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⭐ Competency Appraisal

Professional Nursing Practice, Ethics, and Jurisprudence

PALMER Reviewer by Luansing

PALMER Reviewer by Luansing

May 02, 202475 min read14835 words

 CMPA
Table of Contents

 I: Professional Adjustment and Nursing Practice

 Scope of Nursing Practice
 Roles of a Professional Nurse
 Becoming a Professional Nurse
 The Board of Nursing
 Prohibited Practice of Nursing
 Nursing Positions and Occupations
 Accredited Nursing Organization
 Periods of Nursing Worldwide
 Nursing Leaders Worldwide and their Contributions
 Legislations Affecting Nursing Practice
 II: Nursing Leadership
 Elements of Nursing Leadership
 Theories in Leadership
 Leadership Styles
 The Powers of a Leader
 Skills and Qualities of a Leader
 Authority
 Behavior
  Communication
 Decision Making
 Ethical
 Conflict Resolution
 III: Nursing Management
 Theories in Management
 Management Process
 Planning
 Organizing
 Directing/Delegation
 Coordinating/Collaboration
 Evaluation/Controlling
 IV: Ethics in Nursing Practice
 Ethical Rights of Patients
 Bioethical Principles
 Informed Consent
 Documentation and Charting
 Last Wills and Testaments
 Medication, Drugs and Prescriptions
 Restraints and Detention
 Testimonial Responsibilities in Court
 Legal Doctrines Applied in the Nursing Profession
 Crimes Affecting the Nursing Profession
 Circumstances Affecting Criminal Liabilities
 Criminal Liabilities
 V: Nursing Research
 Ethical Considerations in Nursing Research
 Basic Steps in the Nursing Research Process
 Research Problems
 Purpose of the Study
 Research Variables
 Scope and Limitations
 Definition of Terms
 Review of Related Literature
 Research Concepts and Frameworks
 Research Hypotheses
 Research Design
 Experimental Research
 Non-experimental Research
 Qualitative Research Studies
 Population and Sample
 Data Collection

A summary of Professional Reviewer Dr./Atty. Glenn R.

Luansing’s Nursing Review Guide on Professional
Adjustment, Leadership and Management, Ethics,
and Nursing Research

CITE
Luansing, G. (2024). Nursing Review Guide: Professional
Adjustment, Leadership and Management, Ethics, and Nursing
Research (1st ed.). CentralBooks. ISBN:978-621-02-2289-0.

I: Professional Adjustment and

Nursing Practice
INFO
Most of the following information is based on R.A. 9173,
the Philippine Nursing Act of 2002 as presented in Atty.
Luansing’s book.

A Profession is a calling requiring specialized knowledge and

intensive academic preparations. In nursing, it is the performance,
for a fee or a salary, of professional services e.g. responsible nursing
care, observation of symptoms, accurate reporting and
documentation, supervision of others, execution of nursing
procedures, and execution of valid doctor’s orders. There are seven
specific characteristics of a professional nurse (mn.
AAACCESS):

1. Accountability: the nurse is accountable for their actions.

2. Autonomy: the nurse is able to think independently and take
actions related to patient care within their scope of practice.
3. Altruism: the nurse is selfless and services others without
regard for compensation or reward.
4. Caring Attitude: the nurse puts in diligent efforts to care for
any client, sick or well, and regardless of the patient’s
economic or social status.
5. Competency: the nurse is competent in all of their duties, and
continues professional training to keep up with changes in
patient care. The nurse should be able to recognize when they
are not qualified for their duties and act accordingly.
 oR.A. 10912, The Continuing Professional
Development (CPD) Act of 2017 for nursing
mandates 15 credit units for professional license
renewal, in this case every 3 years. These are obtained
from formal learning, non-formal learning, informal
learning, self-directed learning, online learning activities,
and professional work experience.
6. Ethical: the nurse follows the nursing code of ethics and is
equipped with the morality of human conduct, values, and
standards.
7. Service-Oriented: the nurse is dedicated to service, in that
they are able to anticipate, recognize, and meet the patients’
needs.
8. Specialized: the nursing profession requires a specialized
body of knowledge and well-defined skills.

Scope of Nursing Practice

The scope of nursing practice is defined under Section 28, Article VI
of the Philippine Nursing Act of 2002. A person is said to practice
nursing when they render nursing services to other individuals or
groups from womb to tomb. Nursing services include but are not
limited to:

1. Provision of care through the nursing process

2. Collaborate with communal resources and health teams
3. Provide health education
4. Take student nurses as apprentices, and
5. Undertake nursing and health human resource development,
training, and research.

Roles of a Professional Nurse

(mn. CCC-MART)

1. Caregiver: to provide care and comfort, show concern for

client welfare and safety, and utilize scientific knowledge in
activities to do so.
2. Change Agent: to initiate or assist in changing the
patient’s condition or lifestyle, or the systems of
care via Kurt Lewis’ Unfreeze, Change, Refreeze theory
 3. Counselor: helping the client recognize and cope with
psychologic or social problems, develop an improved
interpersonal relationship, promote personal growth,
develop new or alternate attitudes, feelings, and
behaviors, recognizing health choices, and developing a
sense of control.
4. Teacher: provide information regarding health, help the
client learn or acquire new knowledge and skills, and
encourage adherence to treatment and healthy lifestyles.
5. Researcher: participate in identifying significant
researchable problems and using the research process
for investigation.
6. Advocate: promote for what is best for the client, ensuring
that their needs are met and rights are not
violated; support the client’s decisions.
7. Manager: makes decisions and coordinates the activities of
others, delegating and allocating resources
appropriately. Managers plan, direct, develop, monitor,
and evaluate the quality of care and personnel. They
represent the staff and administration as needed.

Becoming a Professional Nurse

1. Obtain a Bachelor of Science in Nursing (BSN) degree
2. Take the Nurse Licensure Examination (NLE): a test held
for those qualified (a citizen, of good moral character, a holder
of BSN degree) encompassing the basic competencies in
nursing:
o The Nursing Process (ADPIE)
o Therapeutic Communication and Caring Behaviors
o Collaborative Care
o Decision-making Skills
o Delegation
o Promotive, Preventive, Palliative, Curative, and
Rehabilitative Care
o Accountability
o Documentation and Reporting
o Execution of Doctor’s Orders
3. Passing the NLE: a minimum average grade of 75% from all
subjects, with no subjects less than 60% must be met to pass
the licensure examination.
 o If any subjects fall below to 60% mark but the examinee
manages to reach a 75% average, the examinee must re-
take the examination for their failed subjects with a 75%
or greater rating.
4. Oath-taking: all successful candidates are required to take an
oath of professionals before the Board or any government
official authorized to administer oaths.
o Oath of Professionals (Tagalog)
o Nightingale Pledge (1935 revision)
5. Registration: after qualification through examination, one
may become a registered nurse after acquiring a certificate of
registration (Section 17, Article IV)
o Registration by Reciprocity may be provided without
examination for nurses registered foreign countries that
require the same qualifications and provide the same
scope of practice. (Section 20, Article IV)
o Special or Temporary Permits: foreign licensed nurses
who are (1) internationally known specialists or
outstanding experts, (2) on a medical mission providing
free service in a particular institution, and (3) employed
by schools/colleges of nursing as exchange professors.
These permits are only effective for the duration of the
project, medical mission, or employment contract.
(Section 21, Article IV)
o Non-issuance is done for individuals convicted of a
crime involving moral turpitude, immoral/dishonorable
conduct, or being of unsound mind. (Section 22, Article
IV)
6. Revocation and suspension is imposed upon individuals
convicted of a crime involving moral turpitude,
immoral/dishonorable conduct, being of unsound mind, or
those who have performed unprofessional/unethical conduct,
gross incompetence, serious ignorance, malpractice,
negligence, or fraud. This will not exceed a period of four
years. (Section 23, Article IV)
o Reissuance of Revoked Certificates: after the expiry
of the period of suspension (again, not longer than 4
years) for reasons of equity and justice and when the
cause for revocation has disappeared and corrected, upon
proper application therefore and the payment of the
required fees, another certificate of
 registration/professional license may be granted. This is
also applicable to lost certificates or licenses. (Section 24,
Article IV)
o Returning from Inactivity: nurses who have not
actively practiced the profession for five consecutive
years are required to undergo one month of didactic
training and three months of practicum. The Board
shall accredit hospitals to conduct these training
programs. (Section 26, Article V)
7. Nursing Specialization (Comprehensive Nursing Specialty
Program) is mandated by Section 31, Article VII of the Nursing
Act of 2002 to be formulated to upgrade the level of skill and
competence of any clinician for the development of specialty
nurse clinicians in the country, including but not limited to
areas of critical care, oncology, renal, and such other areas as
maybe determined by the Board.
o This is a program by the Board of Nursing and
Department of Health, the beneficiaries of which will be
mandated to serve in any Philippine hospital for a period
of at least two years of continuous service, as this
program is funded by the Philippine Charity Sweepstakes
Office and the Philippine Amusement and Gaming
Corporation.

The Board of Nursing

The Board of Nursing, as stated in Section 3, Article III of the
Nursing Act of 2002, is composed of a Chairperson and six
members (1) appointed by the President of the Republic of the
Philippines, (2) from among two recommendees, per vacancy, of the
Philippine Regulation Commission, (3) chosen and ranked from a list
of three nominees, per vacancy, of the accredited professional
organization of nurses in the Philippines (Philippine Nurses
Association).

1. Qualifications of the Chairperson and Board members are as

follow: (a) be a natural born citizen and resident in the
Philippines, (b) be a member in good standing of the
accredited professional organization of nurses, (c) be a
registered nurse, holder of a master’s degree in nursing,
education, or other allied medical profession (mandatory for
 the Chairperson; while only a majority of Board members must
have a master’s degree), (d) have at least ten years of
continuous practice prior to appointment, the last five years of
which must have been in the Philippines, and (e) not convicted
of any offense involving moral turpitude.
2. Disqualifications and Prohibitions (Section 5, Article II) of
the Chairperson and the Board members must (a) immediately
resign from any teaching position or review program in any
institution, agency, or instrumentality in both government and
private sectors, (b) not have any pecuniary (financial) interest
in or administrative supervision over any institution offering
Bachelor of Science in Nursing, including review classes.
3. Term (Section 6, Article III): the Chairperson and Members of
the Board of Nursing shall hold office for a term of three
years and until their successors have been appointed and
qualified (the hold over period), provided that the
Chairperson and Members of the Board may be
reappointed for another term. Any vacancy filled by an ad
interim appointment for the unexpired portion of the term
only. Oath-taking is performed prior to the performance of
one’s duties.
4. Removal (Section 11, Article I) of a Member of the Board of
Nursing may be due to (a) continuous neglect of duty or
incompetence, (b) commission or toleration of irregularities in
the licensure examination, and (c) unprofessional, immoral, or
dishonorable conduct.

Term vs Tenure
“Term of Office” is a period during which an appointee, e.g. the
Board of Nursing, can validly hold their office/public position
as a matter of right. “Tenure of Office”, however, is the period
during which the appointee is physically/actually occupying their
public office. One’s term is fixed, while their tenure may be
shortened in cases of removal, disqualification, or incapacitation.

The Board of Nursing is given the following Powers and Duties as

written in Section 9, Article II of the Nursing Act of 2002:

1. Conduct the licensure examination for nurses.

2. Issue, suspend, and revoke certificates of registration for
the practice of nursing.
 3. Monitor and enforce quality standards of nursing practice.
4. Ensure quality nursing education by inspection and
recommendation to the CHED. The Board may open and close
colleges of nursing and/or nursing education programs upon
written recommendation to CHED.
5. Conduct hearings and investigations to resolve complaints
against nurse practitioners, with the power to issue subpoena
ad testificandum (respondents and witnesses) and subpoena
duces tecum (documents).
6. Promulgate a Code of Ethics in coordination and
consultation with the Philippine Nurses Association.
7. Recognize nursing specialty organizations in coordination
with the Philippines Nurses Association.
8. Prescribe, adopt, issue, and promulgate guidelines,
regulations, measures, and decisions as may be
necessary for the improvement and advancement of the
nursing profession.

Prohibited Practice of Nursing

Section 35, Article VII of the Nursing Act of 2002 enumerates the
following prohibited acts which, if an individual is convicted of, will
produce a fine of not less than ₱50,000.00 nor more than
₱100,000.00 or imprisonment of not less than one year nor
more than six years, or both upon discretion of the court:

 Practicing nursing without the meaning of the Nursing

Act:
1. Without a certificate or license except if exempted,
including the use of another’s certificate or license,
invalid certificate or license, or falsely obtained certificate
or license.
2. Appending BSN/RN titles or any similar appendage to
their name without having been conferred said degree or
registration.
3. Who, as a registered and licensed nurse, abets or assists
in the illegal practice of another who is not qualified to
practice nursing.
 Conducting in-serve educational programs or review
classes without permit from the Board and the Commission.
  Employers who violate the minimum base pay of
nurses and the incentives and benefits that should be
accorded to them.
 Any person or chief executive officer violating the
provision of this Act and its rules and regulations.

Nursing Positions and Occupations

1. Nurse Supervisor/Manager: requirements are being an RN,
having 2 years of experience in general nursing service
administration, and having taken at least 9 units in
management and administration at the graduate level.
(Section 29, Article VI)
2. Chief Nurse/Director of Nursing Service: requirements are
being an RN, having 5 years of experience in a supervisory
or managerial position in nursing, be a member of good
standing of the Philippine Nurses Association, and having
a Master’s Degree in Nursing. (Section 29, Article VI)
o For primary hospitals, the maximum requirements
are 2 years of experience general nursing service
administration, BSN, RN, and having taken at least 9 units
in a management and administration courses at
the graduate level.
o For public health agencies, those who have a master’s
degree in public health/community health nursing is
prioritized.
o For military hospitals, those who have a master’s
degree in nursing and who have completed the General
Staff Course (GSC) is prioritized.
3. Institutional Nursing: nursing in hospitals and similar
institutions; the provision of comprehensive health services
both for in-patient and out-patient status. The nurse is
developed in many areas of specialization not available in
other areas of nursing practice.
o Perform decision-making, delegation, technical
procedures (e.g., IV therapy, ABG monitoring,
Correlation of lab results with patient
status), coordination of care, health
education, documentation, supervision of
subordinates, and client advocacy
4. Private Duty Nursing: also known as private nurse
practitioners, special duty nurses, or private nurse specialists,
these are nurses expected to provide care to a small group of
clients, usually a one-patient-one nurse ratio. Service is usually
hired directly by individual clients and not by an institution.
o These individuals are independent practitioners and are
expected to be a specialist, working on their own without
any supervision from any superior or manager. They
attend to all basic and advanced procedures related to
the care of their patient.
5. Industrial Nursing: occupational/company nursing; the nurse
practices their nursing skills in factories, offices, industrial
zones, etc. where employer-employee relationships exist.
o The Occupational Health Nurses Association of the
Philippines (OHNAP) is responsible for certifying
occupational health nurses, requiring a BSN, a post-
graduate course for Basic Occupational Health Safety for
Nurses (a specialization course under OHNAP Inc.), and at
least three conventions with OHNAP within five (5) years
of active membership.
o These individuals take care of the health of laborers
whether casual, probationary, or regular employees. They
provide preventive measures to ensure the health and
safety of workers in virtually any type of work setting.
6. Clinical Instructor/Nurse Educator: a nurse tasked with
educating nursing students regarding the different skills,
nursing procedures, and theoretical foundations needed to be
a competent nurse in the future.
o Requirements include: be an RN; be a member of any
accredited nursing organization; have at least one year of
clinical practice in a field specialization; and be a holder
of a master’s degree in nursing, education, or other allied
medical and health sciences.
o After at least five years of being a clinical instructor, a
nurse educator may become a Dean
7. Public Health Nurse: the primary level of nursing practice
mainly involving promotive and preventive health care
approaches. The essence of being a public health nurse is to
provide care not only to a specific client, but primarily to the
community.
 o Basic functions include health teaching, community and
environmental sanitation, immunizations, disease
prevention, nutritional counseling, awareness campaigns,
health programs, etc.
o Appropriate communication techniques are necessary for
a public health nurse. They must accept diversities in
cultures, beliefs, practices, etc. among members of the
community where they are involved.
o Actual provision of care is limited compared to an
institutional nurse.
8. Military Nursing: giving care to sick and injured patients
admitted in any military hospital and installation. Trained and
enlisted military nurses may also be assigned to provide
services outside of the military hospitals, such as on occasions
of calamities, war, and other similar catastrophes.
o Being commissioned in a nurse corps puts a rewarding
rank of 2nd Lieutenant at the respected course of service.
Promotion in rank requires a nurse to complete the
milestones in this career and may include the basics of
competition.
o Requirements for single (unmarried) individuals:
citizenship obtained through birth; pleasing personality;
board passing rate of 80% or above, otherwise by passing
a qualifying examination; must not have given birth; must
not exceed the age of 32 years old; must be at least 5’4”
(men) and 5’2” (women); must be physically and mentally
fit for military service.
o Requirements for married individuals: priority is given to
those who have at least three years of active military
service and have successfully completed the clinical
nursing program for EP nurses being conducted by the
Office of the Chief Nurse, AFP, followed by those
applicants who have satisfied (a) three years of current
and continuous professional experience in hospital/clinic
settings or as a member of a faculty of a school of
nursing. and (b) preferably with a master’s in nursing or
at least 9 units of post graduate studies leading to a
master’s degree in nursing.
9. Clinic/Office Nursing: assisting physicians and other medical
practitioners in their own respective clinics
 10. School Health Nursing: care for students enrolled in
schools/educational institutions
11. Independent Nursing Practice/Nurse Specialist:
highly experienced nursing practitioners who are not employed
to any institution and maintains their own practice or nursing
clinic.

Accredited Nursing Organization

The Philippine Nursing Association (PNA) was founded
on September 2, 1922 under the name of “Filipino Nurses
Association” in a meeting of 150 nurses presided by Anastacia
Giron Tupas (founder). This organization was formed to serve the
common needs and interest of Filipino nurses in so far as the
practice of their profession is concerned.

 The FNA was established for the purposes of: (a) attaining an
optimal level of professionals standards, (b) responding to the
changing health needs of the Philippine society, and (c)
establishing linkages with the government, national and
international agencies in the attainment of national health
goals and welfare of member nurses.
 The FNA was accepted as a member of the International
Council of Nurses during the Congress held in Montreal,
Canada on July 8–13, 1929.
 The FNA took on the current name, PNA, on January 8, 1966,
the same year the head office at 1663 F.T. Benitez Street,
Malate, Manila, was inaugurated.
 The PNA was given its national status under Proclamation
Order No. 539 on October 17, 1988, incidentally declaring
every last week of October the official “Nurse’s week”.

The objectives of the Philippine Nurses Association include:

1. To promote and maintain the highest standards of nursing

practice.
2. To address problems concerning nurses through participation
in formulation of all policies, guidelines, programs, and laws
affecting nurses and nursing practice in the Philippines.
 3. To continuously upgrade professional competence through
research, training, scholarship grants both foreign and local
and dissemination of information.
4. To collaborate with government, non-government and other
allied professional group for the promotion of health services.
5. To foster national and international goodwill among nurses and
harness all energies towards the attainment of common goals.
6. To help advance the science and art of nursing in the
Philippines to meet the needs of a changing society.
7. To recognize the exemplary performance and
accomplishments of members.

Other Professional Nursing Associations

 Association of Deans of the Philippine Colleges of Nursing

 Occupational Health Nurses Association of the Philippines
 Private Duty Nurses Association of the Philippines
 Maternal and Child Nurses Association of the Philippines
 Association of Nursing Service Administrators of the -
Philippines
 National League of Government Nurses
 Military Nurses Association of the Philippines
 Operating Room Nurses Association of the Philippines
 Catholic nurses Guild of the Philippines
 Graduate Nurses Christian Fellowship
 Philippines Orthopedic Nurses Society

Periods of Nursing Worldwide

1. Intuitive Nursing: nursing care was performed out of
compassion, empathy, and the feeling or desire to help others.
Nursing was closely related to religion, superstition, evil spirits,
voodoo, and magic.
2. Apprentice Nursing: the golden age of nursing; nursing was
developed by religious orders, particularly those belonging to
the Catholic religion and its followings.
3. Dark Period: the downfall in Christian faith and the rise of
political and religious anarchism damaged the progress of
nursing. There was a marked decline in the development of
scientific nursing practice worldwide.
 4. Educated Nursing: training, philosophy, and teachings of
Florence Nightingale were introduced into nursing. This period
involved the sudden proliferation of nursing schools in
America. Formal training was started.
5. Contemporary Nursing: period of professionalized and
globalized nursing. The advent of modern machines and
medical technologies that paved the way for advanced care
and clinical services. Nursing became legally backed through
laws to protect both the clients and caregivers, Codes of
Ethics, and other statutes.

First Nursing Schools in the Philippines

1. Iloilo Mission Hospital

2. Philippine General Hospital
3. Mary Johnston Hospital Nursing School
4. St. Luke’s Hospital
5. San Juan De Dios School of Nursing
6. St. Paul School of Nursing
7. Zamboanga General Hospital
8. Chinese General Hospital
9. Baguio General Hospital
10. Manila Sanitarium

Nursing Leaders Worldwide and their

Contributions
⚰️this is the last bit missing from the entire book, i can’t be
bothered to summarize the entire thing. incomplete

1. Florence Nightingale:
2. Lydia Hall:
3. Faye Glenn Abdellah:
4. Virginia Henderson:
5. Hildegard Peplau:
6. Imogene King:
7. Sister Callista Roy:
8. Dorothea Orem:
9. Martha Rogers:
10. Myra Levine:
11. Betty Neumann:
 12. Jean Watson:
13. Madeleine Leininger:
14. Ida Jean Oriando:
15. Ernestine Wiedenbach:
16. Joyce Fitzpatrick:
17. Patricia Benner:

Legislations Affecting Nursing Practice

1. R.A. 7305—The Magna Carta of Public Health Workers
2. R.A. 6675—The Generics Act of 1988
3. P.O. 223—The Law Creating the Professional Regulations
Commission
4. R.A. 6969—Toxic Substances and Hazardous Waste Control
Law
5. R.A. 3573—Law on Reporting of Communicable Diseases
6. R.A. 5901—Forty (40) Hours Work Per Week Law
7. P.O. 442—The Labor Code of the Philippines
8. R.A. 7170—The Organ Donation Act
9. R.A. 7877—Anti-Sexual Harassment Act
10. R.A. 6758—Salary Standardization Act
11. R.A. 8344—No-Deposit Policy in Hospitals During
Emergency Cases
12. P.D. 807—The Civil Service Act
13. R.A. 7160—The Local Government Code
14. L.O.I. 1000—Compulsory Membership to a Professional
Organization
15. P.O. 539—Declaration, Last Week of October as the
Official Nurses Week
16. R.A. 7392—The Midwifery Law of the Philippines
17. P.O. 651—The Birth Registration Act
18. R.A. 2302—Philippine Medical Act
19. E.O. 51—Milk Code of the Philippines
20. L.O.I. 949—Primary Health care Law of the Philippines
21. R.A. 9994—Expanded Senior Citizen’s Act
22. R.A. 7875—National Health Insurance Act
23. R.A. 8981—The PRC Modernization Act
24. R.A. 9288—The Newborn Screening Act
25. R.A. 5921—The New Pharmacy Act
26. R.A. 9165—The New Dangerous Drugs Act
27. R.A. 8302—The Law on Reporting of Fake Drugs
 28. P.O. 825—Environmental Sanitation Act
29. P.D. 856—Sanitation Code of the Philippines
30. R.A. 9231—The Law Against Child Labor
31. R.A. 8187—Paternity Leave Act
32. R.A. 8749—The Clean Air Act
33. R.A. 8042—The Migrant Workers and Overseas Filipinos
34. R.A. 7600—Rooming-In and Breastfeeding Act of 1992
35. E.O. 209—The Family Code of the Philippines
36. R.A. 9439—An Act Prohibiting Detention of patients on
the Ground of Non-Payment of Hospital Bills
37. R.A. 6615—An Act Prohibiting Refusal to Extend Medical
Services during Emergency Cases
38. R.A. 10361—The “Domestic Workers Act” or “Batas
Kasambahay”
39. R.A. 9052—The Universally Accessible and Quality
Medical Act

II: Nursing Leadership

Leadership is the process of persuasion and example-setting of an
individual to influence a group to take action in accordance with
their common goals, and achieve desired objectives. This process
may be formal or informal based on appointment or status of the
leader or de-facto leader. This process may be achieved through:

1. Rationalization
2. Coercion
3. Exchange
4. Blocking
5. Assertion
6. Ingratiation

Elements of Nursing Leadership

1. Leader: the influencer.
2. Followers: the members who are duty-bound to follow and
respect the leader.
3. Group: the combination of the leader and their followers.
 4. Process: the means, style, formulas, and policies used by the
group to reach their common goals.
5. Goal: the purpose, objective, or reason of a group.

Theories in Leadership
 Great Man Theory: the prospect that leaders are born; that
experience is less significant in what makes an individual a
good leader. The characteristics of a leader are inherent and is
not something that can be developed easily.
 Trait Theory: certain traits, such as personality, intelligence,
and abilities, make a leader. Individuals should strive to attain
and develop these traits to become an excellent leader.
 Charismatic Theory: the driving force of leadership
is charisma.
 Situational Theory: the greatest leader depends on the
contexts and attributes of the situation; leadership is a “case-
by-case” basis.
 Vroom-Yetton Expectancy Theory: a model of decision-
making where the leader determines the amount of
participation by followers depending on the situation.
 Contingency Theory: the most appropriate leadership style is
contingent on situational factors.
 Transformational Leadership Theory: the utilization
of group empowerment to allow for success.
 Transactional Leadership Theory: the utilization
of policies, rules, or other written documents for
objectives. Performance is important and rewarded or
sanctioned.
 Fielder’s Theory: the style utilized by a leader must match
the situation it is being used in. (to-do: differentiate from
contingency theory)
 Path-Goal Theory: the leader is the one to set a path and
traverse it along with his followers in achieving a goal, e.g.,
setting clear directions for a certain objective.

Leadership Styles
1. Authoritarian; Autocratic; Dictatorial; “Hard” Leadership:
a leadership style that focuses all power towards those in
 authority or higher positions. Decision-making is done without
the influence of the followers or members of the group.
o Leaders that utilize this style are often task-
oriented and insensitive, and subject to dissatisfaction.
They often display characteristics like a commanding,
boisterous voice; a unilateral approach; a demanding
attitude; a hostile personality; exploitative means; and
demands no inputs or intervention from others.
o This style may only become effective in emergent
situations.
2. Permissive; Ultra-liberal; Laissez-Faire; “Free-
rein” Leadership: a leadership style opposite to a hard
leadership, where freedom is freely given to the group, and
results are often poor. Decision-making is light on all members
of the team and no single individual holds initiative for action.
o Leaders that utilize this style receive criticism for not
taking on major responsibilities, and members often
exercise vast and even leadership functions to
compensate.
o This style is dangerous in health care settings because of
the risk of malpractice. It may only be utilized if all
members of the team are well-trained or skilled.
3. Democratic; Participative Leadership: the “mutual” style,
where the leader exercises his powers and control to all
members but allows for the participation of subordinates in the
decision-making process. In this style, both the goals of the
group and the welfare of its members are valued.
o This style of leadership is highly valuable as it allows for
highly flexible and cohesive group functioning.

The Powers of a Leader

1. Legitimate Power: all powers vested upon the leader along
with his position or rank; power formalized and sanctioned
by the institution itself.
2. Expert Power: the power of control based on the
exceptional expertise a leader that is not ordinarily found
in other members of the staff.
3. Referent Power: power obtained from the admiration and
respect of members based on special
characteristics (e.g. charisma) of the leader.
 4. Connection Power: the ability to influence others based on
linkages to other influential or powerful individuals.
5. Reward Power: the positive power of a leader to incentivise
actions or achievements, such as with bonuses, awards,
promotions, or transfers.
6. Coercive Power: the negative power of a leader to
use duress to gain control, such as with reprimands,
termination, and penalties.

Skills and Qualities of a Leader

Authority

Authority is the legitimate right of a leader to exact obligations

from his subordinates. The abilities of a leader to delegate tasks
to his subordinates for its compliance and discipline for its non-
compliance.

 Accountability is the legal liability arising from any

omission or improper performance of any task or responsibility.
 Responsibility is the personal or professional obligation
and dependability to perform a specific task.

There are two ways of delegating authority:

1. Centralized Authority: only individuals occupying

administrative or top-level positions obtain the right to
authority.
o Ex.: staffing patterns and schedules is solely given to the
Office of the Nursing Director, and they issue notices to
inform all subordinates and demands immediate
compliance.
2. Decentralized Authority: authority itself is delegated to the
operational level or even to ordinary personnel. This
encourages full participation, better communication,
representation, and relationship in a group.
o Ex.: before the approval of a staff pattern or schedule, the
Nursing Director requests unit managers for the type of
schedules and patterns applicable for their respective
units, where the unit manager then consults their
 subordinates. The Director then simply approves the
submitted plans for each unit manager.

Behavior

Behavior affects leadership. It is required that a leader must possess

a behavior that is group-centered:

1. Vision
2. Integrity
3. Patience
4. Passion
5. Direction and Purpose
6. Ability to Motivate
7. Ability to Listen
8. Trustworthy
9. Critical Thinker
10. Intelligence
11. Self-Confidence
12. Flexibility

Communication

The transfer of information with understanding from one person to

another. This is used for Therapeutic Relationships, and occurs
with four phases:

1. Pre-interaction: prior to any initial contact with a client,

where all relevant and necessary information related to
the client are collected and reviewed prior to any initial
meeting. The data obtained could be either primary or
secondary depending on its source.
2. Orientation: the initial meeting between the client and
caregiver, where rapport and trust are established.
3. Interaction/Working: the caregiver and client communicate
and work together in order to determine, plan for, and
intervene with the client’s problems for the fulfillment of
the client’s needs.
4. Termination: the client’s needs are met and the relationship
is terminated.
Communication undergoes a cyclic process. The sender produces a
message, encodes it via a means to deliver the message (verbal,
nonverbal, written), and transmits it to the receiver. The receiver
then decodes the message, then produces a message in return
(feedback) to the initial sender.

1. Sender/Encoder: the initiator of the communication process

in order to transmit information.
2. Message: the actual meaning sent.
3. Encoding: the form the meaning takes in order to be
delivered. This may be verbal, non-verbal, written, etc.
4. Transmission: the actual transference of data.
5. Receiver: the recipient of the message, and the one to decode
(interpretation, perception, understanding of the message).
o Decoding a message may meet barriers (alterations in
the intended message) by various environmental, social,
or cultural obstacles (Noise) like language barriers,
physical noise, perceptive biases, etc. Discussed later in
this section.
6. Feedback: the response or alteration in behavior of the
receiver as a reaction to the received message.

There are various types of communication behaviors utilized for the

delivery of various kinds of data:

1. Aggressive-Type Communication: loud, inappropriate, and

confronting behavior utilized by hostile, egotistic, and sarcastic
individuals.
2. Passive-Type Communication: shy, quiet, uninvolved,
apologetic, repressive, and easily manipulated individuals use
this form of communication.
3. Assertive-Type Communication: a balance of aggression
and passivity, altering the dominance of one or the other
depending on the needs of the context wherein communication
is necessary. They may display the following characteristics
(mn. FEW RIGHTS):
o Facial Expressions are appropriate to the scenario and
people.
o Eye Contact is proper.
o Well-Modulated Voice, tone, and intonation.
o Respectful in communication.
 o Ideal in all situations.
o Gestures are used appropriately.
o Honest
o Truthful
o Spontaneously responsive

Effective communication utilizes various techniques:

1. Offering Oneself
2. Focusing on the Client
3. Clarifying
4. Summarizing
5. Open-ended Questions
6. Conveying Acceptance
7. Supporting
8. Providing Information
9. Reflecting

Communication may be “blocked” by various barriers:

1. Psychological Barrier: psychological states like panic,

phobias, extreme anxiety, grief, loss, intense fear, aggression,
or other emotional disturbances can alter the perception or
even reception of messages.
2. Environmental Barriers: noise, distance, and space, etc.
3. Disinterested Listeners: a lack of interest in the sender’s
messages interrupts the meaningful transference of
information, even if the message is physically heard by the
receivers.
4. Semantic Barriers: multiple interpretations may be obtained
from a single message due to ambiguity, lack of tone
indicators, or the decoder.
5. Physical Barriers: defects in speaking, seeing, listening, or
cognition of the message.
6. Others include non-legible handwriting, differences in dialect,
use of jargon, etc.

Channels of Communication:
 1. Downward Communication: top-level positions that transmit
messages down to subordinates, e.g. imposition of a new
staffing pattern for all nursing personnel.
2. Upward Communication: operational-level messages
transmitted to the top-level positions, e.g. an appeal for an
increment in wages and compensation from staff nurses.
3. Lateral Communication: communication between equally-
positioned individuals in the hierarchy.
4. Diagonal Communication: the flow between different
hierarchal levels but without a direct supervisor-subordinate
relationship.

Decision Making

Decision-making is the process of providing resolutions of conflicts

or problems by careful analyses of all possible information, data, or
alternative solutions. This occurs in stages, almost similar to the
nursing process, but where diagnosis occurs first (identify the
problem and individuals affected), followed by assessment (gather
all pertinent data), then PIE:

1. Identify the Problem with the group.

2. Determine the People Affected
3. Gather All Pertinent Data
4. Brainstorm All Possible Solutions
5. Choose the Best Solution
6. Implement the Chosen Solution
7. Develop a Criteria for Evaluation of the solution’s effect on
the problem.
8. Evaluate the Solution Using the Criteria

Ethical

A leader is ethical. They must have good manners and the right
conduct. They display appropriate behaviors, morality, and
conscience in guiding and motivating other members of the team to
function conscientiously.

Conflict Resolution

Conflict is the clash of ideas resulting in a potential crisis. These

must be resolved by leaders as conflict hinders the achievement of
common objectives. Conflict occurs in three
contexts: Intrapersonal, occuring within an
individual; Interpersonal, occuring between individuals;
and Organizational or Interdepartmental, where conflict arises
between two units, departments, or groups.

Conflict resolution utilizes different methods:

1. Avoidance: the problem is avoided by the leader.

2. Bargaining/Compromising: something is given up to gain
something else; both parties gain something and lose
something. They attempt to meet half-way their respective
demands, and do their best to equally benefit all parties i.e.
“We both win some and lose some”.
3. Competing/Unilateral Action: the side with an advantage
takes the opportunity to exploit the other party, i.e. “I win, you
lose”.
4. Smoothing/Accommodating: a party appeases the other
party by using conscientious efforts or kindness. This may not
resolve the conflict, producing a temporary result.
5. Negotiation: the most advisable solution; both parties
recognize the problem and mutually look for a solution
acceptable to both.

III: Nursing Management

Management is a process for the accomplishment of organizational
objects using both interpersonal and technical aspects, and using
resources efficiently and effectively. A manager coordinates actions
and resources available to achieve organizational goals and
outcomes.

Theories in Management
 Frederick Taylor’s Scientific Management Theory:
management work can be scientifically done to be able to
increase work production or output. It may be summarized as
follows:
o Selection of workers
 o Training of selected workers
o Provision of adequate tools for workers
o Proper treatment or evaluation
 Human Relations Theory: effective management arises
from good working relationships between the manager and
laborers, and among the laborers themselves.
 Douglas McGregor’s Motivational Theory: a manager may
have two classes of workers:
o Theory X: a “negative” type of worker that dislikes
work and avoids responsibilities. They require duress
to perform obligations. A high level of motivation is
required for them to work.
o Theory Y: a “positive” type of worker that are reliable
and gives importance to their job for the best
results. These workers are responsible, diligent, and
trustworthy. They productively utilize time, energy, and
efforts.
 Henry Fayol’s Principles of Management: fourteen
principles of management are outlined.
o Division of Work: assignment of tasks to nurses based
on their expertise to improve efficiency and quality of
care.
o Proper Authority, Responsibility, and
Accountability: Nurse leaders delegate tasks clearly,
ensuring nurses have the authority to act, are responsible
for outcomes, and are held accountable for their actions.
o Unity of Command: Each nurse receives instructions
from only one supervisor to avoid confusion and
conflicting directives.
o Unity of Direction: All nursing activities (e.g., patient
care plans) are aligned toward common healthcare goals
and organizational priorities.
o Remuneration of Personnel: Fair and competitive
salaries, benefits, and rewards are provided to nurses to
motivate and retain them.
o Balance between Centralization and
Decentralization: Decisions like hospital policies are
centralized, while daily patient care decisions are
decentralized to empower bedside nurses.
 o Subordination of Personal Interest with General
Interest: Nurses prioritize patient welfare and team
objectives over personal preferences or gains.
o Scalar Chain/Chain of Command: A clear line of
authority exists from nurse managers down to staff
nurses to streamline communication and decisions.
o Security of Tenure: Providing job stability and fair
employment practices to nurses fosters loyalty and
reduces turnover.
o Esprit de Corps; Team Spirit: Promoting camaraderie
and mutual support among nurses enhances teamwork
and morale.
o Span of Control: Each nurse manager oversees a
manageable number of nurses to ensure effective
supervision and quality patient care.
o Channels of Communication: Maintaining clear,
structured communication pathways (e.g., shift reports,
team meetings) to ensure accurate information flow.
o Respondeat Superior; Command Responsibility:
Nurse leaders are legally responsible for the actions of
their nursing staff performed under their supervision.
 William Ouchi’s Theory Z: management is a shared
relationships between the manager and their members. A
participative form of management is utilized.
 Total Quality Management: TQM; effective management
involves a collective approach of the whole organization with
the aim of providing quality and continuous client satisfaction
based on resulting data.

Management Process
Planning

Planning involves no actual or physical tasks, and is merely a

management tool used to conceptualized what is to be done in a
future time. It is a future projection of the group’s goal and allows
for the team to decide (form a blueprint) in advance. There are
different types of plans:

 Standing/Operational Plan: a plan used for regular or

daily activities.
  Strategic/Contingency Plan: a plan used during
emergencies or crises.
 Long-Term Plan: a plan utilized and revised or amended as
necessary over weeks, months, or even years to accomplish
and evaluate.

Planning involves multiple elements that outline the organization’s

concept:

 Mission: the present reason for establishing the

organization, and the actual function and purpose of its
existence.
 Vision: what the organization wishes to achieve in the
future; the prospective reason for its establishment.
 Philosophy: the set of values and beliefs in an organization
to promote unity in the fulfillment of their respective goal.
 Goal: the general statement of the purpose of the
organization.
 Objective: the specific and measurable statement of the
purpose of the organization.
 Policies: a general statement on the course of action to be
undertaken in fulfilling the organizational goals.
 Procedure: the specific statement of a step-by-step
process in undertaking the goal of the organization.
 Rules: punitive steps in the event of any misdemeanor or
omissions in the organization.

Budgeting is a tool used by a nurse manager during planning when

allocating future resources in their respective health care units.

 Personnel Budget: allocated expenses for compensation and

remuneration of staff or workers, and is the most important
budget.
 Operational Budget: allotted expenses for day-to-day
activities undertaken by an institution to operate, e.g.
electricity, medical-surgical supplies, and other equipment for
short-term use.
 Capital Budget: capital expenditures; major equipment and
facilities that can be utilized for long periods of time. It is the
most expensive form of budget.
  Other forms include a zero-based budget (all expenses equal
all income), fixed-ceiling budget (a budget is set and does
not move despite any changes in activity), and flexible
budget (budget depends on organizational activity).

Organizing

Organizing is a management tool that determines the right

people and their tasks to perform to achieve common
objectives. It normally utilizes an Organizational Chart that
structurally outlines the various parts and areas of an organization,
and how they are interrelated with one another. It determines
organizational control, the policy and decision-making process, and
evaluates the strong and weak areas in an organization.

Staffing is a tool to determine the appropriate and adequate ratio

of health care personnel to perform their respective
organizational tasks for the benefit of the clients. These are
schedules which the staff follows, and take various forms/types:

1. Traditional: an 8-hours/day schedule (40 hour week)

2. Non-Traditional: >8 hours/day schedule
3. Baylor Plan: the division of a schedule to both traditional and
non-traditional schedules (8 hour shifts during weekdays, 12
hour shifts during weekends)
4. Part-Time: flexible (elective) and shorter schedules
5. On-Call: the worker may be called to work when necessary,
but is otherwise off-work.

Staffing can take on different patterns, depending on how schedules

are decided/change:

1. Centralized Staffing Pattern: schedules are decided and

approved by top-level administrators.
2. Decentralized Staffing Pattern: schedules are discussed
and submitted by unit managers to administrators, who then
approve the schedules.
3. Permanent Schedule: an unchanging schedule.
4. Self-scheduling: the operational-level workers decide on their
shifts.
5. Cyclical: definition needed
Nursing Care Delivery Methodologies enumerate the methods
that a nursing staff team can respond to patient needs:

1. Case Method: total patient care is given by an individual

nurse to a specific case or diagnosis of a client. The
nurse informs the nurse-manager regarding the patient’s
concerns (private duty nurse).
2. Functional Method: also commonly known as “task-based
nursing”, wherein nurses are assigned specific tasks for
patients. It is the poorest method of nursing care delivery, but
is highly utilized when nurses are scarce or patients are
abundant.
3. Team Nursing: teams are formed from the group, and appoint
a team leader or “charge nurse”. They assume responsibilities
from the nurse manager for their members, and coordinates
and supervises all the care provided by members of the team.
4. Primary Nursing: direct patient care formulated by a primary
nurse (and their team, if also utilizing team nursing) from the
moment of admission until discharge. This is practically 24-
hour continuous care, and demands an increase in
accountability, responsibility, planning, communication, and
coordination.

Directing/Delegation

Delegation is a management function wherein a task, procedure,

or obligation is done by another person who accepts it. Effective
delegation is done by:

1. Determine the task to be delegated. Tasks that are

delegated are usually characterized as standard unchanging
procedures.
2. Choose a delegee to perform the task. It is the primary
responsibility of the nurse to screen the delegee, provide
proper instructions and tools needed, inform the scope of their
duties and evaluate the result of tasks performed.
3. Match staff competency with the task. There must be
capacity and acceptance to perform the delegated task.
4. Provide open and continuous communication with the
delegee.
 5. Obtain constant feedback and evaluation from your
subordinate during and after performing the task. As such, only
tasks that the delegator can best perform, assess and evaluate
may be delegated.

There are many principles and characteristics to follow for

delegation to be effective:

 Provide a complete and continuous instruction for the

delegated task.
 Assume a face-to-face position and utilize proper eye
contact when delegating.
 Provide a calm environment when providing instructions.
 Do not delegate during an emergency situation, as this
should normally take time. Rushing delegation may result in
errors and miscommunication.
 Responsibilities may be delegated, but not
accountability. Any errors by the delegee will be shared by
the delegator.
 Delegation should not breach confidentiality.
 There must be a periodic and constant evaluation of tasks
completed.
 Give appropriate assistance and supervision.

Coordinating/Collaboration

Quality care is provided by multiple members of the health care

team. Continuous communication, relationship, and interaction with
other professionals is required for holistic care. There are three
kinds of coordination/collaboration:

 Intradepartmental/Interpersonal Coordination occurs

within the same unit.
 Interdepartmental Coordination occurs between
departments under the same institution.
 Interinstitutional/Agency Coordination occurs between
institutions.

Evaluation/Controlling

The final step of the management process wherein the nurse

manager determines whether the desired goal was met or
achieved in accordance with organizational standards. It also
involves management of possible outcome risk. Evaluation can
be on-going, intermittent, terminal, or routine. Evaluation can
be done through:

1. Self-appraisal
2. Checklist System
3. Peer Review
4. Nursing Audit
5. Performance Appraisal
6. Customs/Client Evaluation
7. Benchmarking
8. GANTT Charting
9. Program Evaluation and Review Technique (PERT)
10. Nursing Rounds
11. Sentinel Event Review

IV: Ethics in Nursing Practice

Ethics is a word derived from the Greek word “Ethos”, which
depicts a “characteristic way of acting”. It is a field of moral
science in which deals with the morality of human acts.
Nurses must be ethical, displaying that they are able to distinguish
between right or wrong, that they feel an obligation to do what is
good and avoid what is wrong, and that they have a sense of
accountability for all actions taken.

Ethical Rights of Patients

(with the inclusion of the patients’ bill of rights)

1. Right to Appropriate Medical Care and Humane

Treatment: the provision of considerate and respectful care.
2. Right to Information: Obtaining complete, current
information concerning his diagnosis, treatment and prognosis
in an understandable manner.
3. Right to Informed Consent: receiving information necessary
to give informed consent prior to the start of any procedure
and/or treatment.
4. Right to Refuse Treatment: patients are granted the ability
to refuse treatment to the extent permitted by the law and to
be informed of the medical consequences of their decision.
5. Right to Privacy: every consideration of their privacy
concerning their own medical care program must be provided.
6. Right to Confidentiality: expect that all communications and
records pertaining to their care should be treated as
confidential.
7. Expect that, within their capacity, the hospital must provide
a reasonable response to their request for services.
8. Obtain information regarding any relationship of their hospital
to other health care and educational institutions insofar as
their care is concerned.
9. Right to Refuse Participation in Medical Research: the
patient must be advised if the hospital proposes to engage in
human experimentation affecting their care or treatment. The
patient has the right to refuse and participate in such research
projects.
10. Expect reasonable continuity of care.
11. Examine and receive explanation of the hospital
bill regardless of the source of payment.
12. Right to be Informed of Their Rights and
Obligations as a Patient: the patient must know hospital
rules and regulations apply to their conduct as a patient.
13. Right to Express Grievances: the patient has the right
to express complaints and grievances without fear of
discrimination, reprisal, and to know about the disposition of
such complaints.
14. Right to Choose Health Care Provider and Facility
15. Right to Self-determination: the patient has the right
to avail any recommended diagnostic and treatment
procedures.
16. Right to Religious Belief: refusal of any medical
treatment or procedures which may be contrary to their
religious beliefs is respected.
17. Right to Leave: the patient has the right to leave the
hospital or any other health care institution regardless of their
physical condition, provided that they are informed of the
medical consequences of their decision and a waiver releasing
those involved in their care of any obligation related to the
 consequences is signed, and that public health and safety is
not compromised.

Bioethical Principles
1. Autonomy: respecting the personal liberty or freedom of an
individual to choose and implement one’s own decision.
Patients are free to select appropriate treatment without
external pressures. While nurses must correct faulty health
beliefs and practices and reinforce healthy teachings, they
must continue to respect culture, religion, or belief.
o The only exception to a withdrawal of autonomy is during
cases of emergency, where obtaining consent would
place the life in probable danger, and when there is
an implied waiver or consent— subjecting oneself to
treatment without express consent, but with no objection
or refusal.
2. Beneficence: “do good”. The acts to promote positive
changes or experiences for the patient.
3. Non-maleficence: “do no harm”. The acts to prevent negative
changes or experiences for the patient.
4. Justice: the distribution of resources between parties based on
necessity (equity) and not of external characteristics of race,
age, etc. that are not related to care. This principle is used
especially in periods of scarcity.
5. Double Effect: the principle that actions may be morally good
or at least neutral, yet produce bad effects. In such a case, the
minimization of the bad effect is done, but is otherwise allowed
to allow for the good effects to take place.
o This principle is displayed in a therapeutic abortion: the
“good” of saving the mother from death offsets the “bad”
of performing an abortion.
6. Veracity: “truth telling”. It is the obligation of the nurse to
provide full disclosure of all information related to the care of
the patient. This is backed by the Patient’s Bill of Rights (Right
to Information). This principle extends to prohibition of the
provision of fraudulent information and false
hope/reassurances.
7. Fidelity: “keeping promises”, in conjunction with veracity, is
the completion of all obligations inherent and promised in the
 care of a patient. It is the loyalty to the care of the patient and
the profession.
8. Inviolability of Life: the life of every person is respected.
Nurses must avoid all acts that will curtail, end, or endanger
one’s life.
9. Totality: the value of the “whole” is prioritized over its
individual parts, such as when an amputation is performed—
the totality of the individual is preserved with the sacrifice of
one of its parts.
10. Stewardship: the principle of taking care of those placed
in one’s care.
11. Confidentiality: privacy and anonymity of the patient,
information provided by the patient, and all relevant records is
upheld.
12. Paternalism: the interjection of another person as the
decision-maker in place of another when they are unable to
decide for themselves. This may become a negative principle
in cases where patient autonomy is interrupted, but is good for
patients who are unfit for providing healthcare decisions.
o If necessary, proxy consent may be given (in order of
priority) by (a) the parents of the patient, then (b)
their next of kin (closest relative in genealogy). In cases
of emergent necessity, the physician will sign the consent
in the best interest for the life of the patient.

Informed Consent
A consent is an agreement between parties that creates an
obligation for participating bodies. In healthcare, an example is a
contract outlining services being provided by the institution to the
patient in exchange for the patient’s financial compensation. In a
standard contract, three basic elements are required: (a)
the object, the subject of the contract— treatment, admission, etc.,
(b) the considerations, the reason for producing a contract, and (c)
the consent of the patient itself.

An informed consent, therefore, is a consent only provided once

the patient has full knowledge of the possible benefits, risks,
alternatives, costs, and other pertinent information as provided by
the physician or individual performing treatment in a way that the
individual understands. The provision of an informed consent must
be voluntary (of the individual’s own will) and must
be personal (of the individual’s own act i.e.
handwriting/signature/thumb mark).

The validity of consent can be summarized with the following

criteria (mn. VOTUM):

 Voluntary
 Opportunity to ask questions: the patient must not have
any uncertainties.
 Treatment or surgery must be explained: full disclosure of
the procedures must be given.
 Understood by patients: patients must be given an
explanation in line with their level of understanding and their
language.
 Matured both Physically (18+) and Mentally (Unaltered
LOC)

Documentation and Charting

Documentation, charting, or recording, is the act of placing patient
and care information into writing for posterity. Any care not
documented is not given, despite all testimonies. Patient charts
are legal documents and can be used to vindicate or convict
members of the healthcare team for inadequate, negligent, or
otherwise non-standard care. Good documentation follows the
following characteristics (mn. FLIP):

1. Full, Factual, and Accurate: complete, empirical, and non-

speculatory/circumstantial.
2. Legible in handwriting, syntax, and grammar.
3. Written Immediately after procedure. If late, the entry should
be specified as an addendum.
4. Personal/Confidential; documentation cannot be delegated to
those who did not perform care. The act is personal to the
nurse performing the care being documented.

Conversely, negative characteristics in documentation may be

summarized by the following (mn. LISA):
 1. Language, Jargons, or Words that are unacceptable in
medical records. Use formal, recognizable, objective language.
2. Improper Corrections: crossing out, liquid taper, etc. are not
allowed. Strikethrough: draw one or two straight lines across
the mistake and write it as an error or mistake, then date the
correction and sign.
3. Spaces and skips: do not leave spaces to avoid tampering or
addition of information. Obstruct empty spaces with lines.
4. Abbreviations are only used when recognized by the medical
community and medical terminologists.

Such documents are kept for five years after the discharge or
death of the patient. The records are kept for the following reasons
(mn. CLEARS):

1. Communication for patient’s care between the members of

the healthcare team.
2. Legal document if necessary (if a case is medicolegal in
nature, it is kept for life.)
3. Evidence for insurance claims, decision-making of the nurse,
investigations, professional liabilities, etc.
4. Assurance of Continuous Care
5. Research
6. Statistics

Medical records are owned by the hospital and as such must be

kept confidential against any unauthorized person, with its contents
only being divulged with the consent of the patient’s consent or
upon court order. Medical records are the best written evidence for
medicolegal cases. A court order demanding the release of a
document may be presented to the institution holding the record.
This is known as a subpoena duces tecum.

Last Wills and Testaments

Definition of Terms

1. Will: an act whereby a person is permitted, under the

formalities prescribed by law, to control to a certain
degree, the disposition of his estate or properties, that
will have its effect after his death.
 2. Testator: male person making a will
3. Testatrix: female person making a will
4. Last Will and Testament: a tangible instrument which
states how a testator will dispose his properties according
to law, but will take its effect after the death of said
testator.
5. Decedent: a dead person whose properties remaining at
any point of his death will be transmitted to another by
succession, whether intestate or testate (whether with a
will or none)
6. Succession: a mode of acquisition by virtue of which,
properties, rights and obligations, to the extent of the
value of the inheritance of a person are transmitted to
another through his death either by virtue of a well
(testate succession) or by operation of law (intestate
succession).
7. Testamentary Capacity: it is necessary that a testator,
at the time of making the will must have sound mind as
regards to the nature of his estate, proper objects of his
bounty, and the character of his testamentary act.

1. Notarial/Ordinary Will: it is a type of will which the testator

must sign using his usual signature at the end as well as in
every page thereof. If he cannot sign fully, he may place a
usual mark or may ask assistance from another to write his
name in his presence and express direction, provided, that the
whole act be witnessed by three or more credible witnesses
who shall also sign in each and every page of the will except at
the end part.
2. Holographic Will: the will must only be entirely written,
signed, and dated using the hands of the testator. In this case,
no witness is necessary. However, the interested party must
present any witness who has knowledge of the actual
handwriting and signature of the testator and can fully testify
that they are of the testator’s during probate of the will.

Nursing Responsibilities

1. Witnessing a Will: any person who has a sound mind

and of age 18 years old and above, not deaf, dumb, and
able to read and write, may be a witness to will. However,
 the said nurse must be ready to testify on matters that he
witnesses before the court during probate thereof.
2. Assist in the Mechanical Act of Writing the Will if
the patient cannot physically perform the said act. But
the decision on matters of disposing properties must be
coming from the patient.
3. As custodian and safe keeper of the said will,
provided that the nurse should surrender it to an
appropriate party after the death of the patient.

3. Advance Directives: a written statement made by a

competent person or a patient that states his decisions to be
followed in the event of a sudden serious illness, injury or even
death. It also appoints or designates persons authorized to
make decisions in behalf of the individual executing advanced
directives if the latter is unable to make or state his personal
decisions.
4. Living Will: a legal document signed by an individual during
the time that he is still conscious, lucid and coherent indicating
his wishes, special instructions and other specific measures to
be utilized if the patient’s ability to make decisions becomes
impaired. Discontinuing methods that can prolong life by
heroic means are also included. This is a type of advance
directive specifically for end-of-life care.
5. Durable Power of Attorney: an advance directive that
specifies an individual to make decisions on behalf of the
patient in the event that said patient becomes incompetent.
Said proxy appointed can perform all legal and health decisions
in behalf of said patient. He may also refuse a procedure in
behalf of the patient.

Medication, Drugs and Prescriptions

1. In the Philippines, nurses are generally disallowed to prescribe.
Only licensed physicians, veterinary and dental practitioners
are allowed to prescribe drugs. Any nurse who shall prescribe
medication to his/her client shall be guilty of malpractice.
2. The appropriate contents of a drug prescription include the
physician’s name, clinic address, PRC license number,
professional tax receipt number, patient’s name, age, gender,
 date of prescription, name of the drug and the frequency and
duration of its intake.
o Under R.A. 6675, The Generics Act, all drug prescriptions
must be written in its generic name and brand name or
generic name, but never its brand name alone. Drugs
poorly labeled must be sent back to the pharmacy or
dispensing unit.
3. Observe the 10 R’s of drug administration.
4. Nurses are only bound to follow drug orders only if made into
writing and signed by the physician himself to minimize errors
and doubts. Nurses may demand clarification of any written
order which may appear erroneous, doubtful or dubious.
Anything which is not put into writing and signed by the
physician is considered as not having ordered or prescribed at
all.
5. In ordinary cases, a nurse should not follow any oral or
telephone order for drug administration, except during an
emergency situation, wherein the accepting nurse demands
the ordering physician to sign his own orders immediately as
possible or within the next 24 hours. Repetition and
clarification is required during verbal orders to prevent error.
6. A nurse must be competent as regards the actions of drugs,
dosage, route, effects and side effects. Never administer an
unfamiliar drug. Treatments must be explained to the
patient. Any untoward side effects and reactions must be
reported to the appropriate person, particularly to the
prescribing physician.
7. In administering drugs using intravenous route, it is mandatory
that a nurse obtained proper training. If a nurse is not properly
trained, he may refuse said order or task so that the procedure
will be delegated to a trained IV nurse.
8. Nurses should be knowledgeable with the basic pharmacology
for safe administration of drugs prescribed.

Restraints and Detention

A patient has the right to be free from any types of restraints and
detention, except for his safety. Improper restraints and
detention may charge a nurse of illegal detention—limiting the
liberty to move or travel of another person. If a public officer (ex.
government health officer) was the one who illegally applies
restraint or detention, it shall be a cause for a charge on arbitrary
detention. Patients should be treated in the least restrictive
environment before subjecting into restraint. Restraint is always
used as a last remedy or resort, such as when a patient is already
creating a clear and present danger to himself or to others.

1. Restraint is used for a patient’s safety, not the nurse’s

convenience. If, in an emergency, restraints are applied for a
patient who is combative or unduly, the nurse must obtain a
doctor’s order immediately.
2. Documentation of a patient’s behavior, the need to continue
restraint, monitoring, and removal of restraint must be done
frequently. In America, unlawful use of restraints will result to
committing battery.

Testimonial Responsibilities in Court

The nurse may act as a witness in court for many cases. The nurse’s
responsibilities in courts or other similar forums include:

 Wear proper outfit. Maintain proper decorum at all times.

 Be prepared as regards to your personal circumstances, i.e.
name, age, nationality, address, educational attainment, etc.
 Only provide information being asked for.
 Do not volunteer any information or data which may
incriminate a nurse of any crime or demeanor.
 Consult a legal counsel before answering any question while
under oath. While testifying under oath, any falsehood stated
before the court is punishable by law as perjury.
 Be prepared with all necessary documented evidence in
relation with the case being heard, such as the patient’s
medical record, incident report, etc.
 Testify only on matters which you have a personal or direct
knowledge. Avoid using hearsay, concocted or fabricated
evidence.

Legal Doctrines Applied in the Nursing

Profession
1. Professional Negligence is defined as doing things which
a reasonable and prudent professional would not have
done or performed, or the failure to do that act which a
reasonable and prudent professional would have done in like or
similar circumstances. It is also the failure to exercise due
diligence which results in negligence.
o Immediate Cause: negligence is found in cases where
no other intervening event added to the resulting injury.
o Proximate Cause: the natural and continuous sequence,
unbroken by any new cause, that produces the event and
without which, the injury would not have occurred.
o Negligence requires (a) the existence of a duty on the
part of the person charged or sued, (b) failure or an
omission to perform said duty, (c) injury incurred as a
result of said failure or omission.
o “Res Ipsa Loquitor”, translating to “the thing that
speaks for itself” is a doctrine that proves negligence
simply by the existence of the accident in the first place.
For example, a dislocation occurring after an x-ray
procedure can establish negligence—such an injury would
not occur without mishandling or improper restraint by
the healthcare provider. These are occurrences where the
injury can only occur through negligence, and with no
external factors nor actions by the victim themself that
results in harm.
2. Malpractice is going beyond the context or scope of allowed
practice. Injury to others is not required to be charged with
malpractice. These include acts or conducts, although
performed, were made without requisite competency or
authority. Any professional misconduct or unreasonable lack of
skill or fidelity in the performance of professional or fiduciary
duties may become malpractice.
o Malpractice exists when (a) there is a standard of care
which is required by a particular profession, (b) a nurse is
required to follow said standards of care, and (c) the
nurse exceeds the limit of their authority or failed to
reach the standard expected of them.
3. Doctrine of Force Majeure/Fortuitous Event: these are
events which are unforeseen or, although foreseen, are
inevitable. Force Majeure—Acts of God—are forces of nature
beyond the control of any human being (e.g., storms,
 earthquakes, volcanic eruptions). The law itself exculpates
anyone from any liability in these events. A fortuitous event
may be an act of God or an act of man (e.g., terrorism, war,
riots) and are events that occur out of the control of those
involved, and excuses liability if it prevents someone from
fulfilling an obligation.
4. Doctrine of Respondeat Superior: “Let the master answer”.
This entails that superiors should be answerable for the acts of
their subordinate, provided that the failure of the subordinate
to use such care occurred in the course of their employment.
o Using Respondeat Superior as a doctrine requires (a) the
presence of a superior-subordinate relationship between
the two parties, (b) the task performed by the
subordinate was given by the superior, (c) an injury or
damage resulted in from said performance, and (d) the
task was performed within the knowledge of the superior.
5. Doctrine of Privileged Communication: matters and
information which are within the knowledge of a person, but
has the duty not to disclose it, except, if there be court orders
to disclose such matters. This is information, even if testified,
will not be honored in any court regardless of credibility.
o Absolutely Privileged Communication: matters
absolutely not honored in any forum due to interest of
public service and morality. For example, confessions
made by a patient to a priest while on his death bed.
o Qualified Privileged Communication: matters which
may be divulged publicly with order from the court or
other legitimate forums.
6. Captain of the Ship Doctrine: liabilities arising from a failed
surgical procedure is often tied to the head surgeon (captain)
as they are liable for the safety of both the surgical team
(crew) and the patient (passenger).
7. Borrowed Servant Relationship Doctrine: in the event that
an employee is loaned to another person or department to
perform another task, they are considered a subordinate of the
loaner.
8. Spells of Illness Doctrine: the contractual relationship
between the patient and physician will be valid during the
existence of the disease which prompted said consultation.
Any emerging new health problem entails a new contractual
relationship.
 9. Doctrine of Contributory Negligence: any contributing act
or omission accounting to negligence on the part of the patient
with concurring negligence on the part of the health
practitioner, the latter shall not be solely liable for the resulting
injury or harm.
10. Thin-Skull Patient Doctrine: despite any pre-existing
condition that makes the patient prone to harm, the medical
worker shall still be liable for the resulting negligence.
11. Doctrine of Continuing Attention: once a physician-
patient relationship is established, said obligation extends
throughout the duration of said illness which prompted the
patient to seek professional care.

Crimes Affecting the Nursing Profession

Definition of Terms

1. Felony: act or omission punishable by law.

2. Offense: crimes punishable by special laws (Dangerous
Drugs Act, Law on Anti-Violence on Women and Children)
3. Misdemeanor: minor infraction of the law; less severe
punishment than a felony.
4. Tort: act or omission that gives rise to injury (invasion of
right) or harm (causation of suffering) to another, and
amounts to a civil wrong for which courts impose liability.

According to Manner of Commission

1. Dolo (Deceit): the act was performed with deliberate intent

2. Culpa (Fault): the act resulted from imprudence, negligence,
lack of foresight, or lack of skill.

According to Stages of Execution

1. Consummated: all aspects of the crime were performed and

was successful.
2. Frustrated: all aspects of the crime were performed and was
unsuccessful.
3. Attempted: the felony began but all acts of execution were
not performed.
According to the Degree of Participation

1. Principal: those directly involved with the performance of the

crime.
2. Accomplice: those involved with the crime but are not vital to
its commission.
3. Accessory: those involved with the crime after the fact, such
as destroying evidence or paying for stolen goods.

Circumstances Affecting Criminal Liabilities

1. Justifying Circumstances: justification of the act; release of

any criminal liability.
o Self-defense or defense of others
o Damages incurred by an attempt to escape harm
o Damages incurred while exercising lawful duty or rights,
etc.
2. Exempting Circumstances: the release of punishment,
despite criminal liability.
o Imbeciles/insane individuals
o Minors (<9 years old)
o Accidents with no elements of negligence, etc.
3. Mitigating Circumstances: the reduction of punishment for
criminal liability.
o Offenders who had no intention to commit a so grave a
wrong as that committed, e.g., battery that resulted in
death
o Voluntary surrender
o Deaf and dumb, blind, or otherwise suffering, etc.
4. Aggravating Circumstances: conditions which cause an
increase in penalties imposable.
o Offenders that take advantage of positions of power to
perform crime
o Abuse of confidence or obvious ungratefulness
o Crimes performed during calamity or misfortune, etc.
5. Alternative Circumstances: conditions which may be
aggravating or mitigating.
o Intoxication of the offender may be considered a
mitigating circumstance, but otherwise aggravating if
intoxication is habitual or intentional.
Criminal Liabilities

1. Negligence: the failure to employ the expected prudence and

competence in the provision of care to a client, either through
incompetent commission of an act or through failure to
perform one’s duty.
o There must be four elements to constitute negligence: (a)
duty, (b) breach of duty, (c) resulting in injury, harm, or
death, and (d) causal relations between the breach of
duty and resulting harm.
2. Malpractice: a type of negligence that occurs when a
standard of care expected causes harm. These are actions that
cause harm (malpractice), rather than inactions that cause
harm (just negligence).
3. Assault: the threat of bodily harm that reasonably causes fear
of harm in the victim.
4. Battery: the actual painful, harmful, violent, or offensive
physical impact on another person.
5. Felony: act or omission punishable by law.
6. Offense: crimes punishable by special laws (Dangerous Drugs
Act, Law on Anti-Violence on Women and Children)
7. Misdemeanor: minor infraction of the law; less severe
punishment than a felony.
8. Tort: act or omission that gives rise to injury (invasion of right)
or harm (causation of suffering) to another, and amounts to a
civil wrong for which courts impose liability.
9. Defamation: an oral or written communication to another
person of the public that damages a person’s reputation.
o Libel: a written defamatory statement or representation
that injures a person’s reputation or exposes them to
public contempt.
o Slander: oral defamation that attempts to injure a
person’s reputation or expose them to public contempt.
10. Fraud: the use of deceit, a trick, or some dishonest
means to deprive another of his/her money, property, or a
legal right.
11. Falsification: altering, changing, modifying, passing or
possessing of a document for an unlawful purpose.
o False medical certificates, false certificates of merits or
service, etc.
o Using false certificates
12. Forgery: a type of falsification that refers to making a
false document or altering a genuine one with the intent to
defraud.
13. Impersonation: presenting oneself as a nurse without
the professional and legal requirements to do so.
14. Breaches of Confidentiality: the improper disclosure
of privileged information of a client.
15. Breaches of Anonymity: the improper disclosure of
the identity of a client.
16. Invasion of Privacy: intrusion into an individual’s
personal life or affairs, either through physical intrusion,
surveillance, or misuse of personal information (e.g., address
on the patient chart).
17. Parricide: any person who shall kill his father, mother, or
child, whether legitimate or illegitimate, or any of his
ascendants, or descendants, or his spouse.
18. Murder: the act of killing another with evident
premeditation or cruelty.
19. Homicide: the act of killing another without the
attendance of any circumstances related to murder.
20. Infanticide: the act of killing a child less than three days
of age.
21. Intentional Abortion
22. Unintentional Abortion: abortion caused by violence or
other means but unintentionally.
23. Illegal Detention: the detainment of another in any
manner that deprive him of his liberty.
24. False Imprisonment: a specific type of detention which
refers to the intentional and unlawful restraint of a person’s
movement without legal justification.
25. Simulation of Births: child substitution,
concealment/abandonment of a legitimate child.
26. Libel: a written defamatory statement or representation
that injures a person’s reputation or exposes them to public
contempt.
27. Slander: oral defamation that attempts to injure a
person’s reputation or expose them to public contempt.
28. Theft: with intent to gain, but without violence against or
intimation of person nor force upon things, shall take the
personal property of another without the latter’s consent.
29. Robbery: these persons, who with intent to gain, shall
take any personal property, belongings of others by means of
violence, force as intimidation.
30. Fraud: the use of deceit, a trick, or some dishonest
means to deprive another of his/her money, property, or a
legal right.
31. Falsification: altering, changing, modifying, passing or
possessing of a document for an unlawful purpose.
o False medical certificates, false certificates of merits or
service, etc.
o Using false certificates
32. Forgery: a type of falsification that refers to making a
false document or altering a genuine one with the intent to
defraud.
o Falsification of the Certificate of Registration
33. Impersonation: presenting oneself as a nurse without
the professional and legal requirements to do so.
34. Breaches of Confidentiality: the improper disclosure
of privileged information of a client.
35. Breaches of Anonymity: the improper disclosure of
the identity of a client.
36. Invasion of Privacy: intrusion into an individual’s
personal life or affairs, either through physical intrusion,
surveillance, or misuse of personal information (e.g., address
on the patient chart).
37. Parricide: any person who shall kill his father, mother, or
child, whether legitimate or illegitimate, or any of his
ascendants, or descendants, or his spouse.
38. Murder: the act of killing another with evident
premeditation or cruelty.
39. Homicide: the act of killing another without the
attendance of any circumstances related to murder.
40. Infanticide: the act of killing a child less than three days
of age.
41. Intentional Abortion: termination of pregnancy before
the fetus is viable. Usually occurs during the first 12-24 weeks
or 3-6 months of pregnancy.
42. Unintentional Abortion: abortion caused by violence or
other means but unintentionally.
43. Illegal Detention: the detainment of another in any
manner that deprive him of his liberty.
 44. False Imprisonment: a specific type of detention which
refers to the intentional and unlawful restraint of a person’s
movement without legal justification.
45. Simulation of Births: child substitution,
concealment/abandonment of a legitimate child.
46. Concealment or abandonment of a legitimate child
47. Giving Assistance to Suicide: punishable whether or
not the victim did not die out of the said act.

V: Nursing Research
Research is a systematic, controlled, empirical, critical investigation
and collection of data based on a certain hypothetical proposition
about its relation to a phenomena (Kerlinger); it is a formal,
systematic, and intensive process of analyzing problems through
scientific means for purposes of discovery and development of an
organized body of knowledge (Abdeilah).

 Research is systematic, controlled, empirical/evidence-

based, critical, and may be applied.

Research is used to obtain accurate and complete information

and richer familiarity about phenomena; to provide
explanations to any hypothesis based on observation of human
behavior or through experimentation; to develop a new method or
system of care to clients; to provide new knowledge and
technology to improve the delivery of health services; to
provide scientific knowledge; to provide clarifications about a certain
concept, inquiry, or theory; and to provide predictions, testing, and
control.

Ethical Considerations in Nursing Research

1. Study is based on scientific objectives or purposes, conducted
to develop not to destroy others.
2. Gain proper cooperation and informed consent. Observe the
principles of autonomy and self-determination.
3. Maintain the integrity of the researcher and his work.
4. Proper acknowledgment of the contributions of others.
 5. Protection of the basic human rights of subjects:
o Right to be free from harm
o Right to self-determination; the subject must be free
from coercion, restraint, force, or other undue influences.
Consent must be a voluntary act, and may be
withdrawn at any time.
o Right to privacy, which
involves anonymity and confidentiality.
6. Truthfulness with regards to the presentation of findings.
7. Importance and significance to the nursing profession.
8. Evidence-based practice; a factual basis and empiricism.
9. Must proceed utilizing the basic steps in the research process.
10. Maintain courage, patience, and determination to collect,
analyze, and interpret data or information.
11. As much as possible, experimental research must be free
from any human testing.

Basic Steps in the Nursing Research Process

1. Chapter I: The Problem and Its Setting
o 1.0 Introduction
o 1.1 Statement of the Problem; including historical
background
o 1.2 Problem Rationale
o 1.3 Scope and Limitation
o 1.4 Formulation of hypotheses
o 1.5 Definition of Terms
2. Chapter II: Review of Related Literature
o 2.0 The Review of Related Literature
o 2.1 Theoretical Framework
o 2.2 Conceptual Framework
o 2.3 Other Relevant Theories
3. Chapter III: Research Methodology
o 3.0 Nature of the Methodology Deployed
o 3.1 Methodological Objectives
o 3.2 Advantages and Limitations
o 3.3 Rationale
o 3.4 Sources of Data: selecting your population and
samples, determining the appropriate tool for data
collection, conducting pilot studies, and collection of data
4. Chapter IV: Presentation, Analysis, and Discussion
 o4.0 Presentation of Findings
o 4.1 Analysis and Discussion
o 4.2 Summary
5. Chapter V: Conclusion and Recommendations
o 5.0 Conclusion
o 5.1 Recommendations and Suggestions

Research Problems
A problem is any condition, situation, or inquiry requiring
solution through scientific investigation. They may be sourced
from various concepts, literature, journals, books, essays, clippings,
articles, issues affecting the health care system, experience (of the
researcher), nursing assessment, areas of practice, theories and
principles of nursing, and from curiosity. Good research problems
feature:

 Significance: the problem must be of adequate relevance and

produces an important contribution to the nursing profession.
 Feasibility/Measurability in terms of time, availability of
subjects, cooperating and consent of participants, facilities,
tools, equipment, financing, experience, and ethics.
 General Applicability and Use
 Researchable and Empirically Testable
 Novel/Original
 Clearly defined objectives/purposes

Purpose of the Study

The rationale of the researcher for conducting a study. It shows the
significance and importance of conducting a certain research study
and its probably contribution in the profession. It shows the reason
for focusing on a certain study. Research, based on purpose, may be
divided between:

1. Basic Research: research used to generate new knowledge or

ideas.
2. Applied Research: research used to solve immediate
assessed problems.

Research Variables
Variables are any characteristic or attribute of a person or an object
which may be affected by an experience, events, or phenomenon
being studied. It changes or “varies”, but basically can be measured
either quantitatively or qualitatively. They may be classified as:

1. Independent Variables: the “cause of the study”; the

variable that is manipulated in an experimental research and
greatly influences the dependent variable.
2. Dependent Variables: the “effect or response of the study”;
the variable that is being influenced by the independent
variable.
3. Extraneous/Confounding/Intervening Variables: variables
that may affect the study, but the researcher does not choose
to control.

Variables may be expressed or related in various forms:

1. Proposition: an assertion of the relationship between

concepts.
2. Construct: a set of concepts which can be subjected to
empirical testing.
3. Model: a symbolic representation of phenomena. It symbolizes
some aspects of reality, concrete or abstract, by means of
likeness which may be structural, diagrammatic, pictorial, or
mathematical (Bush, 1979).
4. Assumption: assertions which are held to be true but has not
been scientifically tested or proven. It is often merely
based on common sense or basic reasoning.

Scope and Limitations

The scope of the study determines the specific area/s covered by
the study. It should state the following:

 A brief statement of the general purpose of the study.

 The subject matter and topics studied and discussed.
 The locale of the study, where the data were gathered or the
entity to which the data belong.

The limitations of the study are constraints or restrictions on

generalizability and utility of findings that are the result of the ways
in which you chose to design the study and/or the method used to
establish internal and external validity. This may include a lack of
samples, unavailable data and literature, and other physical
impossibilities during research itself.

Definition of Terms
Terms used within the study which may require specification or are
otherwise significant may be defined by the researchers in the
definition of terms. Terms may be
defined conceptually or operationally, where the former utilizes
the usual or common definitions usually taken from the dictionary or
other common sources, and the latter is based on how the
researcher used and applied the terms in his problem or study.

Review of Related Literature

This provides the researcher an overview of the problem under
study using prior, previous, or past research findings; studies; and
data. It also:

 Provides ideas and techniques in conducting a research study.

 Determines the strengths and weaknesses of a study.
 Provides a simple background, orientation, and current status
regarding the problem.

Various literatures may be available for research, but they are

generally classified as:

1. Conceptual/Non-research Literature: mere narrations of

experience, expert’s opinions, thoughts, and theories related
to the problem.
2. Research Literature: the result of scientific investigations,
studies, and actual research done and published along the
problem area. It may be found using library/index or computer
search.

Research Concepts and Frameworks

A concept is a single abstract thought representing two or more
interrelated ideas. It serves as the building blocks of a theory.
A conceptual framework is a structural and diagrammatically
presented set of relationships between concepts, and is referred to
as a paradigm.

A theory is a tentative relationship between concepts and

phenomena. These describe or explain the relationships of two or
more concepts, and are mere abstractions of processes,
interactions, and observations (Fawcett); a set of interrelated
concepts, definitions, and propositions that presents a systematic
view of phenomena by specifying the relationship among variables,
with the purpose of explaining and predicting a phenomena
(Kertinger, 1973). A theoretical framework is a general
explanation of a problem under study utilizing existing, established,
or well-defined theories.

Research Hypotheses
A hypothesis is a tentative statement, prediction, or
explanation of a supposed answer based on a presumption
about the relationship between two or more variables.

1. Null/Statistical Hypothesis: a type of hypothesis that shows

or predicts no relationship or difference that occurs between
a variable to another variable.
2. Research/Alternate Hypothesis: states an expected
relationship between variables.
3. Simple/Univariate/Operational Hypothesis: a type of
hypothesis that shows an anticipated relationship or difference
between a single independent variable to a single
dependent variable.
4. Complex/Multivariate Hypothesis: a type of hypothesis that
states the anticipated or predicted relationship between two
or more independent variables to two or more
dependent variables.
5. Directional Hypothesis: a type of hypothesis that specifies
a precise direction of the relationship between variables.
6. Non-Directional Hypothesis: a type of hypothesis
that shows no specific direction of the
relationship between variables.

Research Design
A study’s design is the systematic and controlled plan on how the
study will be conducted. It servers as the roadmap, skeletal
framework or the blueprint in research.

Based on existing knowledge, research design may be

1. Exploratory Studies: done to gain richer familiarity for

phenomenon which has less or few existing information or data
available.
2. Descriptive Studies: done to study the relationship between
variables in a known phenomenon; it studies the relationship
and characteristics of a particular subject in a certain
phenomena as it naturally happens (Brink and Wood, 2001)
3. Explanatory Studies: helps provide basic explanations about
the relationships between phenomenon.

Based on the setting or environment, research design may be

1. Clinical Setting: often more controlled.

2. Field Study: ordinary setting where subjects naturally exist.

Based on the type of data collected, research design may be

1. Quantitative Research: a type of research whose result can

be determined by objectivity, senses, and other empirical
methods. This study is usually measurable, single reality, and
can be subjected to statistical analysis based on numerical
data.
o Experimental and non-experimental designs
2. Qualitative Research: a type of research that focuses on a
subject’s subjective insights and values about given facts, i.e.,
perceptions, understanding, emotions, feelings, behavior, etc.
These focus more on words than numbers. Data
is represented in thematic or narrative forms.
o Historical studies, case studies, phenomenological
studies, ethnographic studies, ethnography, and
grounded theory
3. Mixed/Triangulation Research: a combination of
quantitative and qualitative research.

Experimental Research
In this design, researchers try to manipulate or control the
independent variable to reproduce a certain effect (on the
dependent variable). It is mainly concerned with the “cause and
effect” relationship. Some “True Experimental Designs” are Pretest-
Posttest Control Group Design, Posttest Only Control Group, and the
Solomon Four-Group Design. Experimental research has the
following features:

1. Manipulation: the researcher intervenes with the subject

under study.
2. Control: the researcher uses a certain system or condition to
control the investigation or study
3. Randomization of Samples: samples are acquired and
segregated as control or experimental groups.
4. Measurement/Validation of results

Quasi-experimental Studies
These are experimental research designs which may be missing
some of the features listed above. Usually, there is no control or
comparison group because participants are not randomized.

Various phenomenon may affect the validity of the research:

1. Hawthorne’s Effect: changes in behavior attributed to the

knowledge of being under study.
2. Halo Effect: specific attributes, whether positive or negative,
produce an assumption for other, non-related attributes that
the researcher may falsely observe, e.g. good appearance
does not constitute good decorum, but the latter may be
implied by the former, even if not specifically observed.
3. Experimenter’s Effect: the researcher’s own beliefs,
principles, and values seep into the outcome of the research.
4. Reactive Effect of the Pretest: the pretest effects the
participants’ actions for the posttest, which produces an
imbalance in behavior between tests.
5. Selection Effect: a lack of randomization in assigning
participants introduces bias.
6. History Effect: events that occur outside of the study affect
the behavior of the participants under study, such as economic
changes.
 7. Maturation: the participants of the study mature and change
during the study, and the findings become altered as a result.
8. Attrition Effect: the result is altered by participants that drop-
out of the study; the final sample may no longer be
representative of the population.
9. Instrumentation: the result is affected by changes in
calibration of the instruments and equipment used between
periods of measurement.

Non-experimental Research

Samples are not subjected to any burdensome control or

manipulation. They can easily cooperate for these types of research,
and the researcher is not concerned with the cause-and-effect
phenomenon.

1. Historical Approach: a type of research based on past

events, primarily utilizing pre-existing data such as journals,
records, and similar sources or the subjects themselves,
merely recalling some past occurrences. Sources may be
sources or secondary.
2. Survey Studies: the utilization of mass/large/smaller groups;
whether mailed, face-to-face, or through telephone; and
simultaneously between groups (cross-sectional) or
longitudinal (successive surveys for a single group).
3. Comparative Studies: contrasting studies in relation to
particular variables or phenomenon being studied. There are
two types:
o Retrospective Design: a study done “ex post facto”;
after-the-fact. The researcher usually selects subjects
who have undergone some related experience in the past
and attempts to let them describe its relationship with a
present study or investigation.
o Prospective Design: a study done at the present, but
where the study is consummated in any future time or
upon the happening of a future event or occurrence which
is certain to happen. The subjects are followed and
observed for a period of time.
4. Correlational Studies: a study to determine the strength of
relationships among variables in a particular subject. This often
utilizes statistical analysis.
Qualitative Research Studies

1. Case Study/Case Analysis: research data is taken and

analyzed on a certain focus group, institution, or single subject
only. This is a type of subject that focuses on a smaller number
of subjects, making the design costly and time-consuming.
2. Ethnographic Studies: data are collected and analyzed
coming from a certain cultural group or minority.
3. Grounded Theory Studies: studies leading to the discovery
or development of useful theories.
4. Phenomenological Studies: data based on described human
experiences, provided by the very same people involved.
5. Field Studies: studies naturally conducted in an ordinary
setting, such as in a community.

Population and Sample

 A population is a general group to be studied.
 A sample refers to a selected portion of the population from
whom the data will be collected.
 An element is an individual member of the sample population.
 The sampling frame is the listing of all elements.

Samples may be chosen in various ways to improve its

representation of the population:

1. Simple Random Sampling: every element of the population

is given an equal chance or opportunity to be chosen as a
sample. No bias.
2. Stratified Random Sampling: done by first dividing the
population into sub-strata or sub-populations according to
some subject character (e.g. age), then applying random
sampling from each sub-strata or sub-population.
3. Systematic Random Sampling: involves utilizing some
method to choose from the population randomly, most
commonly selecting every nth element from the population.
4. Cluster Random Sampling: sampling by sub-areas of the
population, applicable if a population is spread geographically.
5. Accidental/Convenience Sampling: a non-probability
sampling technique that involves choosing samples from
readily available groups accessible to the researcher.
 6. Purposive/Judgmental Sampling: a non-probability
sampling technique that involves choosing elements based on
common knowledge or as a typical choice.
7. Snowball Sampling: a non-probability sampling technique
where the researchers use networking or referrals from
previous elements to acquire more data, e.g. referrals of one
cancer patient to a fellow cancer patient who underwent the
same treatment.
8. Quota Sampling: a non-probability sampling technique where
the population is divided into subpopulations, and chosen
based on “other” personal criteria instead of random sampling.

Data Collection
Data collection is the stage in the research process wherein the data
is actually collected or received from subjects to ascertain the
veracity of the researcher’s hypothesis and shall form the basis of
the researcher’s conclusion. Among all of the stages of the research
process, it is often the most budget and time-consuming. Good data
collection is based on three characteristics:

1. Reliability: if tested once or twice, the data will likely yield

the same result.
2. Validity: the test measures what it is meant to measure. This
includes face validity, content validity, and construct validity.
3. Accuracy: measurements are accurate and truthful.

Methods of data collection vary depending on requirements and

resources:

1. Questionnaires: among the most accessible forms of data

collection. These may be:
o Dichotomous: Yes-No or True-False questions
o Rating Scale: choices are categorized and subjects
answer according to the criteria, most often utilizing a
Likert scale. One example is a scale of 1 to 5, with 1 as
“Never” and 5 as “Very Frequently”.
2. Observation: data collection using one’s senses. It is an
ocular method of collecting descriptive behavioral data as it
occurs.
 o Participant Observation: the observer actively joins the
subject while performing observation.
o Non-Participant Observation: the researcher is a mere
passive observer during data collection.
o Structured Observation: the researcher prepares a
pre-determined list of phenomenon to observe for.
o Non-Structured Observation: free-style observation.
3. Interview: the utilization of oral communication skills between
the researcher and his source to obtain data. It may be:
o Structured: a list of specific questions are asked in the
same manner to all respondents.
o Unstructured: informal and open-ended questions are
being asked. A simple, normal conversation.
o Combined Method (Semi-structured)
4. Pre-existing data or Record: data is collected from previous
recordings, published, archives, or documented. It may be:
o Primary: recorded by a source who actually experienced
and observed a phenomena.
o Secondary: second-hand information.
5. Others: Q-Sort, Projective Techniques, Delphi Technique,
Physiologic Measures, Visual Analogue Scale (VAS Technique)

Sources of Evidence in Nursing Practice (mn. TALES)

1. Traditions: practices and beliefs that have been retained

for long periods of time. The “norm”.
2. Authority: experts and organizations that procure new
practices, improve current practices, and declare old
practices as suboptimal.
3. Logical Reasoning
4. Experiences
5. Scientific Method (Research)

Backlinks

 Fundamentals of Nursing (Ritchel Acuna)

 Professional Nursing Practice, Ethics, and Jurisprudence
 ⭐ Competency Appraisal
 Nursing Leadership and Management (Luansing)
 Ethical, Legal, and Quality Considerations in Critical Care
Nursing
  Standards and Documentation in Psychiatric Nursing Practice
 Introduction to Nursing Leadership and Management
 Care Bundles for Quality and Safety

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