Social and legal responsibilities of nurses

1. ETHICAL AND LEGAL ASPECTS
OF NURSING PRACTICE:
A NURSE’S
RESPONSIBILITY

2. LAW
is the sum total of rules and
regulations by which society is
governed.
It is man-made and regulates social
conduct in a formal and binding way.
It reflects society’s needs, attitudes
and more.
(Venzon, 2016)
MAIN SOURCES OF
PHILIPPINE LAWS:
1. The Constitution
2. Statutes
3. Treaties and Conventions
4. Judicial Decisions

3. CRIMINAL LAW
branch or division of law which:
• defines crimes
• treats of their nature
• provides for their punishment
(12 Cyc.129)
SOURCES OF PHILIPPINE CRIMINAL LAW:
• The Revised Penal Code
(Act. No. 3815 and its amendments)
• Special Penal Laws
• Penal Presidential Decrees
CIVIL LAW
branch of law that treats the personal and family
relations of a:
• person
• his property and successional rights
• the effects of obligation and contracts
(Black ‘s Law Dictionary)
SOURCE OF CIVIL LAW
• New Civil Code
(Republic Act No. 386)

4. FUNCTIONS OF LAW IN NURSING
Provides a framework for
establishing what nursing
actions in the care of patients
are legal.
Delineates the nurse’s
responsibilities from those of
other professionals
Helps to establish the boundaries
of independent nursing actions
Assists in maintaining a
standard of nursing practice
by making nurses accountable
to the law
1
2
3
4

5. refers to the execution of duties associated with a nurse’s particular
role. That is, the nurse is responsible for providing care within
established standards of the profession. The responsible nurse
demonstrates characteristics of reliability and dependability.
RESPONSIBILIT
Y
RESPONSIBILITY AND ACCOUNTABILITY FOR THE PRACTICE OF
PROFESSIONAL NURSING
ACCOUNTABILITY
refers to the ability to answer for one’s
own actions. The nurse is accountable to
herself most of all. He/she also balances
accountability to the patient, the profession,
the employing institution, and society.
LIABILITY
an obligation one has incurred or might
incur through any act or failure to act. -
When the nurse fails to meet the legal
expectations of care, the client can
initiate action if harm or injury is incurred
by the client.

6. PROFESSIONAL NEGLIGENCE
KINDS OF LIABILITES
• Administrative Liability
• Civil Liability
• Criminal Liability
What is the liability in the practice of
Nursing in the Philippines?
A liability is a penalty of sanction suffered by a nurse
if found guilty of violation of any of the existing laws
in the Philippines and their implementing rules and
regulation.
refers to the commission or omission of an act,
pursuant to a duty, that a reasonably prudent person
in the same or similar circumstances would or would
not do, and acting or the non-acting is the
proximate cause of injury to another person or
his property.
NEGLIGENCE
ELEMENTS OF PROFESSIONAL NEGLIGE
• Existence of a duty on the part of the person charged to
use due care under circumstances,
• Failure to meet the standard of due care,
• The foreseeability of harm resulting from failure to meet
the standard, and
• The fact that the breach of this standard resulted in an
injury to the plaintiff.

7. ELEMENTS OF NEGLIGENCE
To prove NEGLIGENCE, all 4 of the following elements must be proven by the plaintiff:
1
2
3
4
The nurse had a duty
to the patient
The nurse breached the duty
A patient injury occurred
There was a causal relationship
between the breach of duty and the
patient injury

8. E X A M P L E :
An 80-year-old patient was admitted to a nursing unit, and a wound was identified
on her right heel.
Although care was provided for the wound on her heel, the nurse failed to
complete a head-to-toe skin assessment and assess the patient's risk for
pressure ulcer development. As a result, a large pressure ulcer developed on the
sacrum.
When this wound was finally identified, it was a stage IV pressure ulcer and took
several months of additional treatment for healing, including nursing home care.

9. Q U E S T I O N S T H AT N E E D T O B E A S K E D :
Did the nurse have a duty?
Did the nurse breach the
duty?
Was the nurse's failure to
completely assess the
patient a cause of harm to
the patient?
Finally, was there
damage?

10. “Any person who willfully causes loss or injury to another in a
manner that is contrary to morals, good customs or public policy
shall compensate the latter for the damage”.
ARTICLE 21, NCC
PROVISIONS IN THE NEW CIVIL CODE ON HUMAN RELATIONS
ARTICLE 19,NCC
“Every person must, in the exercise of
his rights and in the performance of
his duties, act with justice, give
everyone his due, and observe honesty
and good faith”.
ARTICLE 20, NCC
“Every person who, contrary to law,
willfully or negligently causes
damage to another shall indemnify
the latter for the same”.

11. MALPRACTICE
in the usual sense implies the idea of
improper or unskillful care of a patient by a
nurse. It would also see that malpractice
also denotes stepping beyond one's
authority with serious consequences.
MEDICAL ORDERS,
DRUGS AND
MEDICATIONS
R.A. 6675 states that only validly registered
medical, dental and veterinary practitioners,
whether in private institution/ corporation or in
the government, are authorized to prescribe
drugs.
INTRAVENOUS THERAPIES
AND LEGAL IMPLICATIONS
Nurses must remember that their legal right to give
intravenous injections is based on the Philippine
Nursing Act of 1991 Section 28 which state that "in
the administration of intravenous injections,
special training shall be required according to
protocol established”. Therefore, nurses have to
undertake a certified training course on intravenous
therapy.
NOTE:
Board of Nursing Resolution o. 8 states that any
registered nurse without such training and who
administers IV injections to patients, shall be
held liable, either criminally under Sec. 30 ( c) Art.
VII of said law or administratively under Sec. 21 Art.
III or both (whether causing or not injury or death to
the patient).

12. CONSENT TO MEDICAL AND
SURGICAL PRACTICES
Consent is defined as a “free and rational act
that presupposes knowledge of the thing to
which consent is being given by a person
who is legally capable to give consent.”
For consent to be valid, it must be voluntary
and informed, and the person consenting must
have the capacity to make the decision.
The meaning of these terms are:
Voluntary – the decision to either consent or
not to consent to treatment must be made by
the person, and must not be influenced by
pressure from medical staff, friends or family.
Informed – the person must be given all of the
information about what the treatment involves,
including the benefits and risks, whether there
are reasonable alternative treatments, and
what will happen if treatment does not go
ahead.
Capacity – the person must be capable of
giving consent, which means they understand
the information given to them and can use it to
make an informed decision.

13. ESSENTIAL ELEMENTS OF AN INFORMED
CONSENT:
• the diagnosis and explanation of the condition;
• a fair explanation of the procedures to be done and used and
the consequences;
• a description of alternative treatments or procedures;
• a description of the benefits to be expected;
• material rights if any; and
• the prognosis, if the recommended care, procedure, is refused.

14. W H E N I S A N O T C O N S E N T N E E D E D ?
• Needs emergency treatment to save their life
• Immediately needs an additional emergency procedure during an operation-there has to be a
clear medical reason why it would be unsafe to wait to obtain consent.
• With severe mental health condition, such as schizophrenia, bipolar disorder or dementia, lacks
the capacity to consent to the treatment of their mental health.
REFUSAL TO CONSENT
a patient who is:
• mentally (sane mind)
• legally competent (legal age)
has the right to refuse to permit touching of his body
or to submit to a medical or surgical procedure no
matter how necessary, nor how imminent the danger
to his life or health if he fails to submit to
treatment.
CONSENT FOR STERILIZATIO
Sterilization is the termination of the ability to produce
offsprings.
The husband and the wife must consent to the
procedure if the operation is primarily to accomplish
sterilization. When the sterilization is medically
necessary, the sterilization is an incidental result
such as in cases of abruption placenta, ectopic
pregnancies or ruptured uterus, the patient's consent
alone is sufficient.

15. LIABILITY FOR THE WORK OF NURSING STUDENTS
Under the Philippine Nursing Act of 2002 R.A. 9173, nursing students do not perform
professional nursing.
They are to be supervised by their Clinical Instructors.
In order that the errors committed by nursing students will be avoided/minimized, the
following measures should be taken:
• Nursing students should always be under the
supervision of their Clinical Instructors.
• They should be given assignments that are in
level of their training, experience and competency.
• They should be advised to seek guidance
specially if they are performing a procedure for the
first time.
• They should be oriented to the policies of the
nursing unit where they are assigned.
• Their performance should be assessed frequently
to determine their strengths and their weaknesses.
• Frequent conferences with the students will
reveal their problems, which they may want to
bring to the attention of their instructors or vice-
versa. Discussions of these problems will iron out
doubts and possible solutions may be provided

16. NURSING MALPRACTICE
Malpractice is negligence, misconduct, or breach of duty by a professional that results in
injury/damage to a patient (Reising & Allen, 2007).
According to Reising and Allen, common malpractice claims arise against nurses when nurses fail
to:
Assess and monitor.
Follow standards of care.
Use equipment in a responsible manner.
Communicate.
Document.
Act as a patient advocate and follow the chain
of command.

17. MINIMIZING THE RISK OF MALPRACTICE
Nurses should be cognizant of legal risks in providing care.
Reising (2012) suggests that the following actions can help minimize a nurse's risk of being sued for
malpractice:
• Know and follow your state's nurse practice act
and your facility's policies and procedures.
• Stay up to date in your field of practice.
• Assess your patients in accordance with policy
and their physicians' orders and, more
frequently, if indicated by your nursing judgment.
• Promptly report abnormal assessments,
including laboratory data, and document what
was reported and any follow-up.
• Follow up on assessments or care delegated to
others.
• Communicate openly and factually with patients
and their families and other health care
providers.
• Document all nursing care factually and
thoroughly and ensure that the documentation
reflects the nursing process; never chart ahead
of time.
• Promptly report and file appropriate incident
reports for deviations in care.

18. SOCIAL NETWORKING
Social networking can have a significant impact on health care practice.
Society has become adept at using computers, cell phones, Facebook, and
Twitter for exchange of information.
There have been cases of practitioners sharing an interesting case or
sharing health care information over social networking sites.
Without the patient's consent, it is not appropriate to share information,
especially when the information is not shared on a secured network and is out
there for the world to see.
This can result in civil and criminal penalties.

19. RESPONSIBILITIES OF NURSES RELATED TO SOCIAL NETWORKING
“Social Media” is broad and constantly evolving. The term generally refers to Internet-based tools that allow
individuals and communities to gather and communicate; to share information, ideas, personal messages,
images, and other content; and, in some cases, to collaborate with other users in real time.
INAPPROPRIATE USE OF SOCIAL MEDIA
Nurses may mistakenly assume that what they do in their own homes on their own computers isn’t the business
of their employer or state nursing board.
Yet one’s personal life can become relevant if a professional uses social media inappropriately. Inappropriate
use can lead to legal problems for nurses that involve privacy violations, cyberbullying, questionable moral
character, and questionable ethics.
VIOLATING PATIENTS’ PRIVACY
Trust—the hallmark of the nurse-patient relationship—is compromised when nurses discuss patients outside the
workplace.
Nurses should avoid talking about patients or patient situations online. Even when patients’ names or specific
protected health information aren’t revealed, patients still may be identifiable.

20. CASE EXAMPLE:
A recent case illustrating this danger occurred at a rehabilitation facility in Oregon. Nai
Mai Chao, a nursing assistant at Regency Pacific Nursing and Rehab Center, was sentenced to 8
days in jail after being found guilty of invasion of personal privacy. While she denied taking
residents’ photographs, she admitted to posting them on Facebook. The photographs, which
included nudity and incontinence, were accompanied by demeaning comments. Chao was
terminated by her employer. The patient (who died 2 months after the posting) testified he was
humiliated.
Ms. Chao also was ordered to avoid all social media sites and was banned from taking
pictures of anyone without their explicit consent. She also was forbidden from working with
children or the elderly for 2 years and ordered to write a 1,000-word apology. The Oregon State
Board of Nursing accepted a voluntary surrender of her nursing assistant certificate for failing to
respect client rights and dignity and violating client privacy. Chao’s name was entered into a
national database that prohibits her from obtaining licensure anywhere else.

21. DISPARAGING EMPLOYERS OR COWORKERS ONLINE
“Online comments by a nurse regarding coworkers, even if posted from home during non-work hours, may constitute
lateral violence. Such activity causes concern for current and future employers and regulators because of the patient-
safety ramifications.
The line between speech protected by law and the ability of an employer to impose expectations on employees outside of
work is still being determined.
Nonetheless, such comments can be detrimental to a cohesive healthcare delivery team and may result in sanctions
against the nurse.”
DEMONSTRATING QUESTIONABLE MORAL CHARACTER
Breaching patient confidentiality and disparaging employers or coworkers can lead to charges of unethical conduct.
Posting nude or sexually explicit photos may call one’s judgment and moral character into question; so can using foul
language or making other inappropriate postings.
Being “tagged” in a compromising position in one’s personal life can create legal problems in one’s professional life.
Texting or “friending” patients may suggest boundary violations and violate nursing regulations or codes of conduct.

22. TIPS FOR AVOIDING MISUSE OF SOCIAL MEDIA:
• Adhere to your employer’s social media and
privacy policies and procedures.
• Don’t post anything when angry, sleep deprived,
or otherwise impaired.
• Familiarize yourself with the nurse practice act
or nursing regulations specific to each institution
in which you practice.
• Read and understand all terms of use for every
platform and website in which you participate.
• Assume that whatever you post will be visible to
all seekers and available for reposting
regardless of your privacy settings.
• Avoid making disparaging comments about
people or organizations.
• Never discuss patients. Be aware that
removing patient identifiers isn’t adequate and
that patients still have privacy rights even if
they’ve posted information about themselves
online.
• Don’t give clinical advice online.
• Assume that once posted, material is
permanently accessible to the entire universe.

23. ALWAYS REMEMBER:
A nurse who posts inappropriately creates damaging
impressions of the entire profession.
On the other hand, constructive use of social media can
increase nursing’s visibility, inform practice, and empower the
profession.

24. R E F E R E N C E S :
ANA’s Principles for Social Networking and the Nurse: Guidance for Registered Nurses. Silver Spring, MD:
American Nurses Association; 2010. www.nursesbooks.org/Main-Menu/eBooks/Principles/Social-
Networking.aspx.
Venzon, L. & Venzon, R. (2010). Professional Nursing in the Philippines 11th edition
https://www.nursingcenter.com/upload/static/403753/ch03.html