ELECTIVE II.

1. Republic Act No. 9173 "Philippine Nursing Act of 2002."

AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION, REPEALING FOR THE PURPOSE
REPUBLIC ACT NO. 7164, OTHERWISE KNOWN AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR
OTHER PURPOSES

Section 2. Declaration of Policy. – It is hereby declared the policy of the State to assume responsibility
for the protection and improvement of the nursing profession by instituting measures that will result in
relevant nursing education, humane working conditions, better career prospects and a dignified
existence for our nurses. The State hereby guarantees the delivery of quality basic health services
through an adequate nursing personnel system throughout the country.

2. BON Res. # 220 s. 2004 – Promulgation of the Code of Ethics for Registered Nurses
(amended code of ethics for nurses)

Preamble:
Sec. 1 – Health is a fundamental right of the individual (4-fold responsibilities & if not
possible assistance towards a peaceful death

Sec 2 – Nurses have to gain knowledge & understanding of man’s cultural, social,
spiritual, psychological, & ecological aspects of illness utilizing the therapeutic process.

Sec. 3 – The desire for respect & confidence of clientele, colleagues, co-workers, & the
members of the community provide the incentive to attain & maintain the highest
possible degree of ethical conduct.
Article II - Registered Nurses and People (Service to Others)
1. Values, customs & spiritual beliefs held by the individual shall be represented
2. Individual freedom to make rational & unconstrained decision shall be respected.
3. Personal information acquired in the process of giving nursing care shall be in
strict confidence.

Article III – Registered Nurse and Practice (Integrity and Objectivity)

1. Human life is inviolable
2. Quality & excellence in the care of the patients are the goals of nursing practice
3. Accurate documentation of actions & outcomes of delivered care is the hallmark of
nursing accountability
4. RN’s are the advocate of the patients: they shall take appropriate steps to safeguard
their rights & privileges.
5. RN’s are aware that their actions have professional, moral & legal dimensions. They
strive to perform their work in the best interest of all concerned.

Article IV – Registered Nurses and Co-Workers (Solidarity and Teamwork)

1. The RN is in solidarity with other members of the health care team in working for the
patient’s best interest.
 2. The RN maintains collegial & collaborative working relationship with colleagues &
other health care providers.
Article V – RN, Society and Environment (Social and Civic Responsibility)
1. The preservation of life, respect for human rights & promotion of a healthy
environment shall be a commitment of a RN
2. The establishment of linkages w/ the public in promoting local, national &
international efforts to meet health & social needs of the people as a contributing
member of society is a noble concern of a RN
Article VI – RN and the Profession (Professional Competence; Global
Competitiveness; Equality of all Professions)
1. Maintenance of loyalty to the nursing profession & preservation of its integrity are
ideal
2. Compliance w/ the by-laws of the PNA, & other professional organizations of w/c the
RN is a member is a lofty duty
3. Commitment to continual learning and active participation in the development &
growth of the profession are commendable obligations
4. Contribution to the improvement of the socio-economic conditions & general welfare
of nurses through appropriate legislation is a practice & visionary mission.

6. The Plan-Do-Check-Act (PDCA) Cycle

a.k.a. Continuous Improvement Cycle

• PDCA WAS POPULARIZED BY W EDWARDS DEMING IN THE 1950’S AS AN EASY TO FOLLOW

PROBLEM SOLVING CYCLE

• THE CONCEPT OF PDCA IS BASED ON THE SCIENTIFIC METHOD WRITTEN AS “HYPOTHESIS-

EXPERIMENT-EVALUATION”

• REPEATING THE PDCA CYCLE CAN BRING US CLOSER TO THE GOAL, USUALLY A PERFECT
OPERATION AND OUTPUT

• A WORKFORCE USING PDCA CREATES A CULTURE OF PROBLEM SOLVERS USING PDCA AND
CREATING A CULTURE OF CRITICAL THINKERS

WALTER SHEWHART - DISCUSSED THE CONCEPT OF THE CONTINUOUS IMPROVEMENT CYCLE (PLAN DO
CHECK ACT) IN HIS 1939 BOOK, "STATISTICAL METHOD FROM THE VIEWPOINT OF QUALITY CONTROL“

W. EDWARDS DEMING - MODIFIED AND POPULARIZED THE SHEWART CYCLE (PDCA) TO WHAT IS NOW
REFERRED TO AS THE DEMING CYCLE (PLAN, DO, STUDY, ACT).

HE IS CONSIDERED TO BE THE FATHER OF QUALITY CONTROL.

PDCA SOLVING CYCLE – involve customers satisfaction

 PL
T I NVESTIGATE
C

A
CORRECT &
A STANDARDISE DETERMINE NEEDS

N
 REVIEW FEEDBACK &  DIAGNOSTIC:
MAKE CORRECTIONS  REVIEW CURRENT
PRACTICES.
 STANDARDISE DO,
CHECK, ACT  BENCHMARKING:
 SUMMARISE AND
COMPARE BEST
PRACTICES.

EVALUATE & VALIDATE ENLIGHTEN &

IMPLEMENT
 PILOT TRAINING
PROGRAM  DEFINE
RESPONSIBILITIES:
 FEEDBACK WHY, WHAT & HOW

 RECOGNITION.
RECOGNISE THE
C

CONTRIBUTION OF

O
H

OTHERS.
EC

D
K

PURPOSE: TO INVESTIGATE THE CURRENT SITUATION & UNDERSTAND FULLY THE NATURE OF THE
PROBLEM BEING SOLVED.

IDENTIFY THE PROBLEM AND ANALYZE THE PROBLEM. BUT MAKE SURE TO SET MEASURABLE AND
ATTAINABLE GOALS.

TOOLS FOR PLANNING

• DIRECT OBSERVATION OF PROCESS

• PROCESS MAPPING

• FLOWCHARTING

• CAUSE AND EFFECT DIAGRAMS

• PARETO ANALYSIS
 PL
A

T
I NVESTIGATE
N

C
CORRECT &

A
STANDARDISE DETERMINE NEEDS

 REVIEW FEEDBACK &  DIAGNOSTIC:

MAKE CORRECTIONS  REVIEW CURRENT
PRACTICES.
 STANDARDISE DO,
CHECK, ACT  BENCHMARKING:
 SUMMARISE AND
COMPARE BEST
PRACTICES.

EVALUATE & VALIDATE ENLIGHTEN &

IMPLEMENT
 PILOT TRAINING
PROGRAM  DEFINE
RESPONSIBILITIES:
 FEEDBACK WHY, WHAT & HOW

 RECOGNITION.
C RECOGNISE THE
H CONTRIBUTION OF
EC OTHERS.

O
K

D
PURPOSE: TO ENLIGHTEN THE HEALTHCARE TEAM AS TO THE REAL PROBLEM BY ANALYZING THE DATA
AND DEFINING AND IMPLEMENTING A SOLUTION PLAN.

YOU DEVELOP THE SOLUTION AND IMPLEMENT THE SOLUTION THEREFORE… DESIGNING THE
EXPERIMENT TO TEST THE HYPOTHESIS…. WHICH WAS THE PLAN

TOOLS FOR THE DOING PHASE

• DESIGN OF EXPERIMENT (DOE)

• ON THE JOB TRAINING

 PURPOSE: TO MONITOR THE EFFECTS OF IMPLEMENTATION OF PROJECT PLAN & FIND
COUNTERMEASURES TO FURTHER IMPROVE THE SOLUTION.

YOU EVALUATE THE RESULTS BY GATHERING AND ANALYZING DATA AND SEE IF IT VALIDATES THE
HYPOTHESIS/PLAN

THIS TELLS YOU IF YOU ACHIEVED YOUR DESIRED GOAL

-IF YOU DID ACHIEVE, PROCED TO THE ACT PHASE

-IF NOT, GO BACK TO PLANNING AND REVISE THE HYPOTHESIS/PROBLEM STATEMENT

TOOLS FOR CHECKING – this evaluates the performanceof the employee

• DIRECT OBSERVATION OF PROCESS

• GRAPHICAL ANALYSIS

• CONTROL CHARTS

• KEY PERFORMANCE INDICATORS

 PL
T

A
I NVESTIGATE
N
C

CORRECT &
STANDARDISE DETERMINE NEEDS
A

 REVIEW FEEDBACK &  DIAGNOSTIC:

MAKE CORRECTIONS  REVIEW CURRENT
PRACTICES.
 STANDARDISE DO,
CHECK, ACT  BENCHMARKING:
 SUMMARISE AND
COMPARE BEST
PRACTICES.

EVALUATE & VALIDATE ENLIGHTEN &

IMPLEMENT
 PILOT TRAINING
PROGRAM  DEFINE
RESPONSIBILITIES:
 FEEDBACK WHY, WHAT & HOW

 RECOGNITION.
C RECOGNISE THE
H CONTRIBUTION OF
EC OTHERS.
O

K
D
PURPOSE: TO REVIEW CONTINUOUSLY THE PERFORMANCE MEASURE & MAKE ADJUSTMENTS AS
REQUIRED. INTEGRATE NEW SITUATION INTO NORMAL WORKING PRACTICE. START PDCA CYCLE
AGAIN.

-YOU IDENTIFY THE SYSTEMIC CHANGES AND TRAINING NEEDS FOR FULL IMPLEMENTATION

-YOU ALSO PLAN ONGOING MONITORING OF THE SOLUTION

-AS THIS IS A CONTINUOUS IMPROVEMENT

-AND LOOK FOR OTHER IMPROVEMENT OPPORTUNITIES

TOOLS FOR ACTING PHASE - VISUAL MANAGEMENT IS DISPLAYING THE DATA THAT TELLS THEM HOW
EACH AREA IS DOING (POORLY/WELL) TO UNDERSTAND THEIR CURRENT STATUS.

• PROCESS MAPPING (NEW PROCESS)

• STANDARDIZATION OF WORK AND PROCESS

• VISUAL MANAGEMENT

• ERROR PROOFING

• FORMAL TRAINING

PROBLEM SOLVING PROCESS

 PLAN

• STEP 1 : IDENTIFY THE PROBLEM

• STEP 2: ANALYZE THE PROBLEM

 DO

• STEP 3: DEVELOP SOLUTIONS

• STEP 4: IMPLEMENT A SOLUTION

 CHECK

• STEP 5: EVALUATE THE RESULTS

DO YOU ACHIEVE YOUR DESIRED GOAL?

 ACT

• STEP 6: STANDARDIZE THE SOLUTION

 PLAN

 -ESTABLISH THE OBJECTIVES AND PROCESSES NECESSARY TO DELIVER RESULTS IN

ACCORDANCE WITH THE EXPECTED OUTPUT

 DO

 -IMPLEMENT THE PLANE, EXECUTE THE PROCESS, MAKE THE PRODUCT. COLLECT DATA FOR
CHARTING AND ANALYSIS

 CHECK

 -STUDY THE ACTUAL RESULTS AND COMPARE AGAINST THE EXPECTED RESULTS TO ASCERTAIN
ANY DIFFERENCES

 ACT

 -REQUEST CORRECTIVE ACTIONS ON SIGNIFICANT DIFFERENCES BETWEEN ACTUAL AND

PLANNED RESULTS. ANALYSE THE DIFFERENCES TO DETERMINE THEIR ROOT CAUSE.
REMINDERS

• PROBLEMS CAN STEM FROM OVER PLANNING OR UNDER PLANNING—IMPORTANT TO FIND

THE RIGHT PDCA BALANCE - IT MAY TAKE A DECADE TO LEARN TO “PLAN,” AND/OR A
DECADE TO LEARN TO “DO”

• CONSTRAINED RESOURCES CAN LEAD TO A LOT OF DOING, AND NOT MUCH ELSE

• DOCUMENTATION IS KEY TO PDCA, SO THAT KNOWLEDGE CAN BE RECORDED AND

INTERNALIZED
 4. TOTAL QUALITY MANAGEMENT is defined as a continuous effort by the management as well as
employees of a particular organization to ensure long term customer loyalty and customer
satisfaction.

Total Quality management is indeed a joint effort of management, staff members, workforce,
suppliers in order to meet and exceed customer satisfaction level.

Total quality management ensures that every single employee is working towards the improvement
of work culture, processes, services, systems and so on to ensure long term success.

Total Quality management enables employees to focus on quality than quantity and strive hard to
excel in whatever they

Also called: PDCA, plan–do–study–act (PDSA) cycle, Deming cycle, Shewhart cycle

The plan–do–check–act cycle (Figure 1) is a four–step model for carrying out change. Just as a
circle has no end, the PDCA cycle should be repeated again and again for continuous improvement.

Figure 1: Plan-do-check-act cycle

When to Use Plan–Do–Check–Act

 As a model for continuous improvement.
 When starting a new improvement project.
 When developing a new or improved design of a process, product or service.
 When defining a repetitive work process.
 When planning data collection and analysis in order to verify and prioritize problems or root causes.
 When implementing any change.

Plan–Do–Check–Act Procedure
1. Plan. Recognize an opportunity and plan a change.
2. Do. Test the change. Carry out a small-scale study.
3. Check. Review the test, analyze the results and identify what you’ve learned.
4. Act. Take action based on what you learned in the study step: If the change did not work, go
through the cycle again with a different plan. If you were successful, incorporate what you learned
from the test into wider changes. Use what you learned to plan new improvements, beginning the
cycle again.

Plan–Do–Check–Act Example
The Pearl River, NY School District, a 2001 recipient of the Malcolm Baldrige National Quality
Award, uses the PDCA cycle as a model for defining most of their work processes, from the
boardroom to the classroom.

PDCA is the basic structure for the district’s overall strategic planning, needs–analysis, curriculum
design and delivery, staff goal-setting and evaluation, provision of student services and support
services, and classroom instruction.

Figure 2 shows their “A+ Approach to Classroom Success.” This is a continuous cycle of designing
curriculum and delivering classroom instruction. Improvement is not a separate activity: It is built into
the work process.

Figure 2: Plan–do–check–act example

Plan. The A+ Approach begins with a “plan” step called “analyze.” In this step, students’ needs are
analyzed by examining a range of data available in Pearl River’s electronic data “warehouse,” from
grades to performance on standardized tests. Data can be analyzed for individual students or
stratified by grade, gender or any other subgroup. Because PDCA does not specify how to analyze
data, a separate data analysis process (Figure 3) is used here as well as in other processes
throughout the organization.

Figure 3: Pearl River: analysis process

 Do. The A+ Approach continues with two “do” steps:

1. “Align” asks what national and state standards require and how they will be assessed. Teaching
staff also plans curriculum by looking at what is taught at earlier and later grade levels and in other
disciplines to assure a clear continuity of instruction throughout the student’s schooling. Teachers
develop individual goals to improve their instruction where the “analyze” step showed any gaps.
2. The second “do” step is, in this example, called “act.” This is where instruction is actually provided,
following the curriculum and teaching goals. Within set parameters, teachers vary the delivery of
instruction based on each student’s learning rates and styles and varying teaching methods.

Check. The “check” step is called “assess” in this example. Formal and informal assessments take
place continually, from daily teacher “dipstick” assessments to every-six-weeks progress reports to
annual standardized tests. Teachers also can access comparative data on the electronic database
to identify trends. High-need students are monitored by a special child study team.

Throughout the school year, if assessments show students are not learning as expected, mid-course
corrections are made such as re-instruction, changing teaching methods and more direct teacher
mentoring. Assessment data become input for the next step in the cycle.

Act. In this example the “act” step is called “standardize.” When goals are met, the curriculum
design and teaching methods are considered standardized. Teachers share best practices in formal
and informal settings. Results from this cycle become input for the “analyze” phase of the next A+
cycle.

Excerpted from Nancy R. Tague’s The Quality Toolbox, Second Edition, ASQ Quality Press, 2004,
pages 390-392.