Professional and Personal Development

Ethics- a systematic study of what a persons conduct and actions should be with regards to self, other humans and the environment. - a system of moral conduct and principles that guide persons action in regard to right and wrong and in regard to oneself and the environment. Types of ethical issues: 1. Moral uncertainty- occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. (moral conflict) (when duties and obligation of health care provider are unclear)

2. Moral distress- result of an individual knowing the right thing to do but the organizational constraints make it difficult to take the right course of action. 3. Moral outrage- occurs when an individual witnesses the immoral act of another but feels powerless to stop it. 4. Ethical dilemma- occurs when to or more clear moral principles apply but they support inconsistent courses of action or can be describe by choosing 2 or more undesirable alternatives

and attempting to select the least damaging from the choices available. ( our task as ethical decision makers is to identify the best answer from among the available alternatives and to see to it that we are in a position to meet the challenge of identifying our ethical judgment) - influenced by our values and basic beliefs about the rights, duties and goals of all human beings. - self-awareness, then, is a vital leadership role in decision making, same with other aspect in decision making.

Ethical Frameworks for decision making

Ethical framework- guide individuals in solving ethical dilemmas. - do not solve ethical problem but assist the manager in clarifying personal values and beliefs. commonly used ethical framework/ theories 1. Teleological (consequentialist theory) consist of judging whether the consequence of an action are good or bad. -encourages the manager to make decisions based

on what provides the greatest good for the greatest no. of people. ( travel ) 2. Deontological ethical theory-judges whether the action is right or wrong regardless of the consequences and is based on the philosophy of Emmanuel Kant in the 18th century = uses both duty-based reasoning and rightsbased reasoning as the basis for its philosophy. * duty-based theory- is an ethical framework stating that some decisions must be made because there is a duty to do something or to refrain from doing something. (the supervisor feels a duty to hire the most qualified person for the job, even if the personal cost is high).

* Right-based reasoning- based on the belief that some things just due ( each ind. has basic claims, with which there should be no interference) rights are diff from wants, needs and desires. * intuitionalist framework- allows the decision maker to review each ethical problem or issue on a case by case basis. 3. Other recent theories of ethical philosophy include: ethical relativism and ethical universalism. ethical relativism is the belief that a specific cultures ethical principles cannot be generalized to individuals who do not share that culture.

Principles of ethical reasoning: 1. autonomy- promotes self-determination and freedom of choice (accepting the responsibility for ones choice) (principle) says that the employee has made the choice to be terminated by virtue of his/her actions, not by that of the manager. 2. Beneficence (doing good) actions are taken in an effort to promote good. - if one cant do good , then one should at least do no harm.

- ex. The manager uses this principle in planning performance appraisals, he/she is much more likely to view the performance appraisal as a means of promoting employee growth. 3. paternalism- is related to beneficence in that one person assumes the authority to make a decision for another. - limits freedom of choice, they even believe that this is justified only to prevent a person from coming to harm. 4. utility-the good of the many outweighs the wants or needs of the individual. - managers who uses this principle of utility need to be careful not to become so focused on production that they become less humanistic.

5. Justice (treating people fairly) - applies when there are scarcities or competition for resources or benefits. - the manager who uses this principle of justice will work to see that pay raises reflect performance and not just time of service. 6. Veracity (truth telling) 7. Fidelity (keeping promises)-refers to the moral obligation that individuals should be faithful to their commitments and promises. ( nurses primary commitment is to the patient)

8. Confidentiality (respecting privileged information) - the obligation to observe the privacy of another and to hold certain information in strict confidence is a basic ethical principle and a foundation of both medical and nursing ethics. Considered the highest principle that incorporates all the principles.

Ethical positions: there are several ethical position that do not solve dilemmas, however they do provide ways to structure and clarify them. 1. Utilitarianism- a commonly-oriented position that focuses on the consequences and prefers the greatest amount of good and happiness for the most people, or the least amount of harm. 2. Egoism- seeks solution that are best for oneself w/o regards for others. Ones own pleasure is the concern. 3. Formalism- considers the nature of the act and the related principles w/o thought to personal position or consequences of the action: be honest; remember the golden rule.

4) Rule ethics- expects obedience to laws, rules, professional codes, and authority. 5) Fairness considers distribution of benefits and liabilities from the viewpoint of the least advantaged. Ethical relationships Models for ethical relationships: 1) Priestly the manager is paternalistic and makes decisions w/o considering others values or seeking others input. - although nurses may have expertise that qualifies them to make some decisions, they have no right to make moral decisions affecting other people. (autocratic leader may use priestly model)

2) Engineering model- suggest that one person presents facts to another and sets aside her own code to do what the other wants. 3) contractual-provides a contract that identifies general obligations and benefits for 2 or more people. It deals w/ the moral of both parties and is appropriate for superior-subordinate relationships. 4) Collegial model-individual share mutual goals and reach decisions through discussions and consensus . When there are shared values, this model helps build teams and minimize conflict.

International Council of Nurses (Code for Nurses) - First adopted by the ICN in 1953 and later it was revisedfor several times and the final revision was completed in 2000. Preamble 4 fundamental of responsibility: 1. Promote health 2. Prevent illness 3. Restore health 4. Alleviate suffering

inherent in nursing in the code: -respect for human rights including the right to life, to dignity and to be treated with respect. 4 principal elements of the Code: 1. Nurses and people- the primary responsibility of the nurse is to people requiring nursing care. In providing care , the nurse: - promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. - the nurse ensures that the individual receives sufficient information on w/c to base consent for care and related tx.

- the nurse holds in confidence personal information and uses judgment in sharing this information. - the nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. - shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction.

2. Nurses and practice- the nurse carries personal responsibility and accountability for nursing practice , and for maintaining competence by continual learning. - the nurse uses judgment regarding individual competence when accepting and delegating responsibility. - the nurse at all times maintain standards for personal conduct w/c reflect well on the profession and enhance public confidence. - the nurse, in providing nursing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of the people.

3. Nurses and the profession- the nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice , management , research and education. - active in developing a core of research-base professional knowledge. - the nurse , acting through the professional organization, participate in creating and maintaining equitable social and economic working conditions in nursing

4. Nurses and co-workers - the nurse sustains a c0-operative relationship with co-workers in nursing and other fields. - the nurse takes appropriate action to safeguard individuals when their care is endangered by a co-worker or any other person.

- Approved the first PNA Code of Ethics for Nurses in 1982 or more than 5 decades after it was formed in 1922 under the name Filipino Nurses Association (FNA). - Thereafter, the PRC Board of Nursing adopted the ICN Code of Ethics on March 21, 1984 as an integral part of the Code of Ethics for Nurses in the Phil. - In short: the Code of Ethics for Nurses in the Phil. Was approved by the Board on March 21, 1984, pursuant to R.A. # 877 and P.D. # 223. However, in the said board , the promotion of spiritual environment was added to the ICNs 4 fundamental responsibilities of nurses, making them 5.

Code of Ethics for Filipino Nurses

- The final presentation of the document (code) was on Oct. 21, 1982 after a long period of deliberation regarding this matter wherein there were only 7 responsible and commendable nurses from NCR who actively participated in the said deliberation and made some comments and suggestions that was incorporated in the final draft. - Again , the Code of Ethics went through another series of amendments. The amended was approved by the BON in its Resolution No.1955 - then on Oct 18, 1989 , the same date that the said code was approved by PRC as part of the rules and regulations governing the practice of the profession in the Phil. It took effect upon PRC approval and 15 days of publication in the official Gazette or any newspaper of general circulation.

Nursing Regulation
- R.A. No. 7164 was approved by Pres. Corazon Aquino on Nov. 21, 1991 and took effect on Feb. 20, 1992. - On Oct. 21, 2002. Pres. Arroyo signed into Law R.A. No. 9173, otherwise known as the Phil. Nursing Act of 2002, repealing R.A. No. 7164. - R.A. No. 9173, w/c was passed in a record time of about 3 mos. Is now the prevailing law regulating the nursing practice in the Phil.

R.A. Act No. 9173 includes: (4 fundamental responsibilities of nurses) -curative - preventive - promotive and rehabilitative aspects of care - restoration of health and alleviation of suffering 2 Universal principles in Nursing: - that the need for nursing is universal - respect for human rights is inherent in nursing

On top of this, the universal declaration of human rights specifically Article 25, states that: 1) everyone has the right to a standard of living adequate for health and well-being of himself and of his family, including food, shelter, clothing, housing and medical care and necessary social services and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. 2) motherhood and childhood are entitled to special care and assistance, shall enjoy the same social protection.

R.A No. 9173 known as the Phil. Nursing Act of 2002 ( law that governs nurses and the practice of their profession in the country. - approved on Oct. 21, 2002 ( states the two-fold state policy for the nursing profession. 1) The state responsibility- pertains to the govts responsibility to protect and improve the nursing profession through the institution of measures for the attainment of the following: - relevant nursing educ. - humane nursing condition - better career prospect - dignified existence of the Filipino nurse

Legal Aspects of Nursing

2) The state guarantee- the governments commitment to deliver quality health care services by providing adequate nursing personnel throughout the country. The government affirms the state policy to make education accessible to all, apart from its commitment to provide quality education, deliver quality health care and support the advancement of the nursing practice.

Malpractice and Negligence

Malpractice- improper or unethical conduct by a professional, resulting in harm, injury or death of another person. Elements: - Duty ( of a nurse to employ his/her training, care and skill in the care of the patient commences at the time his/her is engaged by the patient) - Breach ( of these professional duties, of skills and care or their improper performance by a nurse resulting to a damage or - Injury to the body or health of the patient constitute to an actionable malpractice.

- Proximate causation (divided into 2) 1) whether the nurses actions, in fact cause harm to the patient 2) whether these are the proximate cause of the patients injury. Proximate cause- that w/c, in natural and continuous sequence, unbroken by any efficient intervening cause, produces an injury, and w/o w/c the result would not have occurred. ( OR- in the Phil. The liability of nurses maybe subsidiary or secondary to the physician, unless it can be proven that they are the cause of the cause , or the proximate cause.)

Contracts- a meeting of minds bet 2 persons whereby one binds himself w/ respect to the other, to give something or render some service. (ex. If a nurse signed a contract of employment but did not finished , the nurse is liable for a breach contract.) Will- an act whereby a person is permitted , w/ the formalities prescribed by law, to control to a certain degree the disposition of his/her estates or properties, to take effect after his/her death. 2 kinds of wills: 1) notarial will 2) holographic will

Contract and Wills

Notarial will- requires, among other things, an attestation clause, and an acknowledgement . (minors or those of unsound mind cannot make a will Holographic will-is a will w/c is entirely written, dated and signed by a testator. Important legal doctrines and principles in the nursing practice in the Phil. also called jurisprudential doctrines that is applicable to charges against professional misconduct, whether criminal, civil and administrative in nature. 1) Bonus pater familias and respondeat superior-

- The basis of civil liability of the hospital as employer of a nurse is the relationship of bonus pater familias (good father of a family), whereby the employer becomes liable of his own negligence, liable that he has been negligent in the selection of his employees of his employees(culpa in eligiendo) or in the supervision of his employees (culpa in vigilando). - In a negligent lawsuit lawsuit against an employer, the employer is presumed in law, to be negligent either in the selection of his employee or in the supervision over the latter after he/she was selcted or hired as an employee.

- However , this is just a presumption juris tantum (desputable presumption) and not jure et de jure (conclusive presumption). - Juris tantum can be rebutted by proof that in the selection of and supervision over his employees, the employer has exercised care and due diligence of a good father of a family.

- Nurses must study and be aware of applicable law and jurisprudence in nursing practice in the Philippines because this will help them develop their self-esteem in the performance of their duties. Jurisprudence on fault and negligence Can be considered at fault when his/her action is contrary to what should have been done to the patient. Failure in observing the necessary protection and vigilance w/c circumstances demand, whereby such patient suffers an injury or even death.

Jurisprudence on negligence test - Prevention is the best cure in medicine, it is the best defense in law. - negligence maybe criminal when it results to a crime Gross incompetence or serious ignorance- to avoid being held liable the nurse should refuse performing or administering a written prescription for parenteral medication:1) that is an apparent excess; 2) that appears to be inappropriate;3) that has a possible sided-effect that may require immediate medical interventions; 4) she/he feels that her/his training or knowledge of the drug is inadequate for the situation.

- Includes not only the improper or unethical conduct by a nurse, but also the failure of a nurse to follow the standards of care, the omission to observe or misinterpretation of the changes in the patients condition that requires timely intervention, thus causing harm, injury or death of another person. In malpractice cases, whether it be criminal, civil or administrative.

Malpractice or negligence in the practice of nursing

common experience tells us that the most common legal accountabilities of a nurse occurs or happen when: - she/he inappropriately administers medications, neglects to observe changes in the patients condition and fails to provide appropriate intervention. - Thus, negligence may occur , however, when the nurse fails to follow standards of care or misinterprets or does not recognize changes in the patients condition that requires timely intervention. - There is malpractice when the nurse fails to protect the patient from harm - When the nurse is sued for malpractice, the court first determines whether or not there is fault or negligence in the practice of nursing.

- Basically the nurse can be considered at fault when her action is in contrary to what should have been done to the patient. - She is considered negligent when there is failure to observe the necessary protection of interest and wellness of the patient ,