Fundamentals of nursing

practice lecture
Nursing as a professional
Profession – is defined as an occupation that
requires extensive education or calling that
requires special knowledge, skill, and preparation.

- to act professionally you administer care in a

conscientious and knowledgeable manner, and
you are responsible to yourself and others.
PRIMARY CHARACTERISTICS OF A PROFESSION
 A profession requires an extensive an extended
education of its member, as well as a basic liberal
foundation.
 A profession has a theoretical body of knowledge
leading to defined skills, abilities and norms.
 A profession provides specific service
 Members of a profession have autonomy in decision
making and practice
 The profession as a whole has a code of ethics for
practice
Criteria of a Profession

1. To provide a needed to service the society

2. To advanced knowledge on its field
3. To protect its members and made it possible to practice
effectively

What is Nursing?
 Nursing is an art and science.
 as a professional nurse, you will learn to deliver care
artfully with compassion, caring, and a respect for each
client’s dignity and personhood.
 As a science, nursing is based on a body of knowledge that
is continually changing with new discoveries and
innovations.

Characteristics of Nursing
1. Nursing is caring
2. Nursing involves close personal contact with the
recipient of care
3. Nursing is concerned with services that take humans
into account as physiological, psychological, and
sociological organisms
4. Nursing is committed to personalized services for all
persons without regard to color, creed, social, or
economic status
5. Nursing is committed in promoting individual, family,
community, and national health goals in its best manner
possible
6. Nursing is committed to involvement in ethical, legal, and
political issues in the delivery of health care.

Focus: Human Response

 Human response is a way of looking at how individuals,
families or communities react to all areas of life that
influence and impact them.
Nurse Focus on Two Types of Responses
1. Reactions to actual health problems or illness (health
-restoring responses)
2. Concerns about potential health problems (health-
supporting responses)

Personal Qualities of a Nurse

1. Must have a Bachelor of Science in Nursing
2. Must be physically and mentally fit
3. Must have a license to practice nursing in the country
4. A professional nurse therefore, is a person who has
completed a basic nursing education program and is
licensed in his country to practice professional nursing.
Professional Qualities of a Nurse
 A professional nurse therefore, is a person who has
completed a basic nursing education program and is
licensed in his country to practice professional nursing.
 HISTORY OF NURSING IN THE WORLD

Periods of Nursing History

 Intuitive Period/Medieval Period
 Apprentice Period
 Educative Period
 Contemporary Period
INTUITIVE PERIOD
 Prehistoric – Early Christian Era
 More on intuition
 NOMADS –travel from one place to another
 Survival to the fittest
 “Best of the most” – motto
 Sickness is due to “voodoo”
 Performed out of feeling of compassion for others
 Performed out of desire to help
 Performed out of wish to do good
 Nursing is given by the WOMEN
 They are the doctors during those time
 SHAMAN – uses white magic to counteract the black
magic
Continuation
 TREPHINING – drilling the skull used to treat psychotic
patients.
 Psychotic patients believed to be possessed by evil spirit
 Growth of religion – most important thing that happened
 Growth of civilization
 Law of preservation – inspire men in search of knowledge
Rise in Civilization
 from the mode of nomadic life – agrarian society – gradual
development of urban community life
 existence of means of communication
 start of scientific knowledge – more complex life –
increases in health problems – demand for more nurses
 nursing as a duty of slaves and wives. nurses do not change
but there was a progress in the practice of medicine.
 care is still closely allied with supertitiuos, religion, and
magic
Continuation
 Near East – birth place of three religious ideologist:
 Judaism
 Christianity
 Mohammedism or Islam
 Near East was adopted by the Greeks and Romans combined
with the wonders of the Far East by returning crusaders and
explorers improved and was carried to Europe during the
Renaissance Period that resulted greater knowledge then to the
New World by the early settlers.
 New World – a tiny area known as a birth of monotheism that
lies between the Tigris and Euprates River in the Nile River
arose the cultures of babylonia, Egypt and Hebrew.
 MONOTHEISM – believer of one God
 Different Civilization

BABYLONIANS
 1st recording of the medical practice
 Established the medical fees
 Discouraged experimentation
 Specific doctors for each disease
 Right of patient to choose treatment between the use of
charms, medicine, or surgical procedures
EGYPTIANS
Art of Embalming
 Mummification
 Removing the internal organ of the dead body
 Instillation of herbs and salt to the dead
 Used to enhance their knowledge of the human anatomy.
 Documentation of 250 diseases and treatments
HEBREW
TEACHING OF MOSES
 Created Leviticus
 Father of sanitation
 Practice the value of “Hospitality to Strangers” and the “Act of
Charity” – contained in the book of the Old Testament
 Laws governing cleanliness
 Law on preparation of food
 Purification of man and his food
 The ritual of CIRCUMCISSION – on the 8th day afyer birth
MOSAIC LAW
 Meant to keep Hebrews pure so that they may enter the
sanctuary without affronting God
 Meant as a survival for health and hygienic reason only
CHINA
 Use of pharmacologic drugs
“MATERIA MEDICA”
BOOK THAT INDICATE THE PHARMACOLOGIC DRUGS USED FOR
TREATMENT
 No knowledge on anatomy
 Use of wax to preserve the body of the dead
 Method of paper making
 FACTOR THAT HAMPERED THE ADVANCEMENT OF MEDICINE
 PROHIBITS DISSECTING OF HUMAN BODY THUS THWARTING
SCIENTIFIC STUDY
INDIA
SUSHURUTO
1st recording on the nursing practice
 Hampered by Taboos due to social structures and practices of
animal worship
 Medicine men built hospitals
 Intuitive form of asepsis
 There was proficient practice of Medicine and Surgery
 NURSES QUALIFICATIONS: Lay brothers, Priest nurses,
combination of pharmacist, PT, cooks
 There was also decline in Medical practice due to fall of
Buddhism – state religion of India
GREECE

AESCULAPUS
- father of Medicine
HIPPOCRATES
- Father of Modern Medicine
- 1st to reject the idea that diseases are caused by evil
spirits
- 1st to apply assessment
- Practice medical ethics
CADUSEUS
- Insignia of medicine
- Composed of staff of travelers interwined with 2 serpent (the
symbol of Aesculapus and his healing power). At the apex of the staff
are two wings of hermes (Mercury) for speed.
-- Nurses – function of untrained slaves
ROMANS

 Proper turnover for the sick people

 “if you are strong, you are healthy” – motto
 Transition to Pagan to Christianity
 Fabiola – was converted to Christian and later she converted her
home to hospital and used her wealth for the sick.
 1st hospital in the Christian world
APPRENTICE PERIOD/MIDDLE AGES
11th Century – 1836
 On-the-job training period
 Refers to a beginner (on-the-job-training). It means care
performed by people who are directed by more experienced
nurses
 Starts from the founding of Religious orders in the 6th century
(1836 – when the deaconesses School of Nursing was established
in Kaiserweith, Germany by Pastor Theodore Fleidner)
 There was a struggle for religious, political, and economic power
Continuation
 Crusades took place in order to gain religious, political, and
economic power or for adventure
 During the crusade in this period, it happened as an attempt to
recapture the Holy Land from the Turk who obtained and gain
control of the region as a result of power struggle. Christians
were divided due to serveral religious war and Christians were
denied visit to the Holy Sepulcher.
MILITARY RELIGIOUS ORDERS AND THEIR WORKS

KNIGHTS OF ST. JOHN OF JERUSALEM (ITALIAN)

 Also called as Knight of Hospitallers”
 Established to give care

TEUTONIC KNIGHTS (GERMAN)

 Took subsequent wars in the Holy Land
 Cared for the injured and established hospitals in the military
camps

KNIGHTS OF ST. LAZARUS

 Care for those who suffered Leprosy, syphilis, and chronic skin
diseases
ALEXIAN BROTHERS
 A monasteric order founded in 1348. They established the Alexan
brothers School of Nursing, the largest school under religious
auspicies exclusively in US and it closed down in 1969.

THE DARK PERIOD OF NURSING

 From 17th Century to 19th Century
 Also the Period of Reformation until the American Civil War
 Hospitals were closed
 Nursing were the works of the least desirable people (criminals,
prostitutes, drunkards, slaves and opportunist
 Nurses were uneducated, fithy, harsh, ill-fed, overworked
 Mass exodus of nurses
MARTIN LUTHER
 The American Civil War was led by Martin Luther, the war
religious upheaval that resulted to the destruction in the unity
of Christians.
 The conflict swept everything connected to Roman Catholicism
in schools, orphanages, and hospitals.

THEODORE FLIEDNER
 A pastor, reconstituted the deaconesses and laterat be established
the School of Nursing at Kaiserswerth, Germany where Florence
Nigthingale had her 1st formal training for 3 months as nurse.
FLORENCE NIGHTINGALE
 Practice her profession during the Crimean War
 Lady with a Lamp
 From a well-known family
 Went to Germany to study

EDUCATIVE PERIOD/NIGTHINGALE ERA

 Florence Nightingale School of Nursing
 Began in June 15, 1860 when Florence Nightingale School
of Nursing opened at St. Thomas Hospital in London, England
for formal education of Nurses began and contributed growth
of Nursing in the US
Factors the Influenced Development of Nursing Education
 Social Forces
 Trends resulting from war
 Emancipation of women
 Increased educational opportunities

FLORENCE NIGHTINGALE
 Mother of Modern Nursing
 Lady with the Lamp
 Born on May 12, 1820 in Florence, Italy
 Her Self-Appointed Goal – to change the profile of Nurisng
 She complied notes of her visit to hospitals, her observations of
sanitation practices and entered Deaconesses School of Nursing
at Kaiserswerth, Germany for 3 months
Continuation
 Became the Superintendent of the Establishment for Gentle
Women during the illness(refers to the ill governess or
instructors of Nursing
 She disapproved restriction on admission of patient and
considered this unchristian and contrary to health care.
 Upgraded the practice of Nursing and made Nursing a Honorable
Profession
 Led other Nurses in taking care wounded and sick soldiers during
the Crimean War
 She was designated as Superintendent of the Female
Establishment of English General Hospital in Turkey during the
Crimean War
She reduced the casualties of war by 42% - 2% thru her effort by
improving the practice of sanitation techniques
THE CONCEPT OF FLORENCE NIGHTINGALE ON NURSING SCHOOLS
 School of Nursing should be self-supporting not subject to the
whimps of the hospitals
 Have decent living quarters for students and pay Nurse
instructors
 Correlate theories to practice
 Support Nursing Research and promote continuing education for
Nurses
 Introduce teaching knowledge that diseases could eliminated by
cleanliness and sanitation and Florence Nightingale likewise did
not believed in the Germ Theory of Bacterilogy
Continuation
 Opposed central registry of Nurses
 Wrote notes on Nursing, “What is and What is not?”
 Wrote notes on hospitals

Other School of Nursing

 Linda Richards – the first graduate nurse in United States,
graduated in September 1, 1873
 2 NURSING ASSOCIATION/ORGANIZATION THAT UPGRADED
NURSING PRACTICE IN US
 American Nurses Association
 National League for Nursing Education
CONTEMPORARY PERIOD
 WORLD War II – present
 This refers to the period after World War I and the changes and
development in the trends and practice of Nursing since 1945
after World War II
 Includes scientific and technological development, social changes
occurring after the war
 Nursing offered in Colleges and Universities

DEVELOPMENT AND TRENDS

 W.H.O. established by U.N. to fight diseases by providing health
information, proper nutrition, living standards, environmental
conditions
 the use of atomic energy for diagnosis and treatment
continuation
 Health related laws
 Primary Health Care – Nurses involvement in CHN
 Utilization of computers
 Technology advances such as development of disposable
equipment and supplies that relieved the task of Nurses
 Development of expanded role of Nurses

FACTORS AFFECTING NURSING TODAY

 Economics
 Consumer’s demand
 Family structure
 Information and Telecommunication
 legislations
 HISTORY OF NURSING IN THE PHILIPPINES

EARLY BELIEFS AND PRACTICES

Beliefs About Causation of Diseases:
o Caused or inflicted by other person (enemy or witch)
o Evil spirits
Beliefs that evil Spirits could be driven off by person to expel
bad spirits:
o Believed in Gods Healing
o Word doctors – priest physician
o Herbularios – herb doctors
EARLY CARE FOR THE SICK
o HERBICHEROS – herbmen who practice witchcraft
o MANGKUKULAM/MANGANGAWAY – a person suffering from
disease without any identified cause and were believed
bewitched by such.
o Difficult child birth and some diseases attributed to
(NONO) midwives
o Difficult child birth, witches were supposed to be the
cause, gunpowder exploded from a bamboo pole close to
the head of the mother to drive evil spirits
EARLY HOSPITALS

Hospital Real Manila – 1577

o 1st Hospital established
o Gov. Francisco de Sande
o To give service to the King’s Spaniard soldiers

San Lazaro Hospitals – 1578

o Fray Juan Clemente
o Named after the Knights of St. Lazarus
o Hospitals for the lepers
Hospital de Indios – 1586
o Franciscan orders
o Hospital for the poor Filipino people

Hospital de Aguas Santas – 1590

o Fray Juan Bautista Named after its location (near spring)
because people believed that spring has a healing power

San Juan de Dios – 1596

o For poor people
o Located at Roxas Boulevard
PERSONAGES

DOÑA HILARIA DE AGUINALDO

o 1st wife of Emilio Aguinaldo
o Established Philippine Red Cross

DOÑA MARIA AGINCILLO DE AGUINALDO

o 2nd wife of Emilio Aguinaldo
o 1st President of Philippine Red Cross (Batangas Chapter)

JOSEPHINE BRACKEN
o Helped Rizal in treating sick people
MELCHORA AQUINO
o Took care of the wounded Katiponeros

ANASTACIA GIRON TUPAS

o Founder of Filipino Nurses Association- established on
October 15, 1922
o 1st Filipino Chief Nurse of PGH
o 1st Filipino Superintendent of Nurses in the Philippines

CESARIA TAN
o 1st Filipino to receive Masteral Degree
SOCORRO SIRILAN
o Pioneer in social service at San Lazaro Hospital
o Also the Chief Nurse

FRANCISCO DELGADO
o 1st president of Filipino Nurses Association

SOCORRO DIAZ
o 1st editor of PNA magazine called, “The Magazine”

CONCHITA RUIZ
o Full time editor of PNA newly named magazine, “The
Filipino Nurse”
SOR RICARDA MENDOZA
o Pioneer in Nursing Education

LORETO TUPAZ
o “Dean of Philippine Nursing”
o Florence of Iloilo

EARLY NURSING SCHOOLS

1. Ilo-ilo Mission Hospital School of Nursing (1906)
o Ran by Baptist foreign mission society of America
o Miss Rose Nicolet, graduate of New England. Hospital for
women and children. In Boston, Masachusetts was the 1 st
superintendent for nurses. It moved to its present location
in Garo road, Ilo-ilo City 1929
continuation
o Miss Flora Ernst, an American nurse took charge of the
school in 1942.

2. St. Paul Hospital School of Nursing (Manila, 1907)

o The hospital was established by the Archbishop of Manila,
the most Reverend, Jeremiah Harty under the supervision of
the sisters of St. Paul the charters.
o Located in Intramuros, and it provided general hospital
services
o 1908 – operated its training school for nurses with reverend
Mother Melanie as Superintendent and Miss E. Chambers as
Principal.
3. PHILIPPINE GENERAL HOSPITAL SCHOOL OF NURSING (1907)
o Anastacia Giron Tupas – first Filipino nurse to occupy the
position of Chief Nurse and Superintendent

4. ST. LUKE’S HOSPITAL SCHOOL OF NURSING (Q.C. 1907)

o 1907 – the school opened with three Filipino girls admitted.
These girls had their 1st year in combined classes with the PGH
Hospital School of Nursing and St. Paul’s Hospital School of
Nursing
o Vitaliana Beltran was the 1st Filipino Superintendent of nurse.
 FIRST COLLEGES OF NURSING IN THE PHILIPPINES

1. University of Santo Tomas College of Nursing

o February 11, 1941 – the college began as the UST School of
Nursing education
o Sor Taciana Trinanes was the 1st Directress

2. Manila Central University College of Nursing

o 1947, offered the BSN course
o Miss Consuelo Gimeno was its 1st principal
3. University of the Philippines College of Nursing
o The idea of opening the college began in conference
between Miss Julita Sotejo and the UP president Gonzales
o 1946, the university council approved the curriculum, and
the Board of Regents recognized the profession as having
equal standing as medicine, law, engineering, etc.
o Miss Julita Sotejo was its 1st Dean
 GROWTH OF PROFESSIONALISM

Carper’s 4 Patterns of Knowing

1. Ethics: The Components of Moral Knowledge
o Guides and directs how nurses conduct their practice
o Requires:
 Experiential knowledge of social values
 Ethical reasoning
o Focus is on:
 Matters on obligation, what ought to be done
 Right, wrong and responsibility
 Ethical codes of nursing
 Confronting and resolving conflicting values, norms,
interests or principles
continuation
Sources of Ethical Knowing
o Nursing’s ethical codes and professional standards
o An understanding of different philosophical positions
 Consequentialism
 Deontology
 Duty
 Social Justice

2. Personal Knowing: Acceptance of self that is grounded in

self-knowledge and confidence
o Concerned with becoming self-aware
- self-awareness that grows over time through interactions
with others.
continuation
o Used when nurses engage in the therapeutic use of self in
practice
- Scientific confidence, moral/ethical, practice, insight, and
experiences of personal knowing
o Personal knowing needs to be integrated or reconciled with
professional responsibilities
o Personal knowing is the basis of the therapeutic use of self
in the nurse-patient relationship
- Perceiving self-feelings, and prejudices within the
situation
3. AESTHETIC KNOWING: The art of knowing
o Expressed through:
 Actions, bearing, conduct, attitudes, narratives and interaction
 Knowing what to do without conscious deliberation
o Involves:
 Deep appreciation of the meaning of situation
 Moves beyond the surface of a situation
 Often shared without conscious exchange of words
 Transformative art/acts
 Brings together all the elements of a nursing care situation to create
a meaningful whole
 Perceiving the nature of a clinical situation and interpreting this
information
 To respond with skill action
 It uses the nurses intuition and empathy
 Is based on the skill of the nurse
4. EMPIRICS: The science of nursing, based on the
assumption that what is known is accessible through the
physical senses: seeing, touching, and hearing.
- Reality exists and truths about it can be understood
o A pattern of knowing that draws on traditional ideas of
science
o Positivist Science
 Science is systematically organized into general laws and
theories
o Source of the knowledge
 Research
 Theory
 OVERVIEW OF THE PROFESSIONAL NURSING PRACTICE
Berner’s Level of Proficiency
I. Novice
 Beginner with experience
 Performance is limited, inflexible, and governed by
context-free rules and regulations rather than experience

II. Advance beginner

 Demonstrate marginally acceptable performance
 Recognizez the meaning “aspect” of a real situation
 Has experienced enough in real situations to make
judgments about them
… continuation
III. Competent
 Have 2 or 3 years of experience
 Demonstrate organizational and planning abilities
 Differentiates important factors from less important aspects
of care
 Coordinates multiple care demands
IV. Proficient
 Have 3 or 5 years of experience
 Perceives situations as wholes rather than in terms of parts
as in stage II
 Uses maxims as guides for what to consider in a situation
 Has holistic understanding of the client, which improves
decision-making focuses on long term goals.
IV. Expert
 Performance is fluid, flexible, and highly proficient
 No longer requires rules, guidelines, or maxims to connect
an understanding of the situation to appropriate action
 Demonstrate highly intuitive and analytic ability in new
situation is inclined to take action because “it felt right”
 ROLES AND RESPONSIBILITY OF A PROFESSIONAL NURSE
1. CARE GIVER
 it has traditionally included hose activities that assist the
client physically and psychologically while preserving the
client’s dignity. the required nursing actions may involve
full care for the completely dependent client, and
supportive-educative care to assist client in attaining their
highest level of health and wellness.
2. COMMUNICATOR
 It is integral to all nursing roles. Nurses communicate with
the client, support person, other health professional, and
people in the community. In the role of communicator
nurses identify client problems and then communicate these
verbally or in writing to other members of the health care
team
3. TEACHER
 As a teacher, the nurse helps client learn about their
health and the health care procedures they need to
perform to restore or maintain their health. The nurse
assesses the client’s learning needs and readiness to learn,
sets specific objectives goals in conjunction with the
client, enacts teaching strategies, and measures learning
4. CLIENT ADVOCATE
 A client advocate acts to protect the client. In this role
nurse may represent the client’s needs and wishes to other
health professionals, such as relaying the client’s wishes for
information to the physician.

5. COUNSELOR
 Counselling is the process of helping a client to recognize
and cope with stressful psychological or social problems, to
develop improved interpersonal relationships, and to
promote personal growth. It involves providing emotional,
intellectual, and psychological support.
6. CHANGE AGENT
 The nurse as a change agent when assisting the client to
make modification in their behavior. Nurses also often act to
make changes in a system, such as clinical care . It is not
helping a client return to health.
7. LEADER
 a leader influences others to work together to accomplish a
specific goal. The leader role can be employed at different
levels: individual client, family, group of clients, colleagues,
or the community.
8. MANAGER
 the nurse manages the nursing care of individuals, families,
and communities. The nurse manager also delegates nursing
activities to ancillary workers and other nurses, and
supervises and evaluates their performance

9. CASE MANAGER
 Nurse care managers work with the multidisciplinary health
care team to measure the effectiveness of the care
management plan and to monitor outcomes. Each agency or
unit specify the role of the nurse case manager.
10. RESEARCH CONSUMER
 nurses often use research to improve client care. in a
clinical area, nurses need to have some awareness of the
process and language of research. be sensitive to issues
related to protecting the rights of human subjects.
participate in the identification of significant researchable
problems. be a discriminating consumer of research
findings.
 EXPANDED ROLES OF THE NURSE
 NURSE PRACTITIONER
- a nurse who has an advance education and is a graduate
of a nurse practitioner program. Theses nurses are certified
by the American Nurses Credentialing Center in areas such as
adult nurse practitioner, school nurse practitioner, pediatric
nurse practitioner, or gerontology practitioner, they are
employed in helath care agencies or community-based
settings. They usually deal with nonemergency acute or
chronic illness and provide primary care.
 CLINICAL NURSE SPECIALIST
- a nurse who has an advanced degree or expertise and is
considered to be an expert in a specialized area of practice.
The nurse provides direct client care. Educates others,
consults, conducts research, and manages care. The
American Nurses Credentialing Center provides national
certification of clinical specialist.
 NURSE ANESTHETIST
- a nurse who has completed advanced education in an
accredited program in anesthesiology. The nurse anesthetist
carries out preoperative visits and assessment, and administers
general anesthetics for surgery under the supervision of a
physician prepared in anesthesiology. The nurse anesthetist
also assesses postoperative status of clients.
 NURSE MIDWIFE
- an RN who has completed a program in midwifery and is
certified by the American College of Nurse Midwives. The nurse
gives prenatal and postnatal care and manages deliveries in
normal pregnancies. The midwife practices in associated with a
health care agency and can obtain medical services if
complications occur. The nurse midwife may also conduct
routine papnicolaou smears, family planning, and routine
breast examinations.
 NURSE RESEARCHER
- nurse researcher investigate nursing problems to improve
nursing care and to refine and expand nursing knowledge. They
are employed in academic institutions, teaching hospitals and
research centers such as National Institute for Nursing
Research. Nurse researchers usually have advance education at
the doctoral level.
 NURSE ADMINISTRATOR
- the nurse administrator manages client care, including
the delivery of nursing services. The administrator may have a
middle management position, such as head nurse or
supervisor, or a more senior management position, such as
director of nursing sevices. The functions of nurse
administrator include budgeting, staffing, and planning
programs. The educational preparation for nurse administrator
positions is at least a master’s or doctoral degree
 NURSE EDUCATOR
- nurse educators are employed in nursing programs, at
educational institutions, and in hospital staff educator. The
nurse educator has a baccalaureate degree or more advanced
preparation and frequently has expertise in a particular area
of practice. The nurse educator is responsible for classroom
and often clinical teaching.

 NURSE ENTREPRENEUR
- a nurse who usually has an advance degree and manages a
health related business. The nurse may be involved in
education, consultation, or research.
 SCOPE OF NURSING
Scope of Nursing Practice based on RA 9173
Sec. 28 Scope of Nursing Practice – As independent
practitioners, nurses are primarily responsible for the
promotion of health and prevention of illness. As members of
the health team, nurses that collaborate with the health care
givers for the curative, prevention, and rahabilative aspects
of care, restoration of health, alleviate of suffering and when
recovery is not possible, toward a peaceful death.
Code of Ethics for Nurses
The code of ethics is the philosophical ideals of right and
wrong that define the principles you use to provide care to
your clients. A code of ethics is a set of guiding principles
that all members of a profession accept. It is a collective
statement about the group’s expectations and standards of
behavior. Codes serve as guidelines to assist professional
groups when questions arise about correct practice or
behavior.
 American Nurses Association Code of Ethics
 The nurse, in all professional relationships, practices
with compassion and respect for the inherent dignity,
worth, and uniqueness of every individual, unrestricted
by consideration of social or economic status, personal
attributes or the nature of health problem.
 The nurse’s primary commitment is to the patient,
whether an individual, family, group, or community.
 The nurse is responsible and accountable for individual
practice and determines the appropriate delegation of
tasks consistent with the nurse’s obligation to provide
patient care.
 The nurse owes the same duties to self as to others,
including the responsibility to preserve integrity and
safety, to maintain competence, and to continue personal
and professional growth.
 The nurse participates in establishing, maintaining, and
improving health care environments and conditions of
employment conducive to the provision of quality health
care and consistent with the values of the profession
through and collective action
 The nurse participates in the advancement of the
profession through contributions to practice, education,
administration, and knowledge development
 The nurse collaborates with other health professionals and
the public in promoting community, national, and
international efforts to meet health needs.
 The profession of nursing represented by associations and
their members, is responsible for articulating nursing
values, for maintaining the integrity of the profession and
its practice, and for shaping social policy.
BASIC PRINCIPLES TO MAINTAIN INTEGRITY OF PROFESSION

ADVOCACY – refers to the support of a cue. As a nurse

advocate for health, safety, and rights of the client.

RESPONSIBILITY – refers to the willingness to respect

obligations and to follow through on premises.

ACCOUNTABILITY – refers to the ability answer for one’s own

actions.
CONFIDENTIALITY – protection of client’s personal health
information. The legislation defines the rights and privileges of
clients for protection of privacy without diminishing access to
quality care.
 FILIPINO PATIENT’S BILL OF RIGHTS
1. The patient has the right to considerate care irrespective
of socio-economic status.
2. The patient has the right to obtain from his physician
complete current information concerning his diagnosis,
treatment and prognosis in terms the patient can
reasonably be expected to understand. When it is not
medically advisable to give such information to the
patient, the information should be made available to an
appropriate person in his behalf, he has the right to know
by name or in person, the medical team responsible in
coordinating his care.
3. The patient has the right to receive from his physician
information necessary to give informed consent prior to the
start of any procedure and/or treatment. Except in
emergencies, such information for informed consent should
include but not necessarily limited to the specific procedure
and or treatment, the medically significant risks involved, and
the probable duration of incapacitation. When medically
significant alternatives for care or treatment exist, or when
the patient requests information concerning medical
alternatives, the patient has the right to information. The
patient has also the right to know the name of the person
responsible for the procedure and/or treatment
4. The patient has the right to refuse treatment/life giving
measures, to the extent permitted by law, and to be informed
of the medical consequences of his action.
5. The patient has the to every consideration of his privacy
concerning his own medical care program. Case discussion,
consultation, examination and treatment are confidential and
should be conducted discretely. Those not directly involved in
his care must have the permission of the patient to be
present.
6. The patient has the right to expect that all communications
and records pertaining to his care shoul be treated as
confidential.
7. The patient has the right within its capacity, a hospital
must make reasonable response to the request of patient for
services. The hospital provide evaluation, service and/or
referral as indicated by the urgency of care . When medically
permissible a patient may be transferred to another facility
only after he has received complete information concerning
the needs and alternatives to such transfer. The institution to
which the patient is to be transferred must first have
accepted the patient for transfer.
8. The patient has the right to obtain information as to any to
any relationship of the hospital to other health care and
educational institution in so far as his care is concerned .the
patient has the right to obtain as to the existence of any
professional relationship among individuals, by name who are
treating him.
9. The patient has the right to be advised if the hospital
proposes to engage in or perform human experimentation
affecting his care or treatment. The patient has the right to
refuse or participate in such research project.
10. The patient has the right to expect reasonable continuity
of care; he has the right to know in advance what appointment
times the physicians are available and where. The patient has
the right to expect that the hospital will provide a mechanism
whereby he is informed by his physician or a delegate of the
physician of the patient’s continuing health care requirements
following discharge.
11. The patient has the right to examine and receive an
explanation of his bill regardless of source of payment.
12. The patient has the right to know what hospital rules and
regulation apply to his conduct as a patient.
 LEGAL ASPECTS OF NURSING
Nursing practice is governed by many legal concepts. It is
important for nurses to know the basics of legal concepts,
because nurses are accountable for their professional
judgments and actions accountability is an essential concept of
professional nursing practice and the law. Knowledge of laws
that regulate and effect nursing practice is needed fro two
reasons:
1. To ensure that the nurse’s decisions and actions are
consistent with current legal principles
2. To nurses from liability.
 Legal Bases
Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing Act
2002”
Board shall monitor & enforce quality standards of nursing
practice necessary to ensure the maintenance of efficient,
ethical and technical, moral and professional standards in
the practice of nursing taking into account the health
needs of the nation.
 SIGNIFICANCE OF CORE
COMPETENCY STANDARDS
• Unifying framework for nursing practice, education, regulation
Guide in nursing curriculum development

• Framework in developing test syllabus for nursing profession entrants

• Tool for nurses’ performance evaluation

• Basis for advanced nursing practice, specialization

• Framework for developing nursing training curriculum

• Public protection from incompetent practitioners

• Yardstick for unethical, unprofessional nursing practice

11 Key Areas of
Responsibility
 1. Safe and  Quality  Nursing
Care

Core
competency  Core Core
1: Competency 2: Competency 3:

Provides sound
Demonstrates decision making in
knowledge base Promotes safety
the care of and comfort and
on the health /illness
status of individual / individuals / privacy of clients
Groups families/groups
considering their
beliefs and values
 1. Safe and  Quality  Nursing
Care

 Core
Competency  Core  Core
4: Competency 5: Competency 6:

Administers
Sets priorities in Ensures
nursing care based medications
continuity of
on clients’ needs and other
care
health
therapeutics
1. Safe and  Quality  Nursing
Care
 Core
Competency
7:

Utilizes the
nursing
process as
framework for
nursing
 2.  Management of
Resources and Environment

Core
competency  Core Core
1: Competency 2: Competency 3:

Establishes
Organizes work Utilizes mechanism to
load to facilitate financial ensure
client care resources to proper
support client functioning of
care equipment
 2.  Management of
Resources and Environment
 Core
Competency
4:

Maintains a safe
environment
 3. Health Education

Core
competency  Core Core
1: Competency 2: Competency 3:
Develops
Assesses the health
Develops
learning needs education plan
learning
of the client based on
materials for
assessed and
partner health
anticipated
needs
 3. Health Education

 Core
Competency  Core
4: Competency 5:

Implements the Evaluates the

health outcome of
education plan health
education
 4. Legal Responsibility

Core
competency  Core Core
1: Competency 2: Competency 3:

Adheres to practices in Adheres to

accordance with organizational Documents
the nursing law and policies and care rendered
other relevant procedures, local to clients
legislation including and national  
contracts, informed
consent.
 Core Competency
1:

5. Ethico-
Respects the
rights of
individual / groups

moral Core Competency 3:

Adheres to the
Core Competency
2:
Responsibility national and
international code
of ethics for nurses

Accepts
responsibility
 6. Personal and Professional
Development

Core
competency  Core Core
1: Competency 2: Competency 3:

Identifies Pursues Gets involved

in professional
own continuing organizations
learning education and civic
activities
needs
 6. Personal and Professional
Development

 Core
Competency  Core  Core
4: Competency 5: Competency 6:

Possesses
Projects a positive Performs
professional function
attitude according to
image of the towards professional
nurse change and standards 
criticism
 7. Quality Improvement

Core
competency  Core Core
1: Competency 2: Competency 3:

Participates Identifies
Gathers data in nursing
for quality and
improvement
audits and reports
rounds variances
7. Quality Improvement
 Core
Competency
4:

Recommends
solutions to
identified
problems
 8. Research

Core
competency  Core Core
1: Competency 2: Competency 3:

Gather data Analyzes and Recommends

using different interprets data actions for
methodologies gathered implementation 
 8. Research

 Core
Competency  Core
4: Competency 5:

Disseminates Applies
research findings in
results of
nursing practice
research findings
 9. Records Management

Core
competency  Core Core
1: Competency 2: Competency 3:

Observes
Maintains accurate legal
Records outcome
and updated
of client care  imperatives
documentation of
client care  in record
keeping 

 
 10. Communication

Core
competency  Core Core
1: Competency 2: Competency 3:

Establishes rapport Utilizes formal

Identifies verbal and informal
with client,
and non-verbal
significant others channels 
cues 
and members of
the health team  
 10. Communication

 Core
Competency  Core
4: Competency 5:

Responds to needs Uses appropriate

information
of individuals,
technology to
family, group and facilitate
community communication
11. Collaboration and
Teamwork

 Core
Competency  Core
1: Competency 2:

Establishes
collaborative Collaborates plan of
relationship with care with other
colleagues and other members of the
members of the health team
health team