NURSING JURISPRUDENCE department of law which comprise all legal rules and principles affecting the practice of nursing.

. NURSING LEGISLATION the making of laws, or the body of laws already affecting the practice of nursing. LAW a rule of civil conduct prescribed by the supreme power in a state commanding what is right and prohibiting what is wrong. Sum total of rules and regulations by which society is governed TYPES OF LAW PRIVATE OR CIVIL LAW- body of law that deals with relationship among private individuals PUBLIC LAW- body of law for the welfare of the general public; relationship between individuals and the government and government agencies

Duces tecum (papers) bring documents, objects, materials, chart to court Ad testificandum (person) testify as witness at a specified time and place SUMMON- a writ commanding an authorized person to notify a party to appear in court to answer a complaint made against him.

WARRANT- a writing from a competent authority in pursuance of law, directing the doing of an act addressed to a person competent to do it Warrant of arrest- a court order to arrest or detain a person Search warrant- a court order to search for properties WITNESS- person giving necessary details

Nurses as witness: Could not divulge PRIVILEGED COMMUNICATION in a civil case- means that the nurse is incompetent to testify on the communications made to him by the patients, all the COURT device given and all the information gathered by An agency in the government wherein the administration of observation during the seal of secrecy. Exceptions: justice is delegated. LEGAL RIGHT 1. criminal case a claim which can be enforced by legal means against a 2. with the patients consent person whose duty is to respect it. 3. patient sued doctor for damages COURT MECHANISM LAWSUIT- proceeding in court for a purpose. Purpose: Enforce a right Redress a wrong PARTIES TO A CASE Complainant VS Defendant: Civil case Plaintiff VS Accused: Criminal case Witness- an individual held upon to give necessary details either for the accused or against the accused STATUTE OF LIMITATIONS Refers to the length of time following the event during which the plaintiff may file a suit. Example: negligence- filed within 2-3 years from occurrence. DUE PROCESS A fair and orderly process which aims to protect and enforce a persons right. FUNDAMENTAL REQUIREMENTS OF DUE PROCESS: 1. Right to be informed 2. Right to remain silent 3. Right to competent counsel 4. No use of violence, threat, torture 5. Right to know the witness face to face PHASES OF DUE PROCESS PRE-TRIAL- eliminate matters not in dispute, agree on issues or settle procedural matters. TRIAL- facts are presented and determined; law applied at the end. WRITTEN ORDERS OF COURT WRIT- legal notes from court SUBPOENA- an order in court Testimonies of Facts- factual information no opinion unless an expert witness PERJURY- is the willful telling of a lie under oath. HEARSAY EVIDENCE- rumors, not admissible in evidence DYING DECLARATION or ANTE MORTEM STATEMENTS- considered hearsay unless the dying person is a victim of a crime. APPEALS- review of the case by appellate court and when decided by it, the final judgment results and matter is ended. EXECUTION OF JUDGMENT- Failure to comply means contempt of court

FELONIES- acts or omissions punishable by law. Elements: 1. Deceit-( dolo) 2. Fault-(culpa) - due to imprudence, negligence or lack of foresight/ skill Stages of felonies 1. Consummated - all elements executed, with successful result 2. Frustrated - all elements executed but no successful result 3. Attempted - not all elements executed, no successful result Degree of Felonies degree penalty fine grave Capital punishment or >6yrs & 1 day 1 month and 1 day to 6 years 1 day to 30 days above P6k

Less grave

not > P 6 K but not <P200 fine not > P 200

Light felony

CLASSIFICATION OF PERSONS CRIMINALLY LIABLE: 1. PRINCIPAL a) By direct participation- doer of the act b) By inducement-directly force or induce others c) By cooperation- indispensable 2. ACCOMPLICE -a person who cooperates accessory before the fact- absent at the time crime is committed. 3. ACCESSORY accessory after the fact a) Profits b) Conceals/ destroys evidence c) Assists in the escape of the principal Circumstances affecting criminal liability J-E-M-A-A JUSTIFYING SELF-DEFENSE Unlawful aggression Reasonable necessity Lack of sufficient provocation Fulfillment of Duty Obedience to an order from superior Order must be lawful Superior acting within the scope of practice EXEMPTING Insane/imbecile Performance of a lawful act causes injury by mere accident Under 9 y/o Under compulsion of uncontrollable force Under impulse of uncontrollable fear Failure to perform an act required by law when prevented by some lawful cause MITIGATING Under 18y/o or over 70 y/o No intention to commit so grave a wrong Sufficient provocation/threat preceding the act Immediate vindication of a grave offense Voluntary surrender Deaf & dumb/ with physical defect Suffer from such illness that diminishes willpower AGGRAVATING Treachery/taking advantage of superior strength or position Price, reward, promise Use of fire, poison, explosion Calamities Craft, fraud or disguise employed Evident Premeditation Cruelty ALTERNATIVE May increase/ decrease criminal liability depending on the nature and effects of the crime Relationship Intoxication Degree of instruction/ education DRILLS 1. Under compulsion of uncontrollable force 2. There is sufficient provocation 3. Act is committed with abuse of confidence 4. Fulfillment of a duty 5. Offender is over 70 years old

6. Voluntary surrender 7. Disguise be employed 8. Defense of a stranger 9. Acts under the impulse of an uncontrollable fear 10. Offender is insane LAWS THAT PROMOTE THE WELFARE AND WELL-BElNG OF NURSES P.D. 442- Labor Code - Defines among other things, hours of work, contract and nurse staffing in industrial clinics P.D. 807- Civil Service Law - Provide for the recruitment and selection of employees in government service; qualification standards; personnel evaluation system; and personnel discipline R.A. 7305- Magna Carta for Public Health Workers Has provisions on benefits, rights and responsibilities of public health workers R.A. 8344 No Deposit Policy - Prohibits hospitals and clinics from demanding advance payments/cash deposits before patients are admitted or treated LEGAL CONCEPTS AND ISSUES IN NURSING LIABILITY: is an obligation or debt that can be enforced by law A person who is liable for malpractice is usually required to pay for damages. DAMAGES: refer to compensation in money recoverable for a loss of damage PROFESSIONAL NEGLIGENCE Negligence failure to do something which a reasonable & prudent person should have done. 2 types: 1. Commission wrong doing 2. Omission total neglect of care didnt do anything

ELEMENTS OF NEGLIGENCE 4DS Duty for nurse Dereliction (breach of duty) Damages as result Direct result (injury, harm or death) OR An injury incurred within the Breadth of duty of the nurse where Cause of injury is the failure to perform the Duty! SPECIFIC EXAMPLES Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath Objects left inside the patients body; sponges suction tips 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

DOCTRINES OF NEGLIGENCE 1. RES IPSA LOQUITOR - the things speak for itself - the injury is enough proof of negligence 2. RESPONDEAT SUPERIOR - Let the master answer for the acts of the subordinate - The liability is expanded to include the master as well as the employee 3. FORCE MAJEURE - Irresistible force; unforeseen or inevitable event - No person shall be responsible for those events which cannot be foreseen Ex. Flood, fire, earthquake INCOMPETENCE: lack of ability, legal qualifications or fitness to discharge the required duty

Exception: During extreme emergency only! What to do? 1. Nurse should read back such order to the physician to make certain the order has been correctly written. 2. Such order should be signed by the physician within 24 hours. 3. The nurse should sign the physicians name per her own and note the time and order was received. INTENTIONAL WRONGS TORTS: A legal wrong, committed against a person or property TYPES: 1. Unintentional- do not require intent but do require the element of harm. Ex. Negligence and malpractice 2. Intentional- the act was done on purpose or with intent; no harm, injury or damage is needed to be liable. 1.ASSAULT AND BATTERY ASSAULT- an attempt or threat to touch another person unjustifiably; mental or physical threat Ex.- forcing a pt. to take his medication or treatment BATTERY- physical harm through willful touching of person or clothing without consent. Ex. giving of injection without pts consent 2. FALSE IMPRISONMENT Unjustifiable detention of a person without a legal warrant 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. 3. INVASION OF PRIVACY Right to privacy is the right to be left alone Right to be free from unwarranted publicity Exposure to public view Divulge information from patients chart to improper sources or unauthorized person PRIVILEGED COMMUNICATION: Statements uttered in good faith; not permitted to be divulged in court of justice Exceptions: Confidential information can be revealed! Pt. consent, if there is Inform HCT for precautionary measures Crimes, child abuse, BWS Communicable disease- R.A. 3573 (Law on Notifiable Diseases) Ethics 4. DEFAMATION Character assassination 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

MALPRACTICE Doing acts or conducts that are not authorized or licensed or competent or skilled to perform, resulting to injuries or non-injurious consequences Stepping beyond ones authority Negligent act committed in the course of professional performance RN exceeding the scope of nursing practice & does an MDs job. ELEMENTS OF MALPRACTICE Duty of the nurse Dereliction or breach of duty Direct result (injury or harm) Damages Exceeds the limits of the standards of care Foreseability of harm MEDICATIONS & PRESCRIPTIONS 1. Only registered medical, dental and veterinary practitioners are authorized to prescribe drugs. 2. Prescription information (based on R.A. 5921 of the Pharmacy Act)- all prescriptions must contain the following information: Name of MD, PTR, PRC#, location of clinic/ hospital Name of patient, age, sex Information about drug frequency duration Generic & brand name in prescription R.A. 6675- Generics Act of 1988 All prescribed drug must be written in generic and brand names or generic name but never the brand name alone Purpose: for the pt. to choose what brand they want 3. Know rights in giving meds 4. Proper identification of pts name 5. In cases of doubts and errors in medication, refer to the physician. 6. Special training is required before a nurse can administer IV injection. BON Resolution No. 8 states that who administers IV injection without training shall be held liable whether causing or not an injury or death to the patient) 7. Verbal or telephone order General rule: as possible avoid T.O. whatever is not written is not an order

RESTRAINTS 3. Degree of penalty and fine Restraints are protective devices used to limit the physical activity of a client or to immobilize a client or an extremity. grave Capital punishment TYPES: or >6yrs & 1 day Physical restraints: restrict clients movement through Less grave 1 month and 1 day the application of a device to 6 years e.g. restraint jacket, straps, Chemical restraints: Medications given to inhibit a Light felony 1 day to 30 days specific behavior or movement. e.g. sedation, psychotrophic drug RESTRAINTS SHOULD NOT BE USED PRN!!! R-equires physicians order; consent E-mergency, get MDs order ASAP S-hortest duration, least restrictive type T-o protect pt. and others R-enew order every 24 hours A-ssess every 15 to 30 minutes and document I-ndividualized supervision N-ever used as a punishment T-otal documentation S-eclusion as last step ALTERNATIVES TO RESTRAINTS Before restraints offer explanations, ask someone to stay with the client, use clocks, calendars, TV & radio (to decrease disorientation) or any relaxation techniques. Use LESS restrictive methods first. RESTRAINTS should always be the last. Assign confuse and disoriented clients to rooms near the nurses station. Maintain toileting routines & institute exercise and ambulation schedules as the client condition allows. CRIMES & OTHER ACTS CRIME: An act committed or omitted in violation of the law Two elements: Criminal act Evil/criminal intent Criminal Actions Acts or offenses against public welfare Misdemeanor- offenses or acts less than a felony Felony- a public offense committed with deceit and fault Criminal negligence Reckless imprudence- person does an act from which damage results immediately Simple imprudence- did not use precaution and the damage was not immediate CLASSIFICATION 1. Manner of commission: Deceit (dolo) with criminal intent Fault (culpa) without; negligence 2. Stages of Execution 4. Degree of participation PRINCIPAL Primary author

above P6k not > P 6 K but not <P200 fine not > P 200

a. By direct participation- doer of the act b. By inducement-directly force or induce others c. By cooperation- indispensable cooperates before the fact- absent at the time crime is committed. cooperates after the fact Profits Conceals/ destroys evidence Assists in the escape of the principal

ACCOMPLICEA person who cooperates ACCESSORY

CRIMES CONCERNING THE NURSE MORAL TURPITUDE Are acts contrary to the accepted and customary rule of right 1. Rape: a.) Ordinary rape forcible penetration of sex organ to a sex organ b.) Sexual assault anything forcibly inserted to any orifice. Intervention Safety (emotional and physical) Report the incidence Referral (if the father is the rapist, refer to DSWD) ANTI- RAPE LAW (RA 8353) R.A. 7877 Anti-sexual Harassment Act 1. Any person who exercises authority 2. Asking sexual favors in exchange of another favor 2.MURDER- killing of another with intent 3. HOMICIDE- unintentional killing of another person 4. PARRICIDE Killing of a person to whom you have a relationship 1. father 2. mother 3. brothers/sisters 4. ascendants 5. descendants 6. spouse 5. ABORTION- termination of product of conception before the age of viability.

1. Consummated 2. Frustrated 3. Attempted

all elements executed, with successful result all elements executed but no successful result not all elements executed, no successful result

6. INFANTICIDE - the killing of an infant less than three days or 72 hours. 7. ROBBERY - Anyone who gets the personal property of another with the use of force,violence or intimidation. 8. THEFT- -anyone who gets the personal property of another without the latters permission. 9. SIMULATION OF BIRTH 1. Pretend that a woman gave birth 2. Substitution or exchanging of babies in the nursery 3. Intentionally putting wrong information in the birth registration form P.D. 651 Birth Registration Act - requires any person (RN,OB, midwife) who shall assist in giving birth to report within 30 days without penalty any live birth at Local Civil Registrars Office. 10. DISPENSING OF PROHIBITED DRUGS R.A. 6425 (1965) Dangerous Drugs Act o Prohibited chemicals or substances that are totally and absolutely cant be consumed by human being. Ex. Shabu, cocaine, cannabis o Regulated can use this drug - with appropriate prescription - MD with appropriated license Ex.- Valium, dormicum PENALTY FOR VIOLATING THE ACT For licensed health care providers Fines Imprisonment Automatic revocation of license GUIDELINES TO PREVENT CRIMINAL LIABILITY: 1. Be very familiar with the Philippine Nursing law 2. Be familiar with the laws affecting nursing practice 3. Know agency rules, regulations, policies 4. Upgrade skills and competence 5. Develop good IPR with co-workers 6. Consult superior as needed 7. Verify vague/ erroneous orders 8. Always keep doctor updated regarding patient 9. Ensure accurate recording and reporting 10. Get informed consent 11. Do not delegate responsibilities to others TIPS FOR AVOIDING LEGAL PITFALLS: 1. Patient Falls do proper assessment appropriate assistance use protective measures document all nursing interventions 2. Medication errors observe the rights of drug administration Check drs order Understand the medication you will administer Consult drug handbook/ pharmacy Not exempt from liability for following wrong drs order

3. Equipment injuries refuse to use a device you do not know how to operate report adverse events to superiors monitor patient regularly bring questionable orders to the attention of the doctor or superior DRILLS 1. A student nurse is overheard talking in the cafeteria about a client and his suicidal tendencies. 2. A nurse asks a client why he chose Dr. Smith for her physician when this doctor is always rude to the staff. 3. A client is told he must pay the remainder of his medical bill before he can leave the facility. 4. A nurse told the client that she will inject her with sedatives if he does not cooperate. 5. A nurse forcibly opened the mouth of a pedia patient and gave his medication. 6. A nurse takes the wallet of the patient while the latter is sleeping. 7. A nurse takes the wallet of the patient with the use of violence and intimidation. 8. A nurse gives a potent injection of morphine to a patient causing his death. 9. A nurse poisons his client to end his life. 10. A patient died because of wrong medication given.

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