Question

1. What are the definitions of the following terms and how are they distinct from one another:

A. Ethical

B. Moral

C. Legal

2. What are the sic ethical principles that dictate the actions of healthcare providers in delivering services to clients?

3. What are the eleven core competencies of Nurses in the Philippines and its indicators?

4. What is the difference between the terms Negligence & Malpractice?

5. What is the meant by the legal terms respondent superior, and how does this term apply to professional nursing practice?

Answer 1

What are the definitions of the following terms and how are they distinct from one another:

A. Ethical

B. Moral

C. Legal

Criteria	Ethics	Morals	Law
Definition	Ethics are the moral principles (rules of conduct) that govern a person's behaviour or the conducting of an activity.	Morals are concerned with the principles of right and wrong behaviour and the goodness or badness of human character.	Law is the system of rules that a particular country or community recognizes as for regulating the actions of its members and may enforce by the imposition of penalties.
Governing body	Ethics governs professional interactions (decision making)	Morality governs private, personal interactions.	Law governs society as a whole, often dealing with interactions between total strangers.
Source	Comes from external source like professional organizations - what society/ organizations/ external sources say is right or wrong.	It is autonomous (comes from the inner self of men)- individuals believe what is right or wrong	Enforced by government- what is right or wrong according to legislature.
Punishment on violation	Ethics does not carry any punishment to anyone who violates it.	not enforceable by law so non punishable	The law will punish anyone who happens to violate it.
Applicable to	Applies to professional actions or activities, governs members of a profession	Morality applies to every human act. morality also applies to all persons. But it depends from person to person, from religion to religion, society to society	Applied to all citizens of the country or state
Example	Example: A professional nurse should take informed consent before any invasive procedure to respect patient’s autonomy.	Example: donation to charity institution is a moral principle	Example: Abortion after 20 weeks of gestation is not legal in many countries of the world.

Ethics and morals relate to “right” and “wrong” conduct. While they are sometimes used interchangeably, they are different: ethics refer to rules provided by an external source, e.g., codes of conduct in workplaces or principles in religions. Morals refer to an individual's own principles regarding right and wrong.

Morals and Law differ because the law demands an absolute subjection to its rules and commands. Law has enforcing authority derived from the state. It is heteronymous (being imposed upon men upon the outer life of men). Law regulates men’s relations with others and with society.

What are the siX ethical principles that dictate the actions of healthcare providers in delivering services to clients?

The six ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity and veracity, autonomy.

Justice means fairness or equity. Nurses must be fair when they provide care. Care must be fairly, justifiably, and equitably distributed among a group of patients. Clients need to be treated in a manner that they deserve. Ex. All the clients receive the same treatment when being admitted for surgery, fair distribution of resources without any consideration or outside influence.

Beneficence is doing good and the right thing for the patient. The best interests of the client must be upheld. Ex: immunization

Nonmaleficence is doing no harm. It refers to the avoidance of causing any harm to clients. Harm can be intentional or unintentional. Try to balance the risks and benefits of a plan of care, while striving to do no harm. Ex: bone marrow transplant promises to bring a cure but there may be a long period of pain and suffering, participation of patients in research or clinical trials

Accountability is accepting responsibility for one's own actions. Accountability is the process that mandates that individuals are answerable for their actions and have an obligation to act. ¢Attributes of accountability are answerability& responsibility. Nurses are accountable for their actions. They must accept all of the professional and personal consequences that can occur as the result of their actions. For example drug calculation errors, not responding to client on timely manner

Autonomy and self-determination refers to a person’s independence, self-determination, self-reliance. A patient has the right to make decisions about her/her care. Nurses encourage patients to make their own decision without any judgments or coercion. The patient has the right to reject or accept all treatments. Ex. Signing a consent form for surgery

Fidelity is keeping one's promises, and veracity means telling the truth. The nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner.

What are the eleven core competencies of Nurses in the Philippines and its indicators?

A core competency of nursing is the ability to practice nursing that meets the needs of clients cared for using logical thinking and accurate nursing skills. Nursing competency includes core abilities that are required for fulfilling one’s role as a nurse. Therefore, it is important to clearly define nursing competency to establish a foundation for nursing education curriculum.

Eleven Core competency standards and their competencies for nursing practice in the Philippines are

○ Safe & quality nursing practice

Core competency	indicator
Demonstrate knowledge based on health/illness status of individual/ groups	Identifies health needs of patients/groups ○ Explains patient/group status
Provides sound decision making in care of individual/groups considering	Problem identification ○ Data gathering related to problem ○ Data analysis ○ Selection appropriate action ○ Monitor progress of action taken
Promotes patient safety and comfort	Performs age-specific safety measures and comfort measure in all aspects of patient care
Priority setting in nursing care based on patients’ needs	Identifies priority needs of patients ○ Analysis of patients’ needs ○ Determine appropriate nursing care to be provided
Ensures continuity of care	Refers identified problems to appropriate individuals/ agencies ○ Establish means of providing continuous patient care
Administers medications and other health therapeutics	Conforms to the 10 golden rules in medication administration and health therapeutics
Utilizes nursing process as framework for nursing. Performs comprehensive, systematic nursing assessment	Obtains consent ○ Complete appropriate assessment forms ○ Performs effective assessment techniques ○ Obtains comprehensive client information ○ Maintains privacy and confidentiality ○ Identifies health needs
Formulates care plan in collaboration with patients, other health team members	Includes patients, family in care planning ○ States expected outcomes in nursing interventions ○ Develops comprehensive patient care plan ○ Accomplishes patient centered discharge plan
Implements NCP to achieve identified outcomes	Explain interventions to patient, family before carrying them out ○ Implement safe, comfortable nursing interventions ○ Acts according to client’s health conditions, needs ○ Performs nursing interventions effectively and in timely manner
Implements NCP progress toward expected outcomes	Monitors effectiveness of nursing interventions ○ Revises care plan PRN
Responds to urgency of patient’s condition	Identifies sudden changes in patient’s health conditions ○ Implements immediate, appropriate interventions

○ Management of resources & environment

Core competency	indicator
Organizes workload to facilitate patient care	Identifies task or activities that need to be accomplished ○ Plans the performance of task or activities based on priority ○ Finishes work assignment on time
Utilizes resources to support patient care	Determines the resources needed to deliver patient care ○ Control the use of equipment
Ensures the functioning of resources	Check proper functioning of the equipment ○ Refers Malfunctioning equipment to appropriate unit
Check the Proper functioning of the Equipment	Determines the task and procedures that can be safely assigned to the other members of the team ○ Verifies the competence of the staff prior to delegating tasks
Maintains safe Environment	Observe proper disposal of waste ○ Adheres to policies, procedures and protocols on prevention and control of infection ○ Defines steps to follow in case of fire , earthquake and other emergency situation

○ Health education

Core competency	indicator
Assesses the learning needs of the patient and the family	Obtains learning information through interview, observation and validation ○ Defines relevant information ○ Completes assessment records appropriately ○ Identify priority needs
Develops Health Education plan based on assessed and anticipated needs.	Considers nature of the learner in relation to social, cultural, political, economic, educational, and religious factor
Develops learning material for health education	nvolves the patient, family and significant others and other resources ○ Formulates a comprehensive health educational plan with the following components , objectives, content and time allotment ○ Teaching-learning resources and evaluation parameters ○ Provides for feedback to finalize plan
Implements the health Education Plan	Provides for conducive learning situation in terms of timer and place ○ Considers client and family preparedness○ Utilize appropriate strategies ○ Provides reassuring presence through active listening, touch and facial expression and gestures ○ Monitors client and family’s responses to health education
Evaluates the outcome of health Education	Utilizes evaluation parameters ○ Documents outcome of care ○ Revises health education plan when necessary

○ Legal responsibility

Core competency	indicator
Adheres to practices in accordance with the nursing law and other relevant legislation including contract and informed consent.	Fulfill legal requirements in Nursing Practice ○ Holds current professional license ○ Acts in accordance with the terms of contract of employment and other rules and regulation ○ Complies with the required CPE ○ Confirms information given by the doctor for informed consent ○ Secures waiver of responsibility for refusal to undergo treatment or procedures ○ Check the completeness of informed consent and other legal forms
Adheres to organizational policies and procedures, local and national	Articulates the vision and mission of the institution where one belongs ○ Acts in accordance with the established norms and conduct of the institution/ organization
Document care rendered to patients	Utilizes appropriate patient care records and reports ○ Accomplish accurate documentation in all matters concerning patient care in accordance with the standard of nursing practice.

i. .

○ Ethico – moral responsibility

Core competency	indicator
Respects the rights of individual/ groups	Renders nursing care consistent with the patient’s bill of rights (ie. confidentiality of information, privacy, etc.)
Accepts responsibility & accountability for own decisions and actions	Meets nursing accountability requirements as embodied in the job description ○ Justifies basis for nursing actions and judgment ○ Protects a positive image of the profession
Adheres to the national and international code of ethics for nurse	Adheres to the Code of Ethics for Nurses and abides by its provisions ○ Reports unethical and immoral incidents to proper authorities

○ Personal & professional development

Core competency	indicator
Identifies own learning needs	Verbalizes strengths, weaknesses, limitations. ○ Determines personal and professional goals and aspirations.
Pursues continuing education	○ Participates in formal and non-formal education. ○ Applies learned information for the improvement of care.
Gets involved in professional organizations and civic activities	Participates actively in professional, social, civic and religious activities ○ Maintain membership to professional organizations ○ Support activities related to nursing and health issues
Projects a professional image of nurse	Demonstrate good manners and right conduct at all times. ○ Dresses appropriately. ○ Demonstrates congruence of words and actions. ○ Behaves appropriately at all times.
Possesses positive attitude towards change and criticism	Listens to suggestions and recommendations. ○ Tries new strategies or approaches. ○ Adapts to changes willingly.
Performs function according to professional standards	Assesses own performance against standards of practice. ○ Sets attainable objectives to enhance nursing knowledge and skills. ○ Explains current nursing practices, when situations call for it.

○ Quality improvement

Core competency	indicator
Gathers data for quality improvement	Demonstrates knowledge of method appropriate for the clinical problems identified Detects variation in the vital signs of the patient from day to day Reports necessary elements at the bedside to improve patient stay at hospital Solicits feedback from patient and significant others regarding care rendered
Participates in nursing audits and rounds	Contributes relevant information about patient condition as well as unit condition and patient current reactions Shares with the team current information regarding particular patients condition Encourages the patient to speak about what is relevant to his condition Documents and records all nursing care and actions Performs daily check of patient records/condition Completes patients records Actively contributes relevant information of patients during rounds thru readings and sharing with others
Identifies and reports variances	Documents observed variance regarding patient care and submits to appropriate group within 24 hours Identifies actual and potential variance to patient care Reports actual and potential variance to patient care Submits report to appropriate groups within 24 hours
Recommends solutions to identified problems	Gives appropriate suggestions on corrective and preventive measures Communicates and discusses with appropriate groups Gives and objective and accurate reporton what was observed rather than an interpretation of the event.

○ Research

Gathers data using different methodologies	Identifies researchable problems regarding patient care and community health Identifies appropriate methods of research for a particular patient/community problem Combines quantitative and qualitative nursing design thru simple explanation on the phenomena observed Analyzes data gathered
Recommends actions for implementation	Based on the analysis of data gathered, recommends practical solutions appropriate for the problem
Disseminates results of research findings	Communicates results of findings to colleagues/patients/family and to others Endeavors to publish research Submits research findings to own agencies and others as appropriate
Applies research findings in nursing practice	Utilizes and findings in research in the provision of nursing care to individuals/groups/communities Makes use of evidence-based nursing to ameliorate nursing practice

○ Record management

Maintains accurate and updated documentation of patient care	Completes updated documentation of patient care
Records outcome of patient care	Utilizes a record system
Observes legal imperatives in recording keeping	Observes confidentially and privacy of patient’s records Maintains an organized system of filing and keeping patient’s records in a designated area Refrains from releasing records and other information without proper authority

○ Communication

i. Establishes rapport with patients, significant others and members of the health team.

ii. Identifies verbal and non-verbal cues

iii. Utilizes formal and informal channels

iv. Responds to needs of individuals, family, group and community

v. Uses appropriate information technology to facilitate communication

○ Collaboration & teamwork

i. Establishes collaborative relationship with colleagues and other members of the health team

ii. Collaborates plan of care with other members of the health team