STANDARDS OF CARE-are the skills and learning commonly possessed by members of a profession. (Guido, 2006, p. 55)-are used to evaluate the quality of care nurses provide and, therefore, become legal guidelines for nursing practice.-Why are Standards Important?

•Outlines what the profession expects of its members.•Promotes guides and directs professional nursing practice – important for self-assessment and evaluation of practice by employers, clients and other stakeholders.

•Provides nurses with a framework for developing competencies•Aids in developing a better understanding & respect for the various & complimentary roles that nurses have.-2Classifications:

1. Internal Standards- include “the nurse’s job description, education, expertise as well as individual institutional policies and procedures.

2. External Standards- consist of the following:

Nurse Practice Acts ( PNA RA 9173)

Professional Organizations (ANA, PNA)

Nursing speciality-practice organizations ( ORNAP CCSAP MCNAP PONA)

Federal organizations and federal guidelines (JCAHO DOH PRC)

It is important, therefore that the nurses to know their institution’s policies and procedures and nurse practice act. They also need to be competent through reading professional journals and attending continuing education and in-service program. Again, the purpose of knowing and practicing nursing’s standards of care is to protect the client/consumers.

Nurse Practice Acts

R.A. 9173 also known as the "Philippine Nursing Act of 2002."

ARTICLE VI Nursing Practice

Section 28. Scope of Nursing. A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. A members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and

rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death.

It shall be the duty of the nurse to:

(a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established;

(b) establish linkages with community resources and coordination with the health team;

(c) Provide health education to individuals, families and communities;

(d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and

(e) Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice;

Provided, That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided, further, That in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, That the program and activity for the continuing professional education shall be submitted to and approved by the Board.

ANA Standards of Nursing Practice Establlishing and implementing standards of practice are major functions of a professional organization. The purpose of ANA Standards of Practice is to describe the responsibilities for which nurses are accountable.

Standard 1. AssessmentThe registered nurse collects comprehensive data pertinent to the healthcare consumer’s health or the situation.

Standard 2. Diagnosis The registered nurse analyzes the assessment data to determine the diagnoses or issues.

Standard 3. Outcome Identification The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. Standard 4. Planning The registered nurse develops a plan of care that prescribes strategies and interventions to attain expected outcomes. Standard 5. Implementation The nurse implements the interventions identified in the plan. Standard 5A. Coordination of Care Standard 5B. Health Teaching and Health Promotion Standard 5C. Consultation (Graduate Prepared Specialty or Advanced Practice Nurse) Standard 5D. Prescriptive Authority and Treatment (Advanced Practice Nurse)

Standard 6. Evaluation The registered nurse evaluates progress toward attainment of outcomes.

ANA Standards of Professional Performance

Professional standards ensure that the highest level of quality nursing care is promoted. Excellent nursing practice is a reflection of sound ethical standards. Client care requires more than just the application of scientific knowledge. A nurse must be able to think critically, solve problems, and find the best solution for client’s needs to assist clients in maintaining, regaining, or improving their health. Critical thinking requires the use of scientifically based and practice-based criteria for making clinical judgments. These criteria may be scientifically based on research findings or practice based on standards developed by clinical experts and quality improvement initiatives.

Standard 7. Ethics The registered nurse practices ethically. Standard 8. Education The registered nurse attains knowledge and competence that reflects current nursing practice.

Standard 9. Evidence-Based Practice and Research The registered nurse integrates evidence and research findings into practice.

Standard 10. Quality of Practice The registered nurse contributes to quality nursing practice.

Standard 11. Communication The registered nurse communicates effectively in a variety of formats in all areas of practice.

Standard 12. Leadership The registered nurse demonstrates leadership in the professional practice setting and the profession.

Standard 13. Collaboration The registered nurse collaborates with the healthcare consumer, family and others in the conduct of nursing practice.

Standard 14. Professional Practice Evaluation The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations.

Standard 15. Resource Utilization The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective and financially responsible.

Standard 16. Environmental Health The registered nurse practices in an environmentally safe and healthy manner.

Competency Standards for Nursing Practice in the Philippines by Board of Nursing, PRC in collaboration with CHED TCNE

a) Safe and Quality Nursingb) Management of Resources and Environmentc) Health Educationd) Legal Responsibility

e) Ethico-moral Responsibilityf) Personal and Professional Growthg) Quality Improvementh) Researchi) Recordsj) Communicationk) Collaboration and Teamwork

Standards for Safe Nursing Practice (BON Res. No. 110 Series of 1998)Safe Nursing Practice refers to appropriate and rational acts of the nurse that ensure:1) Protection of clients from harm that may result from disruption in physiologic and sociologic

preventive mechanism.2) Promotion of health and wellness.3) Restoration of optimal functioning, early recovery, alleviation of suffering or when recovery

is not possible, a peaceful and dignified death.4) Protection of health care providers, including client’s family/SO and members of the

community.5) A balanced ecosystem.

Code of Ethics for Registered Nurses (BON Res. 220 Series of 2004)

PREAMBLESECTION 1.

Health is a fundamental right of every individual. The Filipino registered nurse, believing in the worth and dignity of each human being, recognizes the primary responsibility to preserve health at all cost. This responsibility encompasses promotion of health, prevention of illness, alleviation of suffering, and restoration of health. However, when the foregoing are not possible, assistance towards a peaceful death shall be his/her obligation.

SECTION 2.To assume this responsibility, registered nurses have to gain knowledge andunderstanding of man’s cultural, social, spiritual, physiological, psychological, andecological aspects of illness, utilizing the therapeutic process. Cultural diversity andpolitical and socio-economic status are inherent factors to effective nursing care.

SECTION 3.The desire for the respect and confidence of clientele, colleagues, co-workers, andthe members of the community provides the incentive to attain and maintain the highestpossible degree of ethical conduct.

1. Registered Nurses and People-The primary responsibility of nurses to people is to provide nursing care.-Values, customs, and spiritual beliefs held by individuals shall be respected.-Individual freedom to make rational and unconstrained decisions shall berespected.-Personal information acquired in the process of giving nursing care shall be held in strict confidence.

2. Registered Nurses and Practice

-The nurse is personally accountable of the nursing practice and will hold the white uniform with dignity and pride.-Human life is inviolable.-Quality and excellence in the care of the patients are the goals of nursing practice.-Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability.

3. Registered Nurses and Co-workers-The nurse has a responsibility in encouraging a harmonious relationship among colleagues and members of the health care team.-The Registered Nurse is in solidarity with other members of the healthcare team in working for the patient’s best interest.-The Registered Nurse maintains collegial and collaborative working relationship with colleagues and other health care providers.

4. Registered Nurses, Society, and Environment-The preservation of life, respect for human rights, and promotion of healthy environment shall be a commitment of a Registered Nurse.-The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse.

5. Registered Nurses and the Profession-The nurse is responsible in improving the face of the profession in a form of research and practicing using evidenced-based nursing practice.-Maintainance of loyalty to the nursing profession and preservation of its integrity are ideal.-Compliance with the by-laws of the accredited professional organization (PNA), and other professional organizations of which the Registered Nurse is a member is a lofty duty.-Commitment to continual learning and active participation in the developmentand growth of the profession are commendable obligations.-Contribution to the improvement of the socio-economic conditions and generalwelfare of nurses through appropriate legislation is a practice and a visionary mission.

INTENTIONAL TORTS

Intentional torts are intentional actions that result in harm to the plaintiff. The harm need not be intended, but the act must be intentional, not merely careless or reckless. Most intentional torts are also crimes. The classic intentional tort in medical practice is forcing unwanted medical care on a patient. The care may benefit the patient, but if it was refused and the physician has no state mandate to force care on the patient, the patient may sue for the intentional tort of battery.

The key difference between intentional torts and negligent torts is that the plaintiff must prove the additional element that the defendant acted with the specific intent to perform (i.e. acted with a mental state of intentionally performing) the act which was the proximate cause of the plaintiff's

injuries. "The concept of 'intention' in the intentional torts does not require defendants to know that their acts will result in harm to the plaintiffs.

Common law intentional torts include the following:

Assault-  refer to an act that causes another to apprehend immediate and personal violence, or in the more

limited sense of a threat of violence caused by an immediate show of force .

Battery- is a criminal offence involving unlawful physical contact. In the US, it is the use of force against

another, resulting in harmful or offensive contact.

Conversion -  is a voluntary act by one person inconsistent with the ownership rights of another.

False imprisonment-  is a restraint of a person in a bounded area without justification or consent.

Trespass to land- is a common law tort that is committed when an individual or the object of an individual

intentionally (or in Australia negligently) enters the land of another without a lawful excuse.

Trespass to chattels (Personal property)-  is a tort whereby the infringing party has intentionally (or in Australia

negligently) interfered with another person's lawful possession of a chattel (movable personal property). The

interference can be any physical contact with the chattel in a quantifiable way, or any dispossession of the chattel

(whether by taking it, destroying it, or barring the owner's access to it). As opposed to the greater wrong

of conversion, trespass to chattels is argued to be actionable per se.

Intentional infliction of emotional distress- is a tort claim of recent origin for intentional conduct that results in

extreme emotional distress. Some courts and commentators have substituted mental for emotional, but the tort is

the same. Some jurisdictions refer to IIED as the tort of outrage.

Fraud-  is an intentional deception made for personal gain or to damage another individual

Invasion of privacy- the intrusion into the personal life of another, without just cause.

Dignity torts- Dignitary torts are the class of intentional tort, including slander and libel, which arise when the right

invaded involves the reputation or privacy of the individual claiming industry.

Property Torts- are a specific class of intentional torts which arise when the right invaded is a property right rather

than a personal right.

*References:Carl E. Balita Ultimate Learning Guide to Nursing ReviewKozier &Erb’s Fundamentals of Nursing Eight EditionRA 9173http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002.htmlANA http://www.ferris.edu/HTMLS/colleges/alliedhe/Nursing/Standards-of-Professional-Nursing-Practice.htmI.Torthttp://en.wikipedia.org/wiki/Intentional_tort &http://biotech.law.lsu.edu/Books/lbb/x134.htm

Western Mindanao State UniversityGRADUATE SCHOOL

Master in Nursing ProgramZamboanga City

STANDARDS OF CAREand

INTENTIONAL TORTS

In Partial Fulfillment of the Requirement in

Ethical Competence in Nursing (CN-203)Second Semester S.Y. 2012-2013

Presented to:

Prof. Florence A. Alcazar 

Presented by:

Fatima Nurfaida J. Jandul