NCM 108 ETHICS - FINALS

Republic Act No. 9173 or The Philippine Nursing Act of 2002

Scope And Function Of Nurses Perform Nursing Services To: Individuals,

Families And Communities
In Any Health Care Setting.
As Independent Practitioners, We Are Responsible For The”
● Promotion Of Health
● Prevention Of Illness
As Members Of The Health Team, We Must Provide:
-Curative , Preventive And Rehalibilative Aspects Of Care

● Restoration Of Health
● Alleviation Of Suffering And When Recovery Is Not Possible, Towards A
Peaceful Dignified Death.
● Provide Nursing Care Through Utilization Of The Nursing Process.
● Establish Linkage To The Community
● Provide Health Education
● Teach, Guide And Supervise Nursing Students
● Observe The Code Of Ethics

ETHICAL DISCERNMENT:
● Making ethical decisions are based on:
● Consideration for people as human beings.
● Consideration of consequences.
● Proportionate good to come from the choices.
● Propriety of actual needs over ideal or potential needs.
● A desire to enlarge choices and reduce chance.
● A courageous acceptance of the consequences of the decisions.

Patient’s BIll of Rights

1. Right to Appropriate Medical Care and Humane Treatment

2. Right to Informed Consent.
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3. Right to Privacy and Confidentiality.

4. Right to Information.
5. The Right to Choose Health Care Provider and Facility
6. Right to Self-Determination.
7. Right to Religious Belief.
8. Right to Medical Records
9. Right to Leave.
10.Right to Refuse Participation In Medical Research.
11.Right to Correspondence and to Receive Visitors
12.Right to Express Grievances
13.RIght to be Informed of His Rights and Obligations as a Patient

PATIENT’S BILL OF RIGHTS

● right to considerate and respectful care.
● right to and is encouraged to obtain from physicians and other direct
caregivers relevant, current and understandable information concerning
diagnosis, treatment and prognosis.
● right to make decisions about the plan of care prior to and during the course
of treatment and to refuse recommended treatment.
● right to review the records pertaining to his/her medical care and to have the
information explained or interpreted as needed.
● right to expect that, within its capacity and policies, a hospital will make
reasonable response to the request of a patient for appropriate and medically
indicated care and services.
● right to ask and be informed of the existence of business relationship among
the hospital, educational institutions, other health providers or players that
may influence the treatment.
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● right to consent to or decline to participate in proposed research studies or

human experimentation affecting his care /treatment.
● right to expect reasonable continuity of care when appropriate and to be
informed by physicians and other caregivers of available and realistic patient
care options when hospital care is not longer appropriate.
● right to be informed of hospital policies and practices that relate to his/her
care, treatment and responsibilities.

Dying Patient’s Bill of RIghts

1. I have the right to be treated as a living human being until I die

2. I have the right to maintain a sense of hopefulness, however, changing its
focus may be
3. I have the right to be cared for by those who can maintain a sense of
hopefulness, however changing this might be.
4. I have the right to express my feelings and emotions about my approaching
death in my own way.
5. I have the right to participate in decisions concerning my care
6. I have the right to expect continuing medical and nursing attention even
though “cure” goals must be changed to “comfort” goals
7. I have the right not to die alone
8. I have the right to be free from pain
9. I have the right to have my questions answered honestly
10.I have the right not to be deceived
11.I have the right to have help from and for my family in accepting my death
12.I have the right to die in peace and dignity
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13.I have the right to retain my individuality and not be judged for my decisions
which may be contrary to the beliefs of others
14.I have the right to discuss and enlarge my religious and/or spiritual
experiences, whatever these may mean to others
15.I have the right to expect that the sanctity of the human body will be
respected after death
16.I have the right to be cared for by caring, sensitive, knowledgeable people
who will attempt to understand my needs and will be able to gain some
satisfaction in helping me face my death

THE DYING PATIENT’S BILL OF RIGHTS

● I have the right to be treated as a living human being until i die.
● I have the right to maintain a sense of hopefulness however changing its
focus may be.
● I have the right to express my feelings and emotions about my approaching
death in my own way.
● I have the right to participate in decisions concerning my care.
● I have the right not to die alone. i have the right to be free from pain.
● I have the right to have my questions answered honestly.
● I have the right not to be deceived.
● I have the right to have help from and for my family in accepting my death.
● I have the right to die in peace and dignity.
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● I have the right to retain my individuality and not be judged for my decisions
which may be contrary to beliefs of others.
● I have the right to discuss and enlarge my religious and /or spiritual
experiences whatever these may mean to others.
● I have the right to expect that the sanctity of the human body will be
respected after death.
● I have the right to be cared for by caring, sensitive, knowledgeable people
who will attempt to understand my needs and will be able to gain some
satisfaction in helping me face death.

QUALIFICATIONS AND ABILITIES OF A PROFESSIONAL NURSE:

A. PROFESSIONAL PREPARATION:
● Have A License To Practice Nursing In The Country.
● Have A Bachelor Of Science Degree In Nursing
● Be Physically And Mentally Fit.

PERSONAL QUALITIES AND PROFESSIONAL PROFICIENCES:

THE PERSONAL QUALITIES AND PROFESSIONAL PROFICIENCIES OF A
NURSE INCLUDES:
1. Interest and willingness to work and learn with individuals/groups in a
variety of settings.
2. A warm personality and concern for people.
3. Resourcefulness and creativity as well as well-balanced emotional condition.
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4. Capacity and ability to work cooperatively with others

5. Initiative to improve self and service.
6. Competence in performing work through the use of nursing process.
7. Skill in decision making, communicating and relating with others and being
research oriented
8. Active participation in issues confronting nurses nursing.

ROLES AND FUNCTION OF A NURSE:

1. Caregiver caregiver

The caregiver role has traditionally included those activities that assist the client
physically and psychologically while preserving the client’s dignity. Caregiving
encompasses the physical, psychosocial, developmental, cultural and spiritual
levels.

2. Communicator communicator

Communication is an integral to all nursing roles. Nurses communicate with the

client, support persons, other health professionals, and people in the community. In
the role of communicator, nurses identify client problems and then communicate
these verbally or in writing to other members of the health team. The quality of a
nurse’s communication is an important factor in nursing care.

3.Teacher
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As a teacher, the nurse helps clients learn about their health and the health care
procedures they need to perform to restore or maintain their health. The nurse
assesses the client’s learning needs and readiness to learn, sets specific learning
goals in conjunction with the client, enacts teaching strategies and measures
learning. teacher

4. Client advocate client advocate

Client advocate acts to protect the client. In this role the nurse may represent the
client’s needs and wishes to other health professionals, such as relaying the client’s
wishes for information to the physician. They also assist clients in exercising their
rights and help them speak up for themselves.

5. Counselor counselor

Counseling is a process of helping a client to recognize and cope with stressful

psychologic or social problems, to developed improved interpersonal relationships,
and to promote personal growth. It involves providing emotional, intellectual, and
psychologic support.

6. Change agent
change agent

The nurse acts as a change agent when assisting others, that is, clients, to make
modifications in their own behavior. Nurses also often act to make changes in a
system such as clinical care, if it is not helping a client return to health.
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7. A leader:
leader

influences others to work together to accomplish a specific goal. The leader role
can be employed at different levels; individual client, family, groups of clients,
colleagues, or the community. Effective leadership is a learned process requiring an
understanding of the needs and goals that motivate people, the knowledge to apply
the leadership skills, and the interpersonal skills to influence others.

8. Manager
manager

The nurse manages the nursing care of individuals, families, and communities. The
nurse-manager also delegates nursing activities to ancillary workers and other
nurses, and supervises and evaluates their performance.

Researcher– nurses often use research to improve client care. In a clinical area
nurses need to:

● Have some awareness of the process and language of research

● Be sensitive to issues related to protecting the rights of human subjects-
PATIENT.
● Participate in identification of significant researchable problems
● Be a discriminating consumer of research findings
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EXPANDED ROLE OF THE NURSE

1. Clinical Specialists clinical specialists

Is a nurse who has completed a master’s degree in specialty and has considerable
clinical expertise in that specialty. She provides expert care to individuals,
participates in educating health care professionals and ancillary, acts as a clinical
consultant and participates in research.

2. Nurse Practitioner
nurse practitioner

Is a nurse who has completed either as certificate program or a master’s degree in a

specialty and is also certified by the appropriate specialty organization. She is
skilled at making nursing assessments, performing P. E., counseling, teaching and
treating minor and self- limiting illness.

3. Nurse-midwife nurse midwife

A nurse who has completed a program in midwifery; provides prenatal and

postnatal care and delivers babies to woman with uncomplicated pregnancies.

4. Nurse anesthetist – GO THROUGH A SPECIAL CLASS AND TRAINING. TO

EARN YOUR LICENSE.
A nurse who Has completed the course of study in an anesthesia school and carries
out pre-operative status of clients. nurse anesthetist

5. Nurse Educator- THE NOBLE OF ALL NURSING FIELD.

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A nurse usually with advanced degree, who beaches in clinical or educational

settings, teaches theoretical knowledge, clinical skills and conduct research.
nurse educator

6. Nurse Entrepreneur:
nurse entrepreneur
A nurse who has an advanced degree, and manages health-related business.

7. Nurse administrator
A nurse who functions at various levels of management in health settings;
responsible for the management and administration of resources and personnel
involved in giving patient care.

LEGAL ASPECTS AND THE NURSE

When the nurse undertake to practice their profession , they are held
responsible and accountable for the quality of performance of their duties.

PROFESSIONAL NEGLIGENCE - CARELESS

refers to the omission or commission of an act, pursuant to a duty that a

reasonably prudent person in the same or similar circumstance would or would not
, and acting or the non acting of which is the proximate cause of injury to another
person or his property.
if a person charged with negligence shows that she meets or even surpasses
this standard then there is no negligence or carelessness. but if the defendant’s
action fail to meet the standard, then there has been negligence.

DUTY
● duty is owned to the client/
● when a nurse failed to perform her/his duties.
● when duties must be within the boundaries of nursing profession.
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BREACH OF DUTY breach of duty

● Deviation from the standard of care is established.

INJURY – ESTABLISHED HARM TO THE PERSON AND PROPERTY

financial, physical. emotional harm is established.

CAUSATION - EVIDENCE
when direct cause of failure is established to meet the standard of care.

Negligence negligence

refers to the commission or omission of an act, pursuant to a duty, that a

reasonably prudent person in the same or similar situation would or would not do,
and acting or the non-acting of which is the proximate cause of injury to another
person or his property

Elements of a Professional Negligence

● Existence of a duty on the part of the person charged to use due care
under circumstances
● Failure to meet the standard of due care
● The foreseeablity of harm resulting from failure to meet the standard
● The fact that the breach of this standard resulted in an injury to the
plaintiff

SPECIFIC EXAMPLES OF NEGLIGENCE:

● Failure to report observations to attending physician.
● Failure to exercise the degree of diligence which circumstances of the
particular case demands.
● Mistaken Identity.
● Wrong Medicine, Wrong Concentration, Wrong Route, And Wrong
Dose.
● Defects of equipment such as stretchers and wheelchairs may lead to
falls thus injuring the patient
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● Errors duty to family assistance.

● Administration of medicine without a doctor’s prescription

DOCTRINE OF RES IPSA LOQUITUR res ipsa loquitur

● “the thing speaks for itself”
● serves as evidence that the negligence was committed.

MALPRACTICE malpractice
● usual sense implies the idea of improper or unskillful care of a patient
by a nurse. malpractice denotes stepping beyond one’s authority with
serious consequences.
● malpractice is the term for negligence or carelessness of professional
personnel.
● giving anesthesia when the nurse is not licensed.
● prescribing medications that was not done by the doctor.

force majeure
DOCTRINE OF FORCE MAJEURE:
● irresistible force, one that is unforseen or inevitable.
● circumstances such as fire, flood, earthquake, accidents, tsunami.
● habitual tardiness due to heavy traffic is not considered force majeure.

DOCTRINE OF RESPONDEANT SUPERIOR: respondeant superior

● “let the master speak for the acts of the subordinate”

INCOMPETENCE: incompetence

● incompetence is the lack of ability, legal qualifications or fitness to

discharge the required duty.
● there will be grounds of revocation or suspension of his/her license.
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PRINCIPLE OF MORAL DISCERNMENT

I. PRINCIPLE OF MORAL DISCERNMENT:

Moral discernment: concern with or relating to human behavior, the

distinction between good or bad, right or wrong behavior.

Discernment: is not knowing the difference between right and wrong. it is

known difference between right and almost right.

Discernment as a synonym for ‘deciding’, but it is a richer and deeper

concept that, while related and antecedent to it, is dinstinct from it. the goal of
discernment is to see beyond the external manifestations of something and to probe
its deeper significance. discerns comes from the latin “dis” off or away + “cernere”
to distinguish, separate, sift, set apart or divide. discernment is something that
ought to procede a decision and aid in making.

It is the ability to grasp, comprehend and evaluate clearly. it means we can

see the true nature of things; it allows us to distinguish between what is real and
what is imitation. this is one of those intangible qualities that cannot be taught but
can be developed and improved upon over time.

FOUR COMPONENTS OF MORAL DEVELOPMENT:

moral sensitivity 1. Moral Sensitivity – the ability to interpret a situation in moral and
ethical terms.
moral judgment 2. Moral Judgment – the ability to determine a course of action in the
context of what is just.
moral motivation 3. Moral Motivation – the ability to select an approriate course of action
among multiple good alternatives
moral character 4. Moral Character – the courage and skills to follow a course of action
in response to a situation.
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DISCERNMENT IN NURSING
● Rests on sensitive insight involving acute judgment and udnerstanding
and its results in decisive action.
● Includes the ability to make judgments and reach decisions without
being unduly influenced by extraneous considerations, fears and
personal attachments.
● Pairs in action with courage and fidelity to one’s duty and prudence

FOUR PRINCIPLES OF MORAL OF DISCERNMENT/JUDGMENT:

● Principle of formal cooperation: it occurs when someone intentionally helps
another person carry out a sinful act.
● Principle of material cooperation: when a person’s actions unintentionally
help another person to so something wrong.
● Principle of lesser evil: the principle that when faced with selecting from
two immoral options, the one which is least immoral should be chosen.
● Principle of double effect: this principle aims to provide specific guidelines
for determining when it is morally permissible to perform an action in
pursuit of a good end in full knowledge that the action will also bring about
bad results

WAYS DISCERNMENT IS VALUABLE:

1. Discernment helps you see beyond the facts.
2. Discernment can help sort out the best from the rest.
3. Discernment can keep you from making big mistakes
4. Try to avoid snap decisions.
5. Ask the right questions.
6. Own the decision.
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THE SIX STAGES OF MORAL JUDGMENT

1. Authority stage – what is moral is defined by the authority figure, who

is to be strictly obeyed by the follower. authority stage

2. Reciprocity stage – what is moral is defined by the authority figure

but the follower seeks to bargain with the authority figure.” i will do something for
you if you will do something for me”. reciprocity stage

3. Good girl/nice boy stage – what is moral is defined by the peer group.
followers seek to remain in good standing with their peers by following the rules
determined by the group. this leads to competition for power and influence among
peer groups. good girl/nice boy

4. Law and order stage – what is moral is defined by the laws that the
majority makes which essentially control the competing interests of the peer
groups. there is little recognition that the rights of any minority can be overlooked
by the majority. law & order stage

5. Social justice stage – what is moral is defined with consideration for

what is right and just for minority groups as well as the majority. social justice stage

6. Principled reasoning stage – what is moral is undergirded by

principles of goodness and justice. i have a social contract.- to respect and be kind
to all. principled reasoning stage

CONSCIENCE
Conscience – is often described as leading to feelings of remorse when a
person commits an act that conflicts with their moral values.
● The formation of a good conscience is another fundamental elemetn
of christian moral teaching. conscience is a judgment of reason by
which the human person recognizes the moral quality of a concrete
act.
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● Conscience represents both the more general ability we have as

human beings to know what is good and right and the concrete
judgments, we make in particular situations concerning what we
should do or about what we have already done. moral choices
confronts us with the decision ot follow or depart from reason and the
divine law. a good conscience makes judgments that conform to
reason and the good that is willed by the wisdom of god. a good
conscience requires lifelong formation.

There Are Some Rules To Follow In Obeying One’s Conscience.

1. First, always follow a certain conscience.
2. Second, an incorrect conscience must be changed if possible.
3. Third, do not act with a doubtful conscience.
Note: We must always obey the certain judgments of our conscience,
realizing that our conscience can be incorrect that it can make a mistake about what
is truly the good or the right thing to do. this can be due to ignorance is which,
through no fault of our own, we did not have all we needed to make a correct
judgment

THE TWELVE PRINCIPLES TO LIVE BY:

1. THE PRINCIPLE OF WELL -FORMED CONSCIENCE – indicates

that people are obligated to inform themselves about ethical norms, incorporate
that knowledge into their daily lives, act according to that knowledge and take
responsibility for those actions. of well-formed conscience

2. THE PRINCIPLE OF FREE AND

free and INFORMED
informed consent CONSENT – states
that people must have knowledge about and give consent before physical or
psychological therapy may be administered.
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3. THE PRINCIPLE OF MORAL DISCERNMENT - suggests that

moral discernment

being morally discriminating is a way of life that we must adopt and utilize in all
aspects of our lives as a commitment to God and to the dignity of other human
beings.

4. THE PRINCIPLE OF THE DOUBLE

double effect EFFECT – presents an

interesting exercise which serves as a system of checks and balances to insure

against harm inflicted by rationalized actions.

5. THE PRINCIPLE OF LEGITIMATE COOPERATION – portrays the

legitimate cooperation

principle of the double effect in a scenario in which more than one person
participates in the actions being evaluated.

professional communication
6. THE PRINCIPLE OF PROFESSIONAL COMMUNICATION – puts
forth the need for trust, informed consent, clear articulation and continuous update
and feedback when it comes to Moral issues.

7. THE PRINCIPLE OF DIGNITY IN COMMUNITY – is a

dignity in community

foundational statement of the necessity of health care serving human persons, how
health care must be at once a gentle balance of ethical, communal and political
considerations, how all ethical decisions must satisfy both the innate and cultural
needs of every human person.

8. THE PRINCIPLE OF COMMON GOOD,

common good, SUBSIDARITY
subsidarity and functionalism AND

FUNCTIONALISM – “From each according to ability to each according to need

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9. THE PRINCIPLE OF TOTALITY AND INTEGRITY – the whole is

totality and integrity

important as its parts, and vice versa.

10. GROWTH THROUGH

growth through suffering SUFFERING – points us in the direction of a
life beyond this, makes clear the need to endure and make as perfect as possible the
road to that next life, a road that will indeed be laden with potholes and detours.

11. THE PRINCIPLE OF PERSONALIZED

personalized sexualitySEXUALITY – takes note

of a humanized sexuality, one that represents the fulfillment of physical and

sensual need but also evidenced with love and sacramental mystery.

12. THE PRINCIPLE OF STEWARDHSIP

stewardship AND CREATIVITY
creativity – sculpts
an image of our gifts as human and the horizons that such gifts offer us a
multidimensional creature of God

SUMMARY:
The nursing students will realized that to practice nursing is to understand
what is meant by professional nursing and how one may qualify to practice. the
nursing students typically visualize the various fields of nursing they may want to
enter into once they qualify to practice. they have to be familiar with these various
fields to make an intelligent choice of job and opportunities at hand.

The complexities of the roles and relationship of nurses with society, the
public they serve and the members of the health team demand full knoweldge of
their ethical responsibilities. the trend towards greater accountability of nurses in
every work setting clearly defines legal boundaries they must observe in order to
avoid legal problems.