All right, good day guys. This is one of the remaining topics for our prelims, which is decision-making in value, issue, and private law. So the previous session that we conducted focused on ethical theories. So if you would remember teleology, deontology, and utilitarianism. And we appreciate your attention.
presentations, your oral presentations and thank you for sharing what you have understood about the ethical theories. So some of you had role plays to make people understand lightly the ethical theories. Okay, so at this point in time, we will be tackling more about the rest of the ethical theories which is virtue ethics and divine command ethics. Okay, so let me just move the screen to this one. Okay, so the remaining two ethical theories and approach na i-discuss natin or itatakal natin is about virtue ethics and divine command ethics.
Okay? So ano po ang focus nitong mga ethical theories na to? So basically, virtue ethics focuses on the heart of the moral agent making the right decision rather than reasoning to a right action. So basically, from the word itself, virtue, anong characteristic or trait na dapat meron ang isang tao?
Oh, it's a... It's more of an individualized character or moral habit. So let's take a look at the sample scenario.
How are we going to interpret this to virtue ethics? So for example, a nurse might go beyond their basic duties by spending extra time. For example, you have a cancer patient who is terminally ill. And of course, there's a person who is already grieving.
as early as that stage, yung family members and yung patient na din, no? So you are there as a nurse to offer emotional support and kindness. So what does it reflect?
Okay? We empathize, we put ourselves in the shoes of the client or the family members. Kasi syempre hindi biro ang magkaroon ng ganitong klaseng sakit, especially kapag, alam mo yun, end of life stage na. end of life stage na yung phase ng sakit ng patient. Well, coming from the word itself, terminally ill na nga.
And of course, at the same time, as a nurse, you care for them, no? You show them respect at the same time. If they want to have a personal space, gusto nila mapag-isa or gusto nila muna makasama yung family nila, part of your being benevolent or being kind-hearted okay so that's an example of virtue ethics now when we go to when we speak about divine command of course um based on religion of course setting rules that can provide guidance to us especially clients natin or tayo na mga mga considered nasa um religion ng catholicism meron tayong sinusunod for example na ten commandments no if you if you um still remember your your values ayan yung subjects natin ng elementary this is one of in high school this is one of the subjects being taught no yung yung Ten Commandments, especially kapag ka na sa Catholic school ka. And this actually focuses on how a person aligns their religious belief, their moral action based on what they believe is God's will.
Mukagustuhan ni Lord. Ito yung sa tingin nila ang pinaniwal. Ito yung mindset nila na ito ay will ni God. In a similar way, the other religions that They also believe that this is given to them by their God or Lord. So basically, that's how we simplify virtue ethics and divine command.
Now, this chapter actually focuses on the ethical concepts and the law. Let's now move forward and look into the systems of law. So in the Philippines or in any constitution, na meron sa isang bansa, meron silang sistema ng batas, which is focusing on public law and private law.
So, anong difference po nung dalawa, mga kapatid? Ang difference nung dalawa, mga kapatid, is of course, when we talk about public law, we talk about relationships between private parties and the government. So, kung narinig nyo na sa TV or sa balita na... yung PPP, Public-Private Partnerships. That's when big projects, for example, yung mga transportation systems natin, it's not fully funded by the private sector.
Meron ding subsidy or meron ding share yung government natin. Hence, the forge of a partnership within the private sector and the... the government sector okay so when we talk about again public law the law components yeah it's a public someone from the government and someone from the private sector when we talk about private law naman mga kapatid it's it talks about the relationship of citizen to citizen sector yung ating parties. Ayan. So, hindi kasama dito si government kasi nga private.
Okay? So, meron mga kontrata in between. So, pareho naman silang may contracts, no? It's just that there are differences in between the parties for public and private law. Okay.
So, ano naman ibig sabihin ng tort? Ayan, lumabas na siya sa screen. Okay? Hindi na natin siya na-edit. But, If you have heard of torts, a tort is a legal wrong committed against a person or property independent of a contract, which means or which renders the person who commits it liable for damages in a civil action.
Okay, so paano pa natin siya mas masisimplify? The person who has been wronged seeks compensation for the injury or wrong has he has suffered from the wrongdoer. Mayroong isang person na ginawa ng masama at siya ang humihingi ng kapalit o ng hustisya mula doon sa gumawa sa kanya ng mali o ng kasalanan. Ang objective naman ng tort ay Of course, when we talk about tort law, what we want to bring is about preservation of peace between individuals. We want to fix them, identify where they made a mistake, and of course, give them proper compensation.
In the court, the word tagalog sometimes means to give compensation for damages that were done. person or client. So what does it include to consider it a tort?
Of course, you have an obligation to the person who is asking for you or demanding you to pay. And of course, you will not lose the bridge of that duty. Your role goes beyond that and has a negative impact on the person. The person experiences the bad from a person.
And of course, the damage. What happened? What was the result of what an individual did to another individual?
Of course, I'm not... pretty sure how in the court I'm not sure how people in the field of law measures how much or how they quantify the damages. I'm not sure about that. We're not knowledgeable about that. But in case you are familiar with the process, well, let us know.
Share it with the class on how we're going to go about that. Okay? So, moving forward, we shouldn't forget, right?
Mas madali ang buhay kapag may nemo ni. So kapag nakita nyo to, isipin nyo lagi, tort a, a sin. Pag nakita nyo yan, a sin. Tort is a sin.
Paano po natin na siya nasabing sin? Ayan, a sin ang isang tort. A sin. Letter S, I, N. Tort is a sin.
Letter S, strict liability. Meron tayong... Meron...
What is the meaning of liability in Tagalog? Pagkakamayresponsibilidad, if that is the nearest word that I could use for letter S. And we also have what we call intentional thoughts. Sinasadya. And we also have hindi sinasadya.
That kind of thoughts. We will discuss that in the next slide. So, wag kakalimutan ng ating nimunin, tort is a sin. Okay?
Ayan. Okay. Puntahan natin si negligence.
Kasi baka nagkakalituhan kung ano ibig sabihin ng tort at negligence. Actually, ang negligence ay isang klase ng tort. Pero mas madalas nating naririnig tong word na negligence eh. Pagpapabaya.
Ayan. Pagpapabaya. Sa kahit anong bagay.
Sa kahit anong bagay, madalas siyang maririnig especially kapag ka may mga pagka nag-work na kayo or mga nag-start na kayo ng clinical duties nyo, madalas siyang maririnig yung word na negligent or negligence. So ano ba ibig sabihin ng negligence? Ito ay hindi sinasadya pero meron ka pa rin kapabayaan na ginawa dito. It may be committed or omitted na ang isang prudent person.
may be involved in such circumstances. How can we know if a negligent act is commissioned, unintentionally committed, or omitted? Let's say, for example, administration of wronged medication or dosage.
That is an example of a negligent act of commission. Okay? It means that you've already given it to the patient, and the patient has already been treated. So it means that you haven't checked the patient first.
You haven't checked if the medication you're giving him is right. Or if your computation is correct. Have you reconciled with a pharmacist?
If you have a clinical pharmacist partner or a senior nurse who is your buddy. nag-recompute ba kayo, nag-recalculate kayo para sabihin natin na tama yung computation ng medication na ibinigay nyo sa patient. Another one is performing the wrong surgical procedure.
Alam nyo po, isa ito, makukonsider natin itong isang sentinel event. Sir Alex, ano yung ibig sabihin ng sentinel event? Ang sentinel event, mga kapatid, ay isang...
pangyayari na hindi inaasahan na mangyayari sa pasyente outside of his or her medical condition. Just like for instance, may mga nangyari na sa ibang bansa. Halimbawa, may isang pasyente na mag-undergo ng craniotomy. Sabi sabihin, bubutasin yung skull ng patient.
Bubutasin siya, mag-buburr hole. ang tawag doon. Bubutasan siya, i-de-decompress yung brain, and at the same time, magre-remove ng tumor, for example.
So, instead na sa other side, sa left, for example, yung bubutasan, sa kabilang side sila bumutas. So, ano naman yun? Wrong site.
Tama yung procedure, pero wrong site. That's act of... um commission in this island check the number deba meron de meron de is an Case wherein a patient is undergoing a heart surgery when they found out that the mitral valve needs to be replaced.
Kailangan i-replace yung mitral valve kasi nag-regurgitate na yung blood. Ibig sabihin, tawag nito, baliktad na yung pag-flow ng blood sa area na yun ng heart. Okay? So...
Instead of saying goodbye, okay, here, the surgeon gave an instruction to another surgeon. Talk to the family member. Ask for consent because we saw that the mitral valve of the patient's heart is not functioning.
So, maybe later the patient will be congested and this could be a source of... pulmonary congestion, blood will flow to the heart, the patient will be drowned, and at the same time, he will be arrested. He might be killed by the patient.
So, life and death situation. So, the surgeon told his assistant to get the consent of the wife. Yes. The problem is, the first assistant to the surgeon just left.
He forgot about it. hindi siya kumuha ng consent. Oo, kinausap niya lang yung mother, o yung mother yung wife, kinausap niya lang yung wife, sabi niya, ganito po yung ginagawa namin ngayon sa OR, kailangan po namin ng inyong permission, ganyan-ganyan. Sabihin natin, umoo yung wife, pero documented ba yun?
Kailangan nating masilit. So ngayon, ang nangyari, nakalimutan, hindi kumuha ng form, ng consent form, hindi napapirmahan sa wife. So that is already an act of negligent act of commission. Kasi una sa lahat, sinabihan na yung first assist, kumuha ng consent, magpapirma, e verbal consent lang. Anong panghahawakan natin doon?
So pagpumunta tayo sa korte, tatanungin ng husgado, pag tinanong yung doktor, kumingi po ba kayo ng consent, pumirma po ba kayo? Sige, kunin natin ang chart. Oh, nasaan dito sa chart? Yung consent na sinasabi ninyo, sabi nyo kumuha kayo.
Eh, hindi siya documented. Remember, ang mantra natin, what is not documented is not done. Sabi sabihin, yung consent na yun, hindi yun nag-exist.
So, baliwala. Diba? Hindi nga siya documented.
Sabihin na natin, kahit na i-beaten ka pati wari, kumuha ka ng consent. Ganyan. or where is the documentation? We will have a hard time in litigation if we don't have documentation when the court or someone from the institution asks to prove that this was written, put on the chart, and documented.
Now we move forward to omission. Omission is a failure to the following. For example, the patient. ang patient pumasok sa ER, may complain, masakit ang chan, tapos parang medyo namamanhid na yung braso. So that might be an indicator that the patient might be having myocardial infarction or heart attack.
Kasi yun yung isa sa mga... impending sign, the patient's chin is hurting, the pain is radiating to the arm or shoulder, so it could cause cardiac arrest. So apparently, the right team was not given or inactivated, the patient's chin was just managed, he was given antacid and all.
hindi nagtanong masyado yung ER physician. So eventually, nag-arrest yung patient na matay. So that's an act of omission.
May hindi gumawa ng perfect assessment sa pasyente, kaya hindi nabigyan ng tamang management yung pasyente. Nag-focus lang doon sa chief complaint or doon sa symptom. Yun lang yung manage niya. Another one is assessment. Ayun mga, assessment.
and reassessment of clients with nutritional needs. Parang ano lang din yun. Parang fall incidence.
Ang pasyente, kapag may risk, At risk for fall, dapat ina-assess siya. At syempre, nire-re-assess yung patient. Especially kapag nagkaroon na ng incident na nag-fall yung pasyente, tapos gumawa ka na ng measures, nilagay mo na in place yung measures, nagtaas ka ng side rails, naglagay ka ng signage, nag-educate ka. Pero ang problema, hindi ka nag-re-assess after...
12 hours or 24 hours, sabihin na natin na ay, hindi na siya nalaglag ulit eh. Eh, nagbigay ka ng gamot na maaaring mag-cause ng dizziness, or mag-grogi yung patient, tapos tumayo yung patient, nagpumilit mag-CR, tapos nadula sa CR. Nabagok yung ulo.
That's already a form of omission na kung saan, hindi ka kaagad you did not immediately respond or you did not immediately do your task to reassess the client after you initially assisted him. That's very important. Is the patient ready? If he stands up again, he might need assistance.
Or you might need to call the relative or you might need to say, please ring the call bell. If you stand up, I will go and accompany you. Another one is administration or failure to administer medication as prescribed.
Naku, kadalas ang nangyayari ito sa mga nurses na sa dami ng ginagawa, sa dami ng ginagawa at sa dami ng gamot na binibigay nila sa isang araw, may lulusot at lulusot dyan na hindi naibigay sa pasyente. Lumipas na ang isang araw, doon lang naalala, ay, hindi ko pala naibigay. yung medication na yun sa pasyente.
So, bisabihin, na-miss niya yung dose ng previous shift or yung talagang actual dose time niya. Okay? Yung frequency ng medication na yun.
So, that's already an act of omission, a negligent act of omission. So, it's very important that we review that patient's chart, mag-medication review bago mag-proceed. Usually, they discover that they haven't been given the medication when the change of shift is already happening. They are endorsing it. They say, did you give this?
I didn't give it. It's gone. It's been omitted.
It's been misdosed. What if the medication has a frequency? So, the time will adjust. The doctor will get angry at the ending. So kawawa yung patient, especially kapag very important yung medication na yun sa kanya.
Regardless kung anong type ng medication. Kaya nga pin-rescribe para ibigay ng tamang oras. Kung hindi man medyo malapit dun sa tamang oras.
Huwag naman sa sobra kasi talagang, alam mo yun, mamaya na, maaga pa naman eh. Eh hindi pwede yun. Eh paano kung bigla mamaya, matoxic ka.
So ang magsasuffer, hindi lang ikaw, pati yung pasyente mo. Another one is our critical results. Very, very important and crucial is reporting critical value.
Why? Because this is what our physicians sometimes wait for so that they can manage the patient better. For example, since it's raining, the weather is so bad. So, our dengue patients, we monitor their platelet count nila kasi pag yun bumagsak, syempre mas mataas yung risk nila for bleeding.
Hanggat maaari ayaw natin silang mag-bleed, diba? Because syempre yung clotting mechanism nila hindi ganun ka-powerful or hindi ganun ka-strengthen. So it's very important that people from the laboratory or people from the ward or from the nursing unit always look into the laboratory results.
Okay? Abnormal yan, ke critical result yan. Okay?
Paano ba natin mag-de-differentiate ang abnormal sa critical? Pag abnormal, hindi ganun ka-significant yung difference from the normal value. Pwedeng, pwedeng i-manage at a later time, pero hindi pwedeng ipag sa walang bahala.
No? An abnormal result kasi could escalate to a critical result. The critical result is that the difference is significant, far from the normal value, and may cause harm to the patient. So, as much as possible, we can relay this information or we can follow up this information to the right people.
Because at the end of the day, we still have to be advocates for our patients. Now, moving forward to the common forms of negligence. Oh, sir, those terminologies are so hard.
Sorry, but this is our reference, brethren. You're just here. magbabasa pa na ba yan?
Ayaw makita. Okay, ayan. Dito na kayo magbabasa sa book natin na to.
Kasi karanihan naman eh dito natin hinugot. Okay? Malfeasance. Ayan.
Malfeasance is the execution of an un... Ese... Nabubulol ako. The execution of an unlawful act or improper act.
Meaning, may ginawa pero hindi dapat gawin or kasama sa trabaho or hindi kasama sa trabaho. Again. May ginawa pero hindi dapat gawin or hindi kasama sa trabaho.
Halimbawa, intentionally administering a medication to a patient kahit alam mo na na may magre-result siya ng harm sa patient. For example, high dose of pain medication. So pain medication could cause harm.
Paano? Alam mong possible na mahilo itong patient na to sa ganitong type ng medication pero binigay mo pa din without caution. Okay?
Hindi ka pa rin nagtanong, hindi ka nag-interview, hindi ka nag-assess. Ginawa mo pa din. Okay?
So that's malfeasance. Malfeasance. Misfeasance naman is the improper performance of an act that leads to injury.
Ginawa mo yung trabaho mo pero may mali. Sakit nun, no? Ginawa mo na ang lahat pero mali ka pa din.
Example, balik tayo sa medication, no? Balik tayo sa medication. Administering naman ang medication but with the wrong dosage. Okay? Resulting harm to the patient.
Okay? Resulting harm to the patient. Katulad ng example natin kanina, no? That's an act of commission. You gave a drug to a patient but you didn't recalculate if the calculation of medication was correct before you gave it.
So that's a common form of negligence. Misfacence. An act of commission.
and misfeasance. So, pwede natin ipag-connect yung dalawang yun. Third one is non-feasance naman.
Failure to perform an act where there is duty to act. Hindi mo ginawa or iniwasan mo yung dapat mong gawin. For example, may patient ka na for monitoring every 15 minutes.
So, as a nurse, you fail to monitor the patient. For example, post-op yung patient po. or you forgot to monitor it every 15 minutes or every 2 hours. Because before it runs out, the patient in the post-operative anesthesia care unit, 15 minutes after OR, 30 minutes after OR, an hour after OR, 2 hours after OR, we monitor the patient because We check if the patient is capable, awake, and coherent or if the patient is still awake because of the strong anesthesia given to him. So that is our role in monitoring patients, especially in the ICUs.
The frequency of monitoring patients in the ICU is very high, not just in the ICUs. Every four hours, the patient is on the floors. For example, the patient has a blood transfusion. every 30 because we have to check on the blood transfusion reactions okay so basically that's how non-fecense works there are no the tiny not our criminal negligence the committee got it on criminal negligence not on criminal negligence can be classified into for a religious a malita reckless imprudence okay Reckless imprudence.
What does reckless imprudence mean, mga kapatid? It is when a person does an act or fails to do it voluntarily but without malice. Ang lalim.
Halimbawa na lang yan. Halimbawa na lang. Balik ulit tayo sa medication. Okay?
A nurse hastily administer medication without proper verification or review of the medication order. Identifying patients correctly. Isa yan sa mga pinaka-critical na part ng medication administration. process well book of dunsa there is of the 10 rights for medication administration but of course we have to always prioritize seen by your passion they are a canino by it on gumbo not thought about by you could be big and conan gumbo injection pion infusion or tablet napalm in a pen or a papahid nothing so bulletin passion take no it's very important that we identify them first before administering the medication. That's considered an example of reckless imprudence.
May nangyari sa pasyente afterwards. Hindi ka nag-verify. Eh, allergic pala siya doon sa medication na binigay mo sa kanya na dapat sa ibang pasyente. So, ang nangyari, siyempre, ayan na naman.
Complaint, litigation, siyempre, at a higher level. So, yan yung mga dapat na kailangan, ano tayo? be very mindful. So let's be very mindful about that.
Our practices. Even if you're toxic and you know the patient, even if it's repeated, we will ask who they are. Basing it on the example. Another classification of criminal negligence is simple imprudence. What does simple imprudence mean?
It means that the patient or using precautionary measures, or using signage that indicates an impending danger, or something like that. The best example we can use is to go back to fall. Simple imprudence in relation to fall.
For example, the patient is for blood transfusion again. You gave him diphenhydramine. to as a prophylaxis for any transfusion reaction.
It's possible that the patient will get sick as an initial reaction or his allergy will be triggered. So upon administering pre-blood transfusion medication, like diphenhydramine, the side effect of diphenhydramine may cause dizziness or drowsiness to the patient. So after administration, ako nakakalimutan itaas ng bedside nurse yung side rails. E anong ngyari?
Since groggy nga yung patient, drowsy, medyo nag-turn siya sa bed. Pag-turn niya sa bed, nalaglag siya, causing injury. Naka-fracture yung arm ng patient. So, prolonged ang hospitalization ng pasyente.
may harm na din doon sa pasyente. Tapos, instead na magagaling siya kaagad, mas madagdagan pa yung magiging treatment niya. Siyempre, magre-rehab pa yun.
Mag-undergo pa siya ng surgical procedure or diagnostic procedure. May harm din din sa organization because that can be part of service recovery. So, nag-complain yung patient. Ah, hindi ko babayaran yung hospital bill ko kasi ganito yung nangyari sa akin.
because your nurse and everything got sick. As simple as raising the patient's side rails, it has a big impact on the safety of our patient. Sir, what if he tried to stand up on his bed, and my side rail got raised, and he tried to stand up, but it still fell down. That's where our documentation comes in. Did you get an education before you get a free blood transfusion medication that you can experience drowsiness, you can get a headache and all.
So if that's the case, don't force yourself to get up. If you want to go to the bathroom, you're suffocating or dirty, call our station. We will assist you. I will bring a bedpan. commode, kung hindi kayang lumakad ng malayo, or ng urinal.
yung ganon. Diba? Yung mga simpleng ganong scenarios na kumalaki ang nagiging impact sa profession natin at saka sa pasyente natin.
Maaaring humantong sa mga ganyang bagay which is ayaw natin mangyari sa kahit na kanino. Diba? So, as much as possible, yun nga, let's be very mindful of our actions.
Okay? So, to sustain naman, kasi may nag-claim na dinimanda yung nurse or yung hospital staff ng negligence. To sustain the claim ng negligence, kailangan may evidence tayo. Siyempre, di ba? What is not documented nga is not done, di ba?
Eh, paano pa yung mga ganito? Paano natin mapapatunayan na may kapabayaan on our end? Okay?
Meron tayong tinatawag na four Ds. Ayan, yung four Ds na yan. The four Ds of negligence are the following. Una, duty. A provider-patient relationship.
it must be established. Meron kang pananagutan. Meron kang obligasyon dito sa pasyenteng ito.
Naka-designate siya sayo. Ayan. So that's part of your duty.
The reliction of duty, ibig sabihin niya niyo, breach. You breach on your duty. Hindi mo nagawa or lumampas ka sa dapat mong gawin. A failure to act as the primary provider. or the competent provider noong pasyente na yun or noong client na yun na yun under your care.
Okay? So may failure. May failure ng duty mo doon sa client.
Another D is a direct cause. Yan. Yung act na yun is the main cause. The root cause.
Bakit ito nangyari? Bakit nagkaroon ng... injury.
Bakit nagkaroon ng damage? Bakit nagkaroon ng loss? Loss of function or loss of an organ or loss of a limb. For example, dahil nga nagkaroon siya ng fall incident, di ba? Or na-endure siya, may na-damage kung ano man, either a property or a body part when we talk about clients.
And lastly, going back, may damage. May nangyari talaga. May nawala. May na-endure, may na-saktan, evident, may evidentia, may proof ka na meron talagang injury. Paano natin siya malalaman?
For example, yung fall incident kanina, paano natin malalaman kung may injury talaga? Ipa-X-ray ang pasyente, i-assess natin for pain every four hours. Nag-improve ba?
Lumala ba? Kailangan niya ba ng iba pang interventions? maibsan yung damage nung nangyari doon sa pasyente niyo. Pero syempre, haba mas malala yung injury or mas malala yung incident, eh mas malala din yung damage. So pagbabasihan natin yung four Ds na yan.
Duty, dereliction or breach or failure to act on your duty, and direct cause, yung pinanggalingan, the root cause of the incident, causing it to be... the cause of the injury or the damage or the loss and the damage. There is really evidence that it was damaged, injured, or I don't know. What else can we correlate the word to in the word damage?
Okay? Let's talk more of negligence. More of negligence. Earlier, we talked about the tort. Negligence.
The only difference is, because we mentioned earlier, they have differences. Intentional tort and negligence, the difference is the intent. What is the intention of this act or behavior?
Intentional torts involve a willful act. It means you really want to do it. You really have a plan to do it. Okay?
Nandun yung balak atsaka execution. No? Whereas, pagdating naman sa negligence, meron talagang may hindi ka nagawa.
Oo. May gusto kang gawin sa intentional or gusto mo talaga siyang gawin. May motibo ka para gawin mo siya. Yung negligence naman, may nakakalimutan ka. May hindi ka nagawa.
Okay? So, yun lang yung pagkakaiba nila dalawa. Intent.
What is the intention? What are the implications of these two when it comes to private law? There are many more terms that you will also hear when we talk about negligence, the issue about negligence.
Malpractice. Malpractice implies the idea of improper or unskillful care of a patient. by the nurse.
Ibig sabihin, you are stepping beyond your authority as a professional nurse. Kinagawa mo siya kahit hindi na siya sakop ng iyong role. Ang bawa, patient for a surgical procedure. Okay? Siyempre, expected sa isang surgical procedure na mag-undergo ng anesthesia.
induction ang patient. Siyempre, dito sa Pilipinas, sa Philippines na lang yung scenario, dito sa Pilipinas, hindi siya sakop ng practice natin to administer anesthesia or mag-prescribe ng gamot. Wala yun sa role natin.
Kung ikukumpara mo sa ibang Western countries or sa ibang bansa na lang, di ba? May ganito silang specialization. Pero in the Philippines, in the Philippines setting, we are not allowed to administer anesthesia anesthesia nor prescribed medications because that's not part of our scope of practice because under the philippine medical act medical practice doctor physician and gumagawa nito hindi tayo so that is malpractice for sure marami na kayo napanood din sa kmjs na nagpapanggap na nagpapanggap na dentista pero ibig sabi ang ang pag tinanong mo siya kung anong background niya technician lamp pala. Gumagawa ng pustiso and all.
Nagkakabit ng braces pero hindi naman pala siya competent and registered at the same time as a professional as a physician, as a dentist to do that. Hindi siya trained, properly trained to do that. So, bisabihin ang intention niya dun is para kumita ng pera pero gagawa ako ng paraan para gumawa ako ng pera at mag... I will accept it. So that's a violation of the scope of practice for dentists or for nurses, for example.
You went beyond your scope of practice. There, example. Another one is this, res ipsa lucitur. Meaning the thing speaks for itself.
It means, there it is. That's the evidence. You don't need to ask anymore.
Kitang kita naman. Sabi po ni Auntie Annabel Rama. Ayan na oh. Kitang kita naman.
Wala nang tanong-tanong pa. Okay? Yung ebidensya ang nagsasalita.
For example, a patient came in walking to the outpatient clinic for a medication administration. Upon administering the medication to the patient's buttocks, the patient experienced excruciating pain. Ako! Kirap nito.
The patient felt weakness in his left leg and subsequently became paralyzed. So the patient was discharged. For example, upon further assessment, the sciatic nerve was tipped. This is where it was wrong.
I really did it even though you can't see it. So the site was wrong. The atrium was wrong.
nag-administer ng gamot, hindi siya gumamit ng proper technique para mag-administer ng medication sa buttocks. Very critical kasi kapag nahit mo yung sciatic nerve, nako, maaari talagang maparalisa yung pasyente. Or alam mo yun, kung hindi lang yun, mas worse, mamatay yung pasyente. So that's an example of pres-ipsa locature.
The thing speaks for itself. Another one is Respond Yet Superior. This is also something that you'll hear when you're doing a case review or what do you call it, when you're watching legal drama and all.
I'm not sure if this has been mentioned in How to Get Away with Murder but I've never watched anything like that before. But maybe, let's see. Baka matap natin yung isa sa mga episodes na baka may ganitong topic na na-discuss. So, ano yung sabihin ng respondeat superior? Let the master answer for the acts of the subordinate.
Anong example nito? Yung liability ay nasa superior. Okay?
Nasa pinakamataas na level sa hierarchy. Halimbawa, hospital aides employs under-board nurses in place of... professional nurses, naku, nagtitipid ang ospital in an effort to cut down expenses compromising competency and quality of care.
So, alam naman natin na kapag may question, alam nyo naman, may question kapag ikaw ay under-born, na you are not allowed to practice the profession if you are not a registered nurse. Wala kang ID to prove that you are a registered and professional nurse no quite a Sabina Tina conapa Galena sanctioning pero still when we go back to your your to one file or your dog your credentials are you qualified to do that if not well my article Madiman Babalik Tyra do on sa sa issue normal practice pero at the same time since in Oaxaca no Hospital A, as empleado, kasi nga nagtitipig sila, sila ang liable kasi gumawa sila ng ganong guideline. Bakit inalaw na mag-hire ng under board para mag-alaga directly at mag-perform ng mga procedure sa patient kung hindi naman yun yung scope of practice nila.
Now that's the reason why kapag ka-tinanong kayo na ano ba dapat ang dine-delegate natin sa mga nursing attendants natin? By allowed ba silang mag-perform ng invasive? procedures?
But no, that's not their scope of practice. It is our scope of practice as registered professional nurses. Okay?
You cannot delegate such invasive procedures or activities that he is not competent. He is not trained to do that because if he does that, he can inflict harm on the patient. Who is answerable?
If you ask who is on his bedside, it's Sir Alex. Sir Alex will be able to respond to the period. We can't do that.
We can't demand. Of course, we don't want to. We've been struggling for four years.
Then, we'll review for the boards. Then, we'll wait for a long time to get the PRC ID. Then, that's it. We'll be able to pay. So, we don't want that to happen.
That's also the case when we apply this to our students. Of course, who is the immediate superior of the students? It's the clinical instructors who are in charge of the area or the community.
So, who is liable? Of course, your CI. So, if you are already on community duty or clinical duty, always think that each of your clients, aside from the patient, are your CI because they are the answerable to everything you do when you are asked.
or if your CI or nurse's body is asked, who is this CI? Why isn't he being watched? The patient and all will complain.
Choo-choo. Right? And lastly, force majeure.
There. Force majeure. These words are so... Force majeure is what we don't expect.
We don't expect. Sabi nga ni Thanos, he is inevitable. Inevitable. Ano ba yan?
Inevitable. Ayan. Inevitable.
Ang pangit. He is inevitable. Ayan.
Hindi natin napaforce. Hindi natin napaplano. Okay? Example. Gawa tayo ng example para mas maintindihan.
Siyempre, hindi naman natin alam kung kailan babahain. Kailan tayo lilindulin. kailan tayo magkakasunog unless otherwise intentional yung mga yan okay so yan yung mga bagay na hindi tayo magkakaroon ng liability kasi syempre halimbawa nasa unit ka nasa nursing ward ka lumindol so syempre paprioritize mo yung mga pasyente mo kung sino mo yung kaya mong i-rescue eh yung mga hindi natin ma-rescue pasensya na po no syempre kailangan natin i-prioritize kung sino yung uunahin natin may be given a sanction.
We don't know if it will burn, but we know who we will prioritize. If an earthquake hits, will the hospital collapse? Will we be at fault if the hospital collapses? Or will we be at fault if it erupts? No, we won't.
Of course, it's a case-to-case basis. That's the reason why we have these... concepts for us to identify what we think is safe to do and what not, that we can use against ourselves. Okay?
Okay. Now, we move forward to another mnemonic which is bad fin. Earlier, asin. Tort is asin. Ito naman ay common forms of international Intentional towards Let's start with letter B Letter B and A In letter B In the letter BA Battery What is battery?
This is what we put in our remote Battery means Offensive touching You have a grip You hold You hold One Two senior staff mo, o kaya hinawakan mo sa braso ng mahigpit kasi gusto mo siyang kausapin, pwede ka niyang kasuhan ng battery. Wag mo pong hawakan, pero pinilit mo pa din siya. At na-offend siya doon sa scenario na yun, pwede kang makasuhan ng battery. Intentional tort na battery. Isa naman, letter A, assault.
Ayan, etong assault na to, More of threat. Ayan. Verbal threat or verbal cursing.
Ito yung mga usually na na-ano eh, na-na-we witness natin sa ER. Na-ano, ah, nabala kayong kwenta, mga ganyan. Hindi nyo ginagawa yung trabaho ninyo.
O, ipapapatay ko kayong lahat. Ganon. Pinagmumura yung mga staff sa ER, for example.
That is, an act of assault. Hindi asin, ha? Iba to sa asin natin kanina. Ito naman ay bad fin. B-A.
Battery and assault. So, verbally cursing si assault, touching naman si battery. So, pag sinabi natin battery, may body.
Okay? Oo. Pag sinabing assault, isipin nun na lang, asar.
Inaasar kayo. Gumagamit ng... mga salita na hindi kaaya-aya.
Okay? So, yun yung dalawang yan. Next, letter D.
Defamation of character. Naku, ako kayo ay mga mesamarites. Alam na alam nyo tong defamation of character na to.
Sa Tagalog, paninirang puri. Okay? Paninirang puri. Naku, alam naman na natin kung sino mga bumibida dyan sa paninirang puri na yan. Hindi po.
So, what are the examples of our paninirang puri? It can be in a form of libel or nakasulat. Minsan, di ba, naririnig nyo sa balita.
Cyber libel. Ibig sabihin, may isinulat, ipinublish sa social media, for example. Or sa kahit anong form of media.
Diaryo, through asulat, okay? O kaya amemorandum, for example. Can a label be commemorated? No, it's erased. As long as it is written, whether in a hard copy or posted in a media, a social media.
The best example is the cyberlabel that sometimes delivers fake news. That's why many are angry with the NBI's cyberlabel. Yung isa naman, ako, ito yung mga nasa kanto, mahilig. Chubis Miss, eto na nga, ang latest.
Mars, eto na yung latest. Alam mo ba, yung anak ni ganito, naku, nakita ko kagabi. Sa bar, may kasamang mga ganito. Siyempre, wala naman tayong criteria for judging sa mga ganong klaseng tao, pero nahusgahan na kaagad ng mga marites sa kanto. So, maaari silang masampulan ng slander na Why are you ruining me?
You don't even know who my friends were at the bar. They could be my friends. We're just happy.
But the news that came to my parents or my relatives is different. So, maaari idaan natin sa kasong slander or spoken defamation of character. Paninirang puri.
Written or spoken. Letter F. False imprisonment. Ayan.
Yung mga nagsasabi na, for example, ang pasyente, gusto ko nang umuwi. Ayoko na dito or wala kasi akong pambayad. Ganyan-ganyan.
You know, in law, we are not allowed to detain patients. For example, if they can't pay, if their bill is too big, if they can't pay, we can't let them stay in the hospital. Of course, we have ways to manage that. Okay, we have a promissory note, we will break down your payment, but we are interested because of this and that. We are not...
You have the right to go home because it's your decision. We can't keep you here for long. Especially if they don't want to stay. That's why we sometimes have discharge against medical advice. The patient says, I'm okay, I can do this.
Let's discharge them. But they will write a letter that they have decided to go home and the doctor has no answer. hospital or ang healthcare institution.
Dahil ito nga ay hindi nating kagustuhan to begin with na pakawalan sila dahil hindi pa maganda ang kanilang kalagayan pero syempre hindi rin natin sila pwedeng i-detain or i-retain sa hospital kasi hindi sila capable magbayad at the moment or it's a form of coercion na mag-stay ka dito dahil kung hindi ganito-ganya. Another example is putting restraints. Ang restraints po, mga kapatid, hindi yan basta-basta ina-apply.
Ino-order yan ng doktor. Kaya kahit na ang client ko, for example, medyo agresibo, ganyan. So, syempre, kailangan sabihin natin sa physician na present na doc, medyo agresibo tong patient na to.
Ano po yung further assessment mo para maging... grounds for the application of restraint. We don't just put restraint because it's going to disappear.
You're going to restrain yourself. So of course, let's calm her down first. Or let's cover her with a blanket so she won't feel that we're restraining her.
Let's just cover her with, Ma'am, you're already sick. I'm sorry. I need to cover you.
Because of course, it's our safety and the safety of the patient that we remember here. Again, false imprisonment against the individual's will or an illegal confinement. There are healthcare institutions that are being harassed because they've been admitted for a long time because they're not paid. They've been in the hospital for a long time.
or sa institution kaya nanghihimis sila ng tulong sa mga politicians, sa media, bina-viral nila kasi nga itong institution na ito di umano ay hinuhold sila because they're not capable of paying for the bill ganyan-ganyan, eh pwede naman silang mag-promissory note. So again, we go back to the hospital policy and the law, Anti-Detention Act. if I'm not mistaken. Ako.
Kailangan natin hanapin yan. Pero isa yun sa mga ina-apply na na batas especially sa mga hospitals. Okay? And lastly, in. And tapatapos na tayo sa bad.
Bad thing. Letter in. Letter in.
Letter I and letter in. Invasion of privacy. Ako, ano na to?
Self-explanatory. Diba? Yung mga nakikisilip sa mga self- So, this is actually self-explanatory. So, that is the common forms of intentional thoughts, bad things. Don't forget...
Battery, assault, defamation of character, false imprisonment, and invasion of privacy. So, let's review our journey through the past 6 sessions. Let's review.
We go back to the definition of ethics, which came from the Greek word ethos. Ayan. Ethos. Ethos ako. Wale.
Okay. Which means moral duty. Ethos which means moral duty.
It refers to a standard to examine and understand how people make judgment in regard to right or wrong. If we go back to our previous discussion, it's about making choices that are best for the individual or the society as a whole. Now when we talk about bioethics, of course, we break it down to bio which means life. And ethics, which means yung ating moral duty. So moral duty on life.
It's about moral issues in the field of healthcare. Kaya nga ito yung subject natin ngayon, healthcare ethics or bioethics. It's a systematic study of human behavior in the field of science and healthcare. So basically, yan ang prog... course natin for this semester, ang bioethics.
We will talk about the moral duties about life science or life itself. Now, when we talk about naman nursing ethics, of course, siyempre, it pertains to the nursing profession, how we apply the ethical principles, how we behave. as a nurse and we apply the theories and concepts as a nurse when we take care of our clients. Professional ethics or etiquette involves issues such as you will badmouth your partner's nurse, maintenance of appropriate relationships, of course, nurse-patient relationship or colleague-to-colleague relationship, if you would remember. yung mga romantic relationship na yan, medyo, syempre, it's on the internal side.
But of course, we have to still act professional, may courtesy, may merong respect, para mamaintain natin yung integrity natin as a professional nurse. Setting boundaries at the same time. Ito ikaw, ito ako, dito tayo nagkakasundo. So that's professional ethics and nursing ethics.
Now, if you would remember, we mentioned about the Code of Ethics for Registered Nurses, which is under the Board of Nursing, Board Resolution No. 220, Series of 2004, which actually focuses on the following bullets. There you go. You can see it on your screen.
Registered nurses and the people, the practice, coworkers, society, and environment. and at the same time the profession okay so an angle an angle netong code of ethics for registered nurses promotion of health prevention of illness alleviation of suffering and restoration of health info on guidelines yeah you know at your level at your competency and prevention Promotive preventive na tayo. As you level up to level 3 and 4, you now go to alleviation of suffering and restoration of health. Curative and rehabilitative na yung competency na i-mold sa inyo or i-enhance sa inyo. Alright, so what we had so far are the following, of course, I think you can actually go back to...
to what we had so far in teleology, deontology, and utilitarianism. But as a bonus, let's go back to the topic. Teleology focuses on the consequence, consequence-oriented. Benefits outweigh the risks. So we look into the outcome.
Okay, that's our keyword, the outcome. So this is our sample scenario. An emergency department nurse is working in a full house shift.
Puno ang ER. My God, overwhelming. With unlimited resources, he or she must decide between treating a critically ill client or a younger client with a better chance.
recovery. So, of course, we will prioritize the younger patient as they have a high likelihood to survival. When we apply teleology, using the concept of teleology, we will prioritize the one with the highest survival rate.
Now, when we talk about deontology, it's duty-oriented. The objective is to preserve life. If you would remember our discussion on an episode with Dr. House.
Now, a scenario here is a client refuses life-saving blood transfusion due to their religious beliefs. So we have to respect that. It is our duty to do everything possible to save the client's life when we talk about deontology.
Okay? Rerespetuhin natin siya. Sige.
Pero, syempre, in some scenarios, baka emergency situation, matransfusan ng blood to. Because you want to preserve life nga of the client. No? So, basically, that's an example. When we talk about utilitarianism, we talk about the greatest good for the greatest number of people.
Now, for this scenario, five clients approach you with the same complaints. pain may massacred however one described his as extreme pain something nothing 9 over 10 or 10 over 10 due to a severe injury so I know God we not indeed top on anatomy paparazzi stone also as the one attending client as one attending the client We have to consider equal distribution. Lahat sila nakaka-experience ng pain eh.
Nakaka-experience sila ng pain. Lahat sila, iri-relieve natin yung pain. Sa kanan natin, sabihin na, punta na po kayo sa ganitong lugar. Punta na po kayo sa ER. Para lahat po kayo ma-attend.
Kasi ikaw yung pinakamalapit. Ikaw yung may available resource. Lileman na lang yung pain medications mo. Lahat sila para matanggal yung pain nila for the greatest number. Even pa yung distribution mo ng pain medications.
Okay, so that's teleology, deontology, and utilitarianism. As mentioned earlier, yung other ethical theories such as the virtue ethics, divine command ethics, and the systems of law, you can just actually replay the first part of this video, mga kapatid, so that ma-refresh tayo doon sa ating mga napag-usap. Okay?
So basically, that's the content of our prelims. That's the rest of our discussions. I hope that I have shared with you for today that we have simplified the concepts, the topics to the language that you could understand.
I hope you also understood it. And I hope that within the time we have together in this video, So, you learned something. And in our collaboration so far, in the past six days, six days, right? Yes.
So, I hope that you learned something and I wish you good luck to your preliminary examination. I hope we pass. Let's go for the gold. Aim high, Pasay. As they say.
So, with that, I... end this video. I end this session.
And I hope to see you on Saturday. Bye!