject; study

is done for richerfamiliarity and is carried out by mere active observation of a

phenomenon.2. Exploratory purpose : 50 % of the answer is already known.3. Experimental purpose : you determine the cause and effect

ratio by applying activemanipulation bec you are doing active intervention.4. Developmental purpose : done to improve the system or

quality of care for our patients.* The main purpose of nursing research is to improve the quality

of patient care.(**CBQ)

Ethics of a Good Scientific Research : (SCIENTIFIC)Scientific objective : the study should have an objective

beneficial to your patients.Consent : consent should be secured when obtaining all data

needed in the study.**CBQ : If the patient is dead : the hospital legally owns the

records.The information in the patient’s records : owned by the patient.If the patient wants an explanation about information in his

chart, ONLYthe physician is legally allowed to explain the diagnosis,

prognosis,treatment etc.Integrity : should be based on honesty and soundness; no “short-

cuts”, no withholding ofinformation for personal benefit.Equity / Equitable : it should include spaces for appropriate

acknowledgement for thecontribution of others as well as consent for references used.**CBQ :Plagiarism / Illegal replication : unauthorized use of another’s

work /study.Noble / Nobility : the researcher must respect the rights of

his/her subjects.

Three basic rights of a research participant:1. Right not to be harmed2. Right to self-determination3. Right to privacy

I. Types of harm or injury :1. Physical : may happen during the experimental process

throughnegligence :a. by commission : through performance of wrong intervention.b. by omission : by not doing what was rightfully expected ofhim/her from the very start.Ex : omitting to do CPR to someone who fainted in yourpresence.* CPR :Adult : compression-blow ratio : 15 : 2Infants : compression-blow ratio : 5 : 12. Mental : may be two kinds :a. assault : subjecting one to mere mental fear or threat.b. battery : forcible or illegal physical introduction of a

substancee.g. an invalid administration of a drug or injection.3. Moral : may either be :a. slander : when you orally destroy the moral reputation of thepatient.b. libel : when the defamation is published, written, or recorded.

II. Right to self-determination : the patient personally determines whether to join

or not in the research; subject must be free from coercion, restraint, force,

undue influence. It must be voluntary. Informed consent should be sought.

III. The right to privacy may either be :a. anonymity : refers to privacy as regards the identity of theInformant; identity may not be disclosed.b. confidentiality : refers to privacy as regards to the informationor data obtained; information acquired must not bedisclosed.** CBQ : In the process of doing research, the researcher is very

Nursing Research, Leadership and Management of 31

carefulnot to disclose the name of her subjects. This is :a. protection of clientb. confidentialityc. anonymityd. informed consentTruthfulness : should only contain facts not mere fabrications.Importance : significance to the nursing profession.Factual : a nursing research is a fact-finding study (facts not

fiction)Ideal : must proceed following the 10 formal steps in nursing

research process.Courageous : the research should embody the courage to get all

the pertinent facts/data

* CBQ : The main contribution of research towards the improvement of nursing

profession is which of the following?a. provide a scientific basis for nursing careb. assist the nurse administrator in planning nursing staff

requirements.c. assist the faculty in developing the nursing curriculum.d. facilitate the development of staff development.

Ten Major Steps in Nursing Research :1. Identification of a research problem.2. Review of related literature3. Formulation of a conceptual and theoretical framework.4. Choose an appropriate hypothesis5. Choose an appropriate research design.6. Sampling or obtaining a sample from the population7. Collection of data phase8. Analysis of data phase9. Interpretation of the data10. Dissemination of conclusion or recommendations..** CBQ : The correct sequence of steps in research process is :1. Formulate problem information.2. Review literature information3. Analyze data.4. Determine research design5. Make conclusions and recommendations.a. 1,2,4,3,5b. 1,3,2,4,5c. 1,2,4,5,4d. 2,1,3,5,4

I. Identification of a research problem :A research problem is anything that requires solution through a

scientific investigation.1. Sources of problems for nursing research :C : different nursing concepts.L : health literaturesI : issues affecting the professionE : essaysN : Nursing assessmentT : Nursing theories (** CBQ)2. Characteristics of a good nursing research problem :

(GReFIN)General applicability : the study is helpful and advantageous for

the commongood and not just for a selected few.Based on applicability, a problem may be :a. Basic/ Pure : applicable only to the researcher and done

primarily to :1. Answer personal querries or curiosity2. To increase personal knowledge.b. Applied : focused on solving the problems of other people.Researchable : the problem is capable of being investigated

through observation,manipulation, etcFeasible : measureable as to :1. Time 3. Experience of the researcher 5. Population2. Money 4. Research instruments availabilityImportanceNovelty : originality (** CBQ)Significance to the nursing profession*CBQ : Which of the following criteria is least considered in

determining whetheror not a problem is researchable?a. time factorb. availability of a research instrumentc. nationality of the researcherd. cost of the investigation.3. Variable : anything that is subject to change or manipulation.Two types of variables :1. Independent : or the causal variable; the cause of the study.2. Dependent : the effect of the manipulation on the target

population/variablereaction..Ivan Pavlov : formulated the theory that a stimulus when applied

to a certainorganism will elicit a corresponding response.

Stimulus ---------Organism --------------Response(Independent Cause) (Target Population)

(Dependent Cause)4 Definition of terms :1. Conceptual : taken in its ordinary /common meaning;

dictionary-based meaning2. Operational : how the researcher used the definition in his

study.Ex. The word “toxic”:Conceptual meaning : poisonous; hazardousOperational meaning : heavy workload for an undermanned staffII. Review of related literatures :**CBQ : What is the main purpose of review of related

literatures?Ans.: to form a conceptual and theoretical framework.Two sources of the researcher’s review of related materials :

Conceptual Research

Examples Books, internet

Research papers

Who were the sources?

Authors Researchers

For what purpose/s?

For general use

For future research studies only

III. Formulation of a conceptual and theoretical framework :A. Theoretical framework : the theories involved in the

researcher’s study.B. Conceptual framework : the structural relationship (in an

illustrated form) between theindependent and dependent variables.C. Paradigm : the structural or diagrammatic presentation of the

researcher’s conceptualframework.

Ex. # 1 : A study on the difference in the professional opportunities of Filipino nurses

working in the Philippines and those working abroad.Purpose : “Is to compare the professional opportunities of

Filipino nurses working abroadand those working in the Philippines.

Independent Variable

Target Population

Dependent Variable

Place of work

(subject to manipulation)

Filipino nurses

Opportunities for professional growth(result of manipulation)

IV. Choose an appropriate hypothesis :Kinds of hypotheses :1. Null/ Statistical hypothesis : any statement that has NO

relationship or difference between 1variable to another single variable. This is mostly used because

it is aesy to reject oraccept a null hypothesis.

“ There is no difference regarding the professional opportunities


of Filipino nursesworking in the Philippines from those working abroad”.

2. Simple/ Operational hypothesis : states the anticipated relationship or difference between 1

independent variable to another single dependent variable.

“ Filipino nurses working abroad have more professional growth opportunities than those

working in the Philippines”.

3. Complex hypothesis : states the anticipated relatioship between 2 or more variables to other

variables (intervening variables)

Ex. # 2. “Filipino nurses who worked for 5 years and passed the CGFNS, TOEFL, TSE,

and NCLEX have greater opportunities to acquire immigrant visas, higher

starting salaries, insurance benefits and study grants“.

4. Directional hypothesis : specifies the direction of the relationship between variables.

Ex. # 3. “Filipino nurses working in the USA have more professional opportunities than

those working in the Philippines”

5. Non-directional hypothesis : only predicts the relationship, but has no specific direction

between variables.** CBQ : can lead to ambiguity or confusion.

Ex. # 4. “ There is a big difference between a Filipino nurse working in the USA and

those working in the Philippines.”

V. Selecting an appropriate research design :A systematic, controlled plan for finding answers to a problem;

it is a roadmap, blueprint toprovide a result; a plan, structure or strategy of conducting an

investigation.* it is used to control the researcher’s variable/s;the skeletal

framework in his research.

Three basic classifications of research designs :1. According to applicability :a. Basic / pureb. Applied2. According to data collected :a. Qualitative : refers to the quality of the data : these are not

subject to numericalinterpretations; can’t be measured quantitatively; based on

subjective datasuch as :a. perception d. feelingsb. understanding e. emotionsc. attitudes & beliefs f. behaviorsb. Quantitative : readily observable by the senses; can be

numerically interpreted;based on objective data.

3. According to method :a. Non-experimental method : when the method presents no

need for anyintervention or manipulation :1. Passive participation2. Researcher simply has to observe, describe and record the

results.3. It is usually done in the natural setting : where the people

(sample)naturally exist.Ex. : homes, community, schools etc.b. Experimental type of research design :1. Active participation2. Manipulation is needed to get the cause and effect ratio to

determine its

effectiveness (of the manipulation/intervention).3. It is done in a more controlled setting like labs, research units

etc.

Types of non-experimental research design :1. According to time : past, present and future.A. Past :a. Ex-post facto : retrospective style : a study done on a group of

people who had naturally experienced a natural phenomena (after a fact)

but is a subject of a present study.b. Historical type : involves a study of things that happened in

the pastwhich are already :1. written about2. documented3. published, and4. recordedEx. : charts of patients’ data.Two sources of historical data :1. Primary sources : nurse’s notes / diaries which give firsthandinformation.** You rely only on this type of source.*CBQ2. Secondary sources : second hand information : information issupplied by a person other than the one who experienced it.B. Present :Descriptive : based on present occurrence or happening.C. Future :Prospective : the study is done in the present, the result of which

will beknown only in the future; based on a future

occurrence/happening.

2. Based on the number of participants involved :Survey type of research design : based on the answer of the

majority(majority = 50% + 1)Types of surveys :1. According to groups:a. small group : face-to-face interview method where you have

theadvantage of immediately getting the answer / response.b. large group : utilization of mailed survey forms where you

mayhave problems with feedback.2. According to methods3. According to orientation :a. Cross-sectional type :1. Involves two or more evidential groups.2. Done only once.3. For the purpose of comparative study

b. Longitudinal type :1. Involves one core group only2. Entails doing an initial survey and follow-up survey/s.3. For the study on the progress/ development of the group*CBQ : Ex. Is the Sangkap Pinoy movement.

Experimental Type of Research DesignFour compulsory steps of experimental research design :1. Control stage : the population is divided into two groups :a. control population : no intervention or manipulation is done to

thegroup.b. experimental population : the group subjected to manipulation

orintervention.2. Randomization stage : choosing the data by chance where

each member of thegroup is given equal chance to be chosen as a sample.3. Manipulation4. Evaluation of effects.* CBQ :Quasi-experimental research design : if a researcher did not

perform all theprocedures of an experimental research design.Implication : cannot properly evaluate your results bec of lack of


comparative data.Characteristics of a good research tool or instrument :1. Reliability : refers to the accuracy or precision of the tool- if it

is administered twice,the instrument should provide identical data.2. Validity : refers to the relevance of the measurement to the

study being done.3. Sensitivity : means that the fine lines of difference amomg the

study subjects can bedetermined from the measurements, examples of which are

ratings andthermometers.4. Meaningfulness : the measurement must have a practical

application.5. Appropriate : if it is applicable to the subjects being tested.6. Objective : one that is free from bias.7. Ethical : tools should not violate the human rights of clients.

VI. Sampling/Sample from the population :Population : refers to the largest body of the case or individuals

being researched that conform toa specific set of particulars or eligibility criteria.Sampling : the process of selecting a portion of the population to

represent the entire population.Sample : a group of people coming from the population that will

become the recipients of theexperimentation treatment in an experimental type of research.

Factors that determine the sample size :1. Accessibility of sample participants : when it is not feasible to

study a wholepopulation, a sample is taken.2. Cost : funds available limit the size of the sample.3. Amount of time available : if the time is limited, only a small

sample may begathered.Two major types of sampling and selection techniques :I. Probability Sampling : randomization is applied and each

member of the population isgiven an equal opportunity to be a participant in the study.1. Simple random sampling : the selection of the sample is done

by chance; usedonly for a smaller population made up of identical groups.Ex. : fishbowl technique, lottery draws or table of random

numbers2. Stratified random sampling : the population is subdivided into

areas, sections,then random samples are taken from each. This is used for

unidenticalgroups. (Sub-strata before randomization is done). * CBQEx. Divide the students into year levels : first, second, third, and

fourthyear, and then get random samples from each.3. Systematic random sampling : using a tool called a “sampling

frame” wherein asample is taken every nth number. This is used in a big / large

population.Sampling frame : a list of names appearing inyour population.Ex. : yellow pad technique.4. Cluster random sampling : a small sample is taken from

various sections of thetotal population. (sub-areas before randomization)Ex. In studying the attitudes of nurses in Metro Manila towards

their work,a small sample from each hospital will be taken.

II. Non-probability sampling : involves the study of a pre-selected group (bias group)

since the start.1. Accidental/Convenience sampling : data is collected from

anyone mostconveniently available -- accessibility is the main factor for

sample choice.* This is the weakest form of sampling (bias) *CBQ2. Purposive / Judgmental sampling : researcher selects and

studies a specificnumber of a special group that represents the target population

with

regards to certain characteristics such as age, sex or economic status. The

selection is based on the common knowledge/understanding of the

researcher.Ex. Study on poor prostitutes : samples are taken fron Ermita,

Mla.Study on TB patients : you go to San Lazaro Gen Hosp.3. Snowball / Network sample : a kind of convenience sampling

that involvessubjects suggesting or referring other subjects who meet the

researcher’seligibility criteria; last referral to gain momentum- those

qualified but notreferred will not get the chance to participate.4. Cross-cultural sampling : study is done in a variety of cultural

settings.Ex. Getting samples from Tagalogs, Ilocanos, Visayans etc.5. Longitudinal sampling : a given group of subjects are studied

for an extendedperiod of time, which may either be retrospective or prospective.Examples :Prospective : Mastectomy patients are studied from operation to

3years after discharge.Retrospective : Growth of newborns two years ago to the

present.6. Cross-sectional sampling : subjects are only observed at only

one point in time.Ex. Asking high school students their choices of career after

graduation.7. Quota sampling : the researcher identifies the strata of the

population anddetermines the proportion of elements needed in the various

segments

VII. Collection of data phase : the most time- and budget-consuming part of research.

Different methods of collecting data :1. Questionaire : a form prepared and distributed to secure

responses to questions that areintended to obtain information about conditions or practices on

which the respondents ispresumed to have knowledge; method of collecting data using

pen and paper.Different types of questionnaires :a. dichotomous : those that require only two answers e.g. Yes or

No, True or Falseb. rating/checklist : ratings of variables are asked e.g. 1,2,3,4,5,

or poor,fair,goodc. multiple choice : diff alternatives are given as choices :

a,b,c,d, or e.2. Written records : utilization of those pre-recorded or pre-

existing data.Ex. Patient’s charts (written, documented and recorded)3. Interview : the oral method of collecting data; oral

communication is used.Types of interviews :a. structured interview : one wherein specific or pre-seleted

questions are askedwherein an interview schedule is read to the respondent.b. non-structured : one where open-ended or generalized

questions are asked byway of an interview guide and the respondent is allowed to

pursuerelevant ideas in depth.4. Observation : by employing the senses or occular inspection

wherein the researcher may be :a. Participant : active participation is required of the researcher.

The researcher may bedisguised as a patient, nurse, or just a plain eager learner taking

part in theactivity. The attractions and repulsions of the group members are

assessed byplotting their interactions on a devoce called a sociogram.b. Non-participant : the researcher stands outside the phenomena

being studied andrecords the data as objectively as possible even with a passive


participation only.

Two basic problems under data collection :1. Hawthorne effect : people may deliberately change their

behavior bec they know thatthey are being studied or observed.* Common in experimental study and is not reliable bec the

behavior of thesubjects are consciously altered.*CBQ : How to avoid ? By the use of double-blind research.2. Halo effect : the observer may have the tendency to rate

certain subjects consistentlyhigh or low on everything bec of the overall impression the

subjects give the rater.The data collected is untrue bec of a special

relationship/treatment between theresearcher and his sample.

VIII. Analysis and interpretation of data phase :The stage where the researcher is forming a body of knowledge

or conclusion out of the datacollected either to affirm or negate his hypothesis. The

researcher can answer thehypothesis with finality; the presentation of data relevant to the

problem and sufficient toanswer the hypothesis.* Tabulation of tha data is necessary before an analysis can be

done.

Different methods of tabulating or measurement of data collected :

1. Nominal : data are tabulated per category (used in surveys)2. Ordinal : data are classified according to characteristics as

ranked.3. Interval : data are tabulated per space, distance or

measurement using numerical values.Ex. Temperature : 150/90 - 120/80 mm Hg

Two methods of interpreting data : (conclusions are made)1. Quantitative style : data collected are presented in numerical

or graphical forms ;a. pie graphb. line graph : usually utilized in longitudinal studies.c. bar graph2. Qualitative style : interpretation by the use of the narrative

form or approach.

IX. Dissemination of conclusion and recommendations :A. Conclusion : final answer to the problem.B. Recommendations : suggestions on how to affect the results

of the study positively.Different methods of dissemination :1. You can write a book about the study2. You can hold symposium/symposia3. Publish the study4. Through the internet.II. Leadership

L e a d e r

GroupFollowersI

Leadership : is a style or a process whereby a person called a nurse leader will influence a group

of people known as the followers for the purpose of attaining a single goal or objective

towards the good of his patients.* If doing the independent roles : the person is a leader.

Different styles of leadership :1. Autocratic/ Authoritarian / Dictatorial / Bureaucratic or

Traditional : a unilateral styleof leadership; the leader and only the leader himself performs

the decision-makingtowards patient care without getting the inputs of his

subordinates.>Also called “centric” bec the leader makes decision for the

group, he/she, beingthe only center of attention.> Also called “Theory X” by McGregor, meaning, this is boss-

centered.Possible character traits of an autocratic/authoritarian leader :Apathy : insensitive toward othersBoisterous speechConsistencyDemanding attitudeEgoistic and self-centerdeFerocious behavior* Generally not a good leader; may be acceptable ONLY during

emergency/crises.

2. Laissez-faire Style / Freestyle / Permissive / Ultraliberal style of leadership : one in

which there is excessive freedom /liberalities and the leader abdicates the

leadership responsibility and leaces workers without direction, supervision or

coordination.> “let alone” style of leadership*Implication : there could be breakdown of power control and

responsibility andmay result to high incidents of negligence.> This is effective when working with highly motivated

professionals, like thosein research, where independent thinking is rewarded..> Not useful in highly structured organizations e.g. the health

care delivery systemwhere organization and control form the baseline of most

operations.

3. Democratic / Participative / Consultative leadership : is people oriented; focuses on

human aspects and builds effective teamwork; mutual style of leadership.

>The nurse leader gets the opinions, inputs, and suggestions from the staff and

members of the team.> Performance standards exist to provide guidelines and permit

performanceappraisal.> Also called “Theory Y” by McGregor : the leader sees the

workers as ambitiousand she/he does not resist change, is creative and exercises self-

directionand self-control.> Also called “radic” bec he radiates out to encompass the needs

of others.> The most desirable form of leadership and leads to high

productivity.

Different types of leader powers :1. Formal/Legitimate/Exclusive power : the power or authority

to give orders or tasks tohis subordinates.2. Referrent power : a charismatic power: the leader uses his/her

charm. *CBQ3. Expert power : power attained by virtue of his/her extra-

ordinary skills, trainings and abilities.

4. Reward power : the positive power on the part of the leader to compensate or

remunerate staff members by rewards, incentives, promotions, commendations etc

5. Coercive power : the negative power of a leader to implement sanctions, suspensions

and or terminations as a form of disciplinary power.* General rule :“Whoever is at the top, has the right to implement discipline.”Ex. Co-member of the team caught with alcohol breath : report

to the supervisor nurse.Theories :1. Great man Theory : to become a leader, such person must be

born to be a leader.


2. Trait or Character Theory : one must have the following to become a leader :

A. The personality :a. Adaptability : to cope or adjust to the assessed needs of the

communityb. Independence : capable of critical thinkingc. Creative/assertive : must be able to utilize the resources

available todeliver primary health care to the community.d. Advocate : he must be a defender of the rights of the patients;performance of duties should be within the realm of the Patient’sBill of Rights.B. Intelligence :a. Proper judgment } a leader should be more

knowledgeable thanb. Proper decision-making }the patient : use

assessment skills.c. Fluency of speech : one should be able to use proper

communication*CBQ : When dealing with tribal groups, the most important

skill a nurseleader must possess is proper communication skills.C. Leadership ability :a. Influence others : *CBQ : you can properly influence others

throughhealth teachings.b. Command : should have the aura of power w/o being bossyc. Respect : should be respectable in any way to be able to gain

respect.d. Participates }esp in performing care for the comatose patients.

A leadere. Cooperates }should also be willing to do any job in any

contingencies.3. Charismatic Theory : one can become a leader by virtue of

his/her charm or charisma.4. Situational/Contingency : one can be a leader in a situation

when his style ofleadership, managing skills, and expertise matches the needs of

a situation> A good leader in one situation but only a follower in other

situations.> This is a case-to-case basis kind of leadership.*CBQ : Advantage of this style of leadership : you can have the

BEST person forthe needs of the situation.

Skills and Qualities of a Good Leader :Appropriate authorityLeadership BehaviorCommunication skillsDecision-making skillsEthicsAbility to Face conflicts

* Note :RA 3573 : Law on Notifiable Diseases :1. Report within 24 hours : Polio and Measles2. Report within 1 week : Severe Acute Diarrhea, HIV, Tetanus

Neonatorum

I. Appropriate authority : the basis of the leader to issue tasks, responsibilities, and orders to

his/her subordinates.Types :1. Centralized : when flow of authority is from the top to the

bottom2. Decentralized : when authority does not necessarily come

from the top.II. Five leadership behaviors :Specialized body of knowledge and skills and training.Ex.: Who is allowed to do IV insertion? *CBQAns. : In RA 7164 (1991) : qualifications for IV insertion are the

following1. Must be a registered nurse (RN)2. 1-week didactic training3. Completion form of 50 IV insertions4. Certification from a duly authorized nursing organization.

ANSAP : Assoc. of Nrsg Services and Administrators of the Phils.

In RA 9173 (Oct 21, 2002) : qualifications are :1. Must be a registered nurse2. 1-week didactic trainingPatient-centered behaviorAccountabilityConfidentiality : breaking this is “Invasion of Privacy” or

“Breach of Privacy”General Rule : Everything heard and read should be dealt with

confidentiality.Exceptions to the rule :Patient’s consentInform/report to the health care team as a precautionary measure

*CBQCommunicable + standing order from DOHCrime : to fulfill a duty to the society e.g. in cases of child abuse

which isto be reported within 24 hours.Basic things to do in case of child abuse/crime :Safety : most important thing to do firstReportReferral: for further assessment like trauma management.Ethics : (to be discussed later)

III. Communication Skills : the ability to transfer information with understanding.

Communication barriers or backlogs : hinders the communication process.*CBQ

The communication process :1. Sender : the one who initiates the communication2. Message : the data that is to be transmitted3. Encoding : both verbal and non-verbal method of transmitting

the message4. Receiver : the intended recipient of the message5. Decoding : the process/manner of interpretation of the data

being transmitted6. Feedback : action in return by the receiver to the sender.

IV. Decision-making : involves the independent judgment of the nurse leader.

Step-by-step process of scientific decision-making :1. Identify the problem.2. Identify the person/s affected : patients, nurses, members of

the health team

3. Collect options or alternative solutions :a. Brainstorming : scrutiny of the problem within the

group.*CBQb. Delphi technique : seeking for other experts’ advice/opinions4. Choose the BEST option and implement it.5. Evaluation : if possible should always be done.

V. Ethics : In essence is good manners and right conduct.Principles of ethics :1. Autonomy : independent judgment and decision-making; self-

determination. The nurseshould respect the client’s / patient’s decision.*CBQ : 1. Who would decide for the care of the patient?a. the doctorb. nursec. patient himselfd. relatives2. Informed consent should always be obtained in invasive

procedures.Failure to do so would constitute battery.3. In cases where a patient refuses to give his informed

consent :ra waivermust be signed by him stating his refusal.4. In cases where the patient is profusely bleeding and refuses to

undergoblood transfusion, you should :1. Respect the patient’s decision2. Physician should explain the risk to the patient (consequence

ofthe refusal of the procedure)


3. Let the patient sign a waiver.5. An Islamic patient died, the relatives request to do the post

mortem:* Respect the patient’s cultural tradition.6. A nurse is doing a health teaching in a squatters’ area in

Manila,suddenly, a mother stood up and said she is against condom use :respect mother’s views.

2. Principle of Double-effect : if one is made to choose between two alternatives, he/she

should choose the one with more of good effects and less of the evil effects.

* CBQ : This principle frees the health practitioner of legal liabilities.

3. Principle of Veracity : telling the truth or not intentionally deceiving or misleading

patients. The patient has the right to know the truth regarding his state of health.

> Avoid false reassurance : it is non-therapeutic.Principle of Beneficence : this allows the doing of anything that

is good and avoidingharm to the patient.Exceptions :1. If the intervention is non-therapeutic2. If the confidentiality is violated.

4. Non-maleficence : “Do no evil or harm” principle.5. Justice : refers to the obligation to be fair to all people.

Prioritize needs of all patientsunder one’s care bec different patients have different needs and

levels of care.*CBQ : How can justice be achieved ? By applying the nursing

care process.

Characteristics of the Nursing Care Process :*Acceptable universally *CBQ : NCP should be universally

acceptable.Based on patient’s assessed needs.*Client-centered*Dynamic : based on ever-changing needs of the clients’

situationsEquitable : interventions should be always based on what you

see is the patient’s needFamiliarity*Goal-oriented : should always be geared towards solving the

patient’s health care needs*CBQ : A dynamic NCP would prioritize the need of which

patient?a. asthmatic patient who had an attack 2 days ago.b. CVA patient needing discharge instructionsc. patient with head injuryd. 2-year old patient with high fever.* This is an exception to the ABC rule (airway, breathing and

circulation) becalthough asthma is an airway and breathing problem, the patient

had theattack 2 days ago.Patient c would need immediate attention bec

of the headinjury (may have increased ICP).* Dynamism can also be done in the choice of patients’ food.

VI. Face conflicts :A conflict is any clash of ideas resulting to crisis in the

organization.Different methods of resolving conflicts :Avoidance behavior : putting the problem aside but not paying

any attention to it which isnot actually solving the conflict.Smoothing behavior : a temporary relief by appealing to a

person’s kindness.Unilateral action : by application of force, inflicting fear and

threats.Negotiation : the best way to solve conflicts : both parties

mutually discuss and solve theproblem. *CBQ

III. Management> the process of judicious use of available human and material

resources, directing their taskstowards the achievement of a goal or objective.> the process of coordinating and supervising personnel and

resources to accomplishorganizational goals.Theories :1. Human Resource Theory : there must be proper relationship

between the manager andhis members.2. Frederick Taylor’s Scientific Management Theory : the best

manager is a person whohas the following :4 T’s :TaoToolsTrainingsTreatment3. Douglas McGregor’s Motivational Theory :Theory Y assumes that people are self-directed and will accept

responsibilityunder favorable conditions. Individual goal are emphasized.

These peopleneed minimal supervision bec they are :EfficientEffectiveDiligent and love their jobs.Theory X assumes that people dislike their work and must be

directed andcontrolled. Organizational goals are emphasized. These people

need moremotivation (negligent) and close supervision.4. Henry Fayol’s Theory : management principles :a. Unity of Command : one group should only get orders from

one manager.b. Unity of Direction : the whole team should have only one

goal/objective.c. Esprit de corps/Team Spirit : the achievement or fault of one,

is theachievement or fault of all.

*CBQ : A teenaged patient who had appendectomy, complained of pain. There

was no standing orders for pain medications.a. don’t give medications without doctor’s ordersb. positioning : YES4. Respondeat Superior : command responsibility principle :

“Let the master answer forthe negligent subordinate who caused injury, harm or death”.* Note : Head nurse can only delegate the responsibility but not

the accountability.5. Subordination of general over personal interest : in case of

emergency such as in fire :Rescue your patient.Alert : sound the fire alarmContain the fire in one areaExtinguish the fire.6. Proper remuneration of your personnel :Start of work : probationary for the 1st 6 mosRegular employee : work 8 hours/day for 5 days or 40 hours/

week.Overtime pay : + 25%Night shift differential : + 10%Spec Non-working holiday : + 30%Legal holidays : + 100%Work-related disability :a. gov’t. employees : GSIS : ECC (Employees Compensation

Com)b. private employees : SSS : ECCBoth work and non-work-related diseases : PHILHEALTH

(Nat’l Health Ins Act)> benefits do not include dental, aesthetic and cosmetic

procedures.Maternal/paternal leave allowances :Mother FatherNSD 60 days 7 days with

payCS 78 days


* Note : allowed only on the 1st 4 pregnancies of the legitimate spouse.

Senior Citizen’s Act : gives 20% discounts for people 65 yrs and above.

Five steps of management process :PlanningOrganizingDirectingCoordinatingEvaluation

I. Planning : defined as pre-determining a course of action in order to arrive at a desired

result; forecasting of events and based on which decisions are made, goals are set

and prioritized and policies and standards are developed.No actual intervention yet; mere conceptualization stage :

1. Planning process should be clear.Vision : states what the organization wants to achieve in the

future.*DOH : Health for all Filipinos.Mission : describes and reflects the organization’s core value. It

is the presentreason why the organization was formed.Philosophy : the set of values and beliefs of the organization; a

statement ofbeliefs that influence the nursing practice.Goal : the general statement of the organization’s mission.Objective : more specific statement of the team’s mission.Policies : set of rules and regulations in the organization.

2. Budgeting : planning, controlling, and proper allocation of all resources for the

patients/clients :a. operational : refers to the everyday use of the patients (gowns,

caps, etc)b. personnel : for the salaries and compensation of staffc. capital : allocations for long-term use equipments.

II. Organizing Stage : structuring the team to accomplish the tasks necessary to meet its goals.

* for the purpose of managing the care of patients.Organizing your team :Nurse manager Tasks Staff

Stylexx xx xx

xx

Nursing tasks are as follows :Assessment : only the nurses should assess the patients, never

thesubordinates.*CBQTeaching : health teachings should be done upon admission,

orientation or initialcontact with the patient.Explaining of proceduresPreparation of patients : for procedures to be undertakenAdministration of :Treatment and medicationEvaluationJudgmentSubordinates’ tasks :Routinary tasks : include standard, unchanging procedures e.g.

toileting & bathingStable patients : they may handle patients with predictable

outcomes.Supervision of nurses : they should be directly supervised by

RN’s.

Staffing : refers to the correct ratio or mix of nursing personnel in a nursing unit for a

period of 24 hours.Different types of staffing schedules :1. Traditional : 8 hours/day, 40 hours/week2. Non-traditional : 10 hours/day, 40 hours/wk, 4 working

days/wk3. On call : utilized when there is a sudden increase of number

of patientswith less number of nurses.4. Baylor Plan :a. weekdays : one works only on weekdays for 8 hours (M-F)b. weekends : one works only on weekends for 12 hours

(Sat/Sun)

Styles of Nursing Care Delivery (Modalities of Nursing Care) :1. Primary Nursing : the nurse cares for the patient for 24 hours.* The only type that provides 240care for one patient from the

time ofadmission until the patient is discharged.* Done by private duty nurse.2. Functional method : practiced in congested agencies such as

PGH.Duty/task : specific task is assigned toOne nurse : to be done to all or to the majority of patientsHighly recommended : when there’s a shortage of nursing staff

and budget* The poorest method of giving care.3. Case nursing/ Case method :Total care to a patient per shiftOne-on-one handling : in extreme shortage of nurses : 1:2.III. Directing / Delegation :The process by which a manager assigns specific tasks, duties, or procedures to workerswith commensurate authority to perform the job (someone else performs ajob/task in behalf of the person delegating with authority).*CBQ : One can only delegate the responsibility but NEVER the accountability.Ex. : The nurse delegates the preparations for the celebration of the hospital’sanniversary but she’s responsible for the outcome of the preparations.Two important criteria in delegation :1. The ability of the worker to carry out the task2. Fairness not only to the employee but to the team as a whole.Exceptions to the power to delegate :1. Disciplinary tasks : the authority to discipline erring staff such as sanctions,suspensions etc cannot be delegated.2. Technical tasks : highly technical procedures which require special trainings orskills should never be delegated.3. Confidential tasks : tasks which are strictly personal duties / confidential cannotbe delegated. Ex. : charting should be done by the attendant health careprovider and cannot be delegated.

IV. Coordinating / Collaboration Stage :Unites personnel and services toward a common objective. Synchronization of activitiesamong the various services and departments enhances collaborative efforts resulting inefficient, smooth and harmonious flow of work.Ex. : At the unit level, Supervising Nurses and Head Nurses coordinate their workwith the other departments, services or units by conveying clearly-definedpolicies, standard operating procedures, policies, and guidelines using theproper channels of communication.*CBQ : Most common instances of collaboration are in cases where referrals for someaspects of the patient’s care such as :a. In patients with tophi, dietary considerations are made to the dieticianbec we always employ the interdisciplinary approach.b. Food rich in purines :a. canned foodsb. sardinesc. anchoviesd. vegetables


Types of collaboration :1. Intradepartmental/Interpersonal : a collaboration between one single person toanother person under one and the same unit or department.Ex. : endorsement between shifts.2. Interdepartmental : a collaboration between 2 or more units or two or moredepartments but under one and the same institution.Ex. : A woman admitted for CS will be referred to the DR, RR, etc3. Interagency/Interinstitutional : collaboration between two or more health careinstitutions for the benefit of the patient.Ex. : A patient from a health center is referred to a district hospital.*CBQ : Reasons why the nurses have the responsibility to coordinate :1. The patient is entitled to continuous care by a nurse.2. Nurse should provide holistic care.

V. Evaluation / Controlling Stage :the stage wherei the nurse will determine whether his/her plan, goal or objective for the patient isachieved or met according to the standards of care.

Different types of evaluation :1. Nurses’ rounds : done twice per shift (short term plan)Illustration of proper evaluation : If you are working in the 6-2 shift, you do 2 rounds :a. Around 6am, your team does an ocular inspection around the ward/unit afterwhich, you do a nurses’ conference (First rounds).b. around 2 pm, you evaluate the effectiveness of the shift’s plan of care for thepatient.( Second rounds)*CBQ : Nurses’ rounds are not done/contraindicated in the following areas :a. Emergency roomb. OR/DRc. Inensive care unit (ICU)d. Psyche ward : bec it may not be safe to do so.2. By the use of a checklist : use of ratings scale such as when the HN, UM or NM uses scales oftheir staff’s evaluation.3. Peer evaluation : evaluation done by co-workers.*CBQ : This is the poorest method of evaluation bec it might be affected by halo effect.4. By the use of performance appraisal sheet/form : this is done by the client or patient, being therecipient of care as in the evaluation forms given to patients immediately after/beforedischarge from the hospital.*CBQ : This is the best method of bec the recipient of care does the evaluation.

IV. Professional Adjustments and Ethico-Legal Nursing

Profession : it is a calling, in which its members profess to have acquired a unique or specializedbody of knowledge or skiils for the purpose of properly guiding or caring for others.* Nursing is a profession.

Calling : nurses should always be service-oriented.Specialized body of knowledge /skills : there should be a degree of expertise for competency.Others : refers to the patients or clients; nurses should be “others-oriented.”

Primary characteristics of a profession :Accountability : being liable for the results of one’s actions and responsible for theirpractice decisions.Competency : one must know what he/she is doing (practice should be backed-up withscientific rationale)Caring : nursing is a “caring profession”Ethics : the nursing practice is governed by a Code of Ethics

which embodies itsprofessional and social valuesService : as a caring profession, it should be service-oriented.Specialized body of knowledge /skills : nurses, as professionals should have expertise intheir fields of practice and show a degree of competency.*CBQ : What is the most important attribute of a professional nurse?Ans. : to observe ethical practice.

Is nursing a profession?Ans. : YES, nursing is a profession. It has all the characteristics of a profession.

The informed consent form is a contract between :1. The patient and the members of the health care team2. The patient and the hospital

RA 9173 : The Philippine Nursing Law (promulgated on Oct. 21, 2002)

Expanded roles of a nurse :1. Promotive, preventive, curative and rehabilitative care of patients in all health care settings andin the event that recovery or rehabilitation is not possible, to provide for a peaceful death.Promotive : through health teachings2. Appropriate health education3. Utilization of the nursing care process : part of the duties of a nurse.4. Collaboration of patients’ care5. Link of patients to the different community resources.6. Supervision and training of nursing students*CBQ : A nursing student affiliated in a ward gave an erroneous medication killing thepatient. Who is liable for the patient’s death?a. the nursing studentb. the clinical instructor of the studentc. the staff nurse of the wardd. the hospital7. Supervision of other personnel such as midwives, nursing aides etc.8. Accurate reporting or recording of patient’s care9. Proper execution of valid doctor’s orders : the only dependent duty of a professional nurse.* CBQ : What is the liability of a nurse if he/she gives prescriptions?Ans. : Malpractice

Valid doctor’s order : only when an order put into writing and duly signed by the prescribingphysician.Rationale : Whatever wasn’t put into writing and signed by the doctor is considered as notbeing ordered at all.* CBQ : Whenever a patient solicits a medical advice : refer to the doctor.

General Rule : A nurse should never prescribe any medication noe administer drugs without avalid doctor’s order.Exceptions to the general rule :1. In case of emergency2. In cases of national calamity3. In cases of epidemicPLUS : there’s no doctor around and the patient is in grave danger of death.

Good Samaritan Act : the universal doctrine that protects from any liability, any person who willgive an aid to another person whose life is in danger.* This law provides immunity from civil liability when a person provides assistance in anemergency.* This doctrine is the basis of RA 8344 which mandates the “NO


DEPOSIT POLICY” inany health care facility or hospital in emergency cases only.

*CBQ : An emergency case where a child had ingested a considerable amount of Aspirin,what should the nurse do?Ans. : induce vomiting.What would the discharge health teaching include ?Ans. : ways on childproofing the house.What is the most common form of poisoning?Ans. : Lead poisoning from chipped paints bec paint chips taste sweet and areconducive for a child’s PICA : appetite for eating non-food items.

In emergency poisoning cases :1. Determine the poisonous material involved.2. If non-corrosive : induce vomitingIf corrosive : NEVER induce vomiting bec it will cause irritation of theesophageal mucosa and may lead to aspiration.* give calcium EDTA

Different areas of professional nursing practice :1. Institutional Nursing Practice : done in the hospital setting.Characteristics :Direct supervision of a head nurse or nurse manager.Acquire different technical skills/learningConfidence in your practice.2. Public Health Nursing : the functions of which encompass the 4 P’s :Promotion of public health.Prevention of diseasePsychological and social adjustments : bec one will be taking care of numerous clients.Public relations is maintained with all members of the community, the health care teamand the family.*CBQ : The main thrust toward promotive and preventive nursing practice is PrimaryHealth Care (PHC).

LOI 949 : the PHC Law of 1979 adapting the concepts of the First InternationalConference on PHC held in Alma Ata, USSR on Sept 6-12, 1978.Signed into law by Pres Ferdinand E Marcos on Oct 19. 1979.

Coverage of LOI 949 are the following :1. Preventive Nursing Law :PD 996 : the EPI Law : mandating the compulsory immunization of childrenbelow 8 years old to reduce the morbidity and mortality among infants andchildren caused by the six childhood immunizable diseases :1. Diphtheria 4. Polio2. Pertussis 5. Hepatitis B3. Tetanus 6. Measles* Not included is chicken pox bec the vaccine is expensive.2. Micronutrient Supplementation Law : RA 8976 : to fight childhood malnutritionPD 825 : Environmental Sanitation Law : promotion of cleanliness and sanitationin everything outside of one’s environment.PD 856 : Sanitation Code of the Philippines : promulgates sanitation :1. Within an establishment : covers food and water sourcese.g. carinderia and canteen food.2. Commercial Sex workers : mandatory and proper screening :a. Syphilis : every 6 weeksb. Gonorrhea : every 2 weeksRed ID : health clearance of CSW who had undergone screening issued bythe city health officer.*CBQ : How can you handle health care delivery in the community?`` Ans. : Active community

partnership or participation.

RA 7160 : Local Government Code : Decentralization/ Devolution of Health Care

It’s a partnership :

DOH DILG } Local Health Board : public healthActive community } care services/local gov’t.Partnership } unit; headed by the city orParticipa } municipal mayor or thetion } governor.}LGU : barangaycitymunicipalityprovinceRationale for RA 7160 : it makes quality public health care services accessible inaccordance with the present vision of DOH.

3. Occupational/Industrial/Company Health Nursing : done in factories, companies orindustrial zones with the following functions :a. Curative and rehabilitative :Care : provide immediate care for both the sick and injured workerReferral : proper referrals should be done for clients who need higherlevels of care.Visit : home visits should be done for follow up care.b. Promotive and preventive :Nutritional health teaching : given to the workers for optimal functioningand productivity.*CBQ : The most important consideration when doing healthteachings to these workers :Ans. : income of employees /financial status.Safety and sanitation in the workplaceCounseling : appropriate health counseling can be provided to avoid orprevent occupational diseases/hazards.*CBQ : Health teaching considerations : use of contraceptives.What health hazards should the nurse’s study focus on?Ans. : Past trends of frequent diseases in the workplace.

4. Clinical Instructor :Four major qualifications of a clinical instructor (per RA 9173) :Accredited member of a nursing organization such as PNA.MAN : a masters degree in nursing or other allied coursesOne year clinical nursing experience.Registered nurse

LOI 1000 : requires compulsory membership of professionals to an accreditedprofessional organization such as PNA, PMA etc

Facts about the Philippine Nurses Organization :PNA : founded on October 22, 2002Founder : Anastacia Giron-TupasPresent President (2005) : Ruth PadillaObjective of PNA : Reasons why they give trainings :1. Advancement of the knowledge and skills of the Filipino nurses.

Professional well-being : it is a professional organization composed and headedby nursesUnity : it promotes professional unityPromotes reciprocity even from outside the PhilippinesAdvancement of the knowledge and skills of the nurse


Ethics : it promulgates its own Code of Ethics

First College of Nursing (BSN) in the country : UPFirst nursing schools :Iloilo Mission Hospital School of Nursing (1906)

Philippine General Hospital (1907)Luke : St Luke’s Hospital School of Nursing (1907)Mary Johnston Hospital School of Nursing (1907)St. Paul’s Hospital School of Nursing, Iloilo (1907)San Juan de Dios Hospital School of Nursing (1907)

Proclamation order # 539 : proclaimed the last week of October as Phil. Nurses’ Week.

Legal responsibilities of a nurse : these applies in almost all kinds of settings :1. Consent : it is the responsibility of the nurse to see to it that the client’s informedconsent was taken before any procedure is done.2. Last will and testament3. Illegal detention4. Medication and prescription5. Charting, documentation/recording

I. Consent : the legal permission given by the client before any procedure or treatment afterreceiving proper information or explanation about the treatment or procedure to be done.

Characteristics of a valid consent :Voluntariness : the consent form must have been signed with the absence of fear, force,coercion, or threat.Opportunity : the patient should be given ample opportunity to ask for furtherexplanations if he needs it.Treatment, surgery, or procedure should be properly explained :By the surgeon : whoever is primarily performing the procedure has theresponsibility to explain it fully to the patient.The nurses only act as witnesses to the signing of the consent which involves:1. Witnessing the exchange between the client and the physician2. Witnessing the client affix his signature3. Establishing that the client really understoodUnderstood by the patientMatured both physically and mentally : the signatory should be at least 18 y/o or older.* Consent may not be given by the patient in cases of :1. Insanity2. Imbecility3. Unsound mindEXCEPT if the patient signs it in his lucid intervals.

*CBQ* CBQ : Who can give consent in behalf of a mentally ill child?Proxy consent may be given by the following :1. Parents2. Guardians

3. Guardian ad litem :a. Social welfare personnel : in cases where the child is abandoned.b. Surgeon or the attending physician : in cases of emergency

Example : A psychiatric patient needs a stat appendectomy : surgeon or attendingphysician signs the consent for the patient’s behalf.In vasectomy, who gives the consent ?a. both the husband and wifeb. husband only :bec although the issue of vasectomy affects both spouses,the procedure is done on the husband only (Vas deferens is not aconjugal property)

II. Last Will and Testament : an act whereby a person is permitted by law to have a control in themanner of disposing his estate but will take its effect at the time

of his death.

Decedent : a deceased personTestator : the dead person who made the will (male)Testatrix : the dead person who made the will (female)Two types of succession by heirs :1. Testate succession : the mode of succession wherein the heirs inherit by virtueof a last will and testament.2. Intestate : succeeding by law and not governed by a will.* Without a last will and testament : heirs should divide estate in equalsharing.

Two types of last will and testament :

Concerning properties Concerning body / life

1. Notarial/Ordinary will 1. Advanced directives

2. Holographic will

Notarial or Ordinary Wills :The following are the nursing considerations :1. Check the patient’s level of consciousness : the nurse must ascertain that the patient iscapacitated to make a will2. Check the proper locations of the signatures :a. at the end of the will written by the patientb. in all pages at the sides of the paper, by the testator/testatrix and 3 witnesses.3. Presence of three witnesses.

Holographic Will : wills that are executed during emergencies but the patient is still conscious.Requisites of a holographic will :1. It should be entirely handwritten2. It should be dated and signedusing the hands of the testator/testatrix.* If nobody witnessed the writing of the will, comparison to other documents made by thetestator/testatrix is necessary to ensure its validity.

Advanced directives : are directions or instructions made by the patient in advance with what to do withthe patient’s body, such :1. Living will2. Instructions for DNR, cremation, organ donation, and funeral services

III. Legal rights of a nurse and illegal detention :Illegal detention is a crime if a person, such as a nurse, will limit the freedom of a patientto move or travel from one position / place to anotherException : when there are quarantine regulation orders such as what happen in migration

IV. Medications and prescriptions :General rules :1. Only the following have the right to prescribe medications : MD, DMD, DVM2. Do not follow unless 3 vital informations are present :a. name of physician, location of office, PTR/PRC license no.b. Patient’s name, age, sex,c. Name of the drug itself : both generic and brand name (RA 6675)

RA 6675 : the Generics Act of 1988 which requires that all prescriptions of drugsshould include the generic name and the brand name or the generic namealone.Purpose : to let the patient choose among the different brand names available of aspecific generic drug name.Impossible prescription : are prescriptions written by a doctor in which the generic


and brand names do not correspond to each other.Exception to RA 6675 : The physician can only be allowed to write only the brandname if only one brand is available for the particular drug beingprescribed.Ex. : Alaxan, Minocin3. Responsible for the 10 R’s of giving medications :1. The right drug2. The right storage3. In the right dose4. By the right route5. To the right patient6. At the right time7.With the right documentation8.9.10.

For accuracy and safety, the nurse should do the three checks :1. When choosing the medication to take out of the drawer or cupboard2. When the dose is in hand and can be held side-by-side with the record tocompare the label and the medication administration record (MAR)3. One last time after all drugs have been located and before leaving themedication cart or room for the patient’s bedside.*CBQ : What is the method to identify the right patient in all health care settings?a. ask his name and let him spell it : only possible if patient is consciousb. through the patient’s wristbandc. through the name hung on the doord. confer with the doctor4. Oral/ Telephone orders :General Rule : Generally, an order done orally or through the telephone is not avalid order EXCEPT in emergency cases where the nurse should simul-taneously write the order, the physician’s name and time it was given andrepeat it to the ordering physician and have it signed by the prescribing

physician when he/she arrives later.

5. Doubtful medications and prescriptions :General Rule : In case there is doubt on the correctness of the prescription or incases where the medication is wrong, the nurse has the right to object tosuch and call the attention of the prescribing authority and let him rectifythe wrong order. This is for the protection of your patient (Advocacy)6. IV training

V. Charting / Documentation / Recording : in the patient’s chart which is legally, absolutely alegal document.Nurse’s responsibility : to write chronologically, truthfully and accurately on the patient’sclinical record what he/ she has seen, encountered or observed in connection withthe care and treatment of the patient.A fundamental legal principle about medical record :“If information is not charted, it was not done or observed”.

Purposes of charting :Communication : it was created as a means of communicating among the healthcare providers.Assurance of quality care : records the patient’s whole treatment and care regimenResearch purposesLegal documentationStatistics : are good bases for studies since they are deemed accurate and true.

*Ownership of the charts/records belongs to the hospital/institution although theinformation in it belongs to the patient.* Charts, being confidential records cannot just be used by anybody even for legalpurposes EXCEPT when the court issues a subpoena.

Subpoena : an order from the court which is of two types :1. Subpoena duces tecum : issued against documents, papers, materials/ordersEx. : patient’s chart2. Subpoena ad testificandum : issued for somebody to act as a witness.

DO’s and DON’T’s of charting :

DO’s DON’T’s

Full, factual & objectively accurateLegible handwritingImmediately upon doing the procedure.Addendum : late entries entered in the chartPersonal/confidential document*Proper way to terminate chart : write theprofession, not the position

Language :avoid language/words/jargonsunacceptable in nursingImproper corrections : follow the agency’s policyon corrections; or the std waySpace/skips : avoid leaving spaces/skips inbetween every charting.Avoid frequent use of abbreviations : some wordsif abbreviated will result to diff definitionsEx. : Ambulated pt to BR (wrong bec the BRintended to mean bathroom may be takenanother way by others)

Doctrines affecting the professional nurse :1. Professional negligence2. Professional malpractice3. Res ipsa loquitor4. Force majeure

1. Professional Negligence : refers to the failure to do something which a reasonable and prudentnurse should have done, under a particular situation.Types :1. Commission :doing something which a prudent or reasonable person would not do.2. Omission : not doing something which a reasonable or prudent person would do.

Three elements to prove negligence :1. There must be the existence of duty2. There must be a failure to to do the duty3. Injury or harm has resulted from the failure to do the duty.*CBQ : This is a major reason for suspension/revocation of license.2. Professional Malpractice :Elements in order for malpractice to exist :1. RN2. Acts or conducts self3. Does something for which he/she is :a. not authorizedb. not licensed to doc. not trained or skilled to do.4. And has resulted in injurious or non-injurious consequences.*CBQ : RN can do the following :1. Episiorrhaphy : after training but not episiotomy2. Internal exam (IE) : but only in the absence of antenatal bleeding and abnormalcomplications.3. Res ipsa loquitur : “The thing speaks for itself”: when the harm that resulted from negligenceand the responsibility for the harm are clear that anyone would agree on it.*CBQ : This principle accelerates the identification of the last


person attending to thepatient which caused the negligence.4. Force majeure : An act of God or nature; an irresistible or superior force, one that cannot beforeseen or prevented; fortuitous event.Principle :“No person shall be hels liable or accountable for non-performance of what wasexpected of him/her if the cause of the non-performance was a forcemajeure or for those events beyond one’s control”.

Classifications of crimes affecting nurses :I. According to the manner of its commission :1. Dolo (Deceit) : one which is done with real criminal intention.Ex. : putting poison in a medication to kill the patient.2. Culpa (Fault) : one in which there is no real criminal intent and is merely just a resultof one’s negligence.Ex. : inadvertently poisoning a pateint bec of erroneous drugadministration.

II. According to the degree/level of execution :1. Consummated crime : when all the elements to fully commit the crime were all presentand the crime was committed or executed.2. Frustrated crime : when one performed everything to consummate the crime but failed.3. Attempted crime : consists only of overt acts to commit the crime; it is merely showingthe intent to commit the crime.

III. According to the degree of participation :1. Principal : one who performs a very important or indispensable role in the crime, beingthe “author of the crime” itself.2. Accomplice : one who performs a dispensable role, appearing only before or during thetime the crime was committed.3. Accessory : one who ONLY appears after the crime was committed :a. by profiting from the effects of the crime committedb. by concealing/destroying any evidence relating to a crime to prevent itsdiscovery.c. by assisting in the escape of the criminal.

Different crimes affecting the Filipino nurses :1. RA 7877 : Anti-Sexual Harassment Law :Protects employees against sexual harassment. Sexual harassment is committed by….any person who exercises authority, influence or moral ascendancy overanother… by demanding, requesting or requiring sexual favor regardless ofwhether or not…is accepted by the object of sexual solicitation.* CBQ : Mere indecent proposal constitutes sexual harassment.2. Rape : there are two types of rape, namely :a. Ordinary rape : any forcible penetration of an organ for copulation : a sexualorgan penetrating another sexual organ (only female victims)b. Sexual assault : results from anything inserted to any body orifice with sexualmalice (both genders can be victims).3. Abortion : termination of the products of conception before age of viability(3-6 mos/12-24 weeks)4. Infanticide : killing of a person less than 3 days or less than 72 hours of life.5. Parricide : killing of a person to whom one has familial relationship : parents / siblings.*CBQ : adopted children are included.6. Homicide : unintentional killing of a person more than 3 days old to whom one has nofamilial relationship. Most cases in nursing involve drug errors which are mereresults of negligence.7. Murder : intentional killing of a person

8. Simulation of birth : committed by any person who shall substitute one child withanother child or alter a child’s identities for the purpose of losing the child’s civilstatus.Ex. : Mara and Clara*CBQ : Non-registry of a live birth : constitutes simulation of birth bec a birthcertificate is a symbol of identity.PD 651 : Mandatory reporting :of any incidence of live birth within 30 days to the localCivil Registrar’s Office.

Different laws affecting nurses in the Philippines :RA 2808 (1919) : the first official Nursing Law in the Philippines.Board of Nursing composition : 3-man-team :1. The Chairman }2. Two members } all nurses1920 : the official Licensure Examination was given to nurses one year after thefirst BON was created.RA 7164 (1991) : the second to the last nursing law : the Philippine Nursing Act of 1991Board of Nursing composition : 5-man-team :1. The Chairman } all nurses chosen from 12 nominees and appointed4. Four members } by the President.

Board of Nursing : 1991 (RA 7164) : OLDMaster of Arts in Nursing holderAccredited member of a nursing organizations like PNAFive-man-team :1 Chairman4 membersSixty-five years old and sits for a term of not > 3 yearsOne-year interim periodNot convicted of any crime in the PhilippinesPecuniary/monetary interest : absence ofTen years of nursing experience/practiceCitizen of the Philippines

NEW Board of Nursing : RA 9173 :Master of Arts in NursingAccredited member of a nursing organization e.g. PNASeven-man team :1 Chairman6 MembersImmediately resigned only assumption of officeNot convicted of any crime in the PhilippinesPecuniary/monetary interest : absence ofTen years of nursing experience/practice, the last 5 yrs should be in the Phil.Citizen and resident of the Philippines

Duties and responsibilities of the BON :Licensure Examinations formulationIssue certificates of registration* CBQ : Just a privilege not a rightMonitor the standards of nursing practice in the PhilEducation quality evaluation :*CBQ : Inspect and recommend to the CHED :1. Opening of a nursing school2. Closure of a non-performing nursing schoolCode of Ethics formulationHear and decide cases of negligence and malpractice :1. Suspension of license2. Revocation of licenseQualifications of a Dean of a College of Nursing :1. Must be a registered nurse (RN)2. Must be hold a MAN3. Must have 5 yrs nursing experience

Qualifications of nursing service administrators :


A. Hospital setting :1. Nursing supervisors/ Managers/Head : responsible for a unit, ward or department :BSN and RNAccredited member of a nursing organization e.g. PNANine (9) units of post-graduate Nursing ManagementTwo (2) years of general nursing practice2. Nursing Chief or Director :RN and MANFive (5) years of supervisory nursing experienceB. Community nursing Supervisors/Managers :BSN and RNAccredited member of a nursing organization e.g. PNAMAN or MPH (Public Health)Five (5) years of experience as PHN/CHN

Present requirements for a Nursing Licensure examinee :1. Good moral conduct2. Proof/s of citizenship3. Proofs that applicant is a valid holder of BSN degree whose curriculum is approved byCHED.

Other relevant laws of nursing practice :PD 223 : Creation of PRC (professional Regulation Commission)RA 1080 : Civil Service ActRA 6425 : Dangerous Drugs Act : covers two types of drugs :1. Prohibited drugs : totally prohibits the sale, administration and use by humanbeings. Ex. : shabu, marijuana, opium derivatives2. Regulated drugs : can be used provided it is covered with a prescription from alicensed physician authorized by BFAD and PDEA.Ex. : Dormicum, Ativan

Liabilities of a health care provider :1. Fines : depends on the weight /grams2. Imprisonment3. Revocation of licenseRA 7600 : Mother-Baby Friendly Hospital Act : requires early bonding through :1. Breastfeeding2. Rooming-in techniqueSSS : Sariling Salat sa SusoGSIS : Galing Sa Ina ang Sustansya* CBQ : How to promote bonding between fathers and newborns?1. Cuddling2. Embracing

PRC Licensure ExaminationRA 8981 : New PRC Computerization and Modernization Act : mandates thatexamination results be out by at least the 5th day after the examination date.

Results are available at :1. www.prc.gov.ph2. PRC rating Family name,First nameRegistration :1. Take an oath2. Pay the registration fee3. Sign the book of RN’s in the PhilippinesTwo types of registration :1. Regular /Ordinary : by those who passed and are qualified already2. Special : registration by reciprocity :a. need to show proofs that one is an RN in a foreign countryb. that foreign country offers employment opportunities forFilipino RN’s in return.

Grounds for disqualification as RN :A person may be denied a license after passing the licensure examination due to:Dishonorable conductUnsound mind

Moral torpitude crime involvementIndecent, immoral conduct

Grounds for revocation of license :Malpractice actsUnprofessional conductNegligenceImmoral, indecent conductDishonesty, deceit, and fraudEthics : violations of the Code of EthicsSuspended license but continues to work

After five (5) years of inactivity (non-practice profession), one cannot go back to practiceat once. To do so, one needs to comply with the following requirements :1. One (1) month didactic training2. Three (3) months practicum

Prohibited Practice of Nursing : Illegal nursing practice :License : practicing without the necessary licenseOwns another RN’s license/COR as his/hersInvalidated license/CORSigns name and affix the title of RN illegallyAdvertisement that is falseFalsification of school/nursing documentsAssist another person in the illegal practice of nursingUnderwaging subordinates/nurse employeesReview/training center operations without gov’t. accreditationAny person violating the Phil Nurses’ Act

Penalties for illegal nursing practice :1. Fines of Php50,000 - Php100,000. } for conviction of any of the ten illegal2.1-6 years imprisonment } nursing practice


Nursing Research, Leadership and Mgmt[1].

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Transcript of Nursing Research, Leadership and Mgmt[1].