Civil Law

Civil law in the Philippines, primarily governed by the Civil Code of the Philippines (Republic
Act No. 386), deals with legal disputes between individuals or entities. In the context of nursing,
this is where a patient or their family can seek monetary compensation for damages caused by
the nurse's professional negligence or wrongdoing.

• Negligence and Malpractice: The most common civil case against a nurse is for
negligence. According to the Civil Code, a person who, by act or omission, causes
damage to another through fault or negligence, is obliged to pay for the damage done. In
nursing, this means a nurse can be held liable if they fail to provide the standard of care
that a reasonably prudent and competent nurse would provide in a similar situation, and
this failure results in a patient's injury or harm.
• Doctrine of Respondeat Superior: In many cases, the hospital or healthcare institution
where the nurse is employed can also be held civilly liable for the negligent acts of its
employees. This is based on the legal principle of respondeat superior (let the master
answer), which holds the employer responsible for the actions of their employees within
the scope of their employment.
• Damages: If a nurse is found liable in a civil case, they may be ordered to pay various
types of damages, including:
o Actual or Compensatory Damages: For medical expenses, lost income, and
other out-of-pocket costs.
o Moral Damages: For the patient's physical and mental suffering, anguish, and
humiliation.
o Exemplary or Punitive Damages: To serve as a deterrent and to punish the
wrongdoer in cases of gross negligence.

Criminal Law

Criminal law, primarily outlined in the Revised Penal Code of the Philippines (Act No. 3815),
deals with offenses against the state. A criminal case is filed by the government and can result in
imprisonment, fines, or both. For nurses, criminal liability often arises from acts of gross
negligence or recklessness that lead to harm.

• Reckless Imprudence: This is a common criminal charge in medical malpractice cases.

Under the Revised Penal Code, a person can be held criminally liable for "reckless
imprudence" that results in homicide or serious physical injuries. This offense involves a
higher degree of negligence than in a civil case, demonstrating a blatant disregard for the
safety of others. For example, a severe medication error or a complete failure to monitor
a patient in critical condition that leads to their death could be prosecuted as reckless
imprudence resulting in homicide.
• Other Criminal Offenses: Nurses can also face criminal charges for other acts, such as:
o Practicing without a license: A violation of the Philippine Nursing Act of 2002
(Republic Act No. 9173), which carries penalties of fines and/or imprisonment.
o Falsification of documents: Forging or altering a patient's medical records.
o Illegal administration of drugs or other substances.
 o Assault or Battery: For example, performing a medical procedure on a patient
without their valid consent.

Administrative Law

Beyond civil and criminal laws, nurses are also subject to administrative law, which is overseen
by the Professional Regulation Commission (PRC) and the Professional Regulatory Board
of Nursing (BON). This is a separate form of liability that focuses on professional conduct and
ethics.

• Violations of the Philippine Nursing Act of 2002 (R.A. No. 9173): This law is the
primary legal framework for nurses in the Philippines. It gives the Board of Nursing the
power to investigate and take action against nurses for violations, including:
o Malpractice or negligence in the practice of nursing.
o Unprofessional and unethical conduct.
o Gross incompetence or serious ignorance.
o Fraud or deceit in obtaining a license.
• Administrative Penalties: If a nurse is found guilty of an administrative offense, the
BON can impose penalties that affect their ability to practice, such as:
o Reprimand or censure.
o Suspension of their Certificate of Registration or professional license.
o Permanent revocation of their license to practice nursing.

In summary, a nurse in the Philippines can face simultaneous lawsuits and charges from different
legal systems for a single act of wrongdoing. The patient can file a civil suit for damages, the
state can file a criminal case for offenses against the public, and the Board of Nursing can initiate
an administrative case to suspend or revoke the nurse's license. This multi-layered accountability
is designed to protect the public and maintain the integrity of the nursing profession.

STANDARDS OF CARE

The standards of care serve as authoritative statements that define the level of performance and
quality of care expected from a professional nurse. They are essential for:

• Protecting the public by ensuring a high level of patient safety and care.
• Guiding nursing practice and serving as a benchmark for competency.
• Providing a legal framework for accountability and liability in cases of malpractice.
• Facilitating the professional development of nurses.

Here are the key organizations and documents that establish these standards in the Philippines:

1. The Critical Care Nurses Association of the Philippines, Inc. (CCNAPI)

CCNAPI is the leading professional organization for critical care nurses in the country. It plays a
crucial role in developing and implementing standards, guidelines, and competencies for its
members. The CCNAPI's standards of practice are based on the nursing process and cover both
clinical and professional performance. They include:

• Standards of Care: These outline the expected level of nursing practice in caring for the
acutely and critically ill. They follow the nursing process, from assessment and diagnosis
to planning, implementation, and evaluation of care.
• Standards of Professional Performance: These define the professional roles and
behaviors expected of a critical care nurse, such as maintaining ethical conduct,
collaboration with other healthcare providers, and continuous professional development.

2. The Professional Regulation Commission-Board of Nursing (PRC-BON)

The PRC-BON, as the government body that regulates the nursing profession, has a mandate to
enforce quality standards of nursing practice as stipulated in the Philippine Nursing Act of 2002
(R.A. 9173). While the BON sets broad, national-level standards that apply to all nurses, it also
works with specialty organizations to ensure that specialized competencies and standards are
recognized.

The National Nursing Core Competency Standards (NNCCS) provides a foundation for all
nurses in the Philippines. It serves as the baseline for nursing practice and is used as a reference
for all specialties, including acute and critical care. The standards developed by CCNAPI build
upon the NNCCS with additional, specialized knowledge and skills required for the critical care
setting.

3. The Department of Health (DOH)

The DOH, as the primary government agency responsible for healthcare, sets standards for
hospital facilities and services, including critical care units. The DOH's standards for hospitals
and intensive care units (ICUs) often include requirements related to staffing, equipment, and
protocols, which directly impact the standards of care for nurses working in those areas.

Key Aspects of Acute and Critical Care Nursing Standards in the Philippines

The standards of care for critical care nurses in the Philippines typically include:

• Holistic and Patient-Centered Care: Emphasizing the bio-psycho-social-spiritual needs

of the critically ill patient and their family.
• Scientific Body of Knowledge: Practice is based on a sound scientific foundation,
advanced technology, and up-to-date knowledge.
• The Nursing Process: The systematic use of assessment, diagnosis, outcome
identification, planning, implementation, and evaluation of care.
• Ethical and Legal Conduct: Adherence to the Code of Ethics for Nurses and other
relevant laws and regulations.
 • Competency in Procedures: Proficiency in specialized procedures such as ventilator
management, advanced cardiac life support (ACLS), and medication administration for
high-risk drugs.
• Collaboration: Working effectively as part of a multidisciplinary team to achieve
optimal patient outcomes.
• Patient and Family Education: Providing education to allay fears, promote
understanding, and assist families in coping with a life-threatening situation.
• Professional Development: A commitment to lifelong learning, including participating
in ongoing educational activities and keeping up with the latest evidence-based practices.

In essence, while the PRC-BON provides the national legal framework, professional
organizations like CCNAPI are instrumental in developing and promoting the specific, detailed
standards that govern acute and critical care nursing practice in the Philippines.

By: Sherlyn D. Platon, MAN