Theoretical Foundation of Nursing NCM 100

NURSING . . . .
. . . . As a PROFESSION
2

Nursing as a PROFESSION
 Student will be able to:
 Define profession
 Discuss criteria of a profession
 Define nursing
 Discuss characteristics of nursing as a profession
 Differentiate personal and professional qualities of a
nurse
 Identify the different stages in the history of nursing:
 In the world
 In the Philippines
3

Nursing as a PROFESSION
 Discuss various fields and opportunities in
nursing
 Discuss various roles and responsibilities of
nurses
 Determine scope of nursing practice
 Discuss the code of ethics for nurses
 Discuss the nursing law of 2002
4

“The Nurse”
 The world grows better year by
year
 Because of some nurses in her
little sphere
 Puts on her apron and smiles
and sings,
 And keeps on doing the same
old things,
 Taking temperatures, giving
the pills
 To remedy mankind’s
numerous ills.
5

 Feeding the baby, answering
the bells,
 Being polite with a heart that
rebels,
 Longing for home and all the
while
 Wearing the same
professional smile
 Blessing the newborn babe’s
first breath
 Closing the eyes there are
still in death.
6

 Taking the blame for many
mistakes,
 Oh dear! What a lot of
patience it takes:
 Going off duty at seven o’
clock,
 Tired discourage, and
ready to drop,
 But called back on special
at seven fifteen
 With woe in her heart which
must not be seen,
7

 Morning and evening, noon
and night,
 Just doing it over and
hoping it’s right
 When we lay down our
caps and cross the bar,
 Oh Lord, will give us just
one little star,
 To wear in our crowns with
the uniforms new
 In that city above where
the head nurse is YOU?
8

THE PROFESSION OF
NURSING
Is nursing a profession?
9

According to Webster. . .
PROFESSION is an occupation or calling
requiring advanced training & experience in some
specific or specialized body of knowledge which
provides service to society in that special field.
10

CRITERIA OF A PROFESSION (C. Hall)
It provides service to society, involving specialized knowledge &
skills
It possesses a unique body of knowledge which it constantly
seeks to extend in order to improve its service.
It educates its own practitioners.
It sets its own standards
It adapts its services to meet changing needs.
11

It accepts its responsibility for safeguarding the public it
services.
It strives to make economical use of its practitioners.
It promotes the welfare & well being of its practitioners &
safeguards its interests
It is motivated more by its commitment to the service it
renders rather than by consideration of economic gain.
It adheres to a code of conduct based on ethical principles.
It unites for strength in achieving its larger purposes.
It is self-governing.
CRITERIA OF A PROFESSION (C. Hall)
12

ACCORDING TO WILLIAM SHEPARD. .
A profession must satisfy an indispensable social need & be
based upon well established & socially accepted principles.
It must demand adequate pre-professional & cultural
training.
It must demand the possession of a body of specialized &
systematized training.
It must give evidence of needed skills which the public does
not possess; that is, skills which are native & partly acquired.
13

It must have developed a scientific technique which is the result of
tested experience.
It must require the discretion & judgment as to time & manner of
the performance of duty.
It must have a group consciousness designed to extend scientific
knowledge in technical knowledge.
It must have sufficient self-impelling power to retain its members
throughout life. IT MUST NOT BE USED AS A MERE
STEPPINGSTONE TO OTHER OCCUPATIONS.
It must recognize its obligations to society by insisting that its
members live up to an established code of ethics.
ACCORDING TO WILLIAM SHEPARD. .
14

ACCDG TO GENEVIEVE K. & ROY W. BIXLER
Utilizes in its practice a well-defined & well-organized body of
specialized knowledge which is on the intellectual level of the higher
learning
constantly enlarges the body of knowledge it uses & improves its
techniques of education & service by the use of scientific method.
Entrust the education of its practitioners to institutions of higher
education.
Applies its body of knowledge in practical services which are vital
to human & social welfare
15

Functions autonomously in the formulation of professional policy
& in the control of professional activity.
Attracts individuals of intellectual & personal qualities who exalt
service above personal gain & who recognize their chosen
occupation as a life work.
Strives to compensate its practitioners by providing freedom to
action, opportunities for continuous professional growth &
economic security.
ACCDG TO GENEVIEVE K. & ROY W. BIXLER
16

DO YOU
BELIEVE
THAT THESE
CRITERIA
APPLY TO
NURSING?
17

Nursing as a Profession
 Although there are some questions as to whether nursing
meets the criteria for professional status, it is generally
recognized and designated as the nursing profession.
18

The term “NURSE” originated from the Latin word”NUTRIX”
which means- TO NOURISH”
•Nursing is both an art & a science
•Nursing is involved in delivery of health care
•Nursing is caring
•Nursing is a discipline rich in history
“NURSE”
20

What is Nursing?
 Nursing is a discipline focused on assisting individuals, families
and communities in attaining, re-attaining and maintaining optimal
health and functioning.
 Nursing is a science and an art that focuses on quality of life as
defined by persons and families.
 Nursing is not only concerned about health and functioning but
with quality of living and dying, lived experience, and universal
lived experiences of health.
21

QUALIFICATIONS & ABILITIES OF A
PROFESSIONAL NURSE
A. PROFESSIONAL PREPARATION
license to practice nursing in the country
a Bachelor of Science in Nursing Degree
Physically & mentally fit
22

B. PERSONAL QUALITIES & PROFESSIONAL
PROFICIENCIES
Interest & willingness to work & learn with
individuals/groups in a variety of settings
Warm personality & concern for people
resourceful & creative
emotionally well-balanced
has capacity & ability to work cooperatively
with others
takes action to improve self & service
has competency in performing work through
the use of nursing process
skilled in decision-making, communicating &
relating with others
is research oriented.
Participates actively in issues confronting 23

Milestones in NURSING HISTORY
Nursing Profession has a PROUD
HISTORY!
“Traditional female roles of wife, mother,
daughter, and sister have always included the
care and nurturing of other family members”
24

“Artifacts in earliest primitive societies establish
the existence of individuals, both men and
women, who comforted and cared for the sick
and those unable to care for themselves”
“There are also artistic representations of
individuals who assisted the society’s healers
in curing.”
25

“The traditional nursing role
was one of Humanistic
caring, nurturing, comforting,
and supporting.”
26

 Ancient Civilizations
3000 BC - “Egypt” ---The Egyptian goddess Isis
and her son Horus were
regarded as creators of the
medical arts. They used the
medium of dreams to
minister to the sick
1900 BC – “Babylonia” --- In a Babylonian sickroom,
healers and assistants
followed the Code of
Hammurabi to cure and to
provide care.
27

 Ancient Civilizations
50 BC – “Greece” --- The ancient Greek gods were
believed to have special healing
powers. In this detail from the bowl
of Sosias, Achilles bandages the
wounds of Patroclus.
28

 The Common Era
400 AD – “Roman Benefactors” --- Wealthy Roman
matrons like
Fabiola – viewed by
some as the patron
saint of early
nursing – used
position and wealth
to establish
hospitals for the
sick.
29

 The Common Era
1096 AD – “Crusaders” --- During the Crusades,
military Knighthood orders
were established to provide
care to soldiers and pilgrims
to the Holy Land. This may
be the first recognition of
men providing nursing care.
1099 AD – “Christians” --- Sisters of the Order of the
Knights Hospitallers of St.
John of Jerusalem
embroidered the cross on
their tunics to represent
their Christian charity.
30

 The Middle Ages
1100 – 1200 --- Formation of charitable institutions to
care for the aged, sick and poor. These
included the Hospital Brothers of St.
Anthony’s, Brothers of Misericordia (Italy),
and the Alexian Brothers.
31

 The Middle Ages
1200 – “Nursing Care of the Outcasts” – The Knights of
Lazarus dedicated themselves to the care of the people with
leprosy, syphilis, and chronic skin conditions. From the time of
Christ to the mid-thirteenth century, leprosy was viewed as an
incurable and terminal disease.
1550 – “Charitable Nursing” – Camillus DeLellis,
considered the patron saint of nurses, was the founder of the
Nursing Order of Ministries of the Sick. His first efforts focused on
preparing nurses to provide care for the poor, the imprisoned, and
the dying.
32

 The Middle Ages
1633 – Sisters of Charity founded by Louise de Marillac,
established the first educational program to be
affiliated with a religious nursing order.
1639 – “Early Canadian Hospitals” --- The Hotel Dieu
Hospital in Quebec, founded by the Duchesse
d’Aiguillon and staffed by three hospital Sisters from
the Order of St. Augustine, is considered the first
hospital in Canada.
1644 – Jeanne Mance, known as the Florence Nightingale
of Canada, founded the Hotel Dieu in Montreal.
33

 The Early Nineteenth Century
1809 – Mother Elizabeth Seton introduced the
Sisters of Charity into America, later known as the
Daughters of Charity.
1836 – Deaconess Institute of Kaiserwerth, Germany,
founded. This is the institute were Florence
Nightingale received her initial education in nursing.
1846 – Florence Nightingale received the Yearbook of the
Institution of Deaconess at Kaiserwerth
34

1854 – Mary Grant Seacole (1805-1881), Jamaican nurse
worked with Florence Nightingale to provide care to
the soldiers of the Crimean War.
1860 – Establishment of the Nightingale Training School for
Nurses at St. Thomas’ Hospital in London, England.
This was the first organized program for training
nurses.
- Florence Nightingale published Notes on Nursing:
What it is and What it is not. This was the first
nursing philosophy based on health maintenance
and restoration of health
35

How have we
evolved as
professionals in
the field of
nursing?
Florence Nightingale, 1820 -
1910
36

 1865
The start of the "Florence
Nightingale" era. The Infirmary
notes the number of nurses
employed - 11! They are
attending up to 175 patients a
day, around the clock. Infection
in surgical patients is a huge
problem, and a change to the
floors is made - polished
varnish instead of scrubbed
boards.
Percy Ward, male surgical
37

HISTORY OF NURSING
 Florence Nightingale
 1836
 Theodor Fliedner, a German pastor in
Kaiserwerth, opened a hospital with a training
school for nurses
 Training School of Deaconesses
 1847
 Florence Nightingale went to train as a nurse
in Kaiserwerth, Germany
 Where she stayed for 3 months
38

HISTORY OF NURSING
 1853
 Nightingale trained in the Sisters of Charity
 Paris
 Returning to London, she worked as administrator and
director of nurses at the Establishment for Gentlewomen
During Illness where she remained
 Until she was called into service during the Crimean
War
39

HISTORY OF NURSING
 1860
 Nightingale opened the Nightingale Training School for
Nurses
 Served as model for other nursing schools
 Its graduates traveled to other countries to manage
hospitals and nurse training schools
40

HISTORY OF NURSING
 Nightingales biggest contributions in Nursing:
 Sanitation Practices
 Nursing Education
 First Nurse Theorist
 Notes on Nursing: What It Is And What It Is Not
42

 In 1857 the India Mutiny
turned Miss Nightingales
interest to the health of
the Army in India. It was
for this purpose the Royal
Commission was
appointed in 1859. In
1868, a sanitary
department was
established.
43

1861 – Dorothea Lynde Dix (1802-1887) was over 60
when she was appointed as Superintendent of the
Female Nurses of the Union Army in 1861 during
the Civil War. After the war, she returned to her work
with the mentally ill.
- Mary Ann Ball (Mother Bickerdyke) organized
ambulance services, searched for wounded, and
supervised nurses
44

1862-1863 – Louisa May Alcott (1832-1888) worked as a
nurse at the Union Hospital in Washington,
D.C. during the Civil War, and documented
the work of Civil War volunteer nurses in her
book, “Hospital Sketches”.
1861-1865 – Harriet Tubman (1820-1913) was known as
“The Moses of her People” for her work with
the Underground Railroad Movement when
she led over 300 slaves to freedom. During
the Civil War, she nursed the sick and
suffering of her own race.
45

1862-1865 – Walt Whitman (1819-1882), a writer and a
poet, was a volunteer nurse during the Civil
War; and chronicled the care of the ill in his
collection of poetry, “Drum Taps”, and his
diary, “Specimen Days”.
- Sojourner Truth (1797-1883), abolitionist,
underground railroad agent, preacher, and
women’s rights advocate, was a nurse for
over four years during the Civil War and
worked as a nurse/counselor for the
Freedmen’s Relief Association after the war.
46

1864 – The International Red Cross --- During the Geneva
Convention, Jean Henri Dunant of Switzerland
organized the international conference that founded
the Red Cross, for the relief of suffering in war.
47

 Early Nursing Education
1868 – Lucy Osborne (1835-1891) trained under
Nightingale at St. Thomas Hospital in London, then
became Superintendent at Sydney Hospital and
developed Australia’s first school for nurses.
1872 – Early Nursing Schools – Woman’s Hospital in
Philadelphia and New England Hospital for Women
and Children in Boston opened training program for
nurses.
48

1873 – Linda Richards (1841-1930) graduated from New
England Hospital for Women and Children training
school for nurses and is considered America’s first
trained nurse.
Linda Richards, America's first trained
nurse
Cap worn by Linda Richards
49

 1874 – First nurses training school in Canada founded: St.
Catherine’s Ontario
 1879 – Mary Mahoney (1819-1882) became first America’s
trained black nurse when she graduated from new
England Hospital for Women and Children training
school for nurses
 1882 – Clara Barton (1812-1912) organized the American
National Red Cross, which linked with the
International Red Cross when the US Congress
ratified the Geneva Convention
50

 1884 – Canadian born Mary Agnes Snively (1847-1933), a
graduate of the Bellevue Hospital Training School
for Nurses in New York, returned to Canada to
develop the Toronto General Hospital School of
Nursing. She was the first president of the Canadian
Nurses Association.
51

 Late Nineteenth Century
 1890 – Establishment of the Nurses’ Associated Alumni of
the US and Canada (NAAUSC). This group was an
initial nursing professional group. It later became the
American Nurses Association.
 1893 – Lillian Wald (1867-1940) founded the Henry Street
Settlement and Visiting Nurse Service, which
provided nursing services, social services, and
organized educational and cultural activities. She is
considered the founder of public health nursing.
52

The operating theatre in 1892
53

 1893 – The Nightingale Pledge was written and
administered for the first time to graduates of
Farrand Training School of Harper Hospital in
Detroit, Michigan.
“THE NIGHTINGALE PLEDGE”
I solemnly pledge myself before God, and in the presence of this
assembly, to pass my life in purity and to practice my profession
faithfully. I will abstain from whatever is deleterious and mischievous
and will not take or knowingly administer any harmful drug. I will do
all in my power to elevate the standard of my profession, and will
hold in confidence all personal matters committed to my keeping,
and all family affairs coming to my knowledge in the practice of my
calling. With loyalty will I endeavor to aid the physician in his work
and devote myself to the welfare of those committed to my care.
54

 1894 - Isabel Hamptom Robb,RN, was the first
superintendent of the Johns Hopkins Training
School in Baltimore, Maryland.
 1897 - Initial discussion of nursing code of ethics
- The Nurses Alumnae Association in the US and
Canada later renamed as the American Nurses
Association, was organized.
 1899 - The International Council of Nurses (ICN) was
established by Mrs. Bedford Fenwick of Great
Britain. Nurses from the US and Canada were
among the founders, and their national associations
among the first admitted to membership.
55

 1900 - The American Journal of Nursing was the first
nursing journal in the US to be owned, operated and
published by nurses
 1901 - Clara Louise Maass (1876-1901), worked as a
contract nurse with the US army during the Spanish-
American War. Volunteering to nurse victims of
yellow fever in Cuba, she died after allowing herself
to be bitten by a mosquito as an experiment on
immunity.
- First university-affiliated nursing programs
- The Army Nurse Corps was established.
56

 Early Twentieth Century
 1908 - The Canadian Society of Superintendents of
Training Schools for Nurses and the Canadian
National Association for Trained Nurses joined to
become the Canadian Nurses Association
 1912 - The National League for Nursing Education, the
forerunner of the National League for Nursing, was
established for the development of nursing
education standards. Today, the NLN is the
accrediting body for all schools of nursing in the US.
 1916 – Nurse activist Margaret Sanger, considered the
founder of Planned Parenthood, was imprisoned for
opening the first birth control information clinic in
Baltimore.
57

 Nursing, as a profession
and a branch of
scholarship, has
progressed since Mary
Adelaide Nutting and
Lavinia Dock penned in
1907 A The North
American authors, both
born in 1858, two years
after Florence
Nightingale’s departure
from Scutari, were well-
qualified Registered
Nurses with a wealth of
experience between
them.

58

 Gradually, the
increasing need of
adequately trained
nurses led to creation
of South India
Examining Board in
1911 and the North
India Examining Board
in 1912. It was the
mission hospital
Nursing leaders who
laid the foundation of
systematic Nursing
education in India.
59

 Early Twentieth Century
 1922 – Sigma Theta Tau, the International honor
society that promotes nursing research and
leadership, was founded by six student nurses from
Indiana University School of Nursing
 1926 - ANA Code of Ethics proposed
60

NURSING AFTER WORLD WAR II
Nursing sisters in training at
Red Deer, 1943.
Nursing sisters taking part in field training in England.
After their initial training in Canada, many nurse
travelled to England where they worked in hospitals
and prepared for duty near the front lines in Europe.
"Modern nursing may be said to have emerged from the
demonstration of nurses' effectiveness during theperiod of war."
61

 Nursing After World War II
 1943-1945 - Through the US Cadet Nurse Corps, the
federal government subsidized the cost of
nursing education for all students agreeing
to serve in civilian or military nursing
services for the duration of the war. The
Corps was discontinued in 1945.
 1953 - The National Student Nurses Association was
founded to promote professionalism among students
and prepare them for membership in ANA.
 1963-1975 - More than 5000 nurses served in Vietnam,
and a 1966 Congressional bill allowed the
appointment of male nurses to the Army,
Navy, and Air Force Nurse Corps.
62

 Diversity in the 70’s
 1971 - Dr. Lauranne Sams served as first president of the
National Black Nurses Association
- M. Lucille Kinlein became the first nurse to hang our
her shingle as an independent practitioner.
 1973 - The ANA began a certification for nurses in specialty
practice. Medical-surgical nursing was the first
specialty to be recognized in this program.
 1974 - Dr. Ildaura Murillo-Rohde, JMR,PhD, ND, FAAN,
served as the first president of the National Hispanic
Nurse Association
63

 Impact on Government
 1992 - Eddie Bernice Johnson of Texas became the first
nurse to be elected to the US House of
Representatives.
- As Chief Nurse Officer, Rear Admiral Julia R.
Plotnick,RN,BSN, MPH is an active leader in policy
coordination for the US Surgeon General and
provided leadership to 6500 nurses with the Public
Health Service
 1993 - Under the directorship of Ada Sue
Hinshaw,PhD,RN,FAAN, the National Center for
Nursing Research became the National Institute for
Nursing Research within the National Institutes for
Health
64

 Contemporary Nursing Leaders
 Virginia Trotter Betts,JD,RN,MSN, President of
ANA, nursing and health policy expert, member of
President Clinton’s Health Care Reform Task Force
 Margretta Styles,RN,EdD, Former president of ANA
and current president of ICN
 Fay Bower,RN,DNSe,FAAN, Twentieth president of
Sigma Theta Tau International Honor Society of
Nursing
65

The Earliest hospital established:
1. Hospital Real de Manila ( 1577) - it was
established mainly to care for the Spanish
kings, soldiers but also admitted Spanish
civilians, founded by Gov. Franco de Sande.
2. San Lazaro Hospital ( 1578)- Founded by
Fray Juan Clemente and was administered
for many years by the Hospitalliers of the St.
John of God; built exclusive for the patient
with leprosy.
66

3. Hospital de Indio (1586)- it was
established by the Franciscan Order;
service was in general supported by
alms and contribution of the charitable
person.
4. Hospital de Aguas Santa(1590)
established in Laguna Near the
Medicinal Spring; Founded by Bro. J.
Bautista.
67

5. San Juan de Dios Hospital ( 1596)
founded by the Brotherhood
Miserecordia and administered by the
Hospitalliers of St. John of God; support
was derived form alms and contributions.
68

Evolution of Nursing in the
Philippines
1906 - 1909
 Nursing evolved as profession
 Apprenticeship system
 No subjects were taught
 Trained on giving both medicines, dress
wounds, attended deliveries, assisted
operations
69

Historical View of Nursing in the Philippines
 1903 – A committee of three was created to draft a bill
for the establishment of a school of nursing.
 1906 – At the Union Mission Hospital (now Iloilo
Mission Hospital) in Iloilo City, it was run by
the Baptist Mission Society of America. Miss
Rose Nicolet First Superintendent four women
started training in nursing. Three graduated in
1909 as “qualified surgical and medical
nurses”. Miss Flora Ernst succeeded the
position in 1942.
70

1907- St. Paul Hospital School of Nursing was
established by the Arch. of Manila Most Rev.
Jeremiah Harty under the supervision of the
Sisters of St. Paul de Chartres ( SPC), located at
the Intramuros and provide general services,
opened its training school for nurses in 1908 with
Rev. Mo. Melanie as Superintendent and Ms. E.
Chambers as principal.
71

Phil Gen. Hospital School of Nursing
The PGH began in 1901 as small dispensary mainly
for officers and employees in the City of Manila.
Later grew into Civil Hosp.
1907-The Phil. General Hospital of School Nursing
was advocated by Mrs. Mary Coleman Masters an
educator pursue the idea of training Filipino girls for
the nursing profession.
With the support of Gov. Gen. Forbes the school of
nursing was opened under the auspices of the
Bureau of Education; First Teacher was Julia
Nichols and Julia Clayton who taught the nursing
subjects .
72

Improvement was done under the administration of
Elsie McCloskey Gaches . The course was become
more attractive and practical. Anastacia Giron Tupas
is the first to occupy the position of Chief Nurse and
Superintendent.
73

St. Luke’s School of Nursing ( Q.C. 1907)
The Hospital is an Episcopalian Inst. it began as a
dispensary in 1903. In 1907 the school opened with
three Filipino girls. Ms. Helen Hicks was the First
principal. Ms. Vitalina Beltran was the first Filipino
Superintendent.
Note: in the period of Organization between1907and
1910, the first year nursing students of the PGH, St.
Lukes and St. Paul had a common first year course.
This was known as the Central School Idea.
74

Mary Johnston Hospital and School of
Nursing (1907)
It started as a small dispensary on Calle Cervates
(now Avenida Rizal). It was called Bethany
Dispensary, funded by the Methodist Mission for the
relief of suffering. Sr.Rebecca Parrish, Rose Dudley
and Gertrude Dreisback organized the Mary
Johnston School of Nursing. Miss Librada Javalera
was First Filipino Director of the School.
75

 1907 – Nineteen students were admitted
to a preliminary course in nursing at the
Philippine Normal School
 1909 – A nursing school was established
under the Bureau of Education, by
authority of Act. No.1931
76

Philippines
 1909 – 1948
 Preliminary course in nursing was instituted under
the Bureau of Education
 GN program evolved in 1915
 Bases for admission in Nursing schools:
 Completion of 7th grade
 Passing written exam
 Practical nursing class consisted of lectures on
Nursing Procedures, treatment, administration of
medicine
 No demonstration, no laboratory work
 The first Board Exam for nurses was conducted
77

 1910 – Act no. 1975 reorganized the school under the
Bureau of Health. The school continued as one
of the activities of the newly-opened Philippine
General Hospital and became known as the
Philippine General hospital School of Nursing.
 1913- San Juan De Dios School of Nursing
In 1through the initiative of Dr. Benito Valdez,
the Board Inspector and the Executive Board of
Board of the Hospital passed a resolution to
open a school of nursing. The scjhool is run by
the Daughters of Charity of St. Vincent de Paul.
Sor Taciana Trinanes was the first Directress of
the School.
78

Southern Islands School of Nursing
1918-
it was established in 1911 under the Bureau of
Health. The school opened in 1918 with Anastacia
Giron Tupas as the Organizer. Miss Visitacion Perez
was the first Principal.
79

 1915 – Public Health Nursing in the Bureau of Health
began in accordance with Act. No 2468, which
was extended the provinces. Activities included
home visits, practical demonstrations in
nursing care of the sick, and preparation of an
adequate diet. Also, after a two-month training
period, graduate nurses were assigned to the
provinces where the Sanitary Commissions
were sent. Their training included the
essentials of public hygiene and sanitation,
care of the sick and injured in the homes,
registration of births, vaccination of the
newborn, care and proper feeding of infants,
preparation of a balanced diet, and detection,
reporting and control of communicable
diseases.
80

 1919 – Act No. 2808 (Nurses Law) was passed. This Act was
later amended in 1922, 1933, 1950.
 1920 – The first board examination for nurses was conducted.
 1922 – The Philippine Health Service with the Philippine
General Hospital opened a post-graduate course leading
to a certificate in public health nursing.
- The Filipino Nurses Association was established.
 1924 – A standard curriculum for schools of nursing was
published by the PNA.
 1929 – A one-year program leading to a certificate in Public
Health Nursing was offered at the School of Public Health
Nursing under the College of Medicine (now the Institute
of Public Health).
81

 1933 – A section of Nursing was formed by the fusion of 175
nurse from the office of the Public Welfare Commission
and the Bureau of Health.
 1940 - The first edition of the Handbook for public Health
Nurses and Midwives was published by the section of
Public Health Nursing Supervision, Bureau of Health &
Public Welfare.
 1947 – Executive Order no. 94 led to the reorganization of the
Department of Health and Public Welfare and the
transfer of the Bureau of Public Welfare to the Office of
the President under the name Social Welfare
Administration.
- A nursing services division was created under the Office
of the Secretary of Health
82

Philippines
 1948 – 1978
 BSN degree evolved (1948)
 Ended the GN program (1975)
 The first independent nurse practitioner
group was established (Psychiatric Nursing
Specialists Inc.) 1960-1975
 M.A.N. degree evolved (1975)
83

 1948 – The UP College of Nursing was established by a
resolution of the Board of Regents. This marked the first
attempt to offer a four-year basic nursing course leading
to a B.S. Nursing degree – the first attempt to elevate
nursing as a profession by enriching and broadening the
preparation of nurses and by educating them in a
university setting. The idea was conceived by Julita V.
Sotejo, a nurse and lawyer, who became the first dean of
the school. She expounded on the idea in a thesis
entitled: “A University School of Nursing”, submitted to
the Division of Biological Sciences of the University of
Chicago in 1943.
- a program was opened for graduates of the 3-year
hospital nursing course to obtain a B.S. Nursing degree,
at the UP College of Nursing. This program ended in
1975.
84

 1951 – R.A. 649 provided for the standardization of nurses’
salaries both in institutions and in public health.
 1953 – The Division of Nursing, in cooperation with the FNA and
ICA nurse consultants, made a study of 13 hospital
schools of nursing. The study revealed that the schools
had unqualified faculty, and inadequate libraries,
classrooms, demonstrations rooms and housing
facilities. As a result, scholarships for nursing school
faculty were granted.
- Creation of 81 rural health units which paved the way for
the progressive public health nursing in rural areas.
- R.A. 877 (Nursing Practice law) was approved. Minor
revisions were incorporated in 1957, 1966, 1970 and
1972.
85

 1954 – R.A. 997 abolished the Division of Nursing and created a
decentralized organization with a Chief Public Health
nurse consultant in the Office of the Secretary of Health,
and five consultant positions in nursing; namely: Maternal
and Child Health, in Preventable Diseases, in Institutional
Nursing, in Nursing Education, and in Hospital
Standardization.
 1955 – The UP College of Nursing offered a Master of Arts
(Nursing) degree program to prepared BSN holders of
demonstrated competence and scholarship for senior
positions in nursing and to encourage nursing research,
- A one-year course leading to a certificate of public health
nursing was opened at the UP College of Nursing. This
program ended in 1969.
86

 1956 – The UP Institute of Hygiene opened a graduate program
in Public Health to qualified nursing candidates.
 1961 – The DOH National League of Nurses, an organization of
nurses employed in the DOH, was founded.
 1963 – The DOH-NLN published the first edition of the
Handbook for Public Health Nurses (Community Health
Nursing in the Philippines)
 1962 – 1966 – WHO and UNICEF provided consultant
services and fellowships in pediatric nursing.
 1968 – a movement towards accreditation of nursing schools in
the Philippines was initiated.
 1971 – WHO started an ongoing project in nursing education on
family planning to prepare faculty members to introduce
family planning in the basic nursing curricula.
87

 1975 – The Psychiatric Nursing Specialists, Inc.
(PNSI), the first independent nurse
practitioners group was established.
 1977 – ILO Convention 149 and Recommendation
157, concerning the employment of nursing
personnel and the conditions of their life and
work, were adopted in Geneva.
 1978 – The Declaration on the Economic and Social
Welfare of Filipino Nurses was passed by the
Philippine Nurses Association.
88

Philippines
 1978 – millennium
 Nursing practice has advanced through the
years
 Nurses shifted interest to the academe as
more colleges of nursing were opened
 Modern interventions evolved
 IT evolved
 Global demand for nurses
89

The First Colleges of Nursing in the Phil.
1. University of Santo Tomas School of Nursing
Education on February 11, 1941. the school was
unique since it operated as a separate entity from
the Santo Tomas Univ. Hospital. In 1947 the
Bureau of Private Schools permitted UST
permitted UST to Grant Graduate Nurse to the 21
students. From 1948 the college offered excellent
education leading to BSN. Sor Taciana Trinanes
was its first directress.
90

Manila Central University College of Nursing
2. The MCU Hospital first offered the BSN
course in 1947. it serve as the clinical
field for practice. Miss Consuelo Gimeno
was its first principal.
91

University of the Phil. College of Nursing
Miss Julita V. Sotejo and the U.P. President
Gonzales conceived the opening of the
college. In April 1948 the University Council
approved the curriculum and the Board of
regents. Miss Sotejo was its first dean.
92

Nursing Leaders
1. Anastacia Giron Tupas – First Filipino nurse to hold
the position of Chief Nurse Superintendent of PGH;
founder of the PNA.
2. Cesaria Tan- First Filipino to receive a Masters
degree in Nursing.
3. Socorro Sirilan- pioneered in Hospital Social
Service in San Lazaro Hospital where she was the
Chief nurse.
4. Rosa Militar- a pioneer in school health organization.
5. Sor Ricarda Mendoza- a pioneer in nursing
education.
93

6. Socorro Diaz- first full time editor of the PNA
magazine called “ The Message”.
7. Conchita Ruiz- first full time editor of the newly
named PNA magazine “ The Filipino Nurse”.
8. Loreto Tupaz – “Dean of the Philippine Nursing”
Florence Nightingale of Iloilo.
94

CLIENTS’ AND Nurses' RIGHTS
96

There are three main types
of rights:
97

1.Option rights
Rights of freedom and
choice; they express the
right of people to live as
they choose between
prescribed boundaries .
Example: A female nurse
working on a hospital can
wear any uniform she
wishes provided it is
white, clean and cover her
body suitably.
98

2.Welfare rights
They are legal entitlement of some
good... E.g. Specific safety standards
of the building or a number of years
of education
Example: The right of client to health
care or the right of citizen to safe
water.
99

3.Legislative rights
Are established by law;
they are based on
concepts by justice.
Example: A woman has
legal right not to be
raped by her
husband
100

1.CLIENT’S BILL OF RIGHTS
Introduction
Effective health care requires collaboration between patients and physicians and
other health care professionals. Open and honest communication, respect for
personal and professional values, and sensitivity to differences are integral to
optimal patient care. As the setting for the provision of health services,
hospitals must provide a foundation for understanding and respecting the rights
and responsibilities of patients, their families, physicians, and other caregivers.
Hospitals must ensure a health care ethic that respects the role of patients in
decision making about treatment choices and other aspects of their care.
Hospitals must be sensitive to cultural, racial, linguistic, religious, age, gender,
and other differences as well as the needs of persons with disabilities.
The American Hospital Association presents A Patient's Bill of Rights with the
expectation that it will contribute to more effective patient care and be
supported by the hospital on behalf of the institution, its medical staff,
employees, and patients. The American Hospital Association encourages health
care institutions to tailor this bill of rights to their patient community by
translating and/or simplifying the language of this bill of rights as may be
necessary to ensure that patients and their families understand their rights
and responsibilities.
103

 The patient has the right to considerate and respectful care.
 The patient has the right to and is encouraged to obtain from physicians
and other direct caregivers relevant, current, and understandable
information concerning diagnosis, treatment, and prognosis.
 Except in emergencies when the patient lacks decision-making capacity and
the need for treatment is urgent, the patient is entitled to the opportunity
to discuss and request information related to the specific procedures
and/or treatments, the risks involved, the possible length of recuperation,
and the medically reasonable alternatives and their accompanying risks and
benefits.
Patients have the right to know the identity of physicians, nurses, and
others involved in their care, as well as when those involved are students,
residents, or other trainees. The patient also has the right to know the
immediate and long-term financial implications of treatment choices, insofar
as they are known.
Bill of Rights
These rights can be exercised on the patient’s behalf by a
designated surrogate or proxy decision maker if the patient lacks
decision-making capacity, is legally incompetent, or is a minor.
104

 The patient has the right to make decisions about the plan of care prior to
and during the course of treatment and to refuse a recommended
treatment or plan of care to the extent permitted by law and hospital policy
and to be informed of the medical consequences of this action. In case of
such refusal, the patient is entitled to other appropriate care and services
that the hospital provides or transfer to another hospital. The hospital
should notify patients of any policy that might affect patient choice within
the institution.
 The patient has the right to have an advance directive (such as a living will,
health care proxy, or durable power of attorney for health care) concerning
treatment or designating a surrogate decision maker with the expectation
that the hospital will honor the intent of that directive to the extent
permitted by law and hospital policy.
Health care institutions must advise patients of their rights under state law
and hospital policy to make informed medical choices, ask if the patient has
an advance directive, and include that information in patient records. The
patient has the right to timely information about hospital policy that may
limit its ability to implement fully a legally valid advance directive.
 The patient has the right to every consideration of privacy. Case discussion,
consultation, examination, and treatment should be conducted so as to
protect each patient's privacy.
105

 The patient has the right to expect that all communications and records
pertaining to his/her care will be treated as confidential by the hospital,
except in cases such as suspected abuse and public health hazards when
reporting is permitted or required by law. The patient has the right to
expect that the hospital will emphasize the confidentiality of this
information when it releases it to any other parties entitled to review
information in these records.
 The patient has the right to review the records pertaining to his/her
medical care and to have the information explained or interpreted as
necessary, except when restricted by law.
 The patient has the right to expect that, within its capacity and policies, a
hospital will make reasonable response to the request of a patient for
appropriate and medically indicated care and services. The hospital must
provide evaluation, service, and/or referral as indicated by the urgency of
the case. When medically appropriate and legally permissible, or when a
patient has so requested, a patient may be transferred to another facility.
The institution to which the patient is to be transferred must first have
accepted the patient for transfer. The patient must also have the benefit
of complete information and explanation concerning the need for, risks,
benefits, and alternatives to such a transfer.
106

 The patient has the right to ask and be informed of the existence of
business relationships among the hospital, educational institutions, other
health care providers, or payers that may influence the patient's
treatment and care.
 The patient has the right to consent to or decline to participate in
proposed research studies or human experimentation affecting care and
treatment or requiring direct patient involvement, and to have those
studies fully explained prior to consent. A patient who declines to
participate in research or experimentation is entitled to the most
effective care that the hospital can otherwise provide.
 The patient has the right to expect reasonable continuity of care when
appropriate and to be informed by physicians and other caregivers of
available and realistic patient care options when hospital care is no
longer appropriate.
 The patient has the right to be informed of hospital policies and
practices that relate to patient care, treatment, and responsibilities.
The patient has the right to be informed of available resources for
resolving disputes, grievances, and conflicts, such as ethics committees,
patient representatives, or other mechanisms available in the institution.
The patient has the right to be informed of the hospital's charges for
services and available payment methods.
107

The collaborative nature of health care requires that patients, or their
families/surrogates, participate in their care. The effectiveness of care and
patient satisfaction with the course of treatment depend, in part, on the
patient fulfilling certain responsibilities. Patients are responsible for
providing information about past illnesses, hospitalizations, medications, and
other matters related to health status. To participate effectively in decision
making, patients must be encouraged to take responsibility for requesting
additional information or clarification about their health status or treatment
when they do not fully understand information and instructions. Patients are
also responsible for ensuring that the health care institution has a copy of
their written advance directive if they have one. Patients are responsible for
informing their physicians and other caregivers if they anticipate problems in
following prescribed treatment.
Patients should also be aware of the hospital's obligation to be reasonably
efficient and equitable in providing care to other patients and the community.
The hospital's rules and regulations are designed to help the hospital meet
this obligation. Patients and their families are responsible for making
reasonable accommodations to the needs of the hospital, other patients,
medical staff, and hospital employees. Patients are responsible for providing
necessary information for insurance claims and for working with the hospital
to make payment arrangements, when necessary.
A person's health depends on many more than health care services. Patients are
responsible for recognizing the impact of their life-style on their personal
health.
108

Conclusion
Hospitals have many functions to perform,
including the enhancement of health status,
health promotion, and the prevention and
treatment of injury and disease; the immediate
and ongoing care and rehabilitation of patients;
the education of health professionals, patients,
and the community; and research. All these
activities must be conducted with an overriding
concern for the values and dignity of patients.
109

2. NURSING IMPLICATION
Because Nursing Research usually focuses on
humans, a major nursing responsibility is to be
aware of and advocate clients’ rights. All clients
must be informed of the consequences of
consenting to serve as research subjects. All
nurses who practice on settings where research
is being conducted with human subject or who
participate in such research as data collectors or
collaborators play an important role in
safeguarding the following rights:
110

Right Not To Be Harmed
Right To Full Disclosure
Right Of Self Determination
Right of Privacy and
Confidentiality
111

3. INFORMED CONCENT
 Involves the legal
right of clients to
receive adequate
and accurate
information about
their medical
condition and
treatment..
112

4.ADVANCED DIRECTIVES
 Is a written document
that provide direction
for health care in the
future, when clients
may be unable to make
personal treatment
choices…
113

Living Wills
A document that provides written
instructions about when life sustaining
treatment should be terminated.
Additionally, it indicate when and if
the person may be hospitalized and
what types of treatment may be
implemented.
115

Durable power of attorney
Also called a proxy directive is a document that designates a
person to make decisions about the client’s medical treatment in the
event that the client becomes unable to do so. The designated person
may be the family member, an attorney, or a friend who is aware of the
client’s wishes.
 Organ Transplant
 Do not resuscitate orders
116

5.CONFIDENTIALITY
 Is the client
right to privacy
in the health
care delivery
system, as
discussed in the
Ethical
Principles.
117

 I. Nurses have the right to be recognized as health professionals with a
defined scope of practice that is unique to the profession.
We need to articulate our scope of practice in a manner that is accepted and
understood by all. Many of our health consumers still lack a real knowledge
of the responsibilities of the contemporary nurse. For too long we have
sought refuge in nursing "jargon" that is explained to each other, but
neither valued nor understood by those outside the profession. That
understanding must occur before nursing can realize its future.
 II. Nurses have the right to be recognized as practitioners of quality,
cost-effective healthcare. They need to be compensated in a manner
equal with their responsibilities and with the quality of care they
provide. Those responsibilities and that compensation must be supported
by public policy.
Nursing is still listed as a "cost center" in most healthcare organizational
budgets. The "costs" for nursing care form a large part of that provider's
budget, and thus make a seemingly attractive target for short-sighted
"budget fixers." However, patients are admitted to hospitals and other
provider venues because they require care which is provided by nurses. Given
that, nurses and nursing care should be regarded as a revenue center, and
its costs valued as such.
120

 III. Nurses have a right to a seat at the table where healthcare policy is
formulated so that they can speak to the issues involved in establishing and
maintaining healthcare delivery systems.
For too long, nurses have been the recipients of policy developed and implemented by
people who may have no working knowledge of patients' needs or nursing issues.
Nurses need to be both visible and articulate in any arena where healthcare policy is
formulated, whether that is in a boardroom or a legislative arena. We need to
develop a cadre of expert practitioners to collaborate with all other stakeholders in
development of policies at the local, state, and national levels. We need nursing
leaders who are able and willing to speak for nursing at the table where decisions are
made and organizational budgets are formulated.
 IV. Nurses have the right to lead and direct their own practice.
The magnet health facilities have shown us the value of shared governance in nursing.
In places that maintain nurses' autonomy, care outcomes are improved, and staff
retention is manifested in a body of nurses whose tenure and skills provide
excellence in patient care. Collaborative practice committees have demonstrated the
value of nurses working with other practitioners to research and develop practice
patterns based on sound outcome-driven data.
 V. Nurses have the right to personnel and material resources commensurate with
the area and scope of their responsibilities.
A major source of dissatisfaction for today's professional nurse is the lack of
adequate and appropriate staff, and the lack of equipment needed to provide quality
care. Mandatory overtime, regular use of agency personnel, continuous need to orient
new or inexperienced staff, dependence on outmoded equipment, and lack of
requisite care supplies all add to the frustration of nurses who are responsible for
quality care of patients with increasing acuities. Wise leaders recognize that
appropriate staff and supplies obviate patient errors and improve outcomes. Quality
is cost-effective.
121

DUTIES AND RESPONSIBILITIES OF
CLIENTS AND NURSES
123

Clients Responsibilities
 Providing information. A patient has the
responsibility to provide- to the best of his/
her knowledge- accurate and complete
information about his/her complaints, past
illnesses, hospitalization, medications and
other manners relating to hi/her health.
Changes in status and level of understanding
must also be communicated. If the patient
cannot provide said information, the family
is responsible for doing so in his/her behalf.
 Complying with instructions. A patient is
responsible for complying with the
treatment plan recommended by the
attending physician or health team that is
primarily responsible for his/her health
care. He/She is expected to keep his/her
appointments, abide by the hospital rules, an
informed those concerned if he/ she cannot
keep them.
 Informing the physician of refusal to
treatment. A patient who refuses treatment
or to be compliant with the treatment
regimen must inform the physician of
his/her decision.
124

 Paying hospital charges. If the patient is in the pay service,
he/she is responsible for insuring that financial obligations of
his/her health care are fulfilled as promptly as possible.
 Following hospital rules and regulations. The patient is responsible
for following the hospital’s rules and regulations and shall advice
his/her family to do so, too.
 Showing respect and consideration. The patient must be
considerate of the rights of other patients and hospital personnel
and shall assist in the control of noise, smoking, and/or playing of
loud music on radio. The patient must respect the property of
other persons and that of the hospital. Since the nurses are the
closest caregivers, they are the most logical guardian of the
patient’s rights. It shall also be part of their duties to inform the
patients and their relatives, upon admission, of the responsibilities
expected of them
125

Nurses have 4 fundamental
responsibilities
 To promote health
 To prevent illness
 To restore health
 Alleviate sufferings
128

Nurses render health services to
the following:
 Individual
 Family
 Community
 Coordinate their services with those
of related groups.
129

 I. Nurses have the responsibility to advance their professional abilities
through ongoing professional education.
Nursing practice is constantly changing. New modes of treatment, research
into treatment efficacy and the constant advancement of our knowledge
about patients and their problems mandate that the nurse in practice today
be involved in continued professional development. Wise leaders encourage
staff development by supporting attendance at continuing education
conferences and membership in professional nursing organizations. Wise
nurses use these opportunities, as well as journal readings, in-house and
computerized educational media to support their own growth and development.
 II. Nurses have the responsibility to collaborate with one another and
with other health care provider colleagues to develop and implement
integrated models for healthcare delivery through research, education,
and practice. These collaborations must also work at developing public
policy to improve the health of the populace for whom they care.
As nurses, we must formulate strategic partnerships to promote the use of
research data and evidence based practice in developing and implementing new
and improved patterns of care. Too much of our current practice is
predicated on "traditions" which no longer have validity or which result in
expensive, sub-optimal outcomes. It is our responsibility to work within our
own profession, and with other professionals to examine all current practices,
promoting those whose efficacy provides the best possible outcomes to each
patient and for each episode of care.
130

 III. Nurses have the responsibility to advocate for advances in healthcare
policy and legislation.
As the largest single body of healthcare providers, nurses must collaborate
with each other and with members of other provider professions to develop
and promote evidence-based health policy. We must educate and communicate
with healthcare providers, with consumers, and with legislators to promote
policies that increase access to healthcare services and competent, cost-
effective healthcare.
 IV. Nurses have the responsibility to promote nursing's image, and
knowledge of nursing's role in the healthcare delivery system to each
other, to other professionals and to the general public.
Nursing guru, Leah Curtin, has told us that: "Nursing is the only
profession that eats its young."
Too many nursing gatherings become venues where nurses gather to complain
about each other, about "higher ups," and about the conditions under which
they work. While understandable, these conversations tend to be
counterproductive. They don't fix the situation; they merely create a "miasma
of misery" which makes nurses wonder why they remain in nursing.
We need to reframe our viewpoints. We need to become advocates for
requisite improvements in the practice settings. We have the responsibility to
articulate our needs to those who have the ability and authority to provide
those improvements.
We are responsible for supporting and nurturing our younger colleagues so
that they may develop the skills and abilities to take their rightful place in the
healthcare arena. We have the responsibility to ameliorate conditions within
nursing so that it becomes an attractive consideration for today's young men
and women.
131

 V. Nurses have the responsibility to be advocates for and promoters
of health for all persons. Nurses are responsible to work in
collaboration with other healthcare providers, with community groups,
and with the legislatures to increase the years of healthy life of the
people in the community and to eliminate disparities in healthcare
delivery systems.
Most of us are aware of the precepts set forth in Healthy People 2010.
We recognize that the majority of healthcare expenditures are spent on
restoration of health, and only a small percent on health promotion. We
are similarly aware of the large numbers of people who are without
appropriate access to the healthcare system because of economic issues.
Nurses are advocates for those in their care. It is an appropriate
extension of our responsibilities to extend our advocacy to those in the
community in which we serve. We need to work with others to reframe
health care delivery systems and to end inequities in care. The end result
should be improvements in the public health and improvements in the
economics and outcomes of care. The representatives from major nursing
associations who prepared Nursing's Agenda for the Future (2001) under
the auspices of the American Nurses Association said it best:
"Nursing is the pivotal healthcare profession, highly valued for its
specialized knowledge, skill and caring in improving the health status of
the public and ensuring safe, effective, quality care.
132

The profession mirrors the diverse population it serves and provides
leadership to create positive changes in health policy and delivery
systems.
Individuals choose nursing as a career, and remain in the profession,
because of the opportunities for personal and professional growth,
supportive work environments and compensation commensurate with roles
and responsibilities."
The Rights and Responsibilities for Nurses is a document that requests
study and continued revision. As nursing and healthcare change, so will our
rights and responsibilities. Nursing asks much of its practitioners. As a
profession we strive to improve our abilities to meet the needs of those
we serve. We appreciate the intangible rewards, and seek the tangible: A
place at the table of decision, and reward commensurate with the skill,
knowledge and effort involved.
133

International Council of Nurses
Code for Nurses
Ethical Concepts Applied to
Nursing
1973
135

 The fundamental responsibility of the nurse is
fourfold : to promote health, to prevent illness, to
restore health and to alleviate suffering.
 The need for nursing is universal. Inherent in
nursing is respect for life, dignity and rights of man.
It is unrestricted by considerations of nationality,
race, creed, color, age, sex, politics or social status.
 Nurses render health services to the individual, the
family and the community and coordinate their
services with those of related groups.
136

 Nurses and People
The nurse's primary
responsibility is to those
people who require
nursing care.
The nurse, in providing care,
promotes an environment
in which the values,
customs and spiritual
beliefs of the individual
are respected.
The nurse holds in
confidence personal
information and uses
judgments in sharing this
information.
137

 Nurses and Practice
The nurse carries personal
responsibility for nursing
practice and for maintaining
competence by continual
learning.
The nurse maintains the
highest standards of nursing
care possible within the reality
of a specific situation.
The nurse uses judgment in
relation to individual
competence when accepting
and delegating responsibilities.
The nurse when acting in a
professional capacity should at
all times maintain standards of
personal conduct which reflect
credit upon the profession.
138

 Nurses and Society
The nurse shares with
other citizens the
responsibility for
initiating and
supporting action to
meet the health and
social needs of the
public.
139

 Nurses and Co-Workers
The nurse sustains a
cooperative relationship
with coworkers in nursing
and other fields.
The nurse takes
appropriate action to
safeguard the individual
when his care is
endangered by a co-worker
or any other person.
140

 Nurses and the Profession
The nurse plays the major role
in determining and implementing
desirable standards of nursing
practice and nursing education.
The nurse is active in developing
a core of professional
knowledge.
The nurse, acting through the
professional organization,
participates in establishing and
maintaining equitable social and
economic working conditions in
nursing.
141

Code for Nurses
Ethical Concepts Applied to Nursing
 It was at the meeting of the Grand Council of the International
Council of Nurses (ICN) in Sao Paulo, Brazil, July 1953, that an
international code of ethics for nurses was first adopted. The
Grand Council subsequently revised the Code at its meeting in
Frankfurt, Germany, June 1965.
 The Code for Nurses, as printed here, was produced by the
Professional Services Committee and adopted by the ICN Council
of National Representatives in Mexico City in May 1973.
 All rights, including that of translation into other languages,
reserved. Photomechanical reproduction (photocopy, microcopy) of
this document or part thereof without special permission of ICN
is prohibited.
142

MORAL AND SPIRITUAL
RESPONSIBILITIES OF NURSES
NURSES, whatever their religion must be
God-loving and God-fearing. They must
realize that the nursing profession is
commitment both to God and people. They
should emphasize the importance of
providing spiritual care as a vital aspect of
nursing care. They must uphold the sanctity
of human life.
143

MORAL PRINCIPLES
When a nurse is confronted
with situations where moral
judgment is necessary, the nurse
must be guided by the following
principles or rules:
144

 The Golden Rule. God said, “Do unto others what
you would like others do unto you.” Since nurses
like others to treat them kindly and with respect,
they should be willing to do the same to others
too.
 The Two-fold Effect. When a nurse is faced with
a situation which may have both good and bad
effect, how should she choose which one to
follow? The basic of action may be the following:
 that the action must be morally good;
 that the good effect must be willed and the bad
effect merely allowed;
 that the good effect must not come from an evil
action an evil action but from the initial action
itself directly; and
 that the good effect must be greater than the
bad effect.
145

 The Principle of Totality. The whole is greater
than any of its parts.
 Epikia. “Exception to the general rule.” It is a
reasonable presumption that the authority making
the law will not wish to bind a person in some
particular case, even though the case is covered
by the letter of the law.
 One who acts through an agent is himself
responsible. For example, a patient wants to have
an abortion and as a nurse if she can do it. The
nurse refuses, but then recommends a doctor who
is capable of performing an abortion. The nurse
becomes liable to such a crime, since he/she is an
accomplice of the said doctor.
146

 No one is obliged to betray himself/herself. In testifying
before a court, no one can be forced any person to answer a
question if such will incriminates him/her.
 The end does not justify the means. Giving a sleeping tablet
to a chronically ill person so he/she can die in peace is
morally wrong.
 Defects of nature may be corrected. A patient with a
harelip or cleft palate may have their defects corrected by
plastic surgery. What shall be the role of the nurse in a
case in which parents of a severely deformed newborn child
(Down’s Syndrome with intestinal atresia) refuse to feed
and allow their child to starve to death?
 Withholding nutrition can constitute nursing neglect and
expose the nurse to criminal charges of negligence or
conspiracy to commit murder.
147

 If one is willing to cooperate in the act, no justice is
done to him/her. Suppose a patient subjects
himself/herself willingly to an experimental drug and
he/she has been told of the possible effects of the
same, is of right age, and is sane, there is no violation
of human rights.
 A little more of less does not change the substance
of an act. If a nurse gets a medicine from a hospital
stock without permission or without prescription,
he/she will be guilty of theft even if he/she got only
one tablet of the same.
 The greatest good for the greatest number. During
an epidemic, immunization against communicable
diseases is administered to the people. Although
there may be some who may have slight reactions to
the vaccine, the greater majority of the population
shall be considered rather than the isolated few.
148

 No one is held to the impossible. To promise that a
patient with heart transplant will live may be
impossibility. Yet, such procedures are done in the
hope of saving or prolonging the patient’s life. The
doctor or the nurse cannot be held to the impossible
if they have done their best to take care of the
patient and the latter dies.
 The morality cooperation. Formal cooperation in a n
evil act is never allowed. Immoral operations such as
abortions shall not be participated upon by a nurse
even if the doctor commands it.
 Principles relating to the origin and destruction of
life.
149

Theoretical Foundation of Nursing NCM 100

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Theoretical Foundation of Nursing NCM 100