PROFESSIONAL

ADJUSTMENT
-growth of the individual
and development of his
capacities- physical,
mental, emotional, social
and spiritual.
 Characteristics of a
profession:
1. Altruism- work for the good of society
2. Autonomy- self- determination
3. Authority- based on knowledge
4. Accountability- answerable for their
conduct and responsible for their practice.
5. Code of Ethics- relevance to social values
6. Distinct identity
 A profession is best
defined as:
a. The work that suits the person
b. An activity which one engages
c. Calling that requires special knowledge
skill and preparation
d. Any of these
A nurse is considered a
professional when she is:
1. Goal oriented
2. Person oriented

3. Autonomous and accountable

4. Ethical

a. 1,2,3 b. 2,3,4 c. all d. 1,3,4

 Nursing as it is today, is
best defined as:

b. The act of utilizing the environment of the

patient to assist him in his recovery
c. Assisting the individual, sick or well, in the
performance of those activities
d. Providing care for the dying patient
e. Direct, goal oriented, adaptable to the
needs of the individual, family and
community during health and illness
TRENDS IN NURSING
PRACTICE:
1. Automation
2. Independent Practice
3. Specialization
4. Primary Care Nursing
5. Team teaching
 FIELDS OF
PRACTICE:
I. Hospital
First level
position -
staff nurse
A. General Staff Nurse

General wards
 Surgical Ward

 Medical Ward
 Pediatric Ward
 Obstetric-
Gynecology ward
 Communicable
Disease Nurse
 Orthopedic Nurse
B. Nurse in the Special
Areas
1. Emergency
Room Nurse
 Disaster Nursing
2. Intensive/ Critical
Care Nurse
3. Operating Room
Nurse
Nurse Anesthetist
4. Delivery Room
5. Nursery
6. Diagnostic Nurse
7. Psychiatric
Nursing
8. Hemodialysis
Nurse
9. Post mortem
Nurse
2. Community Health
Nurse
A. School nurse
B. Occupational/
Company Nurse
C. Public health
Nurse
D. Military Nurse
3. Private Duty Nurse
4. Para- legal Nurse
5. Forensic Nurse
6. Flight Nurse
7. Nurse Entrepreneur
- nursing homes, review
centers
8. Nursing Education
9. Nurse Researcher
10. Independent Nurse
practitioner
- self- employed; reach out and offer their
service
- Make referrals and collaborates with
physicians
11. Advanced Practice
Nursing/ Specialist
The focus of nursing is on:
a. Health promotion
b. Health maintenance and restoration
c. Care of the dying
d. Holistic care
VIRTUES:
VIRTUES to do what is
MORALLY RIGHT
PRUDENCE-FORESIGHT; “look before you
leap
COMPASSION- Loving kindness; self-
sacrifice
RESPECT- Listening to patients or
colleagues
HUMILITY-Recognizing one’s capabilities &
limitations
INTEGRITY- WHOLENESS; acting in
the same way one says
HONESTY- TRUTHFULNESS
FIDELITY- FAITHFULNESS
COURAGE-Doing what one sees as
right without undue fear
1.As a professional, you
should be described with
the1.professional
following:competence
2.autonomy
3.accountability
4.discipline
a. 1 b. 1,2 c. 1,2,3 d. all
2.As a staff nurse, which of
the following is your most
important
1.nursing function?
process
2.caring
3.intravenous injection
4.giving comfort measures
a. 1,2 b. 2 c. 4 d. 2,3
3.Nursing as a profession is
characterized by:
1.service orientation
2.body of knowledge
3.accountability
4.concern for the well being of its
practitioners
a. 1,2,3 b. 2,3,4 c. 1,2,3,4 d. 1,3
4. A nurse should be able to initiate
nursing action even in the absence of
a physician’s order. This is called:
a. authority c.independence
b. autonomy d. all
5. A graduate of nursing in
the Philippines is expected
to 1.scientifically
be: informed
2.desirous of material wealth
3.proficient in the use of computers
4.skillful in health promotion and disease
prevention
a. all b. 1,2,3 c. 1,4 d. 1,3,4

6. Like other professions,
what is unique in
professional
a. nursing?
It’s compassionate and caring role
b. It’s caring role
c. A well-defined body and knowledge and
expertise
d. It’s involvement in nursing research
7. A patient is:
a. An individual which uses a commodity
b. A person who is waiting for or undergoing
medical treatment
c. A person who engages the advice or
services of another who is qualified to provide
this service
d. Any of these
8. The degree to which a
nurse behavior as a
professional is perfected in
which of promotes
a. Accepts, the following?
and maintain
interdependence of theory and practice
b. Work in coordination of other professional
group
c. Demonstrate the ideals of nursing
d. Is a member of the accredited professional
groups
9. Florence Nightingale
views nursing as:

a. Assisting patient’s towards early recover

b. Utilizing the patient’s environment for
health
c. Caring for both healthy and ill individuals
d. Helping patients deal with health
problems
10. Professionalism is
demonstrated in which of
the following
a. Maintains behaviors?
interdependence of members of
the health team
b. Observes moral and ethical values
c. Supporting, counseling and assisting other
nurses
d. Communicates and disseminates health
knowledge
 NURSING ETHICS
 ETHICS- study of the norm of
human acts as guided by human
reason.
THEORIES:

1. EGOISM- self-interest of the doer

determines goodness of the act.
2. UTILITARIANISM- consequentialism
Ethical if: a. minimizes pain and suffering
 b. maximizes pleasure
 c. seeks happiness of the
majority
3. DEONTOLOGISM- legalistic view
 “ what is legal is not necessarily ethical”
4. RELATIVISM/ SUBJECTIVISM- standard of
right or wrong is relative to people, to time and to
place.
5. SITUATIONALISM- “ love theory”
6. NATURAL LAW THEORY- work of creator
 if act preserves life, it is good; if rejects life, it is
bad.
ADDITIONAL:
1. HEDONISM- the principle of pleasure, of
what is easy; of what is profitable for self.
* honest attitude and commitment
2. PLURALISM- to do what majority of
people are doing.
* priorities in life/ proper decorum
3. CONSUMERISM- “ madness sale”
principle of buying all that is advertised.
* simple lifestyle
1. EGOISM- self-interest of the doer
determines goodness of the act.
2. UTILITARIANISM- consequentialism
Ethical if: a. minimizes pain and suffering
 b. maximizes pleasure
c. seeks happiness of the
majority
DEONTOLOGISM- legalistic view
 “ what is legal is not necessarily ethical”
RELATIVISM/ SUBJECTIVISM- standard of
right or wrong is relative to people, to time and to
place.
SITUATIONALISM- “ love theory”
NATURAL LAW THEORY- work of creator
 if act preserves life, it is good; if rejects life, it is bad.
 BIOETHICS
- is the study of human conduct in the
area of the life sciences and health
care using moral values and principles.
 PRINCIPLES IN
BIOETHICS
1. BENEFICENCE- means to do good and not
to do harm.
2. NON- MALEFICENCE- one ought not to
inflict evil or harm.
3. AUTONOMY- means self-determination
4. JUSTICE- refers to the obligation to be
fair to other people.
Types of justice:
a. Distributive Justice- fair, equitable
and appropriate distribution.
b. Criminal Justice- just infliction of
punishment or penalty.
c. Rectificatory Justice- just
compensation under civil laws.
5. STEWARDSHIP- not harm our body
because it is God’s not ours.
6. TOTALITY- body should function as a whole
7. FIDELITY- refers to the obligation to be
faithful to the agreements, commitments and
responsibilities that one has made to oneself
and others
8. VERACITY- refers to telling the truth or not
intentionally deceiving or misleading patients
9. RESPECT- treat all individuals as persons
with rights with or without abnormality.
10. SHARING OR ALLOCATION OF
RESOURCES- applies when resources are
scanty or very limited
STEWARDSHIP- not harm our body because it
is God’s not ours
NON- MALEFICENCE- one ought not to inflict
evil or harm.
BENEFICENCE- means to do good and not to
do harm.
AUTONOMY- means self-determination
VERACITY- refers to telling the truth or not
intentionally deceiving or misleading patients
FIDELITY- refers to the obligation to be faithful to the
agreements, commitments and responsibilities that
one has made to oneself and others

JUSTICE- refers to the obligation to be fair to other

people.

SHARING OR ALLOCATION OF RESOURCES- applies

when resources are scanty or very limited

TOTALITY- body should function as a whole

RESPECT- treat all individuals as persons with rights

with or without abnormality.
BOARD QUESTIONS ( JUNE 2005 )
 Situation: Bioethics in caring for children

capitalizes on some important principles. You

are expected to know these by heart because
nurses care for children as well as adults.
1. What is the principle to hold on when
caring for children who have been
abandoned and abused?
 a. consistent assurance b. respect
 c. allocation of resources d. autonomy
2. The principle that tells children are to be
treated accordingly as persons is
 a. beneficence b. non- maleficence
 c. autonomy d. respect
3.When there is only one pacemaker and
there are many patients needing it, the
principle to be used is
 a. autonomy b. justice
 c. respect d. beneficence
4. When the nurse triage patients to render
care accordingly, you are using this
particular principle
 a. respect b. allocation of resources
 c. beneficence d. autonomy
5. In choosing sharp intramuscular needles
for injection, you are practicing this
principle
 a. beneficence b. justice
 c. respect d. non-maleficence
Situation: In rendering care to a
handicapped child, the nurse has many
responsibilities, most of all the nurse
should be ethical.
1. What principle should a nurse carry
when caring for a handicapped child?
a. respect b. non-maleficence
c. beneficence d. justice
2. Regarding idiosyncracies of a
handicapped child, how should the nurse
deal with the tantrums?
a. respect b. justice
c. beneficence d. non- maleficence
3. In apportioning candies and other nice
goodies among children, what bioethical
principle should a nurse observe?
a. respect b. non- maleficence
c. beneficence d. justice
4. What is the nursing ethical guiding
principle during invasive procedures
being done to children?
a. non- maleficence b. justice
c. respect d. beneficence
5. A handicapped child like any other child
should be loaded with
 a. care b. toys
 c. food d. love
 PATIENT’S BILL OF
RIGHTS
1. Right to considerate and respectful care
 - nurse avoids discriminating acts that tends

to bring the appearance of favoritism

 - “ tender loving care attitude”
2. Right to information about diagnosis, treatment
and prognosis
3. Right to informed consent
 - refers to the capacity of the patient to accept or
refuse treatment options offered by the health care
provider.
 Elements:

 Voluntariness
 Information
 Capacity
4. Right to an advance care directive

5. Right to Privacy
6. Right to confidentiality
 - all records and communications held in
confidence
when to divulge information:
 1. patient placed in serious danger
 2. public welfare
 3. legal proceeding
7. Right to go over records
8. Right to services and to transfer
 - referrals
9. Right to know relationship with other
health care and educational institutions
10. Right not to be subjects of research or
experimentation
11. Right to expect reasonable continuity of
care
 - follow up consultations
12. Right to examine and receive an
explanation of his bill, Right to know
what hospital rules and regulations
apply to his conduct as a patient
PATIENT’S
RESPONSIBILITIES:
1. Providing information
2. Complying with instructions
3. Informing the physician of refusal to
treatment
4. Paying hospital charges
5. Following hospital rules and regulations
6. Showing respect and consideration
ETHICAL DILEMMAS
1. ARTIFICIAL
INSEMINATION-
is a procedure or process whereby the
fertilization of an egg is the result of the
sperm being introduced into the female
reproductive system other than the
natural, that is, other than the sexual act or
intercourse.
Types:
1. Artificial
Insemination by the
Husband (AIH) or
Homologous Type

2. Artificial
Insemination by a
Donor(AID) or
Heterologous Type
Argument that support A.I
 strengthens and enhances family
relationship.
Ethical Objections:
 Ethically wrong by reason of the manner of
procuring semen.
 Contrary to the signification of the Human
Sexual act.
2) IN VITRO
FERTILIZATION
Laboratory
procedure whereby
one or a few eggs
are surgically taken
from a woman’s
ovary, fertilized with
sperm in a petri
dish, and
transferred to and
implanted in the
woman’s uterus,
hoping for a normal
pregnancy to
happen.
Argument that support IVF
 “ Technological Imperative”

 opens infertile couples to joy of having

children
 Guarantee society with healthier children
Ethical Objections:
 manner of procuring semen

 “product” factor

 “ surrogate mother” factor

 disadvantage of pregnancy in later years

3) HUMAN CLONING-

Refers to the production of one or more

living human beings that are genetically
identical to an original human being.
Types:
1. Embryo Cloning- “ Artificial Twinning”
 POSSIBLE EXAMPLE OF DEFECTIVE
CLONING
2. Adult DNA Cloning

3. Therapeutic Cloning
( Somatic Cell Nuclear
Transfer)
Argument that support Cloning:
 improvement to humanity

 production of human tissues or organs

 a fundamental human right- Reproductive

freedom
Ethical Objections:
 Violates the autonomy of the individual

 Diminishes the value of human life

 Disadvantageous to child

 Humans subjected to exploitation for

commercial purposes
1) CONTRACEPTION

is any act done before, during, or after the

act of intercourse that purposely
frustrates begetting of new life.
Types:
1. Direct- deliberately intended
A. Artificial
 Mechanical

1. condom
 2.diaphragm
 3.cervical cup

 4.IUD

 Chemical = cervical sponge, vaginal

suppository, vaginal jelly
 Surgical = tubal ligation, vasectomy
B. Natural
2. Indirect
 Argument that support
contraception:
 Woman’s autonomy or right
 Situationalism ( Love Theory)
 Utilitarianism (Sexual pleasure or
happiness)
 Population “Time Bomb”
Ethical objections:
 Meaning of human Sexual Act

 Population “Time Bomb” Scare

5) ABORTION

Termination of pregnancy.
Q: When will termination of pregnancy be
called abortion punishable by law? If
terminated
a. First trimester
b. 20 weeks age of gestation
c. Moment of conception
d. 7 months pregnancy
Types:

1. Spontaneous Abortion-
miscarriage, kind that occurs without
medical or some other kind of
intervention.
 Complete- all content in uterus expelled

 Incomplete- part or entire placenta is

retained
 Missed abortion- fetus is retained in
the uterus for a period of time after its
death.
2. Direct, induced or procured
Abortion- elective or
therapeutic abortion
 Early Uterine Evacuation or Vacuum
aspiration- suctioning
 Dilatation and Evacuation, Dilatation and
Curettage (D & C)
 Prostaglandin and Saline injection-
through amniotic sac
 Hysterectomy
3. Indirect Abortion- necessary
result of another medical
procedure.
Right of the mother versus
Right of the unborn/ fetus

Principle of Double Effect

refers to an act that causes two
immediate effects: one good, the other
bad.
Conditions:
1. The act must either be good or at least
indifferent.
2. The intention is to achieve the good
effect.
3. The expected good effect must be equal
to or greater than the harmful effect that is
expected.
4. The good effect must follow from the
action,or at least,must happen as
immediately as the bad effect.
6 ) EU THA NA SIA-

“ MERCY KILLING”, is the intentional

taking of the life of an ailing person.
rea son s:
 Incurability of illness

 Unbearable intensity of physical or

emotional pain
 Unbearable financial burden arising from

the illness.
Types:

1. By Reason of the
manner of attaining
death
 a. Active or

Direct
Euthanasia- the
active taking of
steps by the
physician or the
caregiver to end the
life of the patient.
b. Passive or Indirect Euthanasia- the
intentional omission or non-
administration of medical treatment to
cause or hasten the death of the patient.
2. By reason of patient’s consent
a. Voluntary Euthanasia- the patient
consciously and directly requests the
health care provider to take the steps to
put an end to the patient’s life.
b. Involuntary Euthanasia- the act of
seeking the death of the patient is
without the patient’s consent or
knowledge.
 Q: If a nurse stops giving
medications with the consent of
the family, what type of
a. Active voluntary
euthanasia?
b. Inactive involuntary
c. Active involuntary
d. Inactive voluntary
 “ DO NOT
RESCUCITATE ORDER”
Q : A patient has been in the ICU for two
weeks. The relatives consented to a
“DNR” order. What should the nurse do?
b. Only medications will be given
c. All ordinary measures will be stopped
d. Basic and advance life support will not be
given
e. Mechanical ventilation and NGT stopped
 Types of treatment:
1. Ordinary treatment

2. Extraordinary treatment
a. not easily available
b. risky
c. expensive
d. gravely inconvenient or burdensome
7. PHYSICIAN ASSISTED
SUICIDE-
the patient requests from the physician
to provide the means to end his life.
8. HUMAN
TRANSPLANTATION-
surgical procedure whereby an organ or
tissue is transferred from one part of the
body to another or from one organism to
another organism.
TYPES:

1. Autotransplantation- donor and recipient

are one and the same
Ex: skin and bones
2. Heterologous-
donor and recipient
are two different
individuals.
a. animal to human
b. human to human
 cadaver donor

 living donor
Ty pes of o rg an s used :
1. Those that regenerate
- bone marrow, skin

2. Those that come in pair

- kidneys, eyes
Q: What Ethical consideration is
violated in human
transplantation?
b. Principle of totality
c. Stewardship
d. Autonomy
e. Respect
 ADVANCE CARE
DIRECTIVE
-makes known in writing the wishes or preferences
of the patient when no longer able to speak for
himself.
SUBJ ECTS:
1. Show risk for early dementia
2. Show risk for stroke
3. Activities- severe head injuries
4. Severe and recurring psychiatric illness
5. Terminally ill
TYPES:
1. INSTRUCTIVE
DIRECTIVE- specifies
life- sustaining treatment
to be withheld or
withdrawn.
 Ex: living will

2. PROXY OR DURABLE
POWER OF
ATTORNEY- assigns a
surrogate if becomes
unconscious or mentally
incompetent
BOARD QUESTIONS:
1. Which of the following Ethical
Philosophies makes obligations and rules
primary?
a. teleontologism
b. relativism
c. deontologism
d. utilitarianism
2. The PRC Board of Nursing adopted
certain rules and regulations in
professional nursing practice as the “
The Code of Nursing Ethics in the Phils”
through:
a. BR # 223 s 1989
b. RA 7164
c. House Bill 264
d. BR # 220 s 2004
3. The Code stresses that:
1. the need for nursing is universal
2. respect for life, dignity and right of man is
inherent in nursing
3. the nurse’s primary responsibility is the
family
4. the nurse carries personal responsibilities
for nursing practice
 a. all b. 1,2 c. 2,3,4 d. 1,2,4
4. As a nurse, maintaining privacy and
confidentiality is an important aspect of
which of the following:
a. Hospital policy
b. Nurse Code of Ethics
c. What all client expect
d. It is an accepted practice
5. Which of the following principles apply to
the action of the nurse to refrain from
discussing the disease condition of the
patient with those who are not involved in his
care?
a. beneficence
b. non-maleficence
c. justice
d. autonomy
6. Which statement is true concerning
informed consent?
a. minors are permitted to give informed
consent
b. professional nurse and physician may both
obtain informed consent
c. the client must be fully informed regarding
treatment, surgery and risks and benefits
prior to giving informed consent
d. mentally competent and incompetent clients
can legally give informed consent
7. Which concept refers to the role of the
professional nurse in client advocacy?
a. the nurse makes decisions for clients who can’t
make decisions for themselves
b. the nurse follows the basic standards for
providing care for clients
c. the nurse promotes and protects the client’s
interest and rights
d. the nurse adapts paternalistic approach to the
care of clients
8. A basic structure against which
competent care is objectively measured
is which of the following?
a. principles
b. standards
c. laws
d. codes
9. Giving a lethal dose of morphine to a
patient with terminal cancer is:
a. passive euthanasia
b. active euthanasia
c. voluntary euthanasia
d. indirect euthanasia
10. The ultimate Ethical Norm is:
 a. Conscience

 b. God

 c. Natural Law

 d. Man-made law
Board Resolution #
220
CODE OF ETHICS
FOR REGISTERED
NURSES
 Four basic ethical
principles:
1. Fundamental responsibility of the nurse is
four fold
2. Nurse renders service regardless of race,
creed, nationality or political belief.
3. Nurse protects life and respects the
dignity of man.
4. Nurse works in collaboration with
members of the health team
 REGISTERED NURSES AND
PEOPLE

 Ethical Principles:
1.Values, customs and spiritual beliefs shall be
respected
2.Individual freedom to make decisions
3.Personal information acquired must be held
in confidence
 Guidelines to be observed:
a.individuality and totality of patients
b.respect
c.uphold the rights of individuals
d.take into consideration culture and values
- in the event of conflict, welfare and
safety take precedence
 REGISTERED NURSES AND
PRACTICE
 Ethical Principles:
a.Human life is inviolable
b.Quality and excellence in the care of patients
c.Accurate documentation- nursing
accountability
 Guidelines to be observed:
a.know the definition and scope of
nursing practice
b.be aware of duties and responsibilities
c.acquire and develop competence in
knowledge, skills and attitude
d.optimum standard of safe nursing
practice
e.be morally and legally responsible
f.patient’s records considered
confidential
 Guidelin es t o be observ ed:
1. duties in conformity with law
2.not allow to be used in advertisements that
demean image of the profession
3.decline any gift, favor or hospitality from
patient
4.not demand and receive any commission,
fee or emoluments for recommendations
made
5.avoid any abuse of relationship
 REGISTERED NURSES AND
CO-WORKERS

 Ethical Principles:
1.work in solidarity with other members of the
health team
2.maintains collegial and collaborative working
relationships
 Guidelines to be observed:
a.maintain professional identity
b.conform with group activities
c.contribute to professional growth
d.actively participate in prof organizations
e.respect rights of co-workers
 REGISTERED NURSES,
SOCIETY AND ENVIRONMENT
 Ethical Principles:
1.preservation of life, respect for human rights
and promotion of a healthy environment
2.establishment of linkages
 Guidelines to be observed:
a.be conscious of obligations as citizens
b.equipped with knowledge of health resources
within the community
c.actively participate in programs, projects and
activities
d.right conduct and proper decorum
e.project image that will uplift nursing profession
 REGISTERED NURSES AND
THE PROFESSION
 Ethical Principles:
1.maintain loyalty
2.compliance with by laws of accredited prof
organizations
3.commitment to continual learning
4.contribute to the improvement of the socio-
economic conditions and welfare of nurses
 Guide line s to b e o bs erv ed:
a.be members of Accredited Prof Organizations
(PNA)
b.strictly adhere to nursing standards
c.strive to secure equitable working conditions
through appropriate legislation and other means
d.assert for the implementation of labor and work
standards
BOARD QUESTIONS:
 Situation A. The Philippines Regulation Commission
Board of Nursing adopted certain rules and
regulations in the nursing practice.
 1.The “ Code of Nursing Ethics in the

Philippines” is also known as:

 a. BR # 223 c. House Bill 264

 b. RA 7164 d. Board resolution # 220

 2.In the above mentioned code, the
fundamental responsibility of the nurse is four
fold: to promote health, prevent illness, to
restore health, to alleviate suffering and to:
 a. protect man from disease
 b. give assistance toward a peaceful death
 c. promote cure of disease
 d. promote spiritual environment for patient
 3.The Code further stresses that:
 1.the need for nursing is universal
 2.respect for life, dignity and rights of man is
inherent in nursing
 3.the nurse’s primary responsibility is the family
 4.the nurse carries personal responsibility for
nursing practice and for maintaining
competence
 a. all b. 1,2 c. 2,3,4 d. 1,2,4
 4. Professional Nursing is founded on ethics of health care.
Which of the following concepts are pertinent guides for a nurse
practitioner?
 1.health is a functional whole in which all necessary
functions are present and acting cooperatively and
harmoniously
 2.health is freedom from superimposed or unnatural
influences or disease
 3.health is the state of being in which the individual does
the best with the capacities he has
 4.health is a state of complete well-being
 a. all of these b. 1,3,4 c. 2,4 d. all but 3
 5. The ultimate Ethical Norm is:
 a. Conscience
 b. God
 c. Natural Law
 d. Man-made law