PROFESSIONAL ADJUSTMENT / JURIS PRUDENCE First Hospitals: I Iloilo P - PGH L St Lukes M Mary Johnson S St Paul Nsg is a profession.

on. Profession defined by PNA adapted from Americans NA * a calling which its members profess to have acquired a unique body of knowledge & skills for purpose of guiding & caring others. Calling service oriented Members RN Unique special body of knowledge Others pt recipient of care Characteristics of nsg prof: A ccountability liable for his/her actions C ompetency having scientific knowledge E thics S ervice oriented Prof nsg resp: RA 9173 Oct 21,02 Independent Function: 1. Promotive, Preventive, Curative, Rehabilitative in all health care settings. 2. Preventive immunization. Provide health education 3. Utilization of nsg process 4. Link of pts & families to diff community resources - community health nurses libreng bakuna 5. Collaboration of pts care to other health care team - for continuity of care. 6. Resp for training/ supervision of nsg students 7. Accurate reporting/ recording. 8. Observation of S&Sx provide proper intervention Dependent fx 9. Execution of valid Drs order General rule: RN cant give meds without Drs order otherwise RN will be liable for malpractice. Exception, under code of ethics, RN can give drugs during emergency, calamity, national epidemics, no MD around. Life of patient is in danger. Protected under Good Samaritan Act. Good Samaritan Act universal law that protects any person who will give an aid to another person whose life is in danger. RA 8344 No deposit policy during emergency cases. * emergency care 1st before asking for deposit. Mom calls re: 2 yo girl ingested baby aspirin at home. Whats best action for RN to advice mom on phone. 1. Advice mom to bring kid to hosp 2. Advice to call doc 3. Advice to take emetic meds

4. Advice to call h nrse Health teaching child proofing the home! Aspirin should not be reached by kid. Principal direct author of crime. Dispensable Accomplice dispensable, crime will still happen without accomplice. Accessory entered scene after the crime LEGAL RESPONSIBILITIES 1. CONTRACTS/ CONSENTS absence of coercion char: V voluntary Free act. Independent act. Rational O opportunity to ask questions, suggestions & make recommendations T treatment, surgery, procedure specifically explained to the patient by MD U understood by patient M matured physically age 18 yo & above Mentally with sound mind, same & not an imbecile. Substitute or proxy consent if pt is mentally or physically incapable of giving consent 1. Parent 2. Guardian 3. Adliter (not a relative!) DSWD, MD 2. ILLEGAL DETENTION limit freedom of patient to move or travel from one place to another. Hosp promissory note or guarantee HIV dont detain patient High risk HIV transmission felatio Quarantine regulation SARS, Meningococcemia, anthrax - public safety is priority. 3. LAST WILL & TESTAMENT - a person in permitted by the law to control/ dispose of his estate. Effect is only upon his death. Decedent person who died and left no will. The law will handle estate. Testator / Testatoux died and left a will Testate succession heirs will inherit under a last will and testament. Illegitimate entitled to of what legit children will inherit Kabit will get nothing Intestate Succession without last will 2 types of last will & testament 1.) Properties 2.) Life/ Body a) Ordinary will - Advance directives - RN should check LOC of pt - pt is still alive giving instructions -determine location of signature a) Living will DNR, - end of last word last page organ donation, order for cremation - sign all pages - RN is part of 3 witnesses b) Holographic will * handwritten by testator * dated and signed by testator * no need for witness 4. MEDICATONS/ PRESCRIPTIONS

Rules 1. MD, DVM, DMD can prescribe meds 2. Should have : a.) Name MD, PTR, PRC#, location of clinic/ hospital b.) Name of patient, age, sex c.) Information about drug frequency duration d.) Generic & brand name in prescription RA 6675 Generics Act * Should have BOTH generic & brand name on prescription Impossible Prescription generic & brand name does not correspond with each other. 3. Know 10 rights in giving meds What is the right way to ask identity of patient a. call patent by his name b. check chart c. verify name at nurses station d. check name at identification wrist band 4. Telephone orders General rule - no telephone order Whatever is not written is not an order Exception Emergency! After MD says order repeat instruction on phone Have resident MD sign! Administer meds. When MD arrives have him counter sign his order 5. Documentation recording/ charting Purposes: C communication A assurance of quality R research purposes L legal document S statistics source SUBPOENA - an order from court Duces Tecum (papers) documents obj, materials, papers, chart Ad Testificadum (person) witness Dos & Donts of charting Dos Donts F full, factual & accurate L language unacceptable L legible I improper corrections I immediately after procedure S- spaces, skips P personal notes, not delegated A avoid using too much abbreviations addendum late entry Negligence failure to do something which a reasonable & prudent person should have done. 2 types: 1. Commission 2. Omission total neglect of care didnt do anything Elements to prove negligence 1. Duty

2. Failure to do his duty 3. Injury, harm, death= result Malpractice doing acts or conducts that you are not authorized/ licensed/ competent/ skilled to perform, resulting to injuries/ non injurious consequences * RN exceeding the scope of nursing practice & does an MDs job. Episioraphy after proper training, RN can perform this procedure. In absence of fetal & maternal aberration, RN can perform internal examination RES IPSA LOQUITOR the thing speaks for itself * obvious fault FORCE MAJEURE - God nature storm, earthquake, flood, - not liable Fortuitous event created by man traffic not liable due beyond his control. CRIMES AFFECTING RNs Classification: 1.) Manner of its commission dolo (deceit) with criminal content - culpa (fault) without criminal intention, negligence 2.)Stages of execution Consumated all elements to commit crime were all present. Frustrated offender performs everything to consummate but it did not happen for reasons beyond his control Attempted overt acts mere intensions to commit crime. 3.) Degree of participation Principal indispensable. Without the principal = no crime- author of crime Accomplice with or without accomplice = crime will happen - dispensable, look out. - enters scene before or during crime Accessory enters scene after crime is committed * conceals/ destroys evidence. RA 7877 anti sexual Harassment act 1. Any person who exercises authority (Prof & student, Dr & RN) 2. Asking sexual favors in exchange of another favor Rape: a.) Ordinary rape forcible penetration of sex organ to a sex organ b.) Sexual assault anything forcibly inserted to any orifice. Illegal abortion termination of product of conception before the age of viability. Infanticide crime committed of person killed is age < 72h or <3days old Parricide killing of a person with relationship, ex. Bro in-law, sis, - relative Homicide killed a person to whom you have no relationship- product of negligence. Murder killing of a person with intension. Simulation of birth any person who shall substitute 1 child or identity of a child for the purpose of losing his civil status. PD651 Birth registration act - requires any person (RN,OB, midwife, pilot) who shall assist in giving birth to report within 30 days without penalty any live birth at Local Civil Registrars Office. RA 2808 (y1919) BON 1 chairman, 2 members = all RNs 1920 1st board exam RA 9173 (Oct21,02)

BON qualifications M masters in NSG A- accredited nsg org (PNA) S seven (1 chairman, 6 members) I immediately resign upon appointment N not convicted of any crime P pecuniary interest, absence of T ten yrs experience (last 5 years hr in RP) C citizen & resident of RP DEAN qualification- RN + MAN + 5 yrs experience in nsg Nurse Licensure Exam 1. Cert of Good Moral Char (Optional) 2. Proof holder of Fil citizenship Birth cert. 3. Proof BSN degree Transcript with scanned picture done by reg. NSG SERVICE ADMINISTRATOR S supervisor head nurse/ ward/ shift/ day M manager C chief nurse manage whole hosp D director Supervisor B BSN holder RN Manager A accredited nsg org PNA N Nine units nsg mgt T two years practice Chief nurse RN+ MAN Director 5 years supervisory experience PD 223 - PRC regulatory body to all profession in Phil RA 1080 Civil Svc Act * Automatic civil service eligible once you pass PRC nsg exam RA 6425 (9165) Dangerous Drugs Act Prohibited totally absolutely, cant be used by human being. Ex. Methaphetamine Hcl (Shabu) cocaine, cannabis Regulated can use this drug * with appropriate prescription * MD with appropriated license (BFAD, PDEA licence) * Valium, dormicum Penalty for licensed health care provider 1. Fines 2. Imprisonment 3. Automatic revocation of license RA 7600 Mother Baby Friendly Hosp Act * early bonding of mom to child through breast feeding & rooming in technique * Sen. Flavier December 1 World AIDS day RA 8981 PRC modernization / Computerization Act * after 5 days result of board exam will come out * June 11 result * www.prc.gov.ph

* results of board exam Nurse * or txt 233 globe/ 136 smart txt PRC (space) Rating (space) TABUENA,ABIGAILC Registration. Sign in both of registry of BON Special can get license by reciprocity RN in a foreign country & that country where you are registering has employment for Fil RN in their country PROHIBITED / ILLEGAL PRACTICE OF NURSING Imprisonment / jail 1-6 yrs / P50 100k fines L license , without O own (using as your own license of another) I invalidated license + revoked , suspended S sign name & attach title BSN, RN (not true) F falsification of documents (diploma, experiences) A assist another person in illegal practice of nsg U underwaging R review/ training centers for RN not accredited by government A- any person violating this act
PROFESSIONAL ADJUSTMENTS, NURSING ETHICS & JURISPRUDENCE A. LAWS AFFECTING THE PRACTICE OF NURSING IN THE PHILIPPINES LAWS It is the sum total of rules and regulations by which society is governed; It is man-made & regulates social conduct in a formal & binding way; It reflects societys needs, attitudes & more; Also defined as a rule of conduct pronounced by controlling authority & is enforceable

3 Essential Characteristics of a Law 1. Authority or the Right to declare that the Rule exists 2. Such a Rule is pronounced or expressed and its source is identified (declared in writing; in order to enforce control) 3. A Right to enforce is provided Government = Controlling Authority in the Philippine System Constitution = Fundamental Law of Government Principal Sources of Pronouncements 1. Philippine Constitution 2. The Statutes or Legislations 3. Regulations issued by the Executive Branch of Government 4. Case Decisions or Judicial Opinions 5. Presidential Decrees 6. Letters of Instructions History of Philippine Nursing Law Act No. 2493 of 1915 1st law in relation to nursing practice in the Philippines Regulated the practice of Medicine Provided for examination & registration of nurse in the Ph.

Applicants needed to be 20 years ols, in good physical health & with good moral character Graduates of intermediate courses of public schools were allowed to enter the school of nursing The nursing program was only for 2 years of instructions; graduates were called 1st class nurses (2nd class nurses need not to go to school of nursing) Known as the 1st True Nursing Law Created a board of examiners for nurses 1920 1st Board Examination was given in the Philippines Known as The Philippine Nursing Law Provided for the organization of the Board of Examiners for nurses Contained provisions for nursing schools & colleges, examination, registration of nurses 2 Important Sections of 877 o Sec 16 Inhibition against practice of nursing o Sec 30 Prohibition in the practice of nursing & Penal Provision Amended portions of RA 877

Act No.2808of 1919

Republic Act 877 (June 19, 1953)

Republic Act 4704 (June 18, 1966)

List of Laws that Govern/Affect the Practice of Nursing in the Philippines A. Republic Acts RA 1054 Free emergency dental & medical services to workers RA 1080 Civil Service Eligibility RA 1082 Creation of Rural Health Units RA 1612 Privilege Tax/Professional Tax Payments RA 1636 Compulsory Membership to both GSIS &/or SSS RA 2382 Philippine Medical Act RA 3573 Reporting of Communicable Diseases RA 4073 Treatment of Leprosy RA 4226 Hospital Licensure Act RA 4419 Philippine Dental Act RA 5181 Permanent Residency & Reciprocity as Requirements RA 5901 40 working-hours per week for nurses working in hospitals w/ @ least 100 bed capacityover-time pay is required if RN has worked for more than 40 hrs in a week RA 5921 Pharmacy Act requires all pharmacies to have a licensed pharmacist RA 6365 Created the Population Commission (POPCOM) RA 6425 Dangerous Drugs Act of 1972 RA 6675 Generic Acts of 1988 RA 6713 Code of Ethical & Conduct for Government Officials & Employees RA 6758 Salary Standardization Law for Government Workers

RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA RA

7160 7164 7170 7305 7392 7432 7600 7610 7624 7719 7846 7875 7877 8187 8344 8423 8749 8981 9003 9165 9173 9257 9262 9288 9344 9439 9502 9994

Local Autonomy Code Philippine Nursing Act of 1991 Organ Donation Act Magna Carta for Public Health Workers Midwifery Law amended RA 2644 Senior Citizens Act provides 20% discount Rooming-in & Breast Feeding Act Child Abuse & Exploitation Law Drug Education Law Blood Bank Act of 1994 Vaccination of Hepatitis B for Newborns 24 Hours after Birth National Health Insurance Act of 1995 Anti-Sexual Harassment Act Paternity Leave Act Hospital & Doctors required to Provide Emergency Treatment 1st aid Law Creation of Philippine Institute for Traditional & Alternative Health Care PITACH Clean Air Act PRC Modernization Act Solid Waste Management Act Comprehensive Dangerous Act of 2002 Philippine Nursing Act of 2002 Expanded Senior Citizens Act Law on Violence against Women & Children Newborn Screening Act Juvenile Justice and Welfare Act Anti-Patients Detention Act Cheaper Medicines Act of 2008 Mar Roxas Law Exemption of Senior Citizens from Payment of VAT for Good and Services

B. Presidential Decrees PD 48 Paid Maternity Leave Benefits (up to 4 children only) PD 69 Personal Exemptions Claims (up to 4 children only) PD 147 National Immunization Day PD 148 Minimum Employable Age for Women (16 years old) PD 223 Creation of PRC PD 442 Labor Code of the Philippines PD 541 Allowing former Filipino Professionals to Practice their Profession in the Philippines PD 603 Child and Youth Welfare Code PD 626 Employee Compensation & State Insurance Fund PD 651 Compulsory Birth Registration within 30 days after delivery PD 825 Anti-Improper Disposal of Garbage PD 851 13th Month Pay PD 856 Sanitation Code of the Philippines PD 965 Family Planning & Responsible Parenthood Seminar required prior to issuance of marriage of license PD 1636 Compulsory Membership either to GSIS/SSS C. Executive Orders

EO 51 EO 203

Milk Code of the Philippines Lists Regular holidays & Special Holidays includes all special Christian & Muslim Holidays EO 209 Family Code of the Philippines EO 550 Creation of a National Task Force in establishing Centers for NCLEX in the Philippines EO 609 Directs/Orders DOLE to Administer Voluntary exams for nurses licensed in the 2006 NLE Free Re-take of Board Exam for Nurses AO 2009 Administrative Order 2009-0025 Adoption of Unang Yakap D. PRC & BON Resolutions PRC Res. New Rates for Examination & Registration 90-11 PRC Res. Implementing rules & regulations of the new Nursing Law/RA 9173 425 PRC Res. Prohibitions inside examination venues nursing book/review materials, 463 faculty members of nursing schools, review lecturers, etc BON Res. 82 Standards of Safe Nursing Practice BON Res. Adoption of Core Competency Standards for Nursing 112 BON Res. Continuing Professional Education Units 60 CPE units/hours for every 3179 year period required prior to renewal of license with PRC BON Res. Code of Ethics for Filipino Nurses, Series of 2004 220 BON Res. Submission and Attachment of Documents prior to applying for the NLE, 357 official documents must be submitted (TOR, Diploma, RLE hours, Cases OR/DR) E. PROCLAMATIONS/PRONOUNCEMENTS & LETTERS OF INSTRUCTIONS Proc. No. Professional Regulation Week PRC week, celebrated June 16-22 118 Proc. No. Nurses Week every last week of October 539 Proc. No. Legal Basis of Primary Health Care 949 Proc. No. Members of Accredited Professional Organizations given 1000 priority/preference in hiring & attendance in seminars Proc. No. Midwifery Week every 3rd week of October 1275 LOI 47 Family Planning Subjects required in medicine, nursing & other related courses

F. Salient Provision in the 1987 Philippine Constitution I. Article II Declaration of Principles & State Policies Section 11 Human Dignity & Rights Section 12 Sanctity of family, equal protection of the life of the mother & child Section 13 Role of the Youth in Nation building Section 15 Right to Health Section 16 Right to a Balanced & Healthy Ecology II. Article III Bill of Rights Section 1 Equal protection of laws & Due Process of Law

Section 3 Privacy of Communication & Correspondence Section 8 Formation of Unions, Associations & Societies Section 12 Right to Remain Silent & Have Counsel when under investigation Section 14 The Accused is presumed innocent until proven guilty III. Article IV - Citizenship Section 3 Philippine Citizenship may be lost or re-acquired in a manner provided by law (basis for having dual citizenship) IV. Article XIII Social Justice & Human Rights Section 3 Rights of all workers to self-organized, collective bargaining, and negotiations and peaceful concerted activities Section 11 Priority for the needs of the under-privileged, sick, elderly, disables, women & children Section 13 Special agency for disabled persons Section 14 Protection for working women V. Article XV The Family Section 1 Filipino Family as the Foundation of the Nation Section 2 Marriage as an Inviolable Social Institution is the Foundation of the Family Section 4 The Family has the Duty for its Elderly Members

B. NEGLIGENCE, MALPRACTICE, TORT, CRIMES NEGLIGENCE refers to the commission or omission of an act, pursuant to a duty, that a reasonably person in the same or similar circumstance would or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property Reasonable and prudent generally means the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience.

Elements of Professional Negligence 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 standard The fact that the breach of this standard resulted in an injury to the plaintiff

Common Acts of Negligence Burns, objects left inside the patients body, falls of the elderly, confused, unconscious, sedated patients, or those who are fully recovered form anesthesia;falls of children whose side-rails are not pulled up and locked, failure to observe and take appropriate action as needed.

Examples of Negligence 1. Failure to report observations to attending physicians.

2. Failure to exercise the degree of diligence which the circumstances of the particular case demands. 3. Mistaken identity. 4. Wrong medicine, wrong concentration, wrong route, wrong dose. 5. Defects in equipments that may result in injuring the patients. 6. Errors due to family assistance. 7. Administration of medicine without a doctor prescription. Specific Examples of Negligence in Different Areas of Practice Treatment 1. Enema to a preoperative patient with appendicitis, which resulted in ruptured bowel and appendicitis 2. Improperly used equipment, resulting in air embolisms 3. Failure to administer the correct oxygen level 4. Failure to attach a fetal monitor as ordered 5. Burns to an infant from formula heated in a microwave 6. Failure to attend a patient having an asthma attack, resulting in injuries such as brain damage Communication 1. Failure to notify the physician of changes in signs and symptoms 2. Failure to chart vital signs for hours in a labor room 3. Failure to advise the physician of jaundice 4. Failure to notify the physician of circulatory compromise in a casted leg Medication 1. Wrong medication given on discharge (topical eye anesthetic instead of artificial tears) 2. Failure to give diazepam (Valium) as ordered 3. Improper administration of potassium chloride

Monitoring/Observing/Supervising 1. Failure to recognize dehydration and electrolyte imbalance

2. Failure to monitor intravenous therapy 3. Failure to monitor fetal heart rate 4. Negligent supervision of a psychiatric patient who attempted suicide 5. Negligent assignment and supervision of a student nurse who did not take blood pressure for 6 hours The Doctrine of Res Ipsa Loquitor 1. The thing speaks for itself. 2. It means that the nature of the wrongful act or injury is suggestive of negligence 3. Three conditions are required to establish a defendants negligence without proving specific conduct. That the injury was of such nature that it would not normally occur unless there was a negligent act on the part of someone. That the injury was caused by an agency within the control of the defendant That the plaintiff himself did not engage in any manner that would tend to bring about the injury. MALPRACTICE

you do things beyond your scope of practice also denotes stepping beyond ones authority with serious consequences. Professional misconduct, improper discharge of professional duties, or failure to meet the standard of care of a professional which resulted in harm to another.

Doctrine of Force Majeure It means an irresistible force, one that is unforeseen or inevitable. you cannot stop it from happening circumstances such as floods, fire, earthquakes and accidents fall under this doctrine

Doctrine of Respondeat Superior let the master answer for the acts of the subordinate the liability is expanded to include the master as well as the employee and not a shift of liability from the subordinate to the master this doctrine applies only to those actions performed by the employee within the scope of his employment

To Reduce the Risk of Being Sued for Malpractice 1. Practice within the scope of the nurse practice act. BE VERY FAMILIAR WITH THE PHILIPPINE NURSING LAW. 2. Beware of laws that affect nursing practice. 3. At the start of employment, get a copy of your job description, the agencys rules, regulations and policies

4. 5. 6. 7.

Observe agency policies and procedures Model practice after established practice standards. upgrade your skills and competence. Be sure that they are always on a high level. Accept only such responsibility that is within the scope of your employment and your job description. Determine whether you are competent to do the job assigned. If you are not be hones t in admitting so and try your best to learn it. 8. Do not delegate your responsibility to others. 9. Determine whether your subordinates are competent in the work you are assigning them. 10. Develop good interpersonal relationship with your co-workers, whether they by your supervisors, peers or subordinates. 11. Consult your superiors o problems that may be too big for you to handle. 12. Verify orders that are not clear to you or those that seems to be erroneous 13. The Doctor should be informed about the patients condition, effects of medications and treatments, or the patients lack of progress. 14. Keep in mind the value and necessity of keeping accurate and adequate records. 15. Patients are entitled to an informed consent 16. Always put patient rights and welfare first. 17. Be aware of relevant law and legal doctrines and combine such with the biological, psychological and social sciences that form the basis of all rational nursing decisions. 18. Practice within the area of individual competence. 19. Upgrade technical skills consistently by attending continuing education programs and seeking specialty certification. 20. Purchase professional liability insurance and understand fully the limits of the individual policy.

INCOMPETENCE

is the lack of ability, legal qualifications or fitness to discharge the required duty. Although a nurse is registered, if in the performance of her duty she manifests incompetency, there is ground for revocation or suspension of her certificates of registration.

NURSES LIABILITIES Liability of Nurses for the Work of Nursing Aides Nursing aides perform selected nursing activities under the direct supervision of nurses. Nurses should not delegate their functions to nursing aides since the Philippine Nursing Act specifies the scope of nursing practice of professional nurses. If a nurse delegates, he is responsible.

Liability for the Work of Nursing Students

Under the Philippine Nursing Act of 2002, nursing students do not perform professional nursing duties. They are to be supervised by their Clinical Instructors.

Assumption of Risk A nurse cannot bring suit against the patient if she gets hurt or contacts the disease since upon accepting the case, the nurse agreed to assume the risk of harm or infection.

CONSENT

Is defined as a free and rational act that presupposes knowledge of the thing which consent is being given by a person who is legally capable to give consent. It is the NURSE who actually secures the consent of the patient upon admission.

Informed Consent it is established principle of law that every human being of adult years and sound mind has the right to determine what shall be done with his on body Essential elements of Informed Consent 1. Diagnosis and explanation of the condition 2. A fair explanation of the procedures to be done and used and the consequences 3. A description of alternative treatment or procedures 4. A description of benefits to be expected 5. Material rights if any 6. The prognosis, if the recommended care, procedure, is refused.

Proof of Consent A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of procedure A signed special consent is necessary before any medical or surgical treatment is don such as x-rays etc.

Who Must Consent Normally the patient himself is the one who gives the consent, If he is incompetent (minors or mentally ill) or physically unable, consent must be taken from another who is authorized to give it in his behalf.

Consent of Minors Parents, or someone standing in their behalf If emancipated minor consent is signed by them.

Consent of Mentally Ill

They cannot legally give consent. Parents or guardians.

Emergency Situation When an emergency situation exists, no consent is necessary because inaction at such time may cause greater injury.

Refusal to Consent Patients other than those who are incompetent to give consent can refuse consent. If refuses to sign, this should be noted in his chart

Consent for Sterilization Is the termination of the ability to produce offspring. The husband and wife must consent to the procedure if the operation is primarily to accomplish sterilization. If its medically necessary or an incidental result, the patient alone is sufficient.

Medical Records As a record of illness and treatment, it saves duplication in future cases and aids in prompt treatment It serves as a legal protection for the hospital, doctor, and nurse by reflecting the disease or condition of patient and its management. If it was not charted, it was not observed or done. Nurses have the responsibility of keeping the patients right to confidentiality. Permission has to be taken from the Medical Records Division of the Hospital.

TORTS is a legal wrong, committed against a person or property, independent of a contract which renders the person who commits it liable for damages in a civil action. The person who has been wronged seeks compensation for injury or wrong he has suffered Examples 1. Assault and Battery Assault is the imminent threat of harmful or offensive bodily contact Battery is an intentional, unconsented touching of another person. Examples: a. performance of an operation without the patient's consent b. a nurse who has an adult, competent patient held down to administer an injection or forces oral administration c. a physician or hospital may be liable for assault if the hospitalized patient assaults someone else and there was knowledge that the patient was dangerous d. the hospital may be liable if an employee assaults a patient e. sexual assault as a basis for claim has increased in recent years

2. False Imprisonment or Illegal Detention Unjustifiable detention of a person without legal warrant within the boundaries fixed by the defendant by an act or violation of duty intended to result in such confinement 3. Invasion of Right to Privacy and Breach of Confidentiality. The right to privacy is the right to be left alone, the right to be free from unwarranted publicity and exposure to public view 4. Defamation Character assassination, be in written or spoken Nurses must be extremely cautious about comments made about physicians. Any hasty action or comment may subject the nurse to a defamation action. Nurses may bring forth a defamation action if he/she feels their reputation has been injured. Nurses have sued physicians for defamation. Supplying references for employees may subject an employer to a charge of defamation. Slander is oral defamation of a person by speaking unprivileged or false words by which his reputation is damaged. Libel is defamation by written words, cartoons or such representations that cause a person to be avoided, ridiculed or held in contempt or tend to injure him in his work. CRIMES, MISDEMEANORS AND FELONY Crime is defined as an act committed or omitted in violation of the law. Criminal offenses are composed of two elements: (1) criminal act and (2) evil/criminal intent. In criminal action, the state seeks the punishment of the wrongdoers. Conspiracy to commit a crime: A conspiracy to commit a crime exists when two or more persons agree to commit a felony and decide to do it. Person who commit felonies are either principals, accomplices or accessories. Principals are those who take a direct part in the execution of the act: who directly force or induce others to commit it: or who cooperate in the commission of the offense by another act without which it would not have been accomplished. Accomplices are those persons who, not being principals, cooperate in the execution of the offense by previous or simultaneous act. To hold the person liable as an accomplice, it must be shown that he knowledge of the criminal intention of the principal. This may be demonstrated by previous or simultaneous that contribute to the commission of the offense as aid thereto, whether physical or moral. Accessories are those who, having knowledge of the commission of the crime, either as principals or accomplices, take part subsequent to its commission by profiting themselves or assisting the offender to profit from the effects of the crime by concealing or destroying the body of the crime, or the effects or instrument thereof, in order to prevent its discovery of by harboring, concealing, or assisting in the escape of the principal of the crime, provided the accessories act with abuse of their public functions or are known to be habitually guilty of some other crimes. Criminal Actions: Criminal actions deal with acts or offenses against public welfare. These vary from minor offenses and misdemeanors to felonies. A misdemeanor is a general name for a criminal offense which does not in law amount to felony, punishment is usually a fine or imprisonment for a term of less than one year. A felony is a public offense for which a convicted person is liable to be sentenced to death or to be imprisoned in a penitentiary or prison. It is far more atrocious in nature than misdemeanor.

A felony is committed with deceit and fault. A deceit exists when the act is performed with deliberate intent and there is fault when the wrongful acts result from imprudence, negligence, or lack of skill or foresight. Classes of Felonies: Felonies are classified according to the degree of the acts of execution which produces the felony into consummated, frustrated, and attempted felonies. A felony is consummated when all the elements necessary for its execution and accomplishment are present. It is frustrated when the offender performs all the acts or execution which will produce it by reason of causes independent of the will of the perpetrator. There is an attempt to commit a felony when the offender commences the commission of the same directly by overt (open or manifest) acts, and does not perform all the acts or execution which shall produce the felony, by reason of some cause or accident other than this own spontaneous desistance. Consummated felonies, as well as those which are frustrated and attempted, are punishable. Felonies are also classified according to the degree of punishment attached to the felony whether grave, less grave, or light felony. Grave felonies are those to which the law attaches the capital punishment (death) or penalties which in any of their periods are afflictive (imprisonment ranging from six (6) years and one (1) day to life imprisonment or a fine not exceeding P6.000.00). less grave felonies are those which the law punishes with penalties which in their maximum period are correctional (imprisonment ranging from one month and one day to six (6) years, or a fine not exceeding P6.000.00 but not less than P200.00). light felonies are those infractions of law for the commission of which the penalty of arresto menor (imprisonment for one (1) day to thirty (30) days or a fine not exceeding P200.00 or both of which are imposed). Light felonies are punishable only when they have been consummated, with the exception of those committed against a person or property.

Circumstances Affecting Criminal Liability A. Justifying Circumstances A person may not incur criminal liability under the following circumstances: 1) When he/ she acts in defense of his person or rights provided that: (a) there is unlawful aggression on the part of the offended or injured party; (b) there is reasonable necessity for the means employed by the person defending himself/herself to prevent such aggression; and (c) there is lack of sufficient provocation on the part of the person defending himself. 2) When he/she acts in defense of the person of the rights of his/her spouse, ascendant, descendants, or legitimate or natural or adopted brothers or sisters, or relatives by affinity in the same degree, provided that the first and second requisites presented in the next preceding circumstances are present, and further requisite, in the case of provocation was given by the person attacked, that one making defense had not part therein. 3.When he or she acts in defense of the person or rights of stranger provided that the first and second requisites mentioned in the first circumstance and that the person defending is not induced by revenge ,resentment or other evil motives.

4. When any person who in order to avoid an evil or injury, does an act which causes damage to another provided that the evil sought to be avoided actually exists, the injury feared is greater than that done to avoid it and there is no other practical and less harmful means to prevent it. 5. When he/she acts in the fulfillment of a duty or lawful exercise of a right or office. B. Exempting Circumstances These are certain circumstances under which the law exempt a person from criminal liability for the commission of a crime. The following persons under the circumstances stated are expressly exempted by law from criminal liability for the crime they may have committed: 1. An imbecile or an insane person unless the latter has acted a lucid interval. 2. A person under nine years of age. 3. A person over nine years of age and under fifteen unless he acted with discernment. 4. Any person who, while performing a lawful act with due care, causes an injury which is merely an accident without fault or intention of causing it. 5. Any person who acts under compulsion of an irresistible force. 6. Any person who acts under the impulse of an uncontrollable fear of an equal or greater injury. 7. Any person who fails to perform an act required by law, when prevented by some lawful or insuperable cause. C. Mitigating Circumstances Are those which do not constitute justification or excuse of the offense in question but which, in fairness and mercy, may be considered as extenuating or reducing the degree of moral culpability. Following are some of the circumstances considered by law to be mitigating and, as such, lessen the criminal liability of the offenders. a. Circumstances which are otherwise justifying or exempting were it not for the fact that all requisites necessary to justify the act or to attempt the offender from criminal liability in the respective cases are not attendant. b. When the offender has no intention to commit so grave a wrong as the one committed. c. When the offender is under eighteen years of age over seventy years old. d. When sufficient provocation or threat on the part of the offended party immediately precedes the act. e. When the act is committed in the immediate vindication of a grave offense to the one committing the felony, his or her spouse, ascendants, descendants, legitimate, natural or adopted brothers or sisters, or relative by affinity within the same degree. f. When a person acts upon an impulse so powerful as naturally to have produced obfuscation. g. When the offender voluntarily surrender himself to a person in authority or his agents, or that he/she voluntary confesses his/her guilt before the court prior to the presentation of the evidence for the prosecution.

h. When the defender is deaf and dumb, blind or otherwise suffering from some physical defect which thus restrict his/her means of action, defense or communication with his/her fellow beings. i. When the offender is suffering from such illness as would diminish the exercise of his/her willpower without, however, depriving him/her of consciousness of his/her acts. D. Aggravating Circumstances These are those attending the commission of a crime and which increase the criminality liability of the offender or make his guilt more severe. Some of the circumstances considered by law as aggravating the guilt of the offender are the following: a. when an offender takes advantage of his public position. b. When the crime is committed in contempt of or with insult to public authorities: c. When the act is committed with insult or in disregard of the respect of the offended party on a account of his/her rank, age, or sex or that it is committed in the dwelling of the offended party, if the latter has not given provocation: d. When the act is committed with abuse or confidence or obvious ungratefulness: e. When the crime is committed in a place of worship: f. When the crime is committed on the occasion of a conflagration, shipwreck, earthquake, epidemic or other calamity or misfortune: g. When the crime is committed in consideration of a price, reward, or promise: h. When the crime is committed by means of inundation, fire, poison, explosion, standings of a vessel or intentional damage thereto, derailment of a locomotive, or the use of any other artifice involving great waste and ruin: i. When the act is committed with evident premeditation or after an unlawful entry: j. When craft, fraud, or disguise is employed: and k. When the wrong done in the commission of the crime is deliberately augmented by causing other wrongs not necessary for its commission. E. Alternative Circumstances Are those which must be taken into consideration as aggravating or mitigating according to the nature and effects of the crime and other conditions attending its commission. These are the relationship, intoxication and degree of instruction, and education of the offender.