NCMB 419 LEC & RLE REVIEWER c.

Develop Job Simplification: Subject of the

book is Cheaper by the dozen
Nursing Management- guide for nurses who want to learn
3. Henry Gantt “Disciple of Frederick Taylor”
concepts behind nursing management.
a. Develop Gantt chart
● Also it guides nurses to organizing, staffing,
b. Advocates for a humanitarian management
scheduling, directing and controlling.
● Deals with the application of concepts, principles,
Classical Organization Theories
theories, and methods of developing.
1. Henry Fayor (1925) identified management
functions of planning, organization, command,
Management- it is the process of coordinating and
coordination, and control
supervising personnel and resources to accomplish
2. Luther Gulick (1937) expanded on Fayol’s
organizational goals.
management functions, he mentioned that there
are “Seven activities in Management”. He also
According to Venson (2010) management is a process by
believed that management should be taught in
which a cooperative group directs actions towards common
school.
goals, it involves technique to distinguish groups of people and
coordinate the services of people.
Management Process:
a. Planning- is determining philosophy, goals and
Three (3) fold concept to emphasize the broader scope of
objectives.
Management (Harbizon, Myers)
b. Organizing- includes establishing the organizational
● Economic source- factors of production together
structure to carry out plans
with land, and capital.
c. Staffing- consist of recruiting, interviewing, hiring
● System of authority- the constitutional
and orienting staff.
management emphasizes definite and consistent
d. Directing- includes several staffing functions such
concern for policies and procedures in dealing with
as motivating, managing conflict etc.
the working group.
e. Controlling- include performance appraisal
● Class and status system- from sociologist’s point of
view that managers have become an elite group of
3. Max Weber “The Father of Organizational Management”.
brains and education.
He developed the organizational chart. There are # basis of
authority; traditional, charismatic, and rational authority.
THEORIES OF MANAGEMENT
4. Lyndal Urwick combined the theories of Taylor and Fayol
Scientific Management theory (1900-1930)
to develop Classic Organizational theory popularized the
1. Frederick W. Taylor “Father of Scientific
term “span of control and unity of command”
Management”. He postulated that workers could be
taught “one best way to accomplish a task”
Human Relation Management (1930-1970)
Four Principles of Scientific management
1. Mary Parker Follett (1926) Participative decision
❖ Traditional “Rule of thumb” means organizing work
making or management. She believed that the
must be replaced with scientific methods.
managers should have authority with one another.
❖ Workers can be hired, trained and promoted based
2. Elton Mayo together with his associates conducted
on their competence and abilities
a study at the Hawthorne Works , they found out
❖ Employees are entitled to receive financial rewards
that if workers give special attention productivity
and incentives for work accomplished.
increases, regardless of the environment conditions.
❖ Maintain good interpersonal relationship between
3. Jacob Moreno developed a system of pairings
workers and managers
called Sociometry, believing that people are
2. Frank & Lilian Gilbreth “First Lady of Management”
attracted to, repulsed by or just indifferent towards
a. Use motion picture to develop work efficacy
each other.
b. Therbligs- 17 classification of hand
movements
Behavioral Science c. Determines the organization’s mission,
1. Abraham Maslow- developed hierarchy of needs vision
a. Physiologic needs d. Creates goals and allocate resources
b. Safety and security needs 2. Middle Level Manager- coordinates activities of
c. Love and belonging needs different departments
d. Self-esteem needs a. Receives policies from the top level
e. Self-actualization manager
2. Frederick Herberzg- developed a taxonomy of job 3. First Level Manager- directly responsible for the
situations. actual production of services
a. Believes in job satisfiers/motivation factor a. Act as link between the higher level
and dissatisfies/hygiene factor managers and non-managers
3. William Ouchi-developed Theory Z by comparing
the Japanese organization to the American Skills of a Manager according to Katz
organization 1. Technical skill- knowledge and proficiency in
4. Douglas McGregor (1960) theorizing that activities involving methods, procedures and
managerial attitude about employees could be processes.
correlated to employee’s satisfaction. 2. Human skills- ability to work with people
5. William Blake- developed the Managerial Grid 3. Conceptual skill- ability to see the overall picture to
a. Types of Managers in Managerial Grid identify important elements in a situation and to
i. Impoverish manager understand the relationship among the elements.
ii. Country club manager
iii. Organizational manager Other approach according to Summer
iv. Authority obedient manager ● Knowledge factors refer to ideas, concepts that can
v. Team manager be expressed
● Attitude factors relate to those beliefs, feelings that
CLASSIFICATION OF CONTEMPORARY APPROACH be used and may not be subjected to conscious
Contemporary Approach- new, recent or current verbalization
approaches in the field of management. ● Ability factor skill, art, judgment and wisdom.
● Contingency Approach-recognizes that
organization as different, which means they face Roles of a Manager
different situations and require different 1. Interpersonal Role
approaches. a. Symbol because of the position he/she
● System Approach- set of interrelated and occupies and consists of such duties as
interdependent parts arranged in a manner that signing papers
produces a unified whole. b. Leader, who hires, trains, encourage
○ Process close system: not influence by and c. Liaison officer between outside contacts
do not act with their environment 2. Informational Role
○ Open system: interact w/ environment a. Disseminates information from both
“There is no one best way to manage and organize because external and internal sources
circumstances vary.” b. Monitors information
c. Spokesperson or representative of the
Levels of Management organization
1. Top Level Manager- look at the overall operation of 3. Decisional Role
the organization. a. Problem solver, who handles unexpected
a. Coordinate internal and external affairs of situations such as resignation
organization b. Innovator/ entrepreneur, to improve
b. Makes the major decisions projects
 c. Negotiator when conflict arise DIFFERENT LEADERSHIP THEORIES
Great Man Theory (1900-1940)
LEADERSHIP VS MANAGEMENT ● Leaders are born
● Leadership- the act of influencing and motivating a ● Leaders display both instrumental and supportive
group of people to act in the same direction leadership behaviors
towards achieving a common goal ● Great leaders arise when situation demands it
● Management- the process of leading and directing Trait Theory
an organization to meet its goals through the use of ● Traits are inherent; now traits can be learn
appropriate resources. ● Identified traits: energy, affection, enthusiasm,
ambition, aggressiveness, deceit, etc.
Nursing Leadership process whereby a nurse influences Charismatic Theory
one or more persons to achieve a specific goal in the ● Leaders possess charisma; it is an inspirational
provision of quality nursing care. quality that some leaders possess that makes
others feel better in their presence
Comparison between leadership vs management Situational Theory
● Leaders need to do the right things, are challenged ● Traits required of a leader differ according to
by change, focus on purposes and have a future variables
time frame. ○ Degree of interpersonal contact possible
● Managers do right things are challenged by ○ Time pressures
continuity and focus on structures and procedures ○ Physical environment
in a present time frame. ○ Organizational structure
Managers ○ Influence of the leader outside the group
● Are assigned a position by the organization Contingency Theory (Fred Fiedler, 1960’s)
● Have a legitimate source of power due to delegated ● According to Fiedler, no leadership style is ideal for
authority every situation.
● Have specific duties and responsibilities they are ○ Leader member relation assessed
expected to carry out through group atmosphere scale
● Emphasizes control, decision making, decision ○ Task structure
analysis and results. ■ 4 criteria to determine degree of
● Manipulate people, environment, money, time and task structure
other resources ● Goal clarity
● Direct willing and unwilling subordinates ● Extent
Leaders ● Multiplicity of goal
● Often do not have delegated authority but obtain ● Specificity of solution
power through other means, such as influence ○ Position Power is the authority inherent in
● Have a wider variety of roles a position
● Focus on group process, information gathering, Path Goal Theory
feedback ● People act as they do because they expect their
● May or may not be part of formal hierarchy behavior to produce satisfactory results.
● Emphasize interpersonal relationships ● Structured activities were more productive and
● Direct willing followers successful
● Have goals that may or not reflect those of the Situational Leadership Theory (Hersey/Blanchard)
organization ● Predicts the most appropriate leadership style
from the level maturity of the followers through
four quadrant model
 ○ Horizontal continuum registers low ● Less control is maintained
emphasis on the accomplishment of ● Economic and ego rewards are used to motivate
tasks on the left side to right side ● Emphasis is on WE
○ Vertical continuum depicts low emphasis ● Criticism is constructive
on interpersonal; relationships at the Laissez-Faire leadership
bottom to high emphasis. ● Leaving workers without direction and supervision
○ Low left quadrant represents the and allows them to plan
laissez-faire type of leadership style with ● Leader uninvolved, disinterested, withdrawn
little concern for production or ● Permissive with little or no drama
relationships ● Uses upward or downward communication
Leadership Styles by Hersey & Blanchard ● Places emphasis on the group
● Directing- high task, low relationship style and is ● Does not criticize
effective when subordinates are low in motivation
and ability CONTEMPORARY LEADERSHIP
● Coaching- high task, high relationship style and is Transformational theory
effective when subordinates have adequate ● Promotes employee development
motivation but low ability ● Attends to needs and motives of followers
● Supporting- low task, low relationship style and is ● Inspire through optimism
effective when subordinates are very high in ● Influences changes in perception
ability but low motivation ● Provides intellectual stimulation
● Delegating- low task, low relationship style and is ● Encourages followers creativity
effective when subordinates are high in ability and
motivation. Servant leader- they are more concerned with the needs
Transactional Theory of others than themselves.
● Exchange posture that identifies needs of Authentic leader-in order to lead, leaders must be true to
followers and provides rewards to meet those themselves and their values and act
needs in exchange for expected performances Thought leader- applies to a person who is recognized
Behavioral Theory among his or her peers for innovative ideas
● Is a management philosophy that evaluates
leaders according to the actions they display in POWER is the ability to impose the will of one person or
the workplace. groups to bring certain behaviors in another person or
groups.
3 LEADERSHIP STYLES (Kurt Lewin et. al 1930) ● Reward power- it is the leader or manager’s
● His breakthrough occurred when he, White, and power comes from the ability to reward others for
Lippit identified with common leadership styles. complying
Authoritarian leadership ● Coercive power- based on a fear of punishment if
● Uses positional and personal power one fails to conform, an opposite of reward power
● Demanding and controlling ● Legitimate power- right of the manager or leader
● Emphasis is on difference in status to influence and the staff member an obligation
● Others are directed/ motivated with commands to accept that influence
● Criticism is punitive ● Referent power- based on identification with a
● Communications flow up and downward leader and what that leader symbolizes. The
● Decision making does not involve others leader is admired and exerts influence because
Democratic leadership the followers desire to be like the leader.
● Allows for group governance through ● Expert power- gained through knowledge, skills,
collaboration or group efforts information, experience and competence
● Situation of trust and openness
 ● Information power- comes from knowledge, ● Ex: assisting team members, giving direct
access to information, and the sharing of personal care to patients, and coordinating
information patient activities.
● Connection power- comes from formal or
informal coalitions and interpersonal relations Modular Nursing
and links to prestigious people within or outside of ● Uses a mini team. In modular nursing, patient care
the organization units are typically divided into modules or districts,
and assignments are based on the geographical
PATIENT HEALTHCARE DELIVERY SYSTEM location of patients.
Nursing process is defined as a systematic, rational ● In addition, small teams require less
method of planning and providing individualized nursing communication, allowing members better use of
care. their time for direct patient care activities.

The Patient Classification System predicts patient needs Primary Nursing

and requirements for nursing care. ● Also known as relationship-based nursing. It uses
● A PCS groups patients according to acuity of some of the concepts of total patient care or
illness and complexity of nursing activities more patients from admission or the start of
necessary to care for the patient. treatment to discharge or end of treatment.
● Also known as workload management or patient ● Disadvantages to this method lie primarily in
acuity tools, developed in 1960s improper implementation, lack of experience and
necessary skills for the role
Modalities of care
● 5 well known means of organizing nursing care for Case Management
patient care delivery; functional nursing, team ● It is defined by CMSA as a collaborative process of
and modular nursing, primary nursing, and case assessment, planning, facilitation, and advocacy
management. for options and services to meet an individual’s
● health needs through communication and
Case Method Nursing or Total Patient Care Nursing available resources to promote quality
● TPC is the oldest mode of organizing patient care. cost-effective outcomes.
It is sometimes referred to as the case method of ● Case managers often manage care using critical
assignment. pathways and multidisciplinary action plans
(MAPS) to plan patient care.
Functional Nursing ○ MAPS is a combination of a critical
● Functional method of delivering nursing care pathway and ncp. It also indicates times
evolved primarily as a result of WWII and the rapid when nursing interventions should occur.
construction of hospitals as a result of the Hilton ○ If a patient deviates from the normal plan,
Burton Act. a variance is indicated. Variance is
● Ex: checking BP, administering medications, anything that occurs to alter a patient's
changing linens, and bathing patients progress through the normal critical path.

Team Nursing CONTEMPORARY MODELS

● Ancillary personnel collaborate in providing care Also called innovative models are the newest approaches
to a group of patients under the direction of a to organizing patient care to foster patient safety and
professional nurse. As a team leader, the nurse is quality outcomes.
responsible for knowing the condition and needs ● Professional Nursing Practice Model- provides a
of all patients assigned to the team and for framework for guiding and aligning clinical
planning individual care. practice, education, administration, and research
 in order to achieve positive patient and nurse staff ORGANIZATIONAL THEORY AND BUREAUCRACY
outcomes. Max Weber is known as the father of organizational theory.
● Differentiated Nursing Practice Model- this model According to him, bureaucracy is an institutional method
is differentiated based on the level of education, for applying general rules to specific cases.
competence, and clinical expertise of RNs Other characteristics of bureaucracy are:
● Clinical Nurse Leader Model- was developed with ● Must be clear division of labor
the goal to improve the quality of patients across ● Well defined hierarchy of authority must exist
the continuum and as a way to engage highly which separates superiors from subordinates.
skilled clinicians in outcome-based practice and ● Must be impersonal rules and impersonality of
quality improvement. interpersonal relationships
● Synergy Model for Patient Care- this model fosters ● A system of procedures for dealings with work
effective communication and collaboration in situations must exist
achieving optimal, realistic patient and family ● System of rules covering rights and duties
goals. It includes 8 patient characteristics ● Selection for employment and promotion based
○ Resiliency on technical competence.
○ Vulnerability Organizing is the process of establishing formal authority
○ Stability and involves setting up the organizational structure
○ Complexity through identification of groupings, roles, and
○ Resource relationships.
○ Availability ● Organizational chart is a line drawing that shows
○ Participation in care how the parts of an organization are linked. It
○ Participation in decision making depicts formal organizational relationships etc.
○ predictability
● Transforming Care at the Bedside- the goal is to NATIONAL NURSING CARE COMPETENCY STANDARDS
empower nurses and other healthcare team ● The development of NNCCS for nursing practice
members to redesign work processes to improve started in 2001 through the initiative of the
the quality of patient care and decrease turnover PRC-BON and was completed in 2005
● Patient and Family Centered Care Model- places ● PRC Chair T.R, Manzale stated that it emphasize 3
an emphasis on collaboration and planning care roles of nursing; beginning
with patients of all ages, at all levels of care, and ○ Beginning nurse’s role on client
in all healthcare settings. ○ Beginning nurse’s role on management
and leadership
FORMAL AND INFORMAL ORGANIZATION STRUCTURE ○ Beginning nurse’s role in research
● Organizations are essential because through
organizations, collective effort is more effective Goals and Objectives of the project
that individual effort. This goal blended well with the goal of the International
● Formal structure; managerial authority, Labor Organization (ILO) project to improve nursing
responsibility, and accountability is clearly education and practice.
defined. ● Establish the team and system for implementing
● Informal structure; the channel that fills in the the project
gaps with connections and relationships that ● Develop and implement the training design and
illustrate how employees network with one materials aligned with the revised NNCCS
another to get the work done. competences.
○ Grapevine is the communication network ● Pilot the training course in LuzViMin
used in informal structures. (heart of ● Recommend strategies to address sustainability
informal) concerns.
Significance d. Authority and competency
● Basic Nursing Education Program in the PH e. Formulate standards of what is expected
through CHED f. Enforce the standards
● Competency based test framework development 3. Reporting System- NPSC shall develop and
of course syllabi and test questions institutionalize a proactive reporting and learning
● Standards of professional nursing practice in system
various setting in the PH 4. Feedback & Communication
● All related evaluation tools in various practice a. Communicate leadership responses
setting in the PH b. Reports shall be established
c. Demonstrate commitment
10 KEY PHASES d. Patient safety and ensure continuous
1. Work setting scenario improvement
2. Validation studies of roles and responsibilities 5. Adverse Event Prevention & Risk Management
3. Integrative review of outputs from the validation a. Risk and reduction strategies through
strategies patient
4. Core competency consensual validation b. Risk assessment
5. Conduct of public hearing c. Patient feedback survey health
6. Promulgation of the revised and modified core technology and safety assessment code
competency standards. 6. Disclosure of Reported Serious Events
7. Printing of the revised and modified core a. Reporting system ensures confidentiality
competency standards b. Events can be made available to the
8. Training in the implementation of the revised core public through
competency standards i. Disclosure of results of
9. Implementation of core competency standards investigation
10. Evaluation of effectiveness of the revised core ii. Summary reports
competency standards 7. Professional Development
a. Training and supervision of the staff to
Patient Care Safety Standards improve their decision and clinical
● Nurses are vital members of the team. judgments is imperative
● It is important for nurses to know what proven b. It is necessary to instill standard norms of
techniques and interventions they can use to behavior of courtesy, promptness and
enhance patient and organizational outcomes. efficiency
● Safety is one aspect of quality where it includes 8. Patient Centered care and Empowerment of
not only avoiding, preventable harm but also Consumers
making appropriate care available. a. Patients must be all centered of patient
safety initiatives
Key elements of Patient Safety b. Patient centered care and patient safety
1. Leadership- Leadership and political commitment is a national priority and a core agenda
are essential at the health facility where patient i. To improve quality care in all
safety becomes an integral component of quality health
care ii. Protect patients from faulty
2. Institutional Development- approaches to system
institutionalize patient safety and quality in the
health facilities will have to consider the following: Importance of Safety in Healthcare
a. Financial and human resource 1. Improve patient satisfaction
b. Facility and equipment management 2. Ensure accuracy of patient’s identification
c. Strengthen management responsibility 3. Enhance effectiveness of communication
 4. Improve the safety of using medications Standard 4. Planning
5. Reduce risk of infections ● RN develops a plan that prescribed strategies and
6. Reduce risk of harm resulting to injuries alternatives to attain expected outcomes
7. Improve staff productivity Standard 5. Implementation
8. Increase awareness of occupational health and ● S5a. coordination of care
environmental control ● S5b. health teaching and health promotion
9. Workers must be trained ● S5c. consultation
10. Strong ergonomics integration prevents injuries ● S5d. prescriptive authority and treatment
and increases productivity Standard 6. Evaluation
● RN evaluates progress toward attainment of
5 ways to improve Staff Safety in Healthcare outcomes
1. Promote a culture of safety Standard 7. Ethics
2. Measure the performance of safety protocols ● RN practice ethically
3. Optimize staff scheduling Standard 8. Education
4. Improve patient handling ● RN attains knowledge and competence
5. Use safer medical equipment Standard 9. Evidence based practice and research
● RN integrates evidence and research findings into
Nursing Actions to Improve Patient Safety practice
1. Knowledge and implementation about healthcare Standard 10. Quality of Practice
policies and procedures ● RN contributes to quality nursing practice
2. Open communication and teamwork Standard 11. Communication
3. Review the medication rights before giving ● RN communicates effectively in all areas
4. Engage in creating and updating reporting Standard 12. Leadership
system ● RN demonstrates leadership in professional
5. Involve in research and evidence-based activities setting
6. Be updated on all life-saving certification Standard 13. Collaboration
7. Engage in hospital committees ● RN collaborates with healthcare consumer, family
8. Be responsible in reporting all errors and near Standard 14. Professional practice evaluation
misses ● RN evaluates her own nursing practice
9. Ensure better lighting and less clutter in the work Standard 15. Resource utilization
areas. ● RN utilizes appropriate resources to plan and
provide nursing services are safe, effective and
Standards of Professional Nursing Practice (ANA, 2015) financially responsible
Standard of Practice describes a competent level of Standard 16. Environmental health
nursing as demonstrated by the critical thinking model ● RN practices in an environmentally safe and
known as the nursing process. healthy manner

Standard 1. Assessment CODE OF ETHICS FOR RNs (BON)

● The RN collects comprehensive data pertinent to ● Board Resolution No. 220, Series of 2004 approved
the healthcare consumer’s health and situation last July 14, 2004
Standard 2. Diagnosis
● RN analyzes the assessment data to determine CODE OF ETHICS FOR NURSES
the diagnoses or issues. ● The BON has the power to promulgate a Code of
Standard 3. Outcomes identification Ethics for RNs in coordination with the accredited
● RN identifies expected outcomes for a plan professional organization(Sec. 9), Article III R.A No.
individualized 9173, known as the Philippine Nursing Act of 2002
R.A 9173 Philippine Nursing Act of 2002 5. Unenforceable contract- cannot be enforced is a
● Consist of 9 articles and 41 sections valid contract in law, but is incapable of proof, and
therefore cannot be enforced in the Court of Law
The International Council of Nurses Code of Ethics for 6. Executed contract- where both parties have
Nurses performed their obligation
● An international code of ethics for nurses was first 7. Executory contract-neither party to the contract
adopted by the ICN in 1953 has performed his share of the obligation
● It has been revised and reaffirmed at various 8. Express contract- when the terms of contract are
times since, most recently with this review and reduced in writing or are agreed upon spoken
revision completed in 2012 words at the time of its formation.
9. Implied contract-terms are inferred from the
The four principal elements that outline the standards of conduct or dealing between the parties.
ethical conduct 10. Quasi contract- raise out of obligation enjoyed by
● Nurse’s and people one person from the voluntary acts of the other
○ Nurse’s primary professional responsibility which are not intended to be performed
is to people requiring nursing care gratuitously.
● Nurse’s and practice 11. Contingent contract- which is a promise is
○ Nurses carries personal responsibility and conditional and the contract shall be performed
accountability for nursing practice only on the happening of some future uncertain
○ Maintaining competence by continual even illustrations
learning
● Nurse’s and the profession Requisites Of A Contract
○ The nurse assumes the major role in: 1. Two or more people must participate.
determining, and implementing 2. The parties involved must give consent to the
acceptable standards of clinical practice, contract.
management, research & education 3. The object which is the subject matter of the
● Nurse’s and co-workers contract must be specified
○ The nurse sustains a collaborative and 4. The cause of obligation is established
respectful relationship with co-workers in 5. Contracting parties must have the legal capacity
nursing and other fields. to enter into a contract

Contract Inexistent Contract

● Is a meeting of minds between two people 1. Those whose cause, object or purpose are
whereby one binds himself, with respect to the contrary to law.
other. 2. Those whose cause or object did not exist from
the time of transaction
Kinds of Contract 3. Those whose object is outside the commence of
1. Formal contract- refers to an agreement among man
parties involved and is required to be in writing by 4. Those which contemplates an impossible service
some special laws 5. Those were the intention of the parties relative to
2. Informal contract- concluded as a result of a be principal object cannot be as certain
written document or correspondence 6. Those expressly prohibited or declared void by law
3. Voidable contract- enforceable by law at the 7. Those which are absolutely simulated or fictitious
option of one or more parties, but not at the
option of the other/s.
4. Void contract- is a nullity from its inception. No
rights accrue there under.
Voidable Contract Oral Wills, Nuncupative Wills, and Deathbed Wills
1. Those contracts wherein one of the parties is ● It is spoken rather than written. This will is usually
incapable of giving consent to a contract made before witnesses
2. Those whose content is vitaled by mistake,
violence, intimidation, undue influence or fraud. Nuncupative Wills or Noncupation
● Have at least 2 witnesses and meet specific
Illegal Contracts statutory requirements.
1. Those that are made in the protection of law
2. Consent obtained by fraud Testamentary Capacity And Intent
3. Those obtained under duress ● The testator must have the expressed intention of
4. Those obtained under the influence making a will. He must be of the right age.
5. Those obtained through material ● The testator shall name the person who will be in
misinterpretation charge of carrying out the provisions of the will.
● Properties must be disposed of in accordance
Breach of Contract with legal requirements.
1. Prevention of performance ● The will must be signed by the testator, attested,
2. Failure to perform because of inconvenience or and signed by at least three witnesses in his
difficulty presence and of one another.
3. Abandonment of duty ● Every will must be acknowledged before a notary
4. Going off duty without endorsement public by the testator and witnesses.
5. Substitution of performance ● Witnesses to the wills shall be of sound mind, 18
6. Failure to use due care years of age or more, not blind, deaf or dumb, and
able to read and write.
Advantages of Written Contracts ● A married woman may make a will without the
● It avoids uncertainty of human memory consent of her husband and without the authority
● It can specify a definite time within which it is of the court.
binding so as to protect both parties against
sudden changes without notice. The Nurse’s Obligations In The Execution Of A Will
● It sets a standard and relieves an individual ● They Should note the soundness of the patient's
professional person from hanging over mind
compensation ● There was freedom from fraud or undue influence
● It is definite ● The patient was above 18 years of age. He/she
● It can provide definite procedure in case of should note that the will was signed by the
complaints testator, that the witnesses were all present at the
● It creates a minimum of certainty and security for same time and signed the will in the presence of
the professional employee the testator.
● Definite commitments stipulated in a contract are
hours of works and salary Gifts
● The gift must consist of personal property
Will ● There must be an intention to make the gifts;
● Is a legal declaration of person’s intention upon ● There must be an indication of transfer of control
death; called a testamentary over such property; and
● There must be acceptance by the recipient
Holographic Will ● Gifts made by a person because of anticipation of
● Must be entirely written, dated and signed by the death or belief in approaching death are called
hand of the testator himself gifts causa mortis or donatio causa mortis.
Legal Procedure And Trial qualified to testify based on special knowledge,
● In a trial, the judicial procedure is to ascertain skill, experience, and training.
facts by hearing evidence, determine which facts ● Dying declarations or ante-mortem statements
are relevant, apply the appropriate principle of are considered hearsay evidence except when
law, and pass judgment. made by a victim of a crime.

Commencement Of The Action Appeals

● The first step in the trial process is to determine ● An appellate court reviews the case, and when the

what kind of legal action to take. If the action case is decided by it, the final judgment results

relates to negligence, the correct action would be and the matter is ended.

negligence; and if it related to contract, the proper

action would be for breach of contract. CONSENT TO MEDICAL AND SURGICAL PROCEDURES
● Consent is defined as a “free and rational act that

Pleading presupposes knowledge of the thing to which

● First pleading is generally known as the complaint consent is being given by a person who is legally

or petition. In less serious crimes known as capable of giving consent.

misdemeanor, these pleadings are called

complaints while in crimes of more serious nature Nature of Consent

known as felonies, the pleadings are called ● Consent is an authorization, by a patient or person

indictments. authorized by law to give the consent on the

patient's behalf, that changes touching, for

Pre-Trial Procedures example, from non-consensual to consensual.

● This is an informal discussion between the judge

and attorney to eliminate matters not in dispute, Informed Consent

agree on issues, and settle procedural matters ● Haytand Hayt states that “it is an established

relating to the trial. Cases are often settled at this principle of law that every human being of adult

point. years and sound mind has the right to determine

what shall be done with his own body.

Trial
● At the trial, facts of the case are determined, the Essential Elements:

principles of law relating to those facts are ● the diagnosis and explanation of the condition

applied and a conclusion as to liability is reached. ● A fair explanation of the procedures to be done

The judge determines the facts and applies the and used and the consequences of

law. ● A description of alternative treatments or

procedures
Witness ● A description of the benefits to be expected
● Material rights if any
● Subpoena a court summons is served directing a ● the prognosis, if the recommended care,
witness to appear and give testimony on the date procedure, is refused
and time ordered.
● Subpoena duces tecum is served to a witness Proof Of Consent
requiring him to bring records, papers, and the like ● A written consent should be signed to show that
which may be in his possession and which may the procedure is the one consented to and that
help clarify the matter in issue. She should testify the person understands the nature of the
only on what she knows based on facts. This is procedure, the risks involved and the possible
called testimony of facts. consequences.
● Testimony of opinion may only be given by expert
witnesses. An expert witness is one who is
Who Must Consent? Intentional Wrongs
● Ordinarily, the patient is the one who gives ● Tortious acts that a nurse may be held liable
consent on his own behalf. However, if he is which arise in performance of her duties
incompetent or physically unable and is not an
emergency case, consent must be taken from Negligence
another who is authorized to give it on his behalf. ● Refers to the commission or omission of an act,
pursuant to a duty, that a reasonably prudent
Consent of Minors person in the same or similar circumstances
● Parents or someone standing in their behalf, ● If a person charged with negligence shows that
she meets or even surpasses this standard, then
Consent of Mentally ILL there is no negligence or carelessness. But if the
● A mentally incompetent person cannot legally defendant’s action fails to meet the standard,
sign; consent must be taken from the parents or then there has been negligence.
legal guardian.
Elements of professional Negligence
Emergency Situation ● Existence of a duty
● No consent is necessary because inaction at such ● Failure to meet the standard of due care
time may cause greater injury. ● Foreseeability of harm
● Injury to the plaintiff
Refusal to Consent
● A patient who is mentally and legally competent Examples of Negligence
has the right to refuse the touching of his body or ● Mistaken identity
to submit to a medical or surgical procedure no ● Wrong medicine, wrong concentration, wrong
matter how necessary, nor the imminent danger route, wrong dose
to his life or health if he fails to submit to ● Defects in the equipment such as stretchers and
treatment. wheelchairs may lead to falls thus injuring the
patients
Consent for Sterilization ● Administration of medicine w/o a doctor’s
● The husband and the wife must consent to the prescription
procedure if the operation is primarily to ● Errors due to family assistance
accomplish sterilization.
Civil Code, Article 19
Charting Done By Nursing Students ● One shall act with justice, give every man his due,
● When a nurse or a clinical instructor countersigns observe honesty and good faith.
the charting of a nursing student, he/she attests Civil Code, Article 20
that he/she has personal knowledge of ● Those who, in the performance of their obligations
information and that such is accurate and through negligence cause any injury to another,
authentic. Anyone who countersigns without are liable for damages.
verification commits herself to possible legal risks.
3 conditions required to establish a defendant’s
PROFESSIONAL NEGLIGENCE AND MALPRACTICE negligence
Standard ● Injury was of such nature that it would not
● Desired and achievable level of performance normally occur unless there was a negligent act
against which actual practice is compared. on the part of someone
● Serves as benchmark against which to plan, to ● Injury was caused by an agency w/in control of
implement and assess quality of services the defendant
 ● Plaintiff himself did not engage in any manner Liability Of Nurses For The Work Of Nursing Aides
that would tend to bring about the injury ● Nurses should not delegate their functions to
nursing aides
Doctrine Of Res Ipsa Loquitur “the thing speaks for itself” ● Nurses are enjoined to supervise their
● the injury could not have happened if someone subordinates and see to it that they perform only
was not negligent that no further proof is required. those which they have been taught to do and
those which they are capable of doing.
Malpractice ● Nursing aids are responsible for their actions
● Improper or unskillful care of the patient by a ● Nursing aides perform selected nursing activities
nurse; also denotes stepping beyond one’s under the direct supervision of nurses.
authority with serious consequences
● Term of negligence of professional personnel Liability For The Work Of Nursing Students
● Used properly only when it refers to a negligent ● RA 9173 –nursing students do not perform
act committed in the course of professional professional nursing duties.
performance ● Nursing students should be under supervision of
their clinical instructors.
Doctrine Of Force Majeure ● In order that the errors committed by nursing
● An Irresistible force, one that is unforeseen or students will be avoided or minimized, the
inevitable. following measures should be taken:
● Under the Civil Code of the Philippines, no person ○ They should be given assignments that
shall be responsible for those events which are their level of training experience and
cannot be foreseen, or which, though foreseen, competency.
are inevitable, except in cases expressly specified ○ They should be advised to seek guidance
by law. if they are performing a procedure for the
first time.
Doctrine Of Respondeat Superior ○ They should be oriented to the policies
● “Let the master answer for the acts of the where they are assigned.
subordinate.” ○ Their performance should be assessed
● The liability is expanded to include the master as frequently to determine their strengths
well as the employee and not a shift of liability and weaknesses.
from the subordinate to the master.
Note: Private duty nurses, however, are considered Legal Defense in Negligence
independent contractors. They are liable for their own ● When Nurses know and attain the standard of
negligent actions. care giving service and that they have
documented the care they give.
Incompetence ● If the patient’s careless conduct contributes to his
● Lack of ability, or legal qualifications and being own injury.
unfit to discharge the required duty. It is a ground
for the revocation and suspension of her Advocacy
certificate of registration. ● Helping others grow and self-actualize by
informing them of their rights and ascertaining
Liability For Work Of Nurse Trainees And Nurse Volunteers that they have the right information on which to
● Nurses are responsible and accountable for their base their decisions.
practice, nurse volunteers should exercise utmost
caution, critical thinking and independent
judgment to prevent incurring liabilities which
may be hard to get out of.
The Code of Ethics for Registered Nurses, Sec. 8 and Sec. 9 3. Preparation, administration, monitoring and
Guidelines to be Observed: termination of intravenous solution such as
1. Registered nurses are the advocates of the additives, intravenous medications, and
patients. intravenous push
2. Nurses should be able to advocate for themselves 4. Administration of blood/blood products as
and the profession. ordered by physicians
5. Recognition of solution and medicine
Medical Orders, Drugs, And Medications Ra 6675 incompatibilities
● Only validly registered medical, dental and 6. Maintenance and replacement of sites, tubing’s,
veterinary practitioners, whether in private dressings in accordance with established
institutions, corporations or in the government, are procedures
authorized to prescribe drugs. 7. Establishment of flow rate of solutions, medicines,
● Requires that the drug be written in their generic blood and blood components
names. 8. Utilization of thorough knowledge and proficient
● Only when these orders are legal writing and bear technical ability in the use/care, maintenance,
the doctor’s signature thus the nurse has the legal and evaluation of intravenous equipment
right to follow them. 9. Nursing management of TPN, outpatient
● The nurse must not execute an order if she is intravenous care
reasonably certain it will result in harm to the 10. Maintenance of established infection control and
patient. aseptic nursing interventions
11. Maintenance of appropriate documentation
Pharmacy Actra 5921 associated with the preparation, administration
All prescriptions must contain the following information: and termination of all forms of intravenous the
● Name of the prescriber therapy
● Office address
● Professional registration number Telephone Orders
● Professional tax receipt number ● Only in an extreme emergency and when no other
● Patient’s/client’s name, age, sex resident or intern is available should a nurse
● Date of prescription receive telephone orders.
● The nurse should read back such an order to the
Intravenous Therapy And Legal Implications physician to make certain the order has been
● Philippine nursing act of 1991 section 28 “ correctly written.
● in the administration of intravenous injections, ● Such an order should be signed by the physician
special training shall be required according to on his next visit within 24 hours.
protocol established”.
● Basis of nurse’s legal right to give IV injection. Medical Records
● BON resolution no. 8 states that any registered ● Supplies rich material for medical and nursing
nurse without such training and who administers research
IV injections to patients should be held liable, ● Serves as a legal protection for the hospital,
either criminally or administratively or both. doctor, and nurse by reflecting the disease or
condition of the patient and his management.
Scope Of Duties And Responsibilities In Intravenous ● “if it was not charted, it was not observed or done”.
Therapy ● Nurses are expected to record fully, accurately,
1. Interpretation of the doctor’s orders for legibly and promptly their observations from
intravenous therapy admission to the time of the patient’s discharge.
2. Performance of venipuncture, insertion of needles, ● Nurses are legally and ethically bound to protect
cannulas except TPN and cut down the patient’s chart from unauthorized persons
Charting Done By Student Nurses - He/she directly forces or induces others to commit the
● When a nurse or clinical instructor counters signs act.
the charting of the nursing student, he/she has - Considered as the mastermind of the crime: principal by
personal knowledge of information and that such inducement
is accurate and authentic.
● Anyone who countersigns without verification Accomplices
commits herself to possible legal risks. ● Cooperates in the execution of the offense by
previous or simultaneous act and has knowledge
Crimes Affecting Nursing Practice/ Registered Nurses of the criminal intention of the principal
TORT - A tort is a legal wrong, committed against a person
or property independent of a contract which Accessory
renders the person who commits it liable for damages in a ● Have knowledge of the commission of the crime
civil action. ● Take part subsequent to its commission by
● Assault- imminent threat of a harmful or offensive profiting themselves or assisting the offender to
bodily contact/ Verbal threat profit from the effects of the crime
● Battery- intentional, unconsented touching of ● Provides exit strategy
another person
● False Imprisonment or Illegal Detention- Criminal Actions
unjustifiable detention of a person without legal ● Deals with acts or offenses against public welfare.
warrant within boundaries fixed by the defendant These vary from minor offenses and
by an act or violation of duty intended to result in misdemeanors to felonies.
such confinement
● Invasion of Right to Privacy and Breach of Misdemeanor
Confidentiality ● Punishment is usually fine or imprisonment in term
○ Privacy relates to a person or identity. of less than one year
○ Confidentiality relates to data or
information about an individual. Felony
● Defamation- Character assassination, be it ● A felony Is committed with deceit and fault.
written or spoken ● Deceit exists when the act is performed with
○ Slander –oral or spoken defamation deliberate intent and there is fault when the
○ Libel –written defamation wrongful actsresult from imprudence, negligence,
or lack of skill or foresight.
Crimes, Misdemeanors, And Felonies
Crime Criminal Negligence may be classified into:
● Defined as an act committed or omitted in ● Reckless Imprudence when a person does an act
violation of the law or fails to do it voluntarily but without malice, from
● 2 elements: which material damage results immediately.
○ criminal act ● Simple Imprudence the person or nurse did not
○ evil or criminal intent use precaution and the damage was not
immediate or the impending danger was not
Conspiracy to commit a crime evident or manifested immediately.
● Conspiracy to commit a crime exists when 2 or
more persons agree to commit a crime or felony Criminal Intent
and decide to do it. They can be classified as: ● State of mind of a person at the time of the
Principal criminal act is committed. The person is aware
- Has committed a direct part in the execution of the act. that the actis unlawful but commits it anyway.
Deliberate intent includes two elements without
 which can be no crime. These are freedom and Homicide
intelligence. ● killing of a human being by another. It may be
committed without criminal intent by any person
Classified according to the degree of the acts of execution who kills another other than his family without any
● Consummated- when all the elements necessary of the circumstances attendant the crime of
for its execution and accomplishment are present. murder being present.
● Frustrated- when the offender performs all the Abortion
acts or execution which will produce the felony as ● expulsion of a product of conception before the
a consequence but which nevertheless, do not age of viability..
produce it by reason of causes independent of
the will of the perpetrator. Infanticide
● Attempted- when the offender commences the ● killing of a child less than 3 days of age.
commission of the same directly by overt acts
due to unforeseen circumstances there was no Parricide
complete execution to produce the desired felony. ● crime committed when one kills his/her father,
mother or child whether legitimate or illegitimate,
Felonies classified according to the degree of punishment his/her ascendants or descendants or his spouse.
● Grave felonies- those to which the law attaches
the capital punishment (death) or penalties which Robbery
in any of their periods ● crime against person or property of taking
● Less Grave felonies- law punishes with penalties personal property of another person
which in their maximum period are correctional
● Light felonies- those infractions of law for the Controlled Substances Ra 6425 (Dangerous Drugs Act Of
commission of which the penalty of arresto menor 1972)
● covers administration and regulation of
Criminal Liability manufacture, distribution and dispensing of
● Nurse may incur criminal liability or subject herself controlled drugs.
to criminal prosecution either by committing a ● Authorized persons to prescribe or dispense these
felony or by performing an act which would be an drugs require to register and have a special
offense against person or property. Ignorance of license for this purpose.
the law is not an excuse for failure to comply ● Controlled drugs are kept in locked cabinets and
therewith. are documented and counted every shift
● Violators of the criminal law cannot escape
punishment on the ground of ignorance of the Simulation Of Birth, Substitution Of One Child For Another
law. Or Abandonment Of Legitimate Child
● Simulation of birth –one who enters in a birth
Moral Turpitude certificate a birth that did not occur. It is a crime
● act of baseness, vileness or depravity in social or against the civil status of a person.
public duties which a man owes to his fellow man ● Substitution of one child for another or concealing
or to society in general. It is contrary to the or abandoning any legitimate child with intent to
accepted and customary right and duty between cause such a child his/her civil status
men.
Murder Things to remember in order to avoid criminal liability
● unlawful killing of a human being with intent to kill. 1. Be very familiar with the Philippine nursing law.
2. Beware of laws that affecting nursing practice
 3. At the start of employment, get a copy of your job ● Identification phase- The development of a
description, the agency’s rules, regulations and nursing care plan is performed in this phase.
policies. ● Exploitation phase- Utilizes professional
4. Upgrade your skills and competence assistance for problem-solving alternatives/
5. Accept only such responsibility that is within the implementation
scope of your employment and your job ● Resolution phase- This is the termination of the
description. professional relationship after the patient’s needs
6. Do not delegate your responsibilities to others. have been met/ evaluation
7. Determine whether your subordinates are
competent in the work you are assigning them. Barriers to Communication among Healthcare Providers
8. Develop good interpersonal relationships with and Healthcare Recipients
your co-workers, whether they be your Schwarts, Lowe, & Sinclair (2010) identified many
supervisors, peers or subordinates. challenges that impede communication in the healthcare
9. Consult your superior for problems that may be setting.
too big for you to handle. ● Low Health Literacy – individuals who lack the
10. Verify orders that are not clear to you or those skills necessary to acquire and use healthcare
that seem to be erroneous. information are less likely to manage their chronic
11. The doctors should be informed about the conditions and/or medication regimens
patient's conditions. effectively.
12. Keep in mind the values and necessity of keeping ● Cultural Diversity – Culture affects
accurate and adequate records13. Patients are communication in how the content is conveyed,
entitled to an informed consent. emphasized, and understood
● Cultural Competence – This affects the way\y
MODELS AND THEORIES OF COMMUNICATION healthcare providers interact with each other and
● Transmission Model of Communication describes with the populations they service.
communication as a linear, one-way process in ● Interprofessional Communication Education of
which a sender intentionally transmits a message Healthcare Providers – use of concepts and
to a receiver (Ellis & McClintock, 1990). terminology common to once specific discipline
● Interaction Model of Communication describes but not well understood by members of other
communication as a process in which professions.
participants alternate positions as sender and
receiver and generate meaning by sending Written Communication within the Organization
messages and receiving feedback within physical Although many forms of communication take place in
and psychological contexts (Schramm, 1997). organizations, written communication is the most used in
● Transactional Model of Communication describes large organizations.
communication as not an exchange of messages, 1. Memo Writing- written communication used most
but also as a way to create relationships by managers in their daily work life is the memo.
Perkins and Brizee (2013) suggest that business
Peplau’s Theory of Interpersonal Relations. memos have a twofold purpose: they bring
● Hildegard Peplau defined nursing as an attention to problems and they solve problems.
“interpersonal, therapeutic process that takes
place when professionals, specifically educated to Business memos, according to Perkins and Brizee (2013)
be nurses, engage in therapeutic relationships suggest that business memos should be composed of the
with people who are in need of health services.” following components:
○ Orientation phase- The nurse assess the ● Header (includes the to, from, date, and subject
patient, patient seeks assistance, lines
 ● Opening, context, and task (includes the purpose Telephone Reports
of the memo, the context and problem, and the ● Information given through telephone should be
specific assignment or task) accurately transcribed by the receiving nurse in
● Summary, discussion segment (the details that written form
support your ideas or plan) ● There are legal risks in telephone orders.
● Closing segment, necessary attachments (the ○ These may be misunderstood or
action that you want your reader to take and a misinterpreted by the receiving nurse.
notation about what attachments are included) ○ They may sound unclear because of
some trouble in the telephone line.
2. Meeting Minutes- are notes or records, usually ○ the signature of the ordering physician is
taken by the secretary that contains the details of not affixed in the order and may be
what transpired in a meeting, the issues that were denied in case errors exist or when court
discussed, motions proposed, and any votes litigations arise.
taken. ● Nurses should only receive telephone orders only
Purpose of Meeting Minutes in extreme emergencies and when there is no
● Meeting minutes are used to capture important other resident or medical intern available.
details in a meeting. Boards will often refer to ● The nurse should read back the order to the
meeting minutes to make future decisions about physicians to make sure that the order received is
how to move forward with decisions or new correct.
projects. ● The order must be signed by the ordering
Steps on How to Record Meeting Minutes physician once he/she returns to the hospital.
1. Plan and outline. ● The nurse should note the date and time when the
2. Record taking at the meeting. order was made , when he/she wrote the order,
3. Writing the minutes. the name of the physician making the order, then
4. Submission and approval. sign his/her own name, including designation.
5. Distribution of meeting minutes.
Transfer Reports
Reports in Nursing ● the patient may be transferred to the surgical
According to Venzon, reports are oral, taped or written department for further management after proper
exchanges of information between nurses and/pr referral and assessment of a surgeon.
members of the health team. ● A patient may also be transferred to another
● Change-of-Shift Reports. This is a system of agency after proper referral and coordination.
communication aimed at transferring essential ● The transfer report accompanies the patient and
information and holistic care for patients. contains information that the receiving nurse
○ Oral Report – Prior to the nursing rounds, a needs to know for continuity of care.
pre-conference is made at the nurses’ ● An oral report is usually made by the
station or conference room. accompanying nurse so that additional
○ Audio-tape Report – This is made by the information can be made or clarified.
outgoing nurse and is relayed by the
incoming nurse. Preparation and Conduct of Meetings
○ Nursing rounds – These are made at the As discussed by Cherry & Jacobs (2014), the following
patient’s bedside. The patient’s care plan steps must be undertaken to manage effective meetings.
is discussed. This enables the patient and Pre-meeting Work
his family to participate in the discussion, 1. Determine the specific purpose(s) for the meeting
pose questions or seek clarifications. 2. Create a list of meeting topics, such as “revisions
to nursing handbook” or “new admission policy.”
 Create a fact sheet related to each topic to
distribute with the agenda.
3. Determine the meeting attendees4
4. Determine the date, time, and location for the
meeting, and invite attendees.
5. Create the meeting agenda.
a. Title of the group meeting
b. Date, time, and location of the meeting
c. Purpose(s) for the meeting in sentence
form
d. Agenda items, time allotted for each item,
and person responsible for reporting on
each item.
6. Send the meeting agenda out at least 1 week
before the meeting so that attendees come
prepared.

During the Meeting

1. Ensure that the participants’ comfort needs are
met by arranging the seating in an oval or circular
shape and preferably around a table
2. Ask for volunteers to fulfill the following roles.
a. Leader
b. Timekeeper
c. Recorder
3. The leader guides the meeting by:
a. Processing one agenda at a time.
b. Allowing the timekeeper to do his or her
job to keep the meeting on track.
c. Debriefing the end of the meeting

Patient Satisfaction and Customer Service Provider

Customers can be categorized as external and internal,
depending on their relationship to the organization.
● External customers are not employed by the
organization and include patients and families, in
addition to physicians and others who serve as
referral sources for new patients.
● Internal customers are employed by the
organization and may include patient care staff
members, staff members of other departments
(laboratory, dietary), administrators, social
workers, dietitians, and therapists.