Nursing Research, Leadership And Management

NURSING REASEARCH, LEADERSHIP AND MANAGEM ENT I. Nursing research a. Definition of terms b. Characteristics c. Purpose d. Ethics of Scientific Research e. Steps in Nursing Research

is done for richer familiarity and is carried out by mere active observation of a phenomenon. 2. Exploratory purpose : 50 % of the answer is already known. 3. Experimental purpose : you determine the cause and effect ratio by applying active manipulation bec you are doing active intervention. 4. Developmental purpose : done to improve the system or quality of care for our patients. * The main purpose of nursing research is to improve the quality of patient care.(**CBQ)

II. Nursing Leadership a. Definition of Terms b. Elements of Leadership c. Nursing Leadership d. Reasons for the Study of Nursing Leadership e. Theories of Leadership f. Leadership Style g. Powers of a Leader h. Skills and qualities of a Leader III. Nursing M anagement a. Definition of Terms b. Theories of M anagement c. M anager/ Types d. M anagement Process e. Sample Questions or Post-test ** CBQ : Common Board Question I. Nursing Research : Definition : according to Kerlinger, nursing research is the : a. systematic b. empirical c. controlled, and d. critical investigation of a hypothetical proposition in relation with a phenomenon. * First thing to do in nursing research is to choose a problem related to a phenomenon. Nursing problem : is anything that influences the human lives / existence. Ex. : diseases, infections, pollution etc Example of a problem : Tuberculosis 1. You need to apply a hypothetical proposition. Hypothesis : represents not the final answer to the nursing problem being studied BUT is : a. an educated guess b. a scientific guess c. a tentative answer only. * IS a big question mark in the researcher’s mind. 2. Hypothesis for the problem of TB : “ Environmental pollution in M anila increases the cases of TB at San Lazaro General Hospital”. Four M ajor Characteristics of a Scientific Research : 1. Systematic : the study must follow a step -by-step process/procedure.(**CBQ) 2. Empirical/ Empiricism : the study should be dealt with objectivity : the data related to the problem should be readily observable or gathered through the senses. 3. Controlled/ Appropriate Research Design : study should be directed, designed or manipulated by appropriate system, method or process to control all variables of the study. 4. Based on a Critical investigation : the study should be a factfinding investigation on a population or human beings to gather data to answer the hypothesis. Four Basic Purposes of Nursing Research : 1.Descriptive purpose : 100 % knowledge on the subject; study

Nursing Research, Leadership and Management 1 of 31

Ethics of a Good Scientific Research : (SCIENTIFIC) S cientific objective : the study should have an objective beneficial to your patients. Consent : consent should be secured when obtaining all data needed in the study. **CBQ : If the patient is dead : the hospital legally owns the records. The information in the patient’s records : owned by the patient. If the patient wants an explanation about information in his chart, ONLY the physician is legally allowed to explain the diagnosis, prognosis, treatment etc. Integrity : should be based on honesty and soundness; no “shortcuts”, no withholding of information for personal benefit. Equity / Equitable : it should include spaces for appropriate acknowledgement for the contribution of others as well as consent for references used. **CBQ : Plagiarism / Illegal replication : unauthorized use of another’s work /study. Noble / Nobility : the researcher must respect the rights of his/her subjects. Three basic rights of a research participant: 1. Right not to be harmed 2. Right to self-determination 3. Right to privacy I. Types of harm or injury : 1. Physical : may happen during the experimental process through negligence : a. by commission : through performance of wrong intervention. b. by omission : by not doing what was rightfully expected of him/her from the very start. Ex : omitting to do CPR to someone who fainted in your presence. * CPR : Adult : compression-blow ratio : 15 : 2 Infants : compression-blow ratio : 5 : 1 2. M ental : may be two kinds : a. assault : subjecting one to mere mental fear or threat. b. battery : forcible or illegal physical introduction of a substance e.g. an invalid administration of a drug or injection. 3. M oral : may either be : a. slander : when you orally destroy the moral reputation of the patient. b. libel : when the defamation is published, written, or recorded. II. Right to self-determination : the patient personally determines whether to join or not in the research; subject must be free from coercion, restraint, force, undue influence. It must be voluntary. Informed consent should be sought. III. The right to privacy may either be : a. anonymity : refers to privacy as regards the identity of the Informant; identity may not be disclosed. b. confidentiality : refers to privacy as regards to the information or data obtained; information acquired must not be disclosed. ** CBQ : In the process of doing research, the researcher is very

careful not to disclose the name of her subjects. This is : a. protection of client b. confidentiality c. anonymity d. informed consent Truthfulness : should only contain facts not mere fabrications. Importance : significance to the nursing profession. Factual : a nursing research is a fact-finding study (facts not fiction) Ideal : must proceed following the 10 formal steps in nursing research process. Courageous : the research should embody the courage to get all the pertinent facts/data

determining whether or not a problem is researchable? a. time factor b. availability of a research instrument c. nationality of the researcher d. cost of the investigation. 3. Variable : anything that is subject to change or manipulation. Two types of variables : 1. Independent : or the causal variable; the cause of the study. 2. Dependent : the effect of the manipulation on the target population/variable reaction.. Ivan Pavlov : formulated the theory that a stimulus when applied to a certain organism will elicit a corresponding response.

* CBQ : The main contribution of research towards the improvement of nursing profession is which of the following? a. provide a scientific basis for nursing care b. assist the nurse administrator in planning nursing staff requirements. c. assist the faculty in developing the nursing curriculum. d. facilitate the development of staff development.

Stimulus ---------Organism --------------Response (Independent Cause) (Target Population) (Dependent Cause) 4 Definition of terms : 1. Conceptual : taken in its ordinary /common meaning; dictionary-based meaning 2. Operational : how the researcher used the definition in his study. Ex. The word “toxic”: Conceptual meaning : poisonous; hazardous Operational meaning : heavy workload for an undermanned staff II. Review of related literatures : **CBQ : What is the main purpose of review of related literatures? Ans.: to form a conceptual and theoretical framework. Two sources of the researcher’s review of related materials :

Ten M ajor Steps in Nursing Research : 1. Identification of a research problem. 2. Review of related literature 3. Formulation of a conceptual and theoretical framework. 4. Choose an appropriate hypothesis 5. Choose an appropriate research design. 6. Sampling or obtaining a sample from the population 7. Collection of data phase 8. Analysis of data phase 9. Interpretation of the data 10. Dissemination of conclusion or recommendations. .** CBQ : The correct sequence of steps in research process is : 1. Formulate problem information. 2. Review literature information 3. Analyze data. 4. Determine research design 5. M ake conclusions and recommendations. a. 1,2,4,3,5 b. 1,3,2,4,5 c. 1,2,4,5,4 d. 2,1,3,5,4 I. Identification of a research problem : A research problem is anything that requires solution through a scientific investigation. 1. Sources of problems for nursing research : C : different nursing concepts. L : health literatures I : issues affecting the profession E : essays N : Nursing assessment T : Nursing theories (** CBQ) 2. Characteristics of a good nursing research problem : (GReFIN) General applicability : the study is helpful and advantageous for the common good and not just for a selected few. Based on applicability, a problem may be : a. Basic/ Pure : applicable only to the researcher and done primarily to : 1. Answer personal querries or curiosity 2. To increase personal knowledge. b. Applied : focused on solving the problems of other people. Researchable : the problem is capable of being investigated through observation, manipulation, etc Feasible : measureable as to : 1. Time 3. Experience of the researcher 5. Population 2. M oney 4. Research instruments availability Importance Novelty : originality (** CBQ) S ignificance to the nursing profession *CBQ : Which of the following criteria is least considered in

Nursing Research, Leadership and Management 2 of 31

Examples Who were the sources? For what purpose/s?

Conceptual

Research

Books, internet Authors

Research papers

For general use

For future research studies only

Researchers

III. Formulation of a conceptual and theoretical framework : A. Theoretical framework : the theories involved in the researcher’s study. B. Conceptual framework : the structural relationship (in an illustrated form) between the independent and dependent variables. C. Paradigm : the structural or diagrammatic presentation of the researcher’s conceptual framework. Ex. # 1 : A study on the difference in the professional opportunities of Filipino nurses working in the Philippines and those working abroad. Purpose : “Is to compare the professional opportunities of Filipino nurses working abroad and those working in the Philippines. Independent Target Dependent Variable Variable Population Place of work Filipino Opportunities for nurses professional growth (subject to (result of manipulation) manipulation)

IV. Choose an appropriate hypothesis : Kinds of hypotheses : 1. Null/ Statistical hypothesis : any statement that has NO relationship or difference between 1 variable to another single variable. This is mostly used because it is aesy to reject or accept a null hypothesis.

“ There is no difference regarding the professional opportunities of Filipino nurses working in the Philippines from those working abroad”. 2. Simple/ Operational hypothesis : states the anticipated relationship or difference between 1 independent variable to another single dependent variable. “ Filipino nurses working abroad have more professional growth opportunities than those working in the Philippines”. 3. Complex hypothesis : states the anticipated relatioship between 2 or more variables to other variables (intervening variables) Ex. # 2. “Filipino nurses who worked for 5 years and passed the CGFNS, TOEFL, TSE, and NCLEX have greater opportunities to acquire immigrant visas, higher starting salaries, insurance benefits and study grants“. 4. Directional hypothesis : specifies the direction of the relationship between variables. Ex. # 3. “Filipino nurses working in the USA have more professional opportunities than those working in the Philippines” 5. Non-directional hypothesis : only predicts the relationship, but has no specific direction between variables. ** CBQ : can lead to ambiguity or confusion. Ex. # 4. “ There is a big difference between a Filipino nurse working in the USA and those working in the Philippines.” V. Selecting an appropriate research design : A systematic, controlled plan for finding answers to a problem; it is a roadmap, blueprint to provide a result; a plan, structure or strategy of conducting an investigation. * it is used to control the researcher’s variable/s;the skeletal framework in his research. Three basic classifications of research designs : 1. According to applicability : a. Basic / pure b. Applied 2. According to data collected : a. Qualitative : refers to the quality of the data : these are not subject to numerical interpretations; can’t be measured quantitatively; based on subjective data such as : a. perception d. feelings b. understanding e. emotions c. attitudes & beliefs f. behaviors b. Quantitative : readily observable by the senses; can be numerically interpreted; based on objective data.

3. According to method : a. Non-experimental method : when the method presents no need for any intervention or manipulation : 1. Passive participation 2. Researcher simply has to observe, describe and record the results. 3. It is usually done in the natural setting : where the people (sample) naturally exist. Ex. : homes, community, schools etc. b. Experimental type of research design : 1. Active participation 2. M anipulation is needed to get the cause and effect ratio to

Nursing Research, Leadership and Management 3 of 31

determine its effectiveness (of the manipulation/intervention). 3. It is done in a more controlled setting like labs, research units etc. Types of non-experimental research design : 1. According to time : past, present and future. A. Past : a. Ex-post facto : retrospective style : a study done on a group of people who had naturally experienced a natural phenomena (after a fact) but is a subject of a present study. b. Historical type : involves a study of things that happened in the past which are already : 1. written about 2. documented 3. published, and 4. recorded Ex. : charts of patients’ data. Two sources of historical data : 1. Primary sources : nurse’s notes / diaries which give f irsthand information.** You rely only on this type of source.*CBQ 2. Secondary sources : second hand information : information is supplied by a person other than the one who experienced it. B. Present : Descriptive : based on present occurrence or happening. C. Future : Prospective : the study is done in the present, the result of which will be known only in the future; based on a future occurrence/happening. 2. Based on the number of participants involved : Survey type of research design : based on the answer of the majority (majority = 50% + 1) Types of surveys : 1. According to groups: a. small group : face-to-face interview method where you have the advantage of immediately getting the answer / response. b. large group : utilization of mailed survey forms where you may have problems with feedback. 2. According to methods 3. According to orientation : a. Cross-sectional type : 1. Involves two or more evidential groups. 2. Done only once. 3. For the purpose of comparative study

b. Longitudinal type : 1. Involves one core group only 2. Entails doing an initial survey and follow-up survey/s. 3. For the study on the progress/ development of the group *CBQ : Ex. Is the Sangkap Pinoy movement. Experimental Type of Research Design Four compulsory steps of exp erimental research design : 1. Control stage : the population is divided into two groups : a. control population : no intervention or manipulation is done to the group. b. experimental population : the group subjected to manipulation or intervention. 2. Randomization stage : choosing the data by chance where each member of the group is given equal chance to be chosen as a sample. 3. M anipulation 4. Evaluation of effects. * CBQ : Quasi-experimental research design : if a researcher did not perform all the procedures of an experimental research design.

Implication : cannot properly evaluate your results bec of lack of comparative data. Characteristics of a good research tool or instrument : 1. Reliability : refers to the accuracy or precision of the tool- if it is administered twice, the instrument should provide identical data. 2. Validity : refers to the relevance of the measurement to the study being done. 3. Sensitivity : means that the fine lines of difference amomg the study subjects can be determined from the measurements, examples of which are ratings and thermometers. 4. M eaningfulness : the measurement must have a practical application. 5. Appropriate : if it is applicable to the subjects being tested. 6. Objective : one that is free from bias. 7. Ethical : tools should not violate the human rights of clients. VI. Sampling/Sample from the population : Population : refers to the largest body of the case or individuals being researched that conform to a specific set of particulars or eligibility criteria. Sampling : the process of selecting a portion of the population to represent the entire population. Sample : a group of people coming from the population that will become the recipients of the experimentation treatment in an experimental type of research. Factors that determine the sample size : 1. Accessibility of sample participants : when it is not feasible to study a whole population, a sample is taken. 2. Cost : funds available limit the size of the sample. 3. Amount of time available : if the time is limited, only a small sample may be gathered. Two major types of sampling and selection techniques : I. Probability Sampling : randomization is applied and each member of the population is given an equal opportunity to be a participant in the study. 1. Simple random sampling : the selection of the sample is done by chance; used only for a smaller population made up of identical groups. Ex. : fishbowl technique, lottery draws or table of random numbers 2. Stratified random sampling : the population is subdivided into areas, sections, then random samples are taken from each. This is used for unidentical groups. (Sub-strata before randomization is done). * CBQ Ex. Divide the students into year levels : first, second, third, and fourth year, and then get random samples from each. 3. Systematic random sampling : using a tool called a “sampling frame” wherein a sample is taken every nth number. This is used in a big / large population. Sampling frame : a list of names appearing inyour population. Ex. : yellow pad technique. 4. Cluster random sampling : a small sample is taken from various sections of the total population. (sub-areas before randomization) Ex. In studying the attitudes of nurses in M etro M anila towards their work, a small sample from each hospital will be taken. II. Non-probability sampling : involves the study of a preselected group (bias group) since the start. 1. Accidental/Convenience sampling : data is collected from anyone most conveniently available -- accessibility is the main factor for sample choice. * This is the weakest form of sampling (bias) *CBQ 2. Purposive / Judgmental sampling : researcher selects and studies a specific number of a special group that represents the target population

Nursing Research, Leadership and Management 4 of 31

with regards to certain characteristics such as age, sex or economic status. The selection is based on the common knowledge/understanding of the researcher. Ex. Study on poor prostitutes : samples are taken fron Ermita, M la. Study on TB patients : you go to San Lazaro Gen Hosp. 3. Snowball / Network sample : a kind of convenience sampling that involves subjects suggesting or referring other subjects who meet the researcher’s eligibility criteria; last referral to gain momentum- those qualified but not referred will not get the chance to participate. 4. Cross-cultural sampling : study is done in a variety of cultural settings. Ex. Getting samples from Tagalogs, Ilocanos, Visayans etc. 5. Longitudinal sampling : a given group of subjects are studied for an extended period of time, which may either be retrospective or prospective. Examples : Prospective : M astectomy patients are studied from operation to 3 years after discharge. Retrospective : Growth of newborns two years ago to the present. 6. Cross-sectional sampling : subjects are only observed at only one point in time. Ex. Asking high school students their choices of career after graduation. 7. Quota sampling : the researcher identifies the strata of the population and determines the proportion of elements needed in the various segments VII. Collection of data phase : the most time- and budgetconsuming part of research. Different methods of collecting data : 1. Questionaire : a form prepared and distributed to secure responses to questions that are intended to obtain information about conditions or practices on which the respondents is presumed to have knowledge; method of collecting data using pen and paper. Different types of questionnaires : a. dichotomous : those that require only two answers e.g. Yes or No, True or False b. rating/checklist : ratings of variables are asked e.g. 1,2,3,4,5, or poor,fair,good c. multiple choice : diff alternatives are given as choices : a,b,c,d, or e. 2. Written records : utilization of those pre-recorded or preexisting data. Ex. Patient’s charts (written, documented and recorded) 3. Interview : the oral method of collecting data; oral communication is used. Types of interviews : a. structured interview : one wherein specific or pre-seleted questions are asked wherein an interview schedule is read to the respondent. b. non-structured : one where open-ended or generalized questions are asked by way of an interview guide and the respondent is allowed to pursue relevant ideas in depth. 4. Observation : by employing the senses or occular inspection wherein the researcher may be : a. Participant : active participation is required of the researcher. The researcher may be disguised as a patient, nurse, or just a plain eager learner taking part in the activity. The attractions and repulsions of the group members are assessed by plotting their interactions on a devoce called a sociogram. b. Non-participant : the researcher stands outside the phenomena being studied and

records the data as objectively as possible even with a passive participation only. Two basic problems under data collection : 1. Hawthorne effect : people may deliberately change their behavior bec they know that they are being studied or observed. * Common in experimental study and is not reliable bec the behavior of the subjects are consciously altered. *CBQ : How to avoid ? By the use of double-blind research. 2. Halo effect : the observer may have the tendency to rate certain subjects consistently high or low on everything bec of the overall impression the subjects give the rater. The data collected is untrue bec of a special relationship/treatment between the researcher and his sample. VIII. Analysis and interpretation of data phase : The stage where the researcher is forming a body of knowledge or conclusion out of the data collected either to affirm or negate his hypothesis. The researcher can answer the hypothesis with finality; the presentation of data relevant to the problem and sufficient to answer the hypothesis. * Tabulation of tha data is necessary before an analysis can be done. Different methods of tabulating or measurement of data collected : 1. Nominal : data are tabulated per category (used in surveys) 2. Ordinal : data are classified according to characteristics as ranked. 3. Interval : data are tabulated per space, distance or measurement using numerical values. Ex. Temperature : 150/90 - 120/80 mm H g Two methods of interpreting data : (conclusions are made) 1. Quantitative style : data collected are presented in numerical or graphical forms ; a. pie graph b. line graph : usually utilized in longitudinal studies. c. bar graph 2. Qualitative style : interpretation by the use of the narrative form or approach. IX. Dissemination of conclusion and recommendations : A. Conclusion : final answer to the problem. B. Recommendations : suggestions on how to affect the results of the study positively. Different methods of dissemination : 1. You can write a book about the study 2. You can hold symposium/symposia 3. Publish the study 4. Through the internet. II. Leadership Leader

Group Followers I Leadership : is a style or a process whereby a person called a nurse leader will influence a group of people known as the followers for the purpose of attaining a single goal or objective towards the good of his patients. * If doing the independent roles : the person is a leader. Different styles of leadership : 1. Autocratic/ Authoritarian / Dictatorial / Bureaucratic or Traditional : a unilateral style of leadership; the leader and only the leader himself performs the decision-making

Nursing Research, Leadership and Management 5 of 31

towards patient care without getting the inputs of his subordinates. >Also called “centric” bec the leader makes decision for the group, he/she, being the only center of attention. > Also called “Theory X” by M cGregor, meaning, this is bosscentered. Possible character traits of an autocratic/authoritarian leader : Apathy : insensitive toward others Boisterous speech Consistency Demanding attitude Egoistic and self-centerde Ferocious behavior * Generally not a good leader; may be acceptable ONLY during emergency/crises. 2. Laissez-faire Style / Freestyle / Permissive / Ultraliberal style of leadership : one in which there is excessive freedom /liberalities and the leader abdicates the leadership responsibility and leaces workers without direction, supervision or coordination. > “let alone” style of leadership *Implication : there could be breakdown of power control and responsibility and may result to high incidents of negligence. > This is effective when working with highly motivated professionals, like those in research, where independent thinking is rewarded.. > Not useful in highly structured organizations e.g. the health care delivery system where organization and control form the baseline of most operations. 3. Democratic / Participative / Consultative leadership : is people oriented; focuses on human aspects and builds effective teamwork; mutual style of leadership. >The nurse leader gets the opinions, inputs, and suggestions from the staff and members of the team. > Performance standards exist to provide guidelines and permit performance appraisal. > Also called “Theory Y” by M cGregor : the leader sees the workers as ambitious and she/he does not resist change, is creative and exercises selfdirection and self-control. > Also called “radic” bec he radiates out to encompass the needs of others. > The most desirable form of leadership and leads to high productivity. Different types of leader powers : 1. Formal/Legitimate/Exclusive power : the power or authority to give orders or tasks to his subordinates. 2. Referrent power : a charismatic power: the leader uses his/her charm. *CBQ 3. Expert power : power attained by virtue of his/her extraordinary skills, trainings and abilities. 4. Reward power : the positive power on the part of the leader to compensate or remunerate staff members by rewards, incentives, promotions, commendations etc 5. Coercive power : the negative power of a leader to implement sanctions, suspensions and or terminations as a form of disciplinary power. * General rule : “Whoever is at the top, has the right to implement discipline.” Ex. Co-member of the team caught with alcohol breath : report to the supervisor nurse. Theories : 1. Great man Theory : to become a leader, such person must be

born to be a leader. 2. Trait or Character Theory : one must have the following to become a leader : A. The personality : a. Adaptability : to cope or adjust to the assessed needs of the community b. Independence : capable of critical thinking c. Creative/assertive : must be able to utilize the resources available to deliver primary health care to the community. d. Advocate : he must be a defender of the rights of the patients; performance of duties should be within the realm of the Patient’s Bill of Rights. B. Intelligence : a. Proper judgment } a leader should be more knowledgeable than b. Proper decision-making }the patient : use assessment skills. c. Fluency of speech : one should be able to use proper communication *CBQ : When dealing with tribal groups, the most important skill a nurse leader must possess is proper communication skills. C. Leadership ability : a. Influence others : *CBQ : you can properly influence others through health teachings. b. Command : should have the aura of power w/o being bossy c. Respect : should be respectable in any way to be able to gain respect. d. Participates }esp in performing care for the comatose patients. A leader e. Cooperates }should also be willing to do any job in any contingencies. 3. Charismatic Theory : one can become a leader by virtue of his/her charm or charisma. 4. Situational/Contingency : one can be a leader in a situation when his style of leadership, managing skills, and expertise matches the needs of a situation > A good leader in one situation but only a follower in other situations. > This is a case-to-case basis kind of leadership. *CBQ : Advantage of this style of leadership : you can have the BEST person for the needs of the situation. Skills and Qualities of a Good Leader : Appropriate authority Leadership Behavior Communication skills Decision-making skills Ethics Ability to Face conflicts

* Note : RA 3573 : Law on Notifiable Diseases : 1. Report within 24 hours : Polio and M easles 2. Report within 1 week : Severe Acute Diarrhea, HIV, Tetanus Neonatorum I. Appropriate authority : the basis of the leader to issue tasks, responsibilities, and orders to his/her subordinates. Types : 1. Centralized : when flow of authority is from the top to the bottom 2. Decentralized : when authority does not necessarily come from the top. II. Five leadership behaviors : Specialized body of knowledge and skills and training. Ex.: Who is allowed to do IV insertion? *CBQ Ans. : In RA 7164 (1991) : qualifications for IV insertion are the following 1. M ust be a registered nurse (RN) 2. 1-week didactic training 3. Completion form of 50 IV insertions

Nursing Research, Leadership and Management 6 of 31

4. Certification from a duly authorized nursing organization. ANSAP : Assoc. of Nrsg Services and Administrators of the Phils. In RA 9173 (Oct 21, 2002) : qualifications are : 1. M ust be a registered nurse 2. 1-week didactic training Patient-centered behavior Accountability Confidentiality : breaking this is “Invasion of Privacy” or “Breach of Privacy” General Rule : Everything heard and read should be dealt with confidentiality. Exceptions to the rule : Patient’s consent Inform/report to the health care team as a precautionary measure *CBQ Communicable + standing order from DOH Crime : to fulfill a duty to the society e.g. in cases of child abuse which is to be reported within 24 hours. Basic things to do in case of child abuse/crime : S afety : most important thing to do first Report Referral: for further assessment like trauma management. Ethics : (to be discussed later) III. Communication Skills : the ability to transfer information with understanding. Communication barriers or backlogs : hinders the communication process.*CBQ The communication process : 1. Sender : the one who initiates the communication 2. M essage : the data that is to be transmitted 3. Encoding : both verbal and non-verbal method of transmitting the message 4. Receiver : the intended recipient of the message 5. Decoding : the process/manner of interpretation of the data being transmitted 6. Feedback : action in return by the receiver to the sender. IV. Decision-making : involves the independent judgment of the nurse leader. Step-by-step process of scientific decision-making : 1. Identify the problem. 2. Identify the person/s affected : patients, nurses, members of the health team 3. Collect options or alternative solutions : a. Brainstorming : scrutiny of the problem within the group.*CBQ b. Delphi technique : seeking for other experts’ advice/opinions 4. Choose the BEST option and implement it. 5. Evaluation : if possible should always be done. V. Ethics : In essence is good manners and right conduct. Principles of ethics : 1. Autonomy : independent judgment and decision-making; selfdetermination. The nurse should respect the client’s / patient’s decision. *CBQ : 1. Who would decide for the care of the patient? a. the doctor b. nurse c. patient himself d. relatives 2. Informed consent should always be obtained in invasive procedures. Failure to do so would constitute battery. 3. In cases where a patient refuses to give his informed consent :ra waiver must be signed by him stating his refusal. 4. In cases where the patient is profusely bleeding and refuses to undergo blood transfusion, you should : 1. Respect the patient’s decision 2. Physician should explain the risk to the patient (consequence of

the refusal of the procedure) 3. Let the patient sign a waiver. 5. An Islamic patient died, the relatives request to do the post mortem: * Respect the patient’s cultural tradition. 6. A nurse is doing a health teaching in a squatters’ area in M anila, suddenly, a mother stood up and said she is against condom use : respect mother’s views. 2. Principle of Double-effect : if one is made to choose between two alternatives, he/she should choose the one with more of good effects and less of the evil effects. * CBQ : This principle frees the health practitioner of legal liabilities. 3. Principle of Veracity : telling the truth or not intentionally deceiving or misleading patients. The patient has the right to know the truth regarding his state of health. > Avoid false reassurance : it is non-therapeutic. Principle of Beneficence : this allows the doing of anything that is good and avoiding harm to the patient. Exceptions : 1. If the intervention is non-therapeutic 2. If the confidentiality is violated. 4. Non-maleficence : “Do no evil or harm” principle. 5. Justice : refers to the obligation to be fair to all people. Prioritize needs of all patients under one’s care bec different patients have different needs and levels of care. *CBQ : How can justice be achieved ? By applying the nursing care process. Characteristics of the Nursing Care Process : *Acceptable universally *CBQ : NCP should be universally acceptable. Based on patient’s assessed needs. *Client-centered *Dynamic : based on ever-changing needs of the clients’ situations Equitable : interventions should be always based on what you see is the patient’s need Familiarity *Goal-oriented : should always be geared towards solving the patient’s health care needs *CBQ : A dynamic NCP would prioritize the need of which patient? a. asthmatic patient who had an attack 2 days ago. b. CVA patient needing discharge instructions c. patient with head injury d. 2-year old patient with high fever. * This is an exception to the ABC rule (airway, breathing and circulation) bec although asthma is an airway and breathing problem, the patient had the attack 2 days ago.Patient c would need immediate attention bec of the head injury (may have increased ICP). * Dynamism can also be done in the choice of patients’ food. VI. Face conflicts : A conflict is any clash of ideas resulting to crisis in the organization. Different methods of resolving conflicts : Avoidance behavior : putting the problem aside but not paying any attention to it which is not actually solving the conflict. S moothing behavior : a temporary relief by appealing to a person’s kindness. Unilateral action : by application of force, inflicting fear and threats. Negotiation : the best way to solve conflicts : both parties mutually discuss and solve the

Nursing Research, Leadership and Management 7 of 31

problem. *CBQ III. Management > the process of judicious use of available human and material resources, directing their tasks towards the achievement of a goal or objective. > the process of coordinating and supervising personnel and resources to accomplish organizational goals. Theories : 1. Human Resource Theory : there must be proper relationship between the manager and his members. 2. Frederick Taylor’s Scientific M anagement Theory : the best manager is a person who has the following :4 T’s : Tao Tools Trainings Treatment 3. Douglas M cGregor’s M otivational Theory : Theory Y assumes that people are self-directed and will accept responsibility under favorable conditions. Individual goal are emphasized. These people need minimal supervision bec they are : Efficient Effective Diligent and love their jobs. Theory X assumes that people dislike their work and must be directed and controlled. Organizational goals are emphasized. These people need more motivation (negligent) and close supervision. 4. Henry Fayol’s Theory : management principles : a. Unity of Command : one group should only get orders from one manager. b. Unity of Direction : the whole team should have only one goal/objective. c. Esprit de corps/Team Spirit : the achievement or fault of one, is the achievement or fault of all. *CBQ : A teenaged patient who had appendectomy, complained of pain. There was no standing orders for pain medications. a. don’t give medications without doctor’s orders b. positioning : YES 4. Respondeat Superior : command responsibility principle : “Let the master answer for the negligent subordinate who caused injury, harm or death”. * Note : Head nurse can only delegate the responsibility but not the accountability. 5. Subordination of general over personal interest : in case of emergency such as in fire : Rescue your patient. Alert : sound the fire alarm Contain the fire in one area Extinguish the fire. 6. Proper remuneration of your personnel : Start of work : probationary for the 1st 6 mos Regular employee : work 8 hours/day for 5 days or 40 hours/ week. Overtime pay : + 25% Night shift differential : + 10% Spec Non-working holiday : + 30% Legal holidays : + 100% Work-related disability : a. gov’t. employees : GSIS : ECC (Employees Compensation Com) b. private employees : SSS : ECC Both work and non-work-related diseases : PHILHEALTH (Nat’l Health Ins Act) > benefits do not include dental, aesthetic and cosmetic procedures. M aternal/paternal leave allowances : M other Father NSD 60 days 7 days with

pay CS 78 days * Note : allowed only on the 1st 4 pregnancies of the legitimate spouse. Senior Citizen’s Act : gives 20% discounts for people 65 yrs and above. Five steps of management process : Planning Organizing Directing Coordinating Evaluation I. Planning : defined as pre-determining a course of action in order to arrive at a desired result; forecasting of events and based on which decisions are made, goals are set and prioritized and policies and standards are developed. No actual intervention yet; mere conceptualization stage : 1. Planning process should be clear. Vision : states what the organization wants to achieve in the future. *DOH : Health for all Filipinos. M ission : describes and reflects the organization’s core value. It is the present reason why the organization was formed. Philosophy : the set of values and beliefs of the organization; a statement of beliefs that influence the nursing practice. Goal : the general statement of the organization’s mission. Objective : more specific statement of the team’s mission. Policies : set of rules and regulations in the organization.

2. Budgeting : planning, controlling, and proper allocation of all resources for the patients/clients : a. operational : refers to the everyday use of the patients (gowns, caps, etc) b. personnel : for the salaries and compensation of staff c. capital : allocations for long-term use equipments. II. Organizing Stage : structuring the team to accomplish the tasks necessary to meet its goals. * for the purpose of managing the care of patients. Organizing your team : Nurse manager Tasks Staff Style xx xx xx xx Nursing tasks are as follows : Assessment : only the nurses should assess the patients, never the subordinates.*CBQ Teaching : health teachings should be done upon admission, orientation or initial contact with the patient. Explaining of procedures Preparation of patients : for procedures to be undertaken Administration of : Treatment and medication Evaluation Judgment Subordinates’ tasks : Routinary tasks : include standard, unchanging procedures e.g. toileting & bathing Stable patients : they may handle patients with predictable outcomes. S upervision of nurses : they should be directly supervised by RN’s. Staffing : refers to the correct ratio or mix of nursing personnel in a nursing unit for a period of 24 hours. Different types of staffing schedules :

Nursing Research, Leadership and Management 8 of 31

1. Traditional : 8 hours/day, 40 hours/week 2. Non-traditional : 10 hours/day, 40 hours/wk, 4 working days/wk 3. On call : utilized when there is a sudden increase of number of patients with less number of nurses. 4. Baylor Plan : a. weekdays : one works only on weekdays for 8 hours (M -F) b. weekends : one works only on weekends for 12 hours (Sat/Sun) Styles of Nursing Care Delivery (M odalities of Nursing Care) : 1. Primary Nursing : the nurse cares for the patient for 24 hours. * The only type that provides 240care for one patient from the time of admission until the patient is discharged. * Done by private duty nurse. 2. Functional method : practiced in congested agencies such as PGH. Duty/task : specific task is assigned to One nurse : to be done to all or to the majority of patients Highly recommended : when there’s a shortage of nursing staff and budget * The poorest method of giving care. 3. Case nursing/ Case method : Total care to a patient per shift One-on-one handling : in extreme shortage of nurses : 1:2 . III. Directing / Delegation : The process by which a manager assigns specific tasks, duties, or procedures to workers with commensurate authority to perform the job (someone else performs a job/task in behalf of the person delegating with authority). *CBQ : One can only delegate the responsibility but NEVER the accountability. Ex. : The nurse delegates the preparations for the celebration of the hospital’s anniversary but she’s responsible for the outcome of the preparations. Two important criteria in delegation : 1. The ability of the worker to carry out the task 2. Fairness not only to the employee but to the team as a whole. Exceptions to the power to delegate : 1. Disciplinary tasks : the authority to discipline erring staff such as sanctions, suspensions etc cannot be delegated. 2. Technical tasks : highly technical procedures which require special trainings or skills should never be delegated. 3. Confidential tasks : tasks which are strictly personal duties / confidential cannot be delegated. Ex. : charting should be done by the attendant health care provider and cannot be delegated. IV. Coordinating / Collaboration Stage : Unites personnel and services toward a common objective. Synchronization of activities among the various services and departments enhances collaborative efforts resulting in efficient, smooth and harmonious flow of work. Ex. : At the unit level, Supervising Nurses and Head Nurses coordinate their work with the other departments, services or units by conveying clearly-defined policies, standard operating procedures, policies, and guidelines using the proper channels of communication. *CBQ : M ost common instances of collaboration are in cases where referrals for some aspects of the patient’s care such as : a. In patients with tophi, dietary considerations are made to the dietician bec we always employ the interdisciplinary approach. b. Food rich in purines : a. canned foods b. sardines

c. anchovies d. vegetables Types of collaboration : 1. Intradepartmental/Interpersonal : a collaboration between one single person to another person under one and the same unit or department. Ex. : endorsement between shifts. 2. Interdepartmental : a collaboration between 2 or more units or two or more departments but under one and the same institution. Ex. : A woman admitted for CS will be referred to the DR, RR, etc 3. Interagency/Interinstitutional : collaboration between two or more health care institutions for the benefit of the patient. Ex. : A patient from a health center is referred to a district hospital. *CBQ : Reasons why the nurses have the responsibility to coordinate : 1. The patient is entitled to continuous care by a nurse. 2. Nurse should provide holistic care. V. Evaluation / Controlling Stage : the stage wherei the nurse will determine whether his/her plan, goal or objective for the patient is achieved or met according to the standards of care. Different types of evaluation : 1. Nurses’ rounds : done twice per shift (short term plan) Illustration of proper evaluation : If you are working in the 6-2 shift, you do 2 rounds : a. Around 6am, your team does an ocular inspection around the ward/unit after which, you do a nurses’ conference (First rounds). b. around 2 pm, you evaluate the effectiveness of the shift’s plan of care for the patient.( Second rounds) *CBQ : Nurses’ rounds are not done/contraindicated in the following areas : a. Emergency room b. OR/DR c. Inensive care unit (ICU) d. Psyche ward : bec it may not be safe to do so. 2. By the use of a checklist : use of ratings scale such as when the HN, UM or NM uses scales of their staff’s evaluation. 3. Peer evaluation : evaluation done by co-workers. *CBQ : This is the poorest method of evaluation bec it might be affected by halo effect. 4. By the use of performance appraisal sheet/form : this is done by the client or patient, being the recipient of care as in the evaluation forms given to patients immediately after/before discharge from the hospital. *CBQ : This is the best method of bec the recipient of care does the evaluation. IV. Professional Adjustments and Ethico-Legal Nursing Profession : it is a calling, in which its members profess to have acquired a unique or specialized body of knowledge or skiils for the purpose of properly guiding or caring for others. * Nursing is a profession. Calling : nurses should always be service-oriented. Specialized body of knowledge /skills : there should be a degree of expertise for competency. Others : refers to the patients or clients; nurses should be “others-oriented.” Primary characteristics of a profession : Accountability : being liable for the results of one’s actions and responsible for their practice decisions. Competency : one must know what he/she is doing (practice should be backed-up with scientific rationale)

Nursing Research, Leadership and Management 9 of 31

Caring : nursing is a “caring profession” Ethics : the nursing practice is governed by a Code of Ethics which embodies its professional and social values S ervice : as a caring profession, it should be service-oriented. Specialized body of knowledge /skills : nurses, as professionals should have expertise in their fields of practice and show a degree of competency. *CBQ : What is the most important attribute of a professional nurse? Ans. : to observe ethical practice. Is nursing a profession? Ans. : YES, nursing is a profession. It has all the characteristics of a profession. The informed consent form is a contract between : 1. The patient and the members of the health care team 2. The patient and the hospital

RA 9173 : The Philippine Nursing Law (promulgated on Oct. 21, 2002) Expanded roles of a nurse : 1. Promotive, preventive, curative and rehabilitative care of patients in all health care settings and in the event that recovery or rehabilitation is not possible, to provide for a peaceful death. Promotive : through health teachings 2. Appropriate health education 3. Utilization of the nursing care process : part of the duties of a nurse. 4. Collaboration of patients’ care 5. Link of patients to the different community resources. 6. Supervision and training of nursing students *CBQ : A nursing student affiliated in a ward gave an erroneous medication killing the patient. Who is liable for the patient’s death? a. the nursing student b. the clinical instructor of the student c. the staff nurse of the ward d. the hospital 7. Supervision of other personnel such as midwives, nursing aides etc. 8. Accurate reporting or recording of patient’s care 9. Proper execution of valid doctor’s orders : the only dependent duty of a professional nurse. * CBQ : What is the liability of a nurse if he/she gives prescriptions? Ans. : Malpractice Valid doctor’s order : only when an order put into writing and duly signed by the prescribing physician. Rationale : Whatever wasn’t put into writing and signed by the doctor is considered as not being ordered at all. * CBQ : Whenever a patient solicits a medical advice : refer to the doctor. General Rule : A nurse should never prescribe any medication noe administer drugs without a valid doctor’s order. Exceptions to the general rule : 1. In case of emergency 2. In cases of national calamity 3. In cases of epidemic PLUS : there’s no doctor around and the patient is in grave danger of death. Good Samaritan Act : the universal doctrine that protects from any liability, any person who will give an aid to another person whose life is in danger. * This law provides immunity from civil liability when a person provides assistance in an

emergency. * This doctrine is the basis of RA 8344 which mandates the “NO DEPOSIT POLICY” in any health care facility or hospital in emergency cases only. *CBQ : An emergency case where a child had ingested a considerable amount of Aspirin, what should the nurse do? Ans. : induce vomiting. What would the discharge health teaching include ? Ans. : ways on childproofing the house. What is the most common form of poisoning? Ans. : Lead poisoning from chipped paints bec paint chips taste sweet and are conducive for a child’s PICA : appetite for eating non-food items.

In emergency poisoning cases : 1. Determine the poisonous material involved. 2. If non-corrosive : induce vomiting If corrosive : NEVER induce vomiting bec it will cause irritation of the esophageal mucosa and may lead to aspiration. * give calcium EDTA Different areas of professional nursing practice : 1. Institutional Nursing Practice : done in the hospital setting. Characteristics : Direct supervision of a head nurse or nurse manager. Acquire different technical skills/learning Confidence in your practice. 2. Public Health Nursing : the functions of which encompass the 4 P’s : Promotion of public health. Prevention of disease Psychological and social adjustments : bec one will be taking care of numerous clients. Public relations is maintained with all members of the community, the health care team and the family. *CBQ : The main thrust toward promotive and preventive nursing practice is Primary Health Care (PHC). LOI 949 : the PHC Law of 1979 adapting the concepts of the First International Conference on PHC held in Alma Ata, USSR on Sept 6-12, 1978. Signed into law by Pres Ferdinand E M arcos on Oct 19. 1979. Coverage of LOI 949 are the following : 1. Preventive Nursing Law : PD 996 : the EPI Law : mandating the compulsory immunization of children below 8 years old to reduce the morbidity and mortality among infants and children caused by the six childhood immunizable diseases : 1. Diphtheria 4. Polio 2. Pertussis 5. Hepatitis B 3. Tetanus 6. M easles * Not included is chicken pox bec the vaccine is expensive. 2. M icronutrient Supplementation Law : RA 8976 : to fight childhood malnutrition PD 825 : Environmental Sanitation Law : promotion of cleanliness and sanitation in everything outside of one’s environment. PD 856 : Sanitation Code of the Philippines : promulgates sanitation : 1. Within an establishment : covers food and water sources e.g. carinderia and canteen food. 2. Commercial Sex workers : mandatory and proper screening : a. Syphilis : every 6 weeks b. Gonorrhea : every 2 weeks Red ID : health clearance of CSW who had undergone screening issued by the city health officer. *CBQ : How can you handle health care delivery in the

Nursing Research, Leadership and Management 10 of 31

community? `` partnership or participation.

Ans. : Active community

RA 7160 : Local Government Code : Decentralization/ Devolution of Health Care It’s a partnership : DOH DILG } Local Health Board : public health Active community } care services/local gov’t. Partnership } unit; headed by the city or Participa } municipal mayor or the tion } governor. } LGU : barangay city municipality province Rationale for RA 7160 : it makes quality public health care services accessible in accordance with the present vision of DOH. 3. Occupational/Industrial/Company Health Nursing : done in factories, companies or industrial zones with the following functions : a. Curative and rehabilitative : Care : provide immediate care for both the sick and injured worker Referral : proper referrals should be done for clients who need higher levels of care. Visit : home visits should be done for follow up care. b. Promotive and preventive : Nutritional health teaching : given to the workers for optimal functioning and productivity. *CBQ : The most important consideration when doing health teachings to these workers : Ans. : income of employees /financial status. S afety and sanitation in the workplace Counseling : appropriate health counseling can be provided to avoid or prevent occupational diseases/hazards. *CBQ : Health teaching considerations : use of contraceptives. What health hazards should the nurse’s study focus on? Ans. : Past trends of frequent diseases in the workplace. 4. Clinical Instructor : Four major qualifications of a clinical instructor (per RA 9173) : Accredited member of a nursing organization such as PNA. MAN : a masters degree in nursing or other allied courses One year clinical nursing experience. Registered nurse LOI 1000 : requires compulsory membership of professionals to an accredited professional organization such as PNA, PM A etc Facts about the Philippine Nurses Organization : PNA : founded on October 22, 2002 Founder : Anastacia Giron-Tupas Present President (2005) : Ruth Padilla Objective of PNA : Reasons why they give trainings : 1. Advancement of the knowledge and skills of the Filipino nurses. Professional well-being : it is a professional organization composed and headed by nurses Unity : it promotes professional unity

Promotes reciprocity even from outside the Philippines Advancement of the knowledge and skills of the nurse Ethics : it promulgates its own Code of Ethics

permitted by law to have a control in the manner of disposing his estate but will take its effect at the time of his death.

First College of Nursing (BSN) in the country : UP First nursing schools : Iloilo M ission Hospital School of Nursing (1906)

Decedent : a deceased person Testator : the dead person who made the will (male) Testatrix : the dead person who made the will (female) Two types of succession by heirs : 1. Testate succession : the mode of succession wherein the heirs inherit by virtue of a last will and testament. 2. Intestate : succeeding by law and not governed by a will. * Without a last will and testament : heirs should divide estate in equal sharing.

Philippine General Hospital (1907) Luke : St Luke’s Hospital School of Nursing (1907) Mary Johnston Hospital School of Nursing (1907) St. Paul’s Hospital School of Nursing, Iloilo (1907) S an Juan de Dios Hospital School of Nursing (1907) Proclamation order # 539 : proclaimed the last week of October as Phil. Nurses’ Week.

Two types of last will and testament : Legal responsibilities of a nurse : these applies in almost all kinds of settings : 1. Consent : it is the responsibility of the nurse to see to it that the client’s informed consent was taken before any procedure is done. 2. Last will and testament 3. Illegal detention 4. M edication and prescription 5. Charting, documentation/recording I. Consent : the legal permission given by the client before any procedure or treatment after receiving proper information or explanation about the treatment or procedure to be done. Characteristics of a valid consent : Voluntariness : the consent form must have been signed with the absence of fear, force, coercion, or threat. Opportunity : the patient should be given ample opportunity to ask for further explanations if he needs it. Treatment, surgery, or procedure should be properly explained : By the surgeon : whoever is primarily performing the procedure has the responsibility to explain it fully to the patient. The nurses only act as witnesses to the signing of the consent which involves: 1. Witnessing the exchange between the client and the physician 2. Witnessing the client affix his signature 3. Establishing that the client really understood Understood by the patient Matured both physically and mentally : the signatory should be at least 18 y/o or older. * Consent may not be given by the patient in cases of : 1. Insanity 2. Imbecility 3. Unsound mind EXCEPT if the patient signs it in his lucid intervals. *CBQ * CBQ : Who can give consent in behalf of a mentally ill child? Proxy consent may be given by the following : 1. Parents 2. Guardians 3. Guardian ad litem : a. Social welfare personnel : in cases where the child is abandoned. b. Surgeon or the attending physician : in cases of emergency Example : A psychiatric patient needs a stat appendectomy : surgeon or attending physician signs the consent for the patient’s behalf. In vasectomy, who gives the consent ? a. both the husband and wife b. husband only :bec although the issue of vasectomy affects both spouses, the procedure is done on the husband only (Vas deferens is not a conjugal property) II. Last Will and Testament : an act whereby a person is

Nursing Research, Leadership and Management 11 of 31

Concerning properties

Concerning body / life

1. Notarial/Ordinary will

1. Advanced directives

2. Holographic will

Notarial or Ordinary Wills : The following are the nursing considerations : 1. Check the patient’s level of consciousness : the nurse must ascertain that the patient is capacitated to make a will 2. Check the proper locations of the signatures : a. at the end of the will written by the patient b. in all pages at the sides of the paper, by the testator/testatrix and 3 witnesses. 3. Presence of three witnesses. Holographic Will : wills that are executed during emergencies but the patient is still conscious. Requisites of a holographic will : 1. It should be entirely handwritten 2. It should be dated and signed using the hands of the testator/testatrix. * If nobody witnessed the writing of the will, comparison to other documents made by the testator/testatrix is necessary to ensure its validity. Advanced directives : are directions or instructions made by the patient in advance with what to do with the patient’s body, such : 1. Living will 2. Instructions for DNR, cremation, organ donation, and funeral services III. Legal rights of a nurse and illegal detention : Illegal detention is a crime if a person, such as a nurse, will limit the freedom of a patient to move or travel from one position / place to another Exception : when there are quarantine regulation orders such as what happen in migration IV. M edications and prescriptions : General rules : 1. Only the following have the right to prescribe medications : MD, DMD, DVM 2. Do not follow unless 3 vital informations are present : a. name of physician, location of office, PTR/PRC license no. b. Patient’s name, age, sex, c. Name of the drug itself : both generic and brand name (RA 6675) RA 6675 : the Generics Act of 1988 which requires that all prescriptions of drugs should include the generic name and the brand name or the generic name alone. Purpose : to let the patient choose among the different brand names available of a

specific generic drug name. Impossible prescription : are prescriptions written by a doctor in which the generic and brand names do not correspond to each other. Exception to RA 6675 : The physician can only be allowed to write only the brand name if only one brand is available for the particular drug being prescribed. Ex. : Alaxan, M inocin 3. Responsible for the 10 R’s of giving medications : 1. The right drug 2. The right storage 3. In the right dose 4. By the right route 5. To the right patient 6. At the right time 7.With the right documentation 8. 9. 10. For accuracy and safety, the nurse should do the three checks : 1. When choosing the medication to take out of the drawer or cupboard 2. When the dose is in hand and can be held side-by-side with the record to compare the label and the medication administration record (MAR) 3. One last time after all drugs have been located and before leaving the medication cart or room for the patient’s bedside. *CBQ : What is the method to identify the right patient in all health care settings? a. ask his name and let him spell it : only possible if patient is conscious b. through the patient’s wristband c. through the name hung on the door d. confer with the doctor 4. Oral/ Telephone orders : General Rule : Generally, an order done orally or through the telephone is not a valid order EXCEPT in emergency cases where the nurse should simultaneously write the order, the physician’s name and time it was given and repeat it to the ordering physician and have it signed by the prescribing physician when he/she arrives later. 5. Doubtful medications and prescriptions : General Rule : In case there is doubt on the correctness of the prescription or in cases where the medication is wrong, the nurse has the right to object to such and call the attention of the prescribing authority and let him rectify the wrong order. This is for the protection of your patient (Advocacy) 6. IV training V. Charting / Documentation / Recording : in the patient’s chart which is legally, absolutely a legal document. Nurse’s responsibility : to write chronologically, truthfully and accurately on the patient’s clinical record what he/ she has seen, encountered or observed in connection with the care and treatment of the patient. A fundamental legal principle about medical record : “If information is not charted, it was not done or observed”. Purposes of charting : Communication : it was created as a means of communicating among the health care providers. Assurance of quality care : records the patient’s whole treatment and care regimen Research purposes

Nursing Research, Leadership and Management 12 of 31

Legal documentation Statistics : are good bases for studies since they are deemed accurate and true. *Ownership of the charts/records belongs to the hospital/institution although the information in it belongs to the patient. * Charts, being confidential records cannot just be used by anybody even for legal purposes EXCEPT when the court issues a subpoena. Subpoena : an order from the court which is of two types : 1. Subpoena duces tecum : issued against documents, papers, materials/orders Ex. : patient’s chart 2. Subpoena ad testificandum : issued for somebody to act as a witness. DO’s and DON’T’s of charting : DO’s

DON’T’s

Full, factual & objectively accurate Legible handwriting Immediately upon doing the procedure. Addendum : late entries entered in the chart Personal/confidential document *Proper way to terminate chart : write the profession, not the position

Language :avoid language/words/jargons unacceptable in nursing Improper corrections : follow the agency’s policy on corrections; or the std way Space/skips : avoid leaving spaces/skips in between every charting. Avoid frequent use of abbreviations : some words if abbreviated will result to diff definitions Ex. : Ambulated pt to BR (wrong bec the BR intended to mean bathroom may be taken another way by others)

Doctrines affecting the professional nurse : 1. Professional negligence 2. Professional malpractice 3. Res ipsa loquitor 4. Force majeure 1. Professional Negligence : refers to the failure to do something which a reasonable and prudent nurse should have done, under a particular situation. Types : 1. Commission :doing something which a prudent or reasonable person would not do. 2. Omission : not doing something which a reasonable or prudent person would do. Three elements to prove negligence : 1. There must be the existence of duty 2. There must be a failure to to do the duty 3. Injury or harm has resulted from the failure to do the duty. *CBQ : This is a major reason for suspension/revocation of license. 2. Professional M alpractice : Elements in order for malpractice to exist : 1. RN 2. Acts or conducts self 3. Does something for which he/she is : a. not authorized b. not licensed to do c. not trained or skilled to do. 4. And has resulted in injurious or non-injurious consequences. *CBQ : RN can do the following : 1. Episiorrhaphy : after training but not episiotomy 2. Internal exam (IE) : but only in the absence of antenatal bleeding and abnormal complications. 3. Res ipsa loquitur : “The thing speaks for itself”: when the harm that resulted from negligence

and the responsibility for the harm are clear that anyone would agree on it. *CBQ : This principle accelerates the identification of the last person attending to the patient which caused the negligence. 4. Force majeure : An act of God or nature; an irresistible or superior force, one that cannot be foreseen or prevented; fortuitous event. Principle : “No person shall be hels liable or accountable for nonperformance of what was expected of him/her if the cause of the non-performance was a force majeure or for those events beyond one’s control”. Classifications of crimes affecting nurses : I. According to the manner of its commission : 1. Dolo (Deceit) : one which is done with real criminal intention. Ex. : putting poison in a medication to kill the patient. 2. Culpa (Fault) : one in which there is no real criminal intent and is merely just a result of one’s negligence. Ex. : inadvertently poisoning a pateint bec of erroneous drug administration. II. According to the degree/level of execution : 1. Consummated crime : when all the elements to fully commit the crime were all present and the crime was committed or executed. 2. Frustrated crime : when one performed everything to consummate the crime but failed. 3. Attempted crime : consists only of overt acts to commit the crime; it is merely showing the intent to commit the crime. III. According to the degree of participation : 1. Principal : one who performs a very important or indispensable role in the crime, being the “author of the crime” itself. 2. Accomplice : one who performs a dispensable role, appearing only before or during the time the crime was committed. 3. Accessory : one who ONLY appears after the crime was committed : a. by profiting from the effects of the crime committed b. by concealing/destroying any evidence relating to a crime to prevent its discovery. c. by assisting in the escape of the criminal. Different crimes affecting the Filipino nurses : 1. RA 7877 : Anti-Sexual Harassment Law : Protects employees against sexual harassment. Sexual harassment is committed by ….any person who exercises authority, influence or moral ascendancy over another… by demanding, requesting or requiring sexual favor regardless of whether or not…is accepted by the object of sexual solicitation. * CBQ : M ere indecent proposal constitutes sexual harassment. 2. Rape : there are two types of rape, namely : a. Ordinary rape : any forcible penetration of an organ for copulation : a sexual organ penetrating another sexual organ (only female victims) b. Sexual assault : results from anything inserted to any body orifice with sexual malice (both genders can be victims). 3. Abortion : termination of the products of conception before age of viability (3-6 mos/12-24 weeks) 4. Infanticide : killing of a person less than 3 days or less than 72 hours of life. 5. Parricide : killing of a person to whom one has familial relationship : parents / siblings. *CBQ : adopted children are included. 6. Homicide : unintentional killing of a person more than 3 days old to whom one has no familial relationship. M ost cases in nursing involve drug errors

Nursing Research, Leadership and Management 13 of 31

which are mere results of negligence. 7. M urder : intentional killing of a person 8. Simulation of birth : committed by any person who shall substitute one child with another child or alter a child’s identities for the purpose of losing the child’s civil status. Ex. : M ara and Clara *CBQ : Non-registry of a live birth : constitutes simulation of birth bec a birth certificate is a symbol of identity. PD 651 : M andatory reporting :of any incidence of live birth within 30 days to the local Civil Registrar’s Office. Different laws affecting nurses in the Philippines : RA 2808 (1919) : the first official Nursing Law in the Philippines. Board of Nursing composition : 3-man-team : 1. The Chairman } 2. Two members } all nurses 1920 : the official Licensure Examination was given to nurses one year after the first BON was created. RA 7164 (1991) : the second to the last nursing law : the Philippine Nursing Act of 1991 Board of Nursing composition : 5-man-team : 1. The Chairman } all nurses chosen from 12 nominees and appointed 4. Four members } by the President.

Board of Nursing : 1991 (RA 7164) : OLD Master of Arts in Nursing holder Accredited member of a nursing organizations like PNA Five-man-team : 1 Chairman 4 members S ixty-five years old and sits for a term of not > 3 years One-year interim period Not convicted of any crime in the Philippines Pecuniary/monetary interest : absence of Ten years of nursing experience/practice Citizen of the Philippines NEW Board of Nursing : RA 9173 : Master of Arts in Nursing Accredited member of a nursing organization e.g. PNA S even-man team : 1 Chairman 6 M embers Immediately resigned only assumption of office Not convicted of any crime in the Philippines Pecuniary/monetary interest : absence of Ten years of nursing experience/practice, the last 5 yrs should be in the Phil. Citizen and resident of the Philippines Duties and responsibilities of the BON : Licensure Examinations formulation Issue certificates of registration * CBQ : Just a privilege not a right Monitor the standards of nursing practice in the Phil Education quality evaluation : *CBQ : Inspect and recommend to the CHED : 1. Opening of a nursing school 2. Closure of a non-performing nursing school Code of Ethics formulation Hear and decide cases of negligence and malpractice : 1. Suspension of license 2. Revocation of license Qualifications of a Dean of a College of Nursing : 1. M ust be a registered nurse (RN) 2. M ust be hold a M AN

3. M ust have 5 yrs nursing experience Qualifications of nursing service administrators : A. Hospital setting : 1. Nursing supervisors/ M anagers/Head : responsible for a unit, ward or department : BSN and RN Accredited member of a nursing organization e.g. PNA Nine (9) units of post-graduate Nursing M anagement Two (2) years of general nursing practice 2. Nursing Chief or Director : RN and MAN Five (5) years of supervisory nursing experience B. Community nursing Supervisors/M anagers : BSN and RN Accredited member of a nursing organization e.g. PNA MAN or M PH (Public Health) Five (5) years of experience as PHN/CHN Present requirements for a Nursing Licensure examinee : 1. Good moral conduct 2. Proof/s of citizenship 3. Proofs that applicant is a valid holder of BSN degree whose curriculum is approved by CHED. Other relevant laws of nursing practice : PD 223 : Creation of PRC (professional Regulation Commission) RA 1080 : Civil Service Act RA 6425 : Dangerous Drugs Act : covers two types of drugs : 1. Prohibited drugs : totally prohibits the sale, administration and use by human beings. Ex. : shabu, marijuana, opium derivatives 2. Regulated drugs : can be used provided it is covered with a prescription from a licensed physician authorized by BFAD and PDEA. Ex. : Dormicum, Ativan Liabilities of a health care provider : 1. Fines : depends on the weight /grams 2. Imprisonment 3. Revocation of license RA 7600 : M other-Baby Friendly Hospital Act : requires early bonding through : 1. Breastfeeding 2. Rooming-in technique SSS : S ariling S alat sa S uso GSIS : Galing S a Ina ang S ustansya * CBQ : How to promote bonding between fathers and newborns? 1. Cuddling 2. Embracing PRC Licensure Examination RA 8981 : New PRC Computerization and M odernization Act : mandates that examination results be out by at least the 5th day after the examination date. Results are available at : 1. www.prc.gov.ph 2. PRC rating Family name,First name Registration : 1. Take an oath 2. Pay the registration fee 3. Sign the book of RN’s in the Philippines Two types of registration : 1. Regular /Ordinary : by those who passed and are qualified already 2. Special : registration by reciprocity : a. need to show proofs that one is an RN in a foreign country b. that foreign country offers employment opportunities for Filipino RN’s in return.

Grounds for disqualification as RN : A person may be denied a license after passing the licensure

Nursing Research, Leadership and Management 14 of 31

examination due to: Dishonorable conduct Unsound mind Moral torpitude crime involvement Indecent, immoral conduct Grounds for revocation of license : Malpractice acts Unprofessional conduct Negligence Immoral, indecent conduct Dishonesty, deceit, and fraud Ethics : violations of the Code of Ethics S uspended license but continues to work After five (5) years of inactivity (non-practice profession), one cannot go back to practice at once. To do so, one needs to comply with the following requirements : 1. One (1) month didactic training 2. Three (3) months practicum Prohibited Practice of Nursing : Illegal nursing practice : License : practicing without the necessary license Owns another RN’s license/COR as his/hers Invalidated license/COR S igns name and affix the title of RN illegally Advertisement that is false Falsification of school/nursing documents Assist another person in the illegal practice of nursing Underwaging subordinates/nurse employees Review/training center operations without gov’t. accreditation Any person violating the Phil Nurses’ Act Penalties for illegal nursing practice : 1. Fines of Php50,000 - Php100,000. } for conviction of any of the ten illegal 2.1-6 years imprisonment } nursing practice