MIDTERM

III. Evidence-Based Practices in Nursing Management

A. National Nursing Care Competency

Standards (NNCCS)
B. Philippine Professional Nursing Practice
Standards (PPNPS)
C. Patient Care Safety Standards
D. Standards of Nursing Practice
1. Purpose of EBP in Nursing Leadership and Management
• Improve patient safety, quality of care, and organizational
efficiency.
• Foster a culture of inquiry and lifelong learning among
nurses.
• Bridge the gap between research findings and nursing
practice.
2. Manager's Role in Supporting EBP
• Promote staff education and training on EBP.
• Provide resources and time for staff to engage in EBP.
• Serve as a change agent to support EBP implementation.
• Develop policies that encourage use of best evidence.
• Collaborate with interdisciplinary teams for continuous
improvement.
3. Strategies to Promote EBP
• Foster a culture of innovation and openness to change.
• Encourage nurse-led research projects and quality
improvement initiatives.
• Create EBP councils or committees within the organization.
• Partner with academic institutions to support ongoing
education.
4. Barriers to EBP in Nursing Management
• Lack of time or staffing.
• Limited access to research databases and journals.
• Resistance to change among staff.
• Insufficient knowledge or skills in interpreting research.
5. Ethical Considerations
• Ensuring that EBP respects patient autonomy
and values.
• Using evidence fairly and without bias.
• Avoiding the use of outdated or harmful
practices.
A. National Nursing Care Competency Standards
(NNCCS)

• Define the essential competencies expected of

Filipino nurses.
• Provide uniformity in nursing practice.
• Serve as a benchmark for nursing education,
practice, and regulation (e.g., by PRC, CHED,
and PNA).
Seven (7) Core Areas of Nursing Competency

• Applies nursing process effectively

1. Safe and Quality • Uses evidence-based and ethical practice
Nursing Care • Promotes patient safety and risk reduction

2. Management of
• Utilizes material and human resources efficiently
Resources and • Ensures a safe and therapeutic environment
Environment

• Conducts health teaching using appropriate strategies

3. Health Education • Empowers patients and families
 • Practices nursing within legal and ethical boundaries
4. Legal Responsibility
• Maintains patient rights and confidentiality

5. Ethico-Moral • Adheres to the Code of Ethics

Responsibility • Demonstrates integrity and accountability

6. Personal and • Participates in lifelong learning

Professional Development • Engages in self-evaluation and improvement

• Participates in audits and quality assurance programs

7. Quality Improvement
• Uses data to improve nursing practice
B. Philippine Professional Nursing Practice
Standards (PPNPS)
• Provide a framework that defines the scope, competencies, and
quality expectations of professional nursing practice in the
Philippines.
 Definition and Purpose

1. PPNPS is a set of evidence-based, practice-focused standards developed to improve the

quality of nursing care and ensure that Filipino nurses meet both local and international
expectations of competency.

Aligns with the Nursing Law of 2002 (RA 9173) and the Code of Ethics for Nurses.

Helps assess and evaluate performance in various nursing roles (clinical, administrative,
educational, and research).
2. Domains of Practice (7
3. Applications of PPNPS 4. Importance in Practice
core competencies)
• Clinical Practice • Enhances patient safety
• Nursing Education and satisfaction.
• Leadership and • Promotes
Management accountability and
• Licensure and professionalism.
Accreditation • Supports nurse
empowerment and
career development.
• Fosters collaboration
across disciplines and
sectors.
C. Patient Care Safety Standards
• Patient safety refers to the prevention of errors and adverse
effects to patients associated with healthcare. It is a
fundamental principle of quality nursing care.
• Core Safety Goals in Nursing
Practice
• Prevent patient harm
• Improve communication among
caregivers
• Ensure correct patient
identification
• Use medications safely
• Prevent infection and surgical
errors
• Promote a culture of safety
• Leadership and Safety Culture
• Nurse leaders must promote a non-
punitive environment.
• Encourage reporting of errors or near-
misses.
• Use Just Culture principles to balance
accountability and system
improvement.
• Risk Management
• Continuous monitoring for potential
hazards.
• Implementation of incident reports
and root cause analysis.
• Engage staff in quality improvement
programs.
• Evidence-Based Practice
• Clinical decisions and
safety protocols must be
based on scientific
research.
• Nurses should follow
clinical guidelines and
best practices to avoid
harm.
Strategies for Ensuring Patient Safety

Area of Focus Strategy

SBAR (Situation, Background, Assessment,
Communication
Recommendation)
Staff Competency Ongoing training and simulation
Environment Safe patient handling, equipment checks
5 rights: right patient, drug, dose, route,
Medication Safety
time
Educate and involve patients in care
Patient Involvement
decisions
National and Global
Standards
• The Joint Commission (TJC)
• Institute of Medicine (IOM) – To
Err is Human
• QSEN (Quality and Safety
Education for Nurses)
• ANA’s Nursing Scope and
Standards of Practice
Break
D. Standards of Nursing Practice
• are authoritative statements that describe the responsibilities,
competencies, and ethical obligations of nurses in delivering
quality care.

1. Standards of Practice – Focus on the nursing process

(assessment to evaluation).
2. Standards of Professional Performance – Focus on the
professional role of the nurse (ethics, education, leadership, etc.).
D. Standards of Nursing Practice
• 1. Standards of Practice (based on the Nursing Process)
➢Assessment
➢Diagnosis
➢Outcomes Identification
➢Planning
➢Implementation
➢Evaluation
1. Standards of Professional Performance
2. Ethics - Practices ethically in all aspects of care.
3. Culturally Congruent Practice -Practices in a manner that is respectful
and responsive to diverse cultural health beliefs.
4. Communication - Communicates effectively in all areas of practice.
5. Collaboration - Collaborates with healthcare consumers and other
professionals.
6. Leadership - Demonstrates leadership in professional practice.
7. Education - Seeks lifelong learning and competence
development.
8. Evidence-Based Practice & Research - Integrates best current
evidence with clinical expertise.
9. Quality of Practice - Contributes to quality nursing practice
through innovation and evaluation.
10. Professional Practice Evaluation -Evaluates one’s own and
others’ nursing practice.
11. Resource Utilization - Uses appropriate resources to plan and
provide safe care.
12. Environmental Health - Practices in an environmentally safe
and healthy manner.
Role of the Nurse in Records Management
Role Description
Records all patient-related care truthfully and
Accurate Documentation
completely.
Ensures documentation can defend nursing actions
Legal Protection
in legal cases.
Facilitates collaboration among healthcare team
Communication
members.
Continuity of Care Helps the next caregiver continue care effectively.
Provides data for audits and patient care
Quality Improvement
evaluations.
Confidentiality Protects patient privacy and secures information.
Tech Proficiency Uses electronic systems for modern recordkeeping.
IV. Ethico-Legal and Moral Considerations in
Nursing Leadership Management
IV. Ethico-Legal and Moral Considerations in
Nursing Leadership Management
IV. Ethico-Legal and Moral Considerations in
Nursing Leadership Management
IV. Ethico-Legal and Moral Considerations in
Nursing Leadership Management
IV. Ethico-Legal and Moral Considerations in
Nursing Leadership Management
IV. Ethico-Legal and Moral Considerations in
Nursing Leadership Management
IV. Ethico-Legal and Moral Considerations in
Nursing Leadership Management
Quiz 1
IV. Ethico-Legal and Moral Considerations in Nursing Leadership
Management

A. Ethico-Moral Aspects of Nursing

• Code of Ethics for Nurses in the Philippines
• ICN Code of Ethics for Nurses
B. Legal Aspects
IV. Ethico-Legal and Moral Considerations in Nursing Leadership Management
A. Ethico-Moral Aspects of Nursing

• Code of Ethics for Nurses in the Philippines

(Based on Board of Nursing Resolution No. 220,
Series of 2004)

• I. Preamble
• Nurses have a responsibility
• to promote health,
• prevent illness,
• restore health, and
• alleviate suffering.
• They are advocates of patients and adhere to
moral, ethical, and professional standards in
delivering nursing care.
 Code of Ethics for Nurses in the Philippines
(Based on Board of Nursing Resolution No. 220, Series of 2004)

• II. Fundamental Principles

• Respect for the dignity, worth, and uniqueness of
every individual.
• Commitment to professional competence, personal
integrity, and ethical conduct.
• Upholding human rights and values in health care.
• III. Ethical Principles and Guidelines
• A. Registered Nurses and People
• Provide quality health care with compassion and
respect.
• Safeguard the patient’s right to privacy and
confidentiality.
• Protect patients from incompetent, unethical, or illegal
practice of any person.
Code of Ethics for Nurses in the Philippines
(Based on Board of Nursing Resolution No. 220, Series of 2004)

B. Registered Nurses and Practice

• Maintain competence through continuing education.
• Use evidence-based nursing in practice.
• Maintain integrity and accountability in all nursing actions.
C. Registered Nurses and Society
• Participate in initiatives to meet the health and social
needs of the public.
• Advocate for equitable access to health care services.
D. Registered Nurses and Co-Workers
• Maintain collaborative relationships with co-workers and
the health care team.
• Avoid unethical practices such as gossip, bullying, or
abuse in the workplace.
Code of Ethics for Nurses in the Philippines
(Based on Board of Nursing Resolution No. 220, Series of 2004)

E. Registered Nurses, Society, and the

Environment
• Promote environmental health and safety.
• Respond to health emergencies and
disasters with professionalism and integrity.
F. Registered Nurses and the Profession
• Uphold the honor and dignity of the nursing
profession.
• Participate in professional organizations and
nursing development.
• Avoid actions that discredit the profession.
IV. Ethico-Legal and Moral Considerations
in Nursing Leadership Management
• Final Provisions
• Nurses must be guided by this Code in all areas
of their work, from clinical practice to leadership
roles.
• Violation of this Code may be subject to
disciplinary action by the Professional
Regulation Commission (PRC) and Board of
Nursing (BON).
IV. Ethico-Legal and Moral Considerations
in Nursing Leadership Management
• ICN Code of Ethics for Nurses
• Guiding Principles:
• Respect for human rights and dignity
• Commitment to professionalism
• Advocacy for patients, families, and communities
• Promotion of social justice and public health
IV. Ethico-Legal and Moral Considerations
in Nursing Leadership Management
• ICN Code of Ethics for Nurses

• Four Core Elements of the ICN Code of Ethics

❑Nurses and People
❑Nurses and Practice
❑Nurses and the Profession
❑Nurses and Global Health
 • 1. Nurses and People
• Nurses promote health, prevent illness, and
ICN Code of alleviate suffering.
• They respect human rights, including the

Ethics for right to life, dignity, and being treated with

respect.

Nurses
• Nurses ensure that care is respectful,
culturally appropriate, and free from
discrimination or coercion.
 • 2. Nurses and Practice
• Nurses carry personal responsibility and

ICN Code of accountability for nursing practice and

maintaining competence.

Ethics for • They maintain standards of personal conduct

and continually grow professionally.

Nurses • Evidence-based practice is emphasized.

• Nurses are expected to deliver safe,
compassionate, and competent care.
 • 3. Nurses and the Profession
• Nurses play a role in sustaining and advancing
ICN Code of the profession through research, education, and
practice development.
Ethics for • They are encouraged to uphold the values and
integrity of the profession.
Nurses • Collaboration and mentorship are key
responsibilities.
 4. Nurses and Global Health

ICN Code of • Nurses share responsibility for addressing

social determinants of health and advancing
health equity and justice.
Ethics for • Nurses are expected to be aware of global
health issues and contribute to the
Nurses development of ethical international health
policy.
B. Legal Aspects
• The Nursing Act of 2002 (RA 9173)
• Legal Responsibilities of Nurses
• Malpractice, Negligence, Tort, and Crimes
• Contracts/Wills/Treatment
• Labor Law
• Magna Carta for Public Health Workers
• Salary Standardization Law
• GSIS/SSS/PhilHealth/Pag-Ibig/Unified ID System
Objectives

• To protect and improve the nursing profession.

• To ensure safe and competent nursing practice for the public.
• To upgrade nursing education, regulate practice, and promote
human rights and health care delivery.
Qualifications for Licensure
• To become a Registered Nurse, an applicant must:
• Be a Filipino citizen or a citizen of a country with reciprocity.
• Be at least 18 years old.
• Be of good moral character.
• Hold a BS in Nursing from a recognized institution.
• Pass the Nursing Licensure Examination given by the Professional
Regulation Commission (PRC).
Nursing Education

• The minimum educational requirement is a Bachelor of Science

in Nursing (BSN).
• The Commission on Higher Education (CHED) oversees the
development and quality of nursing programs.
• Refer to separate file of nursing law
TELEOLOGICAL DEONTOLOGICAL
“telos” means end goal “deon” means duty – duty to do ONLY
GOOD
Focus on the rightness or wrongness of the Focus on the rightness or wrongness of the
action by examining the consequences; It action itself.
is good because a greater number had
benefited from it

ENDS justify the means. MEANS justify the ends.

consequentialist Non-consequentialist
Case scenario
• Mrs. Ligaya, a 50-year-old patient, is admitted to the emergency
room with severe difficulty swallowing (dysphagia). Due to her
condition, she cannot take nutrients or medications orally, risking
dehydration and worsening health. The medical team decides to
insert a nasogastric tube (NGT) to ensure she receives proper
nutrition and medication. However, they proceed with the NGT
insertion before obtaining written consent from her guardian.
From a teleological (consequentialist)
perspective
• the focus is on the outcome: the goal is to improve Mrs. Ligaya's
health and prevent dehydration, so the action of inserting the NGT
is justified despite bypassing formal consent because the
beneficial outcome outweighs the procedural lapse.
From a deontological perspective
• the emphasis is on the morality of the action itself and
adherence to established rules and duties. The act of inserting
the NGT without consent is morally questionable because it
violates the duty to respect patient autonomy and legal protocols,
regardless of the positive health outcome.
Principles of ETHICS

AUTONOMY Involves freedom to choose and implement one’s decision, free from
coercion, deceit or constraint
VERACITY Tell the truth

exception to the Rule.

Benevolent Deception – it is done when telling the truth would do more harm
to an emotionally unstable or depressed person.
BENEFICENCE Do what is beneficial to the patient
NON-MALEFICENCE Do NO HARM
JUSTICE Being fair and just
FIDELITY Faithfulness to promise or agreements
Scenario
• A nurse or physician administers morphine to relieve severe pain,
fully aware that while the intended effect is pain relief
• a foreseeable but unintended side effect may be respiratory depression
that can hasten the patient's death.
• The principle justifies this action ethically if the intent is solely to relieve
suffering and not to cause death, the act itself is morally good (or neutral),
• the bad effect (death) is not the means to achieve the good effect (pain
relief), and the good effect outweighs the bad effect.
• For example, an elderly woman with terminal cancer in intolerable pain may receive
morphine to relieve her suffering, even though it may potentially hasten her death.
The nurse's or physician's intent is to alleviate pain, not to kill the patient, so their
actions are ethically justified under this principle.
the Principle of Double Effect
• 1. Act itself is good or neutral
• 2. Primacy of the good intent
• 3. Primacy of the good effects
• 4. The means to achieve the good effect must not be achieved
by way of the bad
1. The act itself must be good or morally neutral
• The action chosen should not be inherently evil.
2. Primacy of the good intent (Right intention)
• The person must intend only the good effect, not the bad one. The bad
effect can be foreseen but should never be the intended outcome.
• The act is morally acceptable because the nurse’s intention is to comfort
the patient, not to cause harm or death.
3. Primacy of the good effects (Good effect must outweigh the bad
effect)
• The good effect must be equal to or greater than the bad effect. The
benefit should proportionally justify the risk or harm.
• Example: A terminally ill patient is in severe pain. The nurse administers a
strong opioid (like morphine) as prescribed.

4. The means to achieve the good effect must not be achieved by

way of the bad
• The good result cannot come directly from the bad effect. The bad effect
should be only a side effect, not the method for achieving the good.
Example :
A patient in severe pain is given a strong opioid (e.g.,
morphine) to relieve suffering.
• Good effect: Relief of pain and comfort for the patient.
• Possible bad effect: Respiratory depression as a side effect.
• Application of the principle: The nurse administers the opioid
with the intent to relieve pain, not to hasten death. The good effect
(pain relief) is not achieved by means of the bad effect (respiratory
depression). Instead, the bad effect is a side effect, not the
method of achieving comfort.
NURSING ACT OF 2002
• RA 9173
• Protects the public by ensuring only qualified individuals practice
nursing.
• Promotes professional development and ethical practice.
• Supports the rights and welfare of Filipino nurses.
1. Declaration of Policy (Section 2)
• State Responsibility. It is the policy of the state to protect and improve
the nursing profession by instituting measures that will result in: a. Humane
working conditions
• Better career prospects
• Dignified existence
• State Guarantee. Quality Basic Health Services by providing adequate
nursing personnel across the country.
• 2. Scope of Nursing Practice (Section 28)
• Includes nursing care during wellness and illness.
• Involves health education, disease prevention, administration of
medications and treatments, and collaboration with other health
professionals.
• 3. Qualifications for Licensure (Section 13)
• Filipino citizen or a foreigner whose country allows Filipinos to
practice (reciprocity).
• Graduate of a recognized nursing school.
• Must pass the Philippine Nursing Licensure Examination
(PNLE).
• 4. Board of Nursing (Sections 3–12)
• Composed of a Chairperson and six members appointed by the
President.
• Functions include preparing the board exam, issuing licenses,
investigating violations, and ensuring high nursing standards.
Board of Nursing (BON)

• Composed of a chairperson and six members, all appointed by

the President.
• Functions:
• Enforce the Nursing Law.
• Monitor standards of nursing education and practice.
• Issue, suspend, or revoke licenses.
• Investigate violations and conduct licensure exams.
A BON Must be free from conflict of interest

• Immediate resignation in any teaching position for the BSN

program
• Free from pecuniary interests over any institution offering BSN
program or review.
Kinds of Appointment

• Regular – appointed to serve as BON for 3Y

• Ad interim – to serve for the unexpired portion of a regular
appointee
• Hold Over – service beyond term until there is a new appointment
POWERS OF THE BOARD

➢Conduct PNLE
➢Issue, suspend and revoke licenses
➢QUASI-JUDICIAL POWERS – conduct investigations to resolve
complaints; Issue subpoena [ad testificandum & duces tecum]
➢QUASI-LEGISLATIVE POWERS
➢EXECUTIVE FUNCTIONS
➢Ensure quality of nursing education
➢Recognize specialty organizations
• 5. Nursing Education (Section 26)
• Nursing education must be of high quality and relevant to national
development.
• The CHED (Commission on Higher Education) supervises and
monitors nursing programs.
Distribution of Load
Section 26. Requirement for Inactive Nurses Returning to Practice.

• Inactive Nurse for 5Y

• 1 month of didactic training; and
• 3 months of practicum
Section 27. Nursing Faculty.

• RN
• 3 Years Clinical Experience
• Member of good standing of accredited professional nursing
organization;
• Masters Degree
• Dean - with a total of 5Y experience in teaching, administration or
supervision of Nursing Education and 3 years clinical practice
experience
• 6. Licensure Examination (Section 14)
• The Professional Regulation Commission (PRC) administers the
exam.
• Covers areas such as maternal and child nursing, community
health, and more.
License
• a legal document given by the government that permits a person
to offer to the public their skills and knowledge in a particular
jurisdiction, where such practice would otherwise be unlawful
without it.
• Primary purpose: to protect the health of the people, for legal
control and enforcement of nursing practice.
Practice Through Sepcial Or Temporary Permit

• They are issued for the ff purposes:

• 1. Internationally well-known specialists or experts
• 2. Free medical mission
• 3. Exchange professors
Grounds For Suspension Or Revocation Of License
➢ Moral turpitude - A serious act that goes against honesty, morals, or accepted behavior.
➢ Unprofessional Conduct [ BSN, fitness & License ] - Any behavior by a nurse that is unethical,
unsafe, or violates nursing rules
➢ Gross Incompetence - A complete lack of knowledge or skill that puts patients in danger.
➢ Fraud - Lying or deceiving to gain something, like money, license, or position.
➢ NEGLIGENCE [Malpractice] - Failing to do what a careful nurse would do, which causes
harm to a patient
➢ Unsound Mind - A mental state where a nurse cannot think clearly or make safe decisions.
• 7. Continuing Professional Education (CPE) (Section 31)
• Nurses are encouraged to participate in continuing education to
maintain and improve competence.
8. Penal Provisions (Sections 29–30)
• Imposes fines and penalties for illegal practice,
misrepresentation, and violations of the Act.
• Illegal practice of nursing
• Educational programs who conducts review classes without
permit
• Improper payment to nurses in terms of salary, incentives and
benefits
• No license;
• Use of another’s license or permit;
• Use of Invalid license, suspended, revoked or expired;
• False evidence for purposes of obtaining a license or permit;
• False advertisement;
• Unauthorized use of BSN/RN; and
• Giving assistance to an illegal nursing practice.
• 9. Incentives and Rights (Section 32)
• Includes salary grades, benefits, hazard pay, and career
opportunities especially in public health sectors.
Quiz 2
ARTICLE 6 : Scope of Nursing.

• A person shall be deemed to be practicing nursing singly or

in collaboration with another, initiates and performs nursing
services to individuals, families and communities in any
health care setting.
➢Nursing care during conception, labor, delivery, infancy,
childhood, toddler, pre-school, school age, adolescence,
adulthood and old age.

➢Promotion of health and prevention of illness.

➢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.
Duties of a NURSE
• Provide nursing care through the utilization of nursing process;

• Establish linkages with the community;

• Provide health education

• Teach, guide and supervise students in nursing education programs &

engage in such activities that require the utilization of knowledge and
decision-making skills of a registered nurse
•
• Undertake nursing and health human resource development training
and research
FIELDS OF NURSING

1. Hospital or Institutional
2. Public Health or Community Health
3. Private Duty or Special Duty
4. Industrial or Occupational Health
5. Education
6. Military
7. School
8. Clinic
9. Independent Practice
Legal responsibilities of the nurse
• Defined by laws, regulations, and professional standards to
ensure safe, ethical, and competent care. In the Philippines, these
responsibilities are grounded in Republic Act No. 9173 (The
Philippine Nursing Act of 2002) and supported by the Code of
Ethics for Nurses, as well as other health-related laws
Legal responsibilities of the nurse
• 1. Adherence to Scope of Practice
• Nurses must perform only those duties and responsibilities within
their legal and professional scope, as defined by RA 9173 and
the Board of Nursing.
Legal responsibilities of the nurse
• 2. Accurate Documentation
• Nurses must document all care provided, including
assessments, interventions, medications, and patient responses.
Legal responsibilities of the nurse
• 3. Obtaining Informed Consent
• Nurses are responsible for ensuring that patients understand
procedures and treatments before they are carried out.
Legal responsibilities of the nurse
• 4. Maintaining Confidentiality
• Nurses must protect patient information under data privacy laws
(e.g., Data Privacy Act of 2012 in PH).
Legal responsibilities of the nurse
5. Advocacy and Patient Rights
Nurses must uphold patients’ rights, including the right to informed
decision-making, dignity, privacy, and refusal of care.

6. Duty to Report
• Required to report:
• Abuse or neglect (children, elderly)
• Unsafe practices or impaired colleagues
• Errors in medication or procedures
Legal responsibilities of the nurse
• 7. Avoidance of Negligence and Malpractice
• Nurses must perform with competence, care, and diligence.
• Negligence (failure to act properly) or malpractice (harm due to
unprofessional care) can lead to lawsuits or loss of license.
Legal responsibilities of the nurse
• 8. Following Physician’s Orders — with Accountability
• Nurses must follow lawful medical orders but also have the duty
to question orders that seem unsafe or unclear.
Legal responsibilities of the nurse
9. Continuing Professional Development
• Legal responsibility to keep their knowledge and skills up-to-date,
including complying with CPD units required by PRC.

10. Licensing and Registration

• Must hold a valid PRC license and practice only while registered.