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MSN I: BIOETHICS

                   DEMELU D. MONTA, RN, MPA
What is the relationship between
    ETHICS and the LAW?
  Are all laws ethical and just?
System of process for of
 A formal binding rules
  makingor conduct that
   action logical and
Individuals’ cognitive
 consistent decisions of
  governs the behavior
 examination of right
    people in respect to
  based upon moral
  and wrong & good
 relationships with others
         beliefs.
and with thebad.
        and government.
FUNCTIONS OF LAW IN
                     SOCIETY
               • To define relationships
                 among members and to
                 declare which actions are
                 permitted and not
                 permitted
Latin:   Lex   • To describe what
                 constraints may be applied
                 to maintain rules, and by
                 whom they maybe applied
               • To furnish solutions to
                 problems
               • To redefine relationships
                 between people when
                 circumstances of life
                 change.
CHARACTERISTICS OF LAW
               1. Authority or the
                  right to declare the
                  rule exists
               2. That such rule is
Latin:   Lex      pronounced or
                  expressed and that
                  its source can be
                  identified
               3. Right to enforce
                  DECLARED IN
                  WRITING & is
                  OBLIGATORY
CHARACTERISTICS OF LAW
               • The law establishes
                1. Authority or the
                 rules that define our
                   right to declare the
                 rights and
                   rule exists
                 obligations, and sets
                2. That such rule is
                 penalties for those
Latin:   Lex       pronounced or
                 who violate them.
                   expressed and that
                   its source can be
               • Law can serve as the
                   identified
                 public’s instrument
                3. Right to enforce
                 for converting
                     DECLARED IN
                 morality into clear-
                     WRITING & is
                 cut social guidelines.
                   OBLIGATORY
MARTIN LUTHER KING, JR.
Hindi
 makatao
ang batas!                      Hindi
                             makatarungan
                              ang batas!




 What is the relationship between
     ETHICS and the LAW?
    Are all laws ethical and just?
DEONTOLOGY vs. UTILITARIANISM: TRIAGE
  Is the law dealing with expectant tags ethical?




  “Do your sworn duty.                       “Do the greatest good
     The rightness &                        for the greatest number
  wrongness of an act                              of people.”
depends upon the nature
 of the act, rather than
   the consequences.”
Are all laws ethical?
                                 REASONS FOR THE
                                    DISCREPANCY:
                               Differences between
                                ethical points of view:
       Usually… but not         deontology & utilitarianism.
  necessarily true. Some       Human behavior and
laws can be considered to       motivation are more
   be unethical and some        complex than can be fairly
illegal acts are considered     reflected by law.
   by many to be ethical.      The legal system judges
                                action rather than
                                motivation.
                               Laws change (ex. Rape –
                                RA 8353 & DofD, RH Bill,
                                Abortion).
 To ensure that the nurse’s decision and actions are
    consistent with current legal principles.
   To protect the nurse from liability.

FUNCTIONS OF LAW IN NURSING  YES!
  It provides a framework for establishing which nursing actions in the care of
   clients are legal.
  It differentiates the nurse’s responsibilities from those of other health
   professionals.
  It helps establish the boundaries of independent nursing action.
  It assists in maintaining a standard of nursing practice by making nurses
   accountable under the law.
NURSING JURISPRUDENCE
 JURISPRUDENCE
  Juris + Prudentia
                           is defined as a branch of law
        Latin               which deals with the study of
                            nursing laws, lawsuits,
        Juris
       Law or               liabilities, legal principles,
  legal knowledge           rules and regulations, case
                            laws and doctrines affecting
     Prudentia
   one who behaves          the nursing practice.
  prudently or wisely
    because he has
   knowledge of the
possible consequences
 of a particular action
General or        Individual or
KINDS OF LAW             Public Law        Private Law

                           International
                                               Civil Law
                                Law

       Divine Law
      Law promulgated     Constitutional       Mercantile
       by our Creator         Law                Law



                          Administrative      Procedural
                              Law                Law
       Human Law
       Law promulgated
           by man to
        regulate human    Criminal Law
            relations


                          Religious Law
“Ignorance of the law
     excuses no man;
 Not that all men know
the law, but because „tis
   an excuse every men
 will plead, and no man
 can tell how to confute    John Selden
           him.”


 Ignorantia legis neminem excusat
Sources of law in the Philippines
   Constitution
   Legislations or statutes
   Regulations issued by the Executive Branch of the government
   Case decisions or judicial opinions / Common Law
   Presidential Decrees – Examples:
     PD 651 – Birth Registration within 30 Days.
     PD 996 – Compulsory Immunization of children below 8 yrs old against
      Preventable Diseases.
     PD 442 – New Labor Code
 Letters of Instructions – Ex. LOI 1000 – Members of accredited
  professional organizations are given preference in hiring or
  attendance to seminars.
 Administrative law – “Implementing Rules and Regulations”
       RA 9173 – Philippine Nursing Act of 2002
       RA 6758 – Salary Standardization of Government Employees (SG: 15)
Branches of Law that are directly applicable
to Filipino nurses
Constitutional Constitutional Law

Criminal        Criminal Law

Civil           Civil Law

Labor           Labor Law

Administrative Administrative Law

Civil Service   Civil Service Law

Case            Case Law
Branches of Law that are directly applicable
to Filipino nurses
Constitutional    Constitution of the Philippines or
                     Saligang Batas ng Pilipinas (1987)
Criminal            Supreme law of the Philippines
                    Divided into 18 parts called
Civil                ARTICLES.
                    Article III – Bill of Rights
Labor               Article IX – Constitutional
                     Commissions
Administrative      Article XI – Accountability of Public
                     Officers
Civil Service
                    Article XIII – Social Justice and
                     Human Rights.
Case
Branches of Law that are directly applicable
to Filipino nurses
                            ARTICLE III. BILL OF RIGHTS
Constitutional
                    Section 1. No person shall be deprived of life,
                     liberty, or property without due process of
Criminal             law, nor shall any person be denied the equal
                     protection of the laws. (CRIMINAL LAW, ex.
                     Homicide, murder)
Civil
                    Section 2. The right of the people to be secure
                     in their persons, houses, papers, and effects
Labor                against unreasonable searches and seizures of
                     whatever nature… (Civil Law, Ex. Assault,
                     Battery, etc)
Administrative      Section 5. No law shall be made respecting an
                     establishment of religion, or prohibiting the
Civil Service        free exercise thereof. (Transcultural Nursing)
                    Section 8. The right of the people, including
Case                 those employed in the public and private
                     sectors, to form unions, associations, or
                     societies for purposes not contrary to law shall
                     not be abridged. (PNA)
Branches of Law that are directly applicable
to Filipino nurses
Constitutional          ARTICLE IX. CONSTITUTIONAL
                                 COMMISSIONS
Criminal         1.    Common Provisions
                 2.    The Civil Service Commission
Civil            3.    The Commission on Elections
                 4.    The Commission on Audit
Labor
                      ARTICLE XI – ACCOUNTABILITY OF
Administrative                 PUBLIC OFFICERS
                  Board of Nursing
Civil Service
                  RA 9173 – Philippine Nursing Act of
                      2002
Case
                       Roles of BON
                       Leakage  NLE NLE
Branches of Law that are directly applicable
to Filipino nurses
Constitutional   ARTICLE XIII. SOCIAL JUSTICE &
                         HUMAN RIGHTS
Criminal
                 1. Labor
Civil            2. Agrarian and Natural Resources
                      Reform
Labor
                 3.   Urban Land Reform and Housing
Administrative   4.   Health
                 5.   Women
Civil Service
                 6.   Roles & Rights of People’s
Case                  Organization
                 7.   Human Rights
Branches of Law that are directly applicable
to Filipino nurses
Constitutional    branch of law that governs and
                     regulates the relationship of
Criminal             employers and employees. The
                     Labor Code must be read with
Civil
                     caution because it is one of the
Labor                most frequently amended laws in
                     the country.
Administrative      P.D. 442- Labor Code
Civil Service        Defines among other things, hours of
                     work, contract and nurse staffing in
Case                 industrial clinics
                  Lawyers Labor
Branches of Law that are directly applicable
to Filipino nurses
Constitutional    branch of law which deals with the
                   activities or functions of executive or
Criminal           administrative agencies such as the
                   departments, bureaus, boards, or
Civil              commissions or all other offices under
                   the administrative supervision of the
Labor
                   office of the President. An example of
Administrative     this – Professional Regulations
                   Commission (PRC).
Civil Service

Case
Branches of Law that are directly applicable
to Filipino nurses
Constitutional    branch of law which deals with the civil
                   service in all branches, subdivisions,
Criminal           instrumentalities and agencies of the
                   government, including government
Civil              owned and controlled corporations
                   (GOCC).
Labor
                  Related to HIRING OF QUALIFIED
Administrative     APPLICANTS (TPH)

Civil Service

Case
Branches of Law that are directly applicable
to Filipino nurses
Constitutional    that body of the prevailing
                   jurisprudence or decisions of the
Criminal
                   Supreme Court interpreting the
Civil              laws or the Constitution or
                   applying them to certain sets of
Labor              facts or actual cases of
Administrative     controversies.

Civil Service

Case
DEFINITION
          CIVIL LAW                     CRIMINAL LAW
 branch of law that pertains      branch of law which
  to the “organization of the       defines crimes, their
  family and the regulation of      nature and punishment.
  property. “ (Tolentino,           Criminal law covers
  1990).                            offenses resulting to
 Republic Act 386 – New            injuries or death of the
  Civil Code (NCC) or the Civil     patient.
  Code of the Philippines, is
  the principal legal              The principal legal
  document in the study of          document in the study of
  civil law in the Philippines      Criminal Law in the
 EO 209 – The Family Code          Philippines is Act No.
  related to Informed               3815 – Revised Penal
  Consent.                          Code (RPC)
General or        Individual or
KINDS OF LAW             Public Law        Private Law

                           International
                                               Civil Law
                                Law

       Divine Law
      Law promulgated     Constitutional       Mercantile
       by our Creator         Law                Law



                          Administrative      Procedural
                              Law                Law
       Human Law
       Law promulgated
           by man to
        regulate human    Criminal Law
            relations


                          Religious Law
Negligence
        Unintentional
                         Malpractice


                          Assault
TORTS

                          Battery


                            False
         Intentional
                        Imprisonment

                         Invasion of
                           Privacy
                                        Libel
                        Defamation
                                       Slander
LAWSUIT – court proceedings

 CRIMINAL CASE                                      CIVIL CASE
Regular Court > judge         WHERE            PRC > BON
MoralTurpitude               GROUND            Sec. 23: Revocaion or
                                               suspension of license
Conviction                   VERDICT           Guilty
Imprisonment              PUNISHMENT           Revocation/suspension
Respondent                    NURSE            Defendant
Complainant                  PATIENT           Plaintiff
• Subpoena Ad            Nurse is called to:   • Summon
Testificandum                                  • Summon
• Subpoena Duces Tecum
is a civil wrong committed against a person or a person’s property.
Torts are usually litigated in court by civil action between
individuals.
What is the difference between

Intentional Tort            Unintentional Tort
 the act was done on        do not require intent
  purpose or with intent;     but do require the
  no harm, injury or          element of harm.
  damage is needed to        Ex. Negligence and
  be liable.                  malpractice
 Ex. Assault & Battery
Intentional Torts
    What is the       Assault - an attempt or threat
difference between     to touch another person
   ASSAULT             unjustifiably; mental or physical
      &                threat
   BATTERY               Ex. forcing a pt. to take his
                           medication or treatment, even
                         simple gestures
                      Battery - physical harm
                       through willful touching of
                       person or clothing without
                       consent.
                        Ex. giving of injection without pt’s
                       consent
Informed Consent
     What is        free and rational act that
Informed Consent     presupposes knowledge of the
                     thing to which consent is being
                     given by a person who is legally
                     capable to give consent.
                    signed by the patient or his
                     authorized representative/legal
                     guardian upon admission is for
                     initial diagnosis and treatment.
                     Subsequent treatments or
                     operations require individual
                     informed consent, except for
                     emergencies.
Informed Consent
  What are the      Express Consent – obtained by
    TYPES of         having or requiring a patient to sign a
                     written consent, whether in his/her
Informed Consent     own statement or in a prescribed legal
                     document, or thru an oral agreement.
                     Whether oral or written, consent
                     must be understood by the patient
                     and witnessed by another person to
                     comply with the requirements of law.
                    Implied Consent – arise by
                     implication of certain circumstances.
                     This is manifested in case of medical
                     emergency (Doctrine of Emergency –
                     administrative consent by physician in
                     charge)
Informed Consent
   What are the       1. The diagnosis and explanation
 Essential Elements        of the condition
of Informed Consent   2.   A fair explanation of the
 (to be done by the        procedures to be done and used
 MD & witnessed by         and the consequences
         RN)
                      3.   A description of alternative
                           treatments or procedures
                      4.   A description of the benefits to
                           be expected
                      5.   Material rights if any
                      6.   The diagnosis if the
                           recommended care, procedure
                           is refused.
Informed Consent
 WHO should give    THE PATIENT HIMSELF
  the CONSENT       AUTHORIZED REPRESENTATIVE
                     IF:
                      Minor
                      Mentally ill
                      Physically unable
                    If a nurse is uncertain if the client
                     is competent or not – consult
                     supervisor or physician.
                    Determination of competency is
                     not only a medical decision, it is
                     one made through court hearings.
Informed Consent
WHO are authorized    Minor – RA 6809: 21> 18
 to represent the     Parents
    patient if –
                      Grandparents
    MINOR or             paternal (1st priority)
    mentally Ill         maternal (2nd priority)
                      Eldest brother or sister who is not a
                       minor
                      Guardians
                           Relatives
                           Godparents
                           Fiancé (man)/fiancée (woman)
                           Best friend
                           Teacher (Doctrine of Loco Parentis)
Informed Consent
   WHO are        For married minors or emancipated
  EXEMPTED         minors (free from restrictions), the
 From Parental     husband/wife has the legal right to
    Consent        give consent.
                  EO No. 209 Family Code of RP - Art.
                   236. Emancipation for any cause shall
                   terminate parental authority over the
                   person and property of the child who
                   shall then be qualified and responsible
                   for all acts of civil life.
Informed Consent
REFUSAL to Consent    A patient who is mentally and legally
                       competent (sane mind and of legal
                       age) has the right to refuse the
                       touching of his body or to submit to a
                       medical or surgical procedure no
                       matter how necessary
                      he should be made to fill out the
                       release form to protect the hospital
                       and/or agency and its personnel from
                       any liability
Informed Consent
  Consent for     Sterilization is the termination of the
 Sterilization     ability to produce offspring. The
                   husband and wife must consent to the
                   procedure if the operation is primarily to
                   accomplish sterilization. When it is
                   medically necessary, the patient’s
                   consent alone is sufficient.
                  Ex. Tubaligation:
                     Wife -Yes
                     Husband – No
                  You cannot follow both so ??
                           You get consent only for
                            MARITAL HARMONY
Intentional Torts
    What is     Doctrine is Liberty of Abode
    FALSE       the unjustifiable detention of a
IMPRISONMENT     person without legal warrant to
                 confine. A client must not be
                 detained against his will.
                occurs when the person is not
                 allowed to leave a health care
                 facility when there is no legal
                 justification to detain the client.
                occurs when restraining devices
                 are used without an appropriate
                 clinical need.
Intentional Torts
     What is        Right to privacy is the right
   Invasion of       to be left alone
    Privacy &
                    Right to be free from
    Breach of
 Confidentiality     unwarranted publicity
                    Exposure to public view
                    Divulge information from
                     patient’s chart to improper
                     sources or unauthorized
                     person
Intentional Torts
 Exceptions   Confidential information can be
                revealed if:

              Patient consent
              Inform HCT (HIV Counseling and
                Testing) for precautionary
                measures
              Crimes, child abuse, BWS
                (Battered Woman Syndrome)
              Communicable disease- R.A.
                3573 (Law on Notifiable
                Diseases)
              Ethics – Utilitarian Principle
SITUATION:

                               BREACH OF
INVASION OF PRIVACY            CONFIDENTIALITY
Nurse to another nurse:        Nurse to another nurse:

“Alam mo bang second wife      “Do you know STD pala yung
   pala ni mayor yung nasa       sakit nung nasa room 69?”
   room 143?”

                  Camera inside the hotel
                  room?
                  Camera inside the
                  Operating Room?
Intentional Torts
    What is
                Character assassination
  Defamation
                There must be a third
                person who hears or read
                the comment before it can
                be considered defamation
                TYPES:
                  Slander - oral defamation
                  Libel - written words
QUESTIONS:

The nurse writes the             Two janitors are having a
following note in the client’s   heated argument as to who
chart, “the physician is         shall dispose the waste of a
                                 patient with typhoid fever. The
incompetent because he           first one called the other
ordered the wrong drug           “lazybone” and “pain in the
dosage.” This statement          neck” within the hearing of the
may lead to a charge of:         rest of the nurses. The case is:
   A. Assault                       A. Libel
   B. Slander                       B. Slander
   C. Libel                         C. Invasion of privacy
   D. Invasion of privacy           D. Negligence
QUESTIONS:

                                Who OWNS the
Which of the following
persons cannot have the         MEDICAL CHART?
access to the patient record?    A. Patient
                                 B. Doctor
                                 C. Nurse
  A. physical therapist
                                 D. Hospital
  B. lawyer of the family
                                Who OWNS the
  C. the patient                COMMUNICATION?
  D. speech therapist            A. Patient
                                 B. Doctor
                                 C. Nurse
                                 D. Hospital
MEDICAL CHART
    What is
                Arrange and organize the
 DUTY of the     chart
   nurse
                Ex. If the chart was not
                 arranged properly and
                 someone was able to read
                 the contents:
                  A. Invasion of Privacy
                  B. Breach of Confidentiality
                  C. Negligence
Unintentional Tort
    What is     Failure of perception.
 Negligence?    Failure to do something which a
                   reasonable and prudent person
                   should have done.
                2 TYPES:
                        Commission – wrong doing
                        Omission – total neglect of
                         care (didn’t do anything)
                      Example: Banana peal
                      Gross Negligence – involves extreme
                       lack of knowledge, skill, or decision
                       making. Ex. Position during NGT
                       Feeding
Unintentional Tort
  What are the   1. Existence of a duty on the part
4 Elements of       of the person charged to use
 Negligence?        due care under circumstances
                 2. Failure to meet the standard
                    of due care
                 3. The foreseeability of harm
                    resulting from failure to meet
                    the standard
                 4. The fact that the breach of this
                    standard resulted in an injury
                    to the plaintiff
Unintentional Tort
  What are the       RES IPSA LOQUITUR
                       “The thing speaks for itself.”
 Doctrines of
                         The injury is enough proof of negligence.
 Negligence?             In the absence of 1 – it will not apply:
                         The nurse failed to make use of appropriate
                          judgment (Common Sense)
                         The instrument used is within the exclusive
                          control of the nurse
                         There is lack of voluntary participation on the
                          part of the patient.
                     RESPONDEAT SUPERIOR
                       “Let the master answer for the acts/liability of the
                       employee/subordinate.”
                         The liability is expanded to include the master
                          as well as the employee.
                         There must be an employer-employee
                          relationship.
Unintentional Tort
  What are the          FORCE MAJURE - irresistible force;
 Doctrines of            unforeseen or inevitable. No person
 Negligence?             shall be responsible for those events
                         which cannot be foreseen.
                          Examples:   Fire, Flood, Typhoon, Earthquake


                        CAPTAIN-OF-THE-SHIP DOCTRINE
                         wherein the surgeon is presumed to
                         be the responsible for everything
                         that happens within the confines of
                         the OR.
Unintentional Tort
 What are some    Burns resulting from hot water bags, heat
                     lamps, vaporizers, sitz bath
   Examples         Objects left inside the patient’s body;
                     sponges suction tips
of Negligence?
                    Falls of the elderly, confused, unconscious,
                     sedated patients
                    Falls of children whose bed rails were not
                     pulled up and locked
                    Mistaken identity- drug given to the
                     wrong patient
                    Wrong medicine, wrong concentration,
                     wrong route, wrong dose
                    Defects in the equipment
                    Administration of medicine without
                     doctor’s prescription.
Unintentional Tort
    What is      Failure of action.
 Malpractice?    Doing acts or conducts that are not
                  authorized or licensed or
                  competent or skilled to perform,
                  resulting to injuries.
                 Stepping beyond one’s authority
                 Negligent act committed in the
                  course of professional performance
                 Ex. RN exceeding the Scope of
                  Nursing Practice.
CRIME
 Definition    it an act committed in violation
                of public (criminal) law and
                punishable by fine or
                imprisonment.
               A crime does not have to be
                intended in order to be a crime.
               For example – a nurse may
                accidentally give a client an
                additional and lethal dose of a
                narcotic to relieve discomfort
               Two elements:
                 Criminal act - action
                 Evil/criminal intent – plan/motive
Felony vs. Misdemeanor
 Differentiate    FELONY - a public offense
                   committed with deceit and
                   fault.
                  crime of a serious nature, such
                   as murder, punishable by a
                   term in prison.
                  MISDEMEANOR - offense of
                   a less serious nature and is
                   usually punishable by fine or
                   short term jail sentence, or
                   both.
                  Ex. A nurse who slaps a
                   patient’s face.
Classification of Felony
  According to
  DEGREE OF               Capital        above P6k
                 grave
 PUNISHMENT               punishment
                          or >6yrs & 1
                          day
                 Less     1 month and    not > P 6 K
                          1 day to 6     but not
                 grave    years          <P200
                  Light   1 day to 30    fine not >
                 felony   days           P 200
Classification of Felony
  According to
  DEGREE OF      1. Consummated   all elements
  EXECUTION                       executed, with
                                  successful result
                 2. Frustrated    all elements
                                  executed but no
                                  successful result
                 3. Attempted     not all elements
                                  executed, no
                                  successful result
Nursing Liability
 According to    PRINCIPAL       a. By direct participation-
                Primary author   doer of the act
  DEGREE OF                      b. By inducement - directly
PARTICIPATION                    force or induce others
                                 c. By cooperation-
                                 indispensable
                ACCOMPLICE         “cooperates before the
                A person who     act” BUT absent at the
                 cooperates      time crime is committed.
                ACCESSORY        “cooperates after the
                                 fact”
                                 Profits
                                 Conceals/ destroys evidence
                                 Assists in the escape of the
                                 principal
Moral Turpitude
   Define    is the act of baseness or vileness or
              depravity in social order. It is any act
              contrary to law, morals, honesty &
              justice (Black’s Law Dictionary).
             Chances are, nurses may be called on
              to testify on the matter of injuries or
              death of the patient.

             Subpoena Duces Tecum – order of the
              court requiring you to bring the chart in
              the court proceeding
             Subpoena Ad Testificandum – order to
              appear in court (to testify)
Useful pieces of evidence for criminal
offenses resulting to Death of Patient

                  Body
                  Object on or with the body
                  Injuries sustained
                  Tissues and body fluids
                  Other medical evidences or
                   findings
Murder vs. Homicide
 Differentiate    Murder - unlawful &
                   intentional (planned) killing of
                   the human being
                  Homicide - unintentional
                   killing of another person;
                   committed without criminal
                   intent.
                  HUMAN BEING = body + soul
                  Desecration of the Dead
Parricide
   Define    killing by reason of blood
              relationship in a direct line.
             It takes precedence over
              murder.
             Inclusion to the rule: Spouse &
              legally adopted child.
             Direct line: Grandparents 
              father  mother  Children
             Collateral line: brothers &
              sisters (not parricide but
              homicide or murder)
Infanticide & Abortion
   Define     Infanticide - killing of an infant
                 less than 3 days or 72 hours.
                If EXACTLY 3 days it will now be
                 considered murder or homicide.
                The number of days is more legal
                 and binding than the intention.
                Abortion - termination of product
                 of conception before the age of
                 viability.
                Considered a grave felony.
Robbery & Theft
   Define    Robbery - with force
             Anyone who gets a personal
              property of another with the
              use of force, violence or
              intimidation.
             Theft - without force.
              Anyone who gets the
              personal property of another
              without permission.
QUESTIONS
The hospital research team
offered Nica the opportunity      A client in your med-surg
to participate in research on     unit has a cousin who is a
a new therapy. The nurse-         physician and wants to see
researcher asked you to           the chart. Which of the
obtain consent. What is the       following is the best
most appropriate nursing          response of the nurse?
action?

A. Be sure Nica understands       A.   Hand over the chart, anyway the
   the project before she signs        cousin is a doctor
B. Read the consent from to       B.   Call the attending physician and
                                       have the doctor speak with the
   Nica and allow her to ask Qs        cousin (Dr – Dr)
C. Refuse to be the one to        C.   Ask the client to sign an
   obtain Nica’s consent               authorization and have someone
                                       review the chart with the cousin.
QUESTIONS
The nurse caring for an older adult
tears the skin of the patient while
removing a piece of tape. The skin     In which circumstance/s may
is attached to the upper arm and       the nurse legally and
to the tape. The nurse cuts the
attached part of the skin with         ethically disclose
scissors in order to remove the        confidential information
tape. The nurse fails to
understand that if harm comes to       about a client?
the client during the act of cutting
the skin with scissors, which of
the following could the nurse be
charged with?                          A.   HIV – Status of a single male client to
                                            his family members
A.   Malpractice                       B.   The Dx of a pancreatic CA to the
                                            client’s SO
B.   Assault
                                       C.   The Dx of uncontrolled seizure
C.   Negligence                             disorder of a taxi driver to the
                                            concerned government unit
D.   Acceptable practice
                                       D.   All of the above
QUESTIONS

                              Which of the following
A hospital filed a case of    situations would possibly
damages against a nurse for   cause a nurse to be sued due
breach of contract. Who is    to negligence?
the nurse in the case?        A.   Nurse gave a client wrong
                                   medication, and an hour later, client
                                   complained of dyspnea
                              B.   B. While preparing a medication, the
                                   nurse notices that instead of 1 tablet,
                                   she put two tablets into the client’s
                                   medicine cup
                              C.   As the nurse was about to administer
  A. complainant                   medication, the client questioned
                                   why the medication is still given
  B. accused                       when in fact the physician
                                   discontinued it.
  C. defendant                D.   Nurse administered 2 tablets of
                                   analgesic instead of 1 tablet as
  D. plaintiff                     prescribed. Patient noticed the error
                                   and complained.
QUESTIONS
   Wilfred, 30 years old male, was
    brought to the hospital due to       A telephone order is given
    injuries sustained from a
    vehicular accident. While being      for a client in your ward.
    transported to the X-ray             What is your most
    department, the straps
    accidentally broke and the client    appropriate action?
    fell to the floor hitting to his
    head. In this situation, the nurse
    is:                                  A. Copy the order on to the chart and
                                            sign the physician’s name as close
A. not responsible because of the           to his original signature as possible
    doctrine of respondent superior      B. Repeat the order back to the
                                            physician, copy onto the order
B. free from any negligence that            sheet and indicate that it is a
    caused harm to pt.                      telephone order
C. liable along with the employer for    C. Write the order in the client’s chart
    the use of a defective equipment        and have the head nurse co-sign it
    that harms the client                D. Tell the physician that you can not
D. totally responsible for the              take the order but you will call the
                                            nurse supervisor
    negligence
QUESTIONS
                             Ivy is two-months pregnant.
   The nurse out of pity    Her parents do not know this.
    unhooked the patient     She informed her friend Noemi
    from a respirator. The   about the problem. Noemi
                             then referred Ivy to Nica, an
    patient died after 15    abortionist. Ivy had an
    minutes. This type of    abortion. If those involved will
    felony is:               be charge legally, who is
                             considered the principal?
    A. Consummated             A. Ivy
    B. Frustrated              B. Noemi
    C. Attempted               C. Nica
    D. Murder                  D. All of them
That is all… ThankYou!

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Bioethics

  • 1. MSN I: BIOETHICS DEMELU D. MONTA, RN, MPA
  • 2. What is the relationship between ETHICS and the LAW? Are all laws ethical and just?
  • 3. System of process for of A formal binding rules makingor conduct that action logical and Individuals’ cognitive consistent decisions of governs the behavior examination of right people in respect to based upon moral and wrong & good relationships with others beliefs. and with thebad. and government.
  • 4. FUNCTIONS OF LAW IN SOCIETY • To define relationships among members and to declare which actions are permitted and not permitted Latin: Lex • To describe what constraints may be applied to maintain rules, and by whom they maybe applied • To furnish solutions to problems • To redefine relationships between people when circumstances of life change.
  • 5. CHARACTERISTICS OF LAW 1. Authority or the right to declare the rule exists 2. That such rule is Latin: Lex pronounced or expressed and that its source can be identified 3. Right to enforce DECLARED IN WRITING & is OBLIGATORY
  • 6. CHARACTERISTICS OF LAW • The law establishes 1. Authority or the rules that define our right to declare the rights and rule exists obligations, and sets 2. That such rule is penalties for those Latin: Lex pronounced or who violate them. expressed and that its source can be • Law can serve as the identified public’s instrument 3. Right to enforce for converting DECLARED IN morality into clear- WRITING & is cut social guidelines. OBLIGATORY
  • 8. Hindi makatao ang batas! Hindi makatarungan ang batas! What is the relationship between ETHICS and the LAW? Are all laws ethical and just?
  • 9. DEONTOLOGY vs. UTILITARIANISM: TRIAGE Is the law dealing with expectant tags ethical? “Do your sworn duty. “Do the greatest good The rightness & for the greatest number wrongness of an act of people.” depends upon the nature of the act, rather than the consequences.”
  • 10. Are all laws ethical? REASONS FOR THE DISCREPANCY:  Differences between ethical points of view: Usually… but not deontology & utilitarianism. necessarily true. Some  Human behavior and laws can be considered to motivation are more be unethical and some complex than can be fairly illegal acts are considered reflected by law. by many to be ethical.  The legal system judges action rather than motivation.  Laws change (ex. Rape – RA 8353 & DofD, RH Bill, Abortion).
  • 11.  To ensure that the nurse’s decision and actions are consistent with current legal principles.  To protect the nurse from liability. FUNCTIONS OF LAW IN NURSING YES!  It provides a framework for establishing which nursing actions in the care of clients are legal.  It differentiates the nurse’s responsibilities from those of other health professionals.  It helps establish the boundaries of independent nursing action.  It assists in maintaining a standard of nursing practice by making nurses accountable under the law.
  • 12. NURSING JURISPRUDENCE JURISPRUDENCE Juris + Prudentia  is defined as a branch of law Latin which deals with the study of nursing laws, lawsuits, Juris Law or liabilities, legal principles, legal knowledge rules and regulations, case laws and doctrines affecting Prudentia one who behaves the nursing practice. prudently or wisely because he has knowledge of the possible consequences of a particular action
  • 13. General or Individual or KINDS OF LAW Public Law Private Law International Civil Law Law Divine Law Law promulgated Constitutional Mercantile by our Creator Law Law Administrative Procedural Law Law Human Law Law promulgated by man to regulate human Criminal Law relations Religious Law
  • 14. “Ignorance of the law excuses no man; Not that all men know the law, but because „tis an excuse every men will plead, and no man can tell how to confute John Selden him.” Ignorantia legis neminem excusat
  • 15. Sources of law in the Philippines  Constitution  Legislations or statutes  Regulations issued by the Executive Branch of the government  Case decisions or judicial opinions / Common Law  Presidential Decrees – Examples:  PD 651 – Birth Registration within 30 Days.  PD 996 – Compulsory Immunization of children below 8 yrs old against Preventable Diseases.  PD 442 – New Labor Code  Letters of Instructions – Ex. LOI 1000 – Members of accredited professional organizations are given preference in hiring or attendance to seminars.  Administrative law – “Implementing Rules and Regulations”  RA 9173 – Philippine Nursing Act of 2002  RA 6758 – Salary Standardization of Government Employees (SG: 15)
  • 16. Branches of Law that are directly applicable to Filipino nurses Constitutional Constitutional Law Criminal Criminal Law Civil Civil Law Labor Labor Law Administrative Administrative Law Civil Service Civil Service Law Case Case Law
  • 17. Branches of Law that are directly applicable to Filipino nurses Constitutional  Constitution of the Philippines or Saligang Batas ng Pilipinas (1987) Criminal  Supreme law of the Philippines  Divided into 18 parts called Civil ARTICLES.  Article III – Bill of Rights Labor  Article IX – Constitutional Commissions Administrative  Article XI – Accountability of Public Officers Civil Service  Article XIII – Social Justice and Human Rights. Case
  • 18. Branches of Law that are directly applicable to Filipino nurses ARTICLE III. BILL OF RIGHTS Constitutional  Section 1. No person shall be deprived of life, liberty, or property without due process of Criminal law, nor shall any person be denied the equal protection of the laws. (CRIMINAL LAW, ex. Homicide, murder) Civil  Section 2. The right of the people to be secure in their persons, houses, papers, and effects Labor against unreasonable searches and seizures of whatever nature… (Civil Law, Ex. Assault, Battery, etc) Administrative  Section 5. No law shall be made respecting an establishment of religion, or prohibiting the Civil Service free exercise thereof. (Transcultural Nursing)  Section 8. The right of the people, including Case those employed in the public and private sectors, to form unions, associations, or societies for purposes not contrary to law shall not be abridged. (PNA)
  • 19. Branches of Law that are directly applicable to Filipino nurses Constitutional ARTICLE IX. CONSTITUTIONAL COMMISSIONS Criminal 1. Common Provisions 2. The Civil Service Commission Civil 3. The Commission on Elections 4. The Commission on Audit Labor ARTICLE XI – ACCOUNTABILITY OF Administrative PUBLIC OFFICERS  Board of Nursing Civil Service  RA 9173 – Philippine Nursing Act of 2002 Case  Roles of BON  Leakage  NLE NLE
  • 20. Branches of Law that are directly applicable to Filipino nurses Constitutional ARTICLE XIII. SOCIAL JUSTICE & HUMAN RIGHTS Criminal 1. Labor Civil 2. Agrarian and Natural Resources Reform Labor 3. Urban Land Reform and Housing Administrative 4. Health 5. Women Civil Service 6. Roles & Rights of People’s Case Organization 7. Human Rights
  • 21. Branches of Law that are directly applicable to Filipino nurses Constitutional  branch of law that governs and regulates the relationship of Criminal employers and employees. The Labor Code must be read with Civil caution because it is one of the Labor most frequently amended laws in the country. Administrative  P.D. 442- Labor Code Civil Service Defines among other things, hours of work, contract and nurse staffing in Case industrial clinics  Lawyers Labor
  • 22. Branches of Law that are directly applicable to Filipino nurses Constitutional  branch of law which deals with the activities or functions of executive or Criminal administrative agencies such as the departments, bureaus, boards, or Civil commissions or all other offices under the administrative supervision of the Labor office of the President. An example of Administrative this – Professional Regulations Commission (PRC). Civil Service Case
  • 23. Branches of Law that are directly applicable to Filipino nurses Constitutional  branch of law which deals with the civil service in all branches, subdivisions, Criminal instrumentalities and agencies of the government, including government Civil owned and controlled corporations (GOCC). Labor  Related to HIRING OF QUALIFIED Administrative APPLICANTS (TPH) Civil Service Case
  • 24. Branches of Law that are directly applicable to Filipino nurses Constitutional  that body of the prevailing jurisprudence or decisions of the Criminal Supreme Court interpreting the Civil laws or the Constitution or applying them to certain sets of Labor facts or actual cases of Administrative controversies. Civil Service Case
  • 25.
  • 26. DEFINITION CIVIL LAW CRIMINAL LAW  branch of law that pertains  branch of law which to the “organization of the defines crimes, their family and the regulation of nature and punishment. property. “ (Tolentino, Criminal law covers 1990). offenses resulting to  Republic Act 386 – New injuries or death of the Civil Code (NCC) or the Civil patient. Code of the Philippines, is the principal legal  The principal legal document in the study of document in the study of civil law in the Philippines Criminal Law in the  EO 209 – The Family Code Philippines is Act No. related to Informed 3815 – Revised Penal Consent. Code (RPC)
  • 27. General or Individual or KINDS OF LAW Public Law Private Law International Civil Law Law Divine Law Law promulgated Constitutional Mercantile by our Creator Law Law Administrative Procedural Law Law Human Law Law promulgated by man to regulate human Criminal Law relations Religious Law
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  • 29. Negligence Unintentional Malpractice Assault TORTS Battery False Intentional Imprisonment Invasion of Privacy Libel Defamation Slander
  • 30. LAWSUIT – court proceedings CRIMINAL CASE CIVIL CASE Regular Court > judge WHERE PRC > BON MoralTurpitude GROUND Sec. 23: Revocaion or suspension of license Conviction VERDICT Guilty Imprisonment PUNISHMENT Revocation/suspension Respondent NURSE Defendant Complainant PATIENT Plaintiff • Subpoena Ad Nurse is called to: • Summon Testificandum • Summon • Subpoena Duces Tecum
  • 31. is a civil wrong committed against a person or a person’s property. Torts are usually litigated in court by civil action between individuals.
  • 32. What is the difference between Intentional Tort Unintentional Tort  the act was done on  do not require intent purpose or with intent; but do require the no harm, injury or element of harm. damage is needed to  Ex. Negligence and be liable. malpractice  Ex. Assault & Battery
  • 33. Intentional Torts What is the  Assault - an attempt or threat difference between to touch another person ASSAULT unjustifiably; mental or physical & threat BATTERY Ex. forcing a pt. to take his medication or treatment, even simple gestures  Battery - physical harm through willful touching of person or clothing without consent. Ex. giving of injection without pt’s consent
  • 34. Informed Consent What is  free and rational act that Informed Consent presupposes knowledge of the thing to which consent is being given by a person who is legally capable to give consent.  signed by the patient or his authorized representative/legal guardian upon admission is for initial diagnosis and treatment. Subsequent treatments or operations require individual informed consent, except for emergencies.
  • 35. Informed Consent What are the  Express Consent – obtained by TYPES of having or requiring a patient to sign a written consent, whether in his/her Informed Consent own statement or in a prescribed legal document, or thru an oral agreement. Whether oral or written, consent must be understood by the patient and witnessed by another person to comply with the requirements of law.  Implied Consent – arise by implication of certain circumstances. This is manifested in case of medical emergency (Doctrine of Emergency – administrative consent by physician in charge)
  • 36. Informed Consent What are the 1. The diagnosis and explanation Essential Elements of the condition of Informed Consent 2. A fair explanation of the (to be done by the procedures to be done and used MD & witnessed by and the consequences RN) 3. A description of alternative treatments or procedures 4. A description of the benefits to be expected 5. Material rights if any 6. The diagnosis if the recommended care, procedure is refused.
  • 37. Informed Consent WHO should give  THE PATIENT HIMSELF the CONSENT  AUTHORIZED REPRESENTATIVE IF:  Minor  Mentally ill  Physically unable  If a nurse is uncertain if the client is competent or not – consult supervisor or physician.  Determination of competency is not only a medical decision, it is one made through court hearings.
  • 38. Informed Consent WHO are authorized  Minor – RA 6809: 21> 18 to represent the  Parents patient if –  Grandparents MINOR or  paternal (1st priority) mentally Ill  maternal (2nd priority)  Eldest brother or sister who is not a minor  Guardians  Relatives  Godparents  Fiancé (man)/fiancée (woman)  Best friend  Teacher (Doctrine of Loco Parentis)
  • 39. Informed Consent WHO are  For married minors or emancipated EXEMPTED minors (free from restrictions), the From Parental husband/wife has the legal right to Consent give consent.  EO No. 209 Family Code of RP - Art. 236. Emancipation for any cause shall terminate parental authority over the person and property of the child who shall then be qualified and responsible for all acts of civil life.
  • 40. Informed Consent REFUSAL to Consent  A patient who is mentally and legally competent (sane mind and of legal age) has the right to refuse the touching of his body or to submit to a medical or surgical procedure no matter how necessary  he should be made to fill out the release form to protect the hospital and/or agency and its personnel from any liability
  • 41. Informed Consent Consent for  Sterilization is the termination of the Sterilization ability to produce offspring. The husband and wife must consent to the procedure if the operation is primarily to accomplish sterilization. When it is medically necessary, the patient’s consent alone is sufficient.  Ex. Tubaligation:  Wife -Yes  Husband – No  You cannot follow both so ?? You get consent only for MARITAL HARMONY
  • 42. Intentional Torts What is  Doctrine is Liberty of Abode FALSE  the unjustifiable detention of a IMPRISONMENT person without legal warrant to confine. A client must not be detained against his will.  occurs when the person is not allowed to leave a health care facility when there is no legal justification to detain the client.  occurs when restraining devices are used without an appropriate clinical need.
  • 43. Intentional Torts What is  Right to privacy is the right Invasion of to be left alone Privacy &  Right to be free from Breach of Confidentiality unwarranted publicity  Exposure to public view  Divulge information from patient’s chart to improper sources or unauthorized person
  • 44. Intentional Torts Exceptions Confidential information can be revealed if: Patient consent Inform HCT (HIV Counseling and Testing) for precautionary measures Crimes, child abuse, BWS (Battered Woman Syndrome) Communicable disease- R.A. 3573 (Law on Notifiable Diseases) Ethics – Utilitarian Principle
  • 45. SITUATION: BREACH OF INVASION OF PRIVACY CONFIDENTIALITY Nurse to another nurse: Nurse to another nurse: “Alam mo bang second wife “Do you know STD pala yung pala ni mayor yung nasa sakit nung nasa room 69?” room 143?” Camera inside the hotel room? Camera inside the Operating Room?
  • 46. Intentional Torts What is  Character assassination Defamation  There must be a third person who hears or read the comment before it can be considered defamation  TYPES:  Slander - oral defamation  Libel - written words
  • 47. QUESTIONS: The nurse writes the Two janitors are having a following note in the client’s heated argument as to who chart, “the physician is shall dispose the waste of a patient with typhoid fever. The incompetent because he first one called the other ordered the wrong drug “lazybone” and “pain in the dosage.” This statement neck” within the hearing of the may lead to a charge of: rest of the nurses. The case is: A. Assault A. Libel B. Slander B. Slander C. Libel C. Invasion of privacy D. Invasion of privacy D. Negligence
  • 48. QUESTIONS: Who OWNS the Which of the following persons cannot have the MEDICAL CHART? access to the patient record? A. Patient B. Doctor C. Nurse A. physical therapist D. Hospital B. lawyer of the family Who OWNS the C. the patient COMMUNICATION? D. speech therapist A. Patient B. Doctor C. Nurse D. Hospital
  • 49. MEDICAL CHART What is  Arrange and organize the DUTY of the chart nurse  Ex. If the chart was not arranged properly and someone was able to read the contents: A. Invasion of Privacy B. Breach of Confidentiality C. Negligence
  • 50. Unintentional Tort What is  Failure of perception. Negligence?  Failure to do something which a reasonable and prudent person should have done.  2 TYPES:  Commission – wrong doing  Omission – total neglect of care (didn’t do anything)  Example: Banana peal  Gross Negligence – involves extreme lack of knowledge, skill, or decision making. Ex. Position during NGT Feeding
  • 51. Unintentional Tort What are the 1. Existence of a duty on the part 4 Elements of of the person charged to use Negligence? due care under circumstances 2. Failure to meet the standard of due care 3. The foreseeability of harm resulting from failure to meet the standard 4. The fact that the breach of this standard resulted in an injury to the plaintiff
  • 52. Unintentional Tort What are the  RES IPSA LOQUITUR “The thing speaks for itself.” Doctrines of  The injury is enough proof of negligence. Negligence?  In the absence of 1 – it will not apply:  The nurse failed to make use of appropriate judgment (Common Sense)  The instrument used is within the exclusive control of the nurse  There is lack of voluntary participation on the part of the patient.  RESPONDEAT SUPERIOR “Let the master answer for the acts/liability of the employee/subordinate.”  The liability is expanded to include the master as well as the employee.  There must be an employer-employee relationship.
  • 53. Unintentional Tort What are the  FORCE MAJURE - irresistible force; Doctrines of unforeseen or inevitable. No person Negligence? shall be responsible for those events which cannot be foreseen.  Examples: Fire, Flood, Typhoon, Earthquake  CAPTAIN-OF-THE-SHIP DOCTRINE wherein the surgeon is presumed to be the responsible for everything that happens within the confines of the OR.
  • 54. Unintentional Tort What are some  Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath Examples  Objects left inside the patient’s body; sponges suction tips of Negligence?  Falls of the elderly, confused, unconscious, sedated patients  Falls of children whose bed rails were not pulled up and locked  Mistaken identity- drug given to the wrong patient  Wrong medicine, wrong concentration, wrong route, wrong dose  Defects in the equipment  Administration of medicine without doctor’s prescription.
  • 55. Unintentional Tort What is  Failure of action. Malpractice?  Doing acts or conducts that are not authorized or licensed or competent or skilled to perform, resulting to injuries.  Stepping beyond one’s authority  Negligent act committed in the course of professional performance  Ex. RN exceeding the Scope of Nursing Practice.
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  • 58. CRIME Definition  it an act committed in violation of public (criminal) law and punishable by fine or imprisonment.  A crime does not have to be intended in order to be a crime.  For example – a nurse may accidentally give a client an additional and lethal dose of a narcotic to relieve discomfort  Two elements:  Criminal act - action  Evil/criminal intent – plan/motive
  • 59. Felony vs. Misdemeanor Differentiate  FELONY - a public offense committed with deceit and fault.  crime of a serious nature, such as murder, punishable by a term in prison.  MISDEMEANOR - offense of a less serious nature and is usually punishable by fine or short term jail sentence, or both.  Ex. A nurse who slaps a patient’s face.
  • 60. Classification of Felony According to DEGREE OF Capital above P6k grave PUNISHMENT punishment or >6yrs & 1 day Less 1 month and not > P 6 K 1 day to 6 but not grave years <P200 Light 1 day to 30 fine not > felony days P 200
  • 61. Classification of Felony According to DEGREE OF 1. Consummated all elements EXECUTION executed, with successful result 2. Frustrated all elements executed but no successful result 3. Attempted not all elements executed, no successful result
  • 62. Nursing Liability According to PRINCIPAL a. By direct participation- Primary author doer of the act DEGREE OF b. By inducement - directly PARTICIPATION force or induce others c. By cooperation- indispensable ACCOMPLICE “cooperates before the A person who act” BUT absent at the cooperates time crime is committed. ACCESSORY “cooperates after the fact” Profits Conceals/ destroys evidence Assists in the escape of the principal
  • 63. Moral Turpitude Define  is the act of baseness or vileness or depravity in social order. It is any act contrary to law, morals, honesty & justice (Black’s Law Dictionary).  Chances are, nurses may be called on to testify on the matter of injuries or death of the patient.  Subpoena Duces Tecum – order of the court requiring you to bring the chart in the court proceeding  Subpoena Ad Testificandum – order to appear in court (to testify)
  • 64. Useful pieces of evidence for criminal offenses resulting to Death of Patient  Body  Object on or with the body  Injuries sustained  Tissues and body fluids  Other medical evidences or findings
  • 65. Murder vs. Homicide Differentiate  Murder - unlawful & intentional (planned) killing of the human being  Homicide - unintentional killing of another person; committed without criminal intent.  HUMAN BEING = body + soul  Desecration of the Dead
  • 66. Parricide Define  killing by reason of blood relationship in a direct line.  It takes precedence over murder.  Inclusion to the rule: Spouse & legally adopted child.  Direct line: Grandparents  father  mother  Children  Collateral line: brothers & sisters (not parricide but homicide or murder)
  • 67. Infanticide & Abortion Define  Infanticide - killing of an infant less than 3 days or 72 hours.  If EXACTLY 3 days it will now be considered murder or homicide.  The number of days is more legal and binding than the intention.  Abortion - termination of product of conception before the age of viability.  Considered a grave felony.
  • 68. Robbery & Theft Define  Robbery - with force  Anyone who gets a personal property of another with the use of force, violence or intimidation.  Theft - without force. Anyone who gets the personal property of another without permission.
  • 69. QUESTIONS The hospital research team offered Nica the opportunity A client in your med-surg to participate in research on unit has a cousin who is a a new therapy. The nurse- physician and wants to see researcher asked you to the chart. Which of the obtain consent. What is the following is the best most appropriate nursing response of the nurse? action? A. Be sure Nica understands A. Hand over the chart, anyway the the project before she signs cousin is a doctor B. Read the consent from to B. Call the attending physician and have the doctor speak with the Nica and allow her to ask Qs cousin (Dr – Dr) C. Refuse to be the one to C. Ask the client to sign an obtain Nica’s consent authorization and have someone review the chart with the cousin.
  • 70. QUESTIONS The nurse caring for an older adult tears the skin of the patient while removing a piece of tape. The skin In which circumstance/s may is attached to the upper arm and the nurse legally and to the tape. The nurse cuts the attached part of the skin with ethically disclose scissors in order to remove the confidential information tape. The nurse fails to understand that if harm comes to about a client? the client during the act of cutting the skin with scissors, which of the following could the nurse be charged with? A. HIV – Status of a single male client to his family members A. Malpractice B. The Dx of a pancreatic CA to the client’s SO B. Assault C. The Dx of uncontrolled seizure C. Negligence disorder of a taxi driver to the concerned government unit D. Acceptable practice D. All of the above
  • 71. QUESTIONS Which of the following A hospital filed a case of situations would possibly damages against a nurse for cause a nurse to be sued due breach of contract. Who is to negligence? the nurse in the case? A. Nurse gave a client wrong medication, and an hour later, client complained of dyspnea B. B. While preparing a medication, the nurse notices that instead of 1 tablet, she put two tablets into the client’s medicine cup C. As the nurse was about to administer A. complainant medication, the client questioned why the medication is still given B. accused when in fact the physician discontinued it. C. defendant D. Nurse administered 2 tablets of analgesic instead of 1 tablet as D. plaintiff prescribed. Patient noticed the error and complained.
  • 72. QUESTIONS  Wilfred, 30 years old male, was brought to the hospital due to A telephone order is given injuries sustained from a vehicular accident. While being for a client in your ward. transported to the X-ray What is your most department, the straps accidentally broke and the client appropriate action? fell to the floor hitting to his head. In this situation, the nurse is: A. Copy the order on to the chart and sign the physician’s name as close A. not responsible because of the to his original signature as possible doctrine of respondent superior B. Repeat the order back to the physician, copy onto the order B. free from any negligence that sheet and indicate that it is a caused harm to pt. telephone order C. liable along with the employer for C. Write the order in the client’s chart the use of a defective equipment and have the head nurse co-sign it that harms the client D. Tell the physician that you can not D. totally responsible for the take the order but you will call the nurse supervisor negligence
  • 73. QUESTIONS Ivy is two-months pregnant.  The nurse out of pity Her parents do not know this. unhooked the patient She informed her friend Noemi from a respirator. The about the problem. Noemi then referred Ivy to Nica, an patient died after 15 abortionist. Ivy had an minutes. This type of abortion. If those involved will felony is: be charge legally, who is considered the principal? A. Consummated A. Ivy B. Frustrated B. Noemi C. Attempted C. Nica D. Murder D. All of them
  • 74. That is all… ThankYou!