MODULE I: OBLIGATION OF PROFESSIONAL

What is a Profession?
A profession is an occupation that requires
 extensive training and the study and mastery of specialized knowledge,
 a professional association and follow an ethical code,
 a process of certification or licensing.

Essential characteristics of a profession

I. Competence in a specialized body of knowledge
o Extensive training and the study; and
o Mastery of specialized knowledge
II. The provision of a particular service to society;
III. Standard of education and practice;
o Has a process of education, certification or licensing (Philippines: BSN requirement and
National Licensure Examination)
IV. Self-Regulation;
o Regulated by Law
o Professional association and follow an ETHICAL CODE

Characteristics of nursing as a profession

 Humanistic caring, nurturing, comforting and supporting (field of service on nursing)
 It requires education, training, mastery of the field
 It follows a Code of ethics (RA 9173- Philippine Nursing Act)
 Has an informed membership (determine by a professional association)
 Members are accountable for their action

Ethics
Standards of right and wrong that prescribe what human ought to do, usually in terms of
rights, obligation, benefits to society, fairness, or specific virtues

Importance of Health Care Ethics

Health care professional groups generally operate under practice act that outlines the
activities the providers perform in the delivery of patient care and develop a code of ethics to
assist in self-regulation. In addition to set statements listing minimal criteria for ethical
performance, codes usually included a section outlining the profession’s mission and objectives.
Code of ethics have, as a purpose, the binding together of a group of practitioners and expressing
the aims and aspiration of that group. They speak to our better selves in the area of personal
integrity, dedication, and principled behavior. In regards to clients and patients, practitioners
have fiduciary relationship, which requires them to act primarily in the best interest of those they
serve.

To enter the practice of health care provision, whether you are a doctor, nurse, or allied
health specialist, is to enter into a social compact not only with the patients you serve but with all
other practitioners and the community at large. The honoring of this compact will require a
commitment to excellence in clinical practice and a commitment to set of appropriate legal,
ethical, and professional etiquette behaviors. Most often we think of professional competence in
terms of clinical skills. It is our command of these skills that is adjudged and graded as we
prepare ourselves for entry into the profession.

Professional Etiquette
A significant part of a profession’s self-regulation is our professional code of ethics, which
attempt to provide guidance and regulate the conduct of practitioner within a specialty. However,
most professional codes are vague and incomplete as the duties and prohibitions. It will be a rare
exception when a practitioner involved in a health care dilemma can find the correct answer by

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just reading the professional code, although it is not a bad place to start the search. The
professional etiquette requirements of our roles in health care are usually based on the traditions
of good practice and good manners.

Health Care Ethics

Health care ethics are designed to promote order and maintain civility. Ethical questions
reside in the realm of our values, morals, individual culture intense personal belief, and faith. To
gain clearer understanding between morals and ethics we might consider the distinction offered
by the ethicist Joseph Fletcher, who stated that “morality was what people believed to be right
and good … while ethics the critical reflections about morality and the rational analysis of it”
Ethics, then, is nothing more than a generic term for the study of how we make judgment in
regard to right and wrong.

Nursing Ethics
Simply means the study of ethics and moral conduct in the practice of nursing. It does not
purely mean a good moral behavior or point out how to make a good moral decision regarding
human health-- it is the critical reflections about morality and the rational analysis of it. Nurses
are in the midst of unending searches for truth, right and perfection in the practice of nursing.

Evolution of Ethics in Nursing Practice

1. The changing Philosophy of health care with its increasing emphasis on the principle of
personal autonomy
2. The changing philosophy of nursing with emphasis on patient-oriented care;
3. The revolution of nursing profession as distinct from medicine

Code of Ethics for Nurses in the Philippines was devised as a guide for carrying out nursing
responsibilities which would tackle difficult issues and decisions that a profession might be
facing, and give clear instruction of what action would be considered ethical or right in the given
circumstance.
The Code of Ethics for Registered Nurses in the Philippines is promulgated by the Board of
Nursing (BON) and was consulted with accredited professional organizations like the Philippine
Nurses Association. It also coincides with the ideals of Republic Act No. 9173 or the “Philippine
Nursing Act of 2002.”
The Code of Ethics for Filipino Nurses was made after a consultation on October 23, 2013 at
Iloilo City after accredited professional organizations decided to adopt a new Code of Ethics
under the RA 9173.
CODE OF ETHICS FOR NURSES

WHEREAS, the Board of Nursing (BON) has the power to promulgate a Code of Ethics for
Registered Nurses in coordination and consultation with the accredited professional organization
(Sec. 9, (g), Art III of (Republic Act) No. 9173, known as the “Philippine Nursing Act of 2002);

WHEREAS, in the formulation of the Code of Ethics for Registered Nurses, the Code of Good
Governance for the Professions in the Philippines was utilized as the principal basis thereof: All
the principles under the said Code were adopted and integrated into the Code of Ethics as they
apply to the nursing profession;

WHEREAS, the promulgation of the said Code as a set of guidelines, regulations or measures
shall be subject to approval by the Commission (Sec. 9, Art. II of R.A. No. 9173); and

WHEREAS, the Board, after consultation on October 23, 2003 at Iloilo City with the accredited
professional organization of registered nurses, the Philippine Nurses Association, Inc. (PNA),

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and other affiliate organizations of Registered Nurses, decided to adopt a new Code of Ethics
under the afore-mentioned new law;

NOW, THERFORE, the Board hereby resolved, as it now resolves, to promulgate the hereunder
Code of Ethics for Registered Nurses:

ARTICLE I
PREAMBLE
SECTION 1.
Health is a fundamental right of every individual. The Filipino registered nurse, believing in the
worth and dignity of each human being, recognizes the primary responsibility to preserve health
at all cost. This responsibility encompasses promotion of health, prevention of illness,
alleviation of suffering, and restoration of health. However, when the foregoing are not possible,
assistance towards a peaceful death shall be his/her obligation
.
SECTION 2.
To assume this responsibility, registered nurses have to gain knowledge and understanding of
man’s cultural, social, spiritual, physiological, psychological, and ecological aspects of illness,
utilizing the therapeutic process. Cultural diversity and political and socio-economic status are
inherent factors to effective nursing care.

SECTION 3.
The desire for the respect and confidence of clientele, colleagues, co-workers, and the members
of the community provides the incentive to attain and maintain the highest possible degree of
ethical conduct.
ARTICLE II
REGISTERED NURSES AND PEOPLE
SECTION 4.
Ethical Principles

1. Values, customs, and spiritual beliefs held by individuals shall be respected.

2. Individual freedom to make rational and unconstrained decisions shall be respected.
3. Personal information acquired in the process of giving nursing care shall be held in
strict confidence.

SECTION 5.
Guidelines to be observed:
REGISTERED Nurses must

1. consider the individuality and totality of patients when they administer care.
2. respect the spiritual beliefs and practices of patients regarding diet and treatment.
3. uphold the rights of individuals.
4. take into consideration the culture and values of patients in providing nursing care.
However, in the event of conflicts, their welfare and safety must take precedence.

ARTICLE III
REGISTERED NURSES AND PRACTICE
SECTION 6
Ethical Principles

1. Human life is inviolable.

2. Quality and excellence in the care of the patients are the goals of nursing practice.
3. Accurate documentation of actions and outcomes of delivered care is the hallmark of
nursing accountability.

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SECTION 7.
Guidelines to be observed:
REGISTERED Nurses must

1. know the definition and scope of nursing practice which are in the provisions of R. A.
No. 9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425,
Series of 2003, the “Rules and Regulations Implementing the Philippine Nursing Act.
of 2002”, (the IRR).
2. be aware of their duties and responsibilities in the practice of their profession as
defined in the “Philippine Nursing Act of 2002” and the IRR.
3. acquire and develop the necessary competence in knowledge, skills, and attitudes to
effectively render appropriate nursing services through varied learning situations.
4. if they are administrators, be responsible in providing favorable environment for the
growth and developments of Registered Nurses in their charge.
5. be cognizant that professional programs for specialty certification by the BON are
accredited through the Nursing Specialty Certification Council (NSCC).
6. see to it that quality nursing care and practice meet the optimum standard of safe
nursing practice.
7. insure that modification of practice shall consider the principles of safe nursing
practice.
8. if in position of authority in a work environment, be normally and legally responsible
for devising a system of minimizing occurrences of ineffective and unlawful nursing
practice.
9. ensure that patients’ records shall be available only if they are to be issued to those
who are professionally and directly involved in their care and when they are required
by law.

SECTION 8.
Ethical Principle

1. Registered Nurses are the advocates of the patients: they shall take appropriate steps
to safeguard their rights and privileges.

Guidelines to be observed:
REGISTERED Nurses must

1. respect the “Patients’ Bill of Rights” in the delivery of nursing care.

2. provide the patients or their families with all pertinent information except those which
may be deemed harmful to their well-being.
3. uphold the patients’ rights when conflict arises regarding management of their care.

SECTION 9.
Ethical Principle

1. Registered Nurses are aware that their actions have professional, ethical, moral, and
legal dimensions. They strive to perform their work in the best interest of all
concerned.
SECTION 10.
Guidelines to be observed:
REGISTERED Nurses must

1. perform their professional duties in conformity with existing laws, rules

regulations, measures, and generally accepted principles of moral conduct and proper
decorum.
2. not allow themselves to be used in advertisement that should demean the image of the
profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.).

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 3. decline any gift, favor or hospitality which might be interpreted as capitalizing on
patients.
4. not demand and receive any commission, fee or emolument for recommending or
referring a patient to a physician, a co-nurse or another health care worker; not to pay
any commission, fee or other compensations to the one referring or recommending a
patient to them for nursing care.
5. avoid any abuse of the privilege relationship which exists with patients and of the
privilege access allowed to their property, residence or workplace.

ARTICLE IV
REGISTERED NURSES AND CO-WORKERS
SECTION 11.
Ethical Principles

1. The Registered Nurse is in solidarity with other members of the healthcare team in
working for the patient’s best interest.
2. The Registered Nurse maintains collegial and collaborative working relationship with
colleagues and other health care providers.

SECTION 12.
Guidelines to be observed:
REGISTERED Nurses must

1. maintain their professional role/identity while working with other members of the
health team.
2. conform with group activities as those of a health team should be based on
acceptable, ethico-legal standards.
3. contribute to the professional growth and development of other members of the health
team.
4. actively participate in professional organizations.
5. not act in any manner prejudicial to other professions.
6. honor and safeguard the reputation and dignity of the members of nursing and other
professions; refrain from making unfair and unwarranted comments or criticisms on
their competence, conduct, and procedures; or not do anything that will bring
discredit to a colleague and to any member of other professions. PRC-BN
7. respect the rights of their co-workers.

ARTICLE V
REGISTERED NURSES, SOCIETY, AND ENVIRONMENT

SECTION 13.
Ethical Principles

1. The preservation of life, respect for human rights, and promotion of healthy
environment shall be a commitment of a Registered Nurse.
2. The establishment of linkages with the public in promoting local, national, and
international efforts to meet health and social needs of the people as a contributing
member of society is a noble concern of a Registered Nurse.

SECTION 14.
Guidelines to be observed: REGISTERED Nurses must

1. be conscious of their obligations as citizens and, as such, be involved in community

concerns.
2. be equipped with knowledge of health resources within the community, and take roles
in primary health care.

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 3. actively participate in programs, projects, and activities that respond to the problems
of society.
4. lead their lives in conformity with the principles of right conduct and proper decorum.
5. project an image that will uplift the nursing profession at all times.

ARTICLE VI
REGISTERED NURSES AND THE PROFESSION
SECTION 15.
Ethical Principles:

1. Maintenance of loyalty to the nursing profession and preservation of its integrity are
ideal.
2. Compliance with the by-laws of the accredited professional organization (PNA), and
other professional organizations of which the Registered Nurse is a member is a lofty
duty.
3. Commitment to continual learning and active participation in the development and
growth of the profession are commendable obligations.
4. Contribution to the improvement of the socio-economic conditions and general
welfare of nurses through appropriate legislation is a practice and a visionary mission.

SECTION 16.
Guidelines to be observed:
REGISTERED Nurses must

1. be members of the Accredited Professional Organization (PNA).

2. strictly adhere to the nursing standards. PRC-BN
3. participate actively in the growth and development of the nursing profession.
4. strive to secure equitable socio-economic and work conditions in nursing through
appropriate legislation and other means.
5. assert for the implementation of labor and work standards.

ARTICLE VII
ADMINISTRATIVE PENALTIES, REPEALING
CLAUSE, AND EFFECTIVITY

SECTION 17.
The Certificate of Registration of Registered Nurse shall either be revoked or suspended for
violation of any provisions of this Code pursuant to Sec. 23 (f), Art. IV of R. A. No. 9173 and
Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR.

SECTION 18.
The Amended Code of Ethics promulgated pursuant to R. A. No. 877 and P.D. No. 223 is
accordingly repealed or superseded by the herein Code.

SECTION 19.
This Code of Ethics for Nurses shall take effect after fifteen (15) days from its full and complete
publication in the Official Gazette or in any newspapers of general circulation.
Done in the City of Manila, this 14th day of July, 2004.
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Law and Ethics

The Foundation of Law

Even in his own time, Plato understands on the process where disputes were settled by
authorities using written laws. These laws were to be applied without regard to the circumstances
of the individual involved. It is from this neutral application of law that we take tradition of a
“rule of law and not of men”. Accordingly, each man is to be judged equally under the law. Law,
in its generic sense, is a body of rules of action of conduct prescribed by controlling authority
and having binding legal force. In some sense, law can be considered the minimum standard of
expected performance between individual in the society. To ensure that practitioners abide by the
lowest standards, many codes of professional ethics contain rules that require us to stay within
the law in our professional conduct. Fortunately, obligation of law and ethics are closely aligned
with ethical obligation typically exceeding duties.

Fundamental Principles of Law

o A concern for justice and peace
o Plasticity- although seemingly complete and solid, law is a shifting process that reacts
to its environment.
o Acts are judged on the universal standards of the reasonable person- what would a
similarly trained, reasonable, and prudent person have done in that particular
situation?
o Doctrine of Individual Rights and Responsibilities- failure to meet one’s
responsibilities affects one’s rights. Every person is liable for his or her own actions.

Common Misunderstanding about the Nature of Law

A. There is a feeling that law is all inclusive and that if you need a legal determination, all
you need to do is apply the correct legal precedent.
o In fact, law is incomplete and always growing. This is especially true in areas
such as health care practice, each day, scientific and medical advances create new
environments that have yet to be explored by law.
o Example: Do clones have human rights?

B. The belief that if one does this, the law will do that is misunderstanding based on the idea
that the law is prescriptive and certain.
o In fact, there are areas where we have no previous legal ruling, and even where
we have legal precedence to guide us, growth and change occur.
o Example: young teenager arrested in a DWI accident where several individuals
died, who received probation based on his “Affluenza,” a previously unknown
medical term/legal term

C. The final misunderstanding is that the law tells you what to do.
o In most cases, it is wise to view the law as a guide to proper behavior, yet it would
be mistake to confuse legal and ethical behavior.
o Example: there was a time when the use of contraceptives is illegal in some
jurisdiction, yet current society in general has come to believe, and the law has
followed, that the decision to control one’s own reproduction seems appropriate.

MODULE I: OBLIGATION OF PROFESSIONAL

LESSON LEARNING OUTCOME: Apply major concepts of

nursing as an art and science to identify health needs and nursing
care demand s and issues in a given health and/or nursing care
situations 7
Enabling Lesson Learning Outcome

You, as the learner, are expected to do the following:

1. list four essential characteristics of a profession;

2. list the essential characteristics of nursing as a profession;
3. illustrate the importance of health care ethics;
4. show the three basic principle and three basic common misunderstanding regarding the
nature of law:

KEY CONCEPT: Health care ethics, bioethics, professional ethics

Enabling Lesson Learning Outcome 1: List four essential characteristics of a
profession;
Read: PROFESSION: the word implies professed attainments in special knowledge, as
distinguished from a mere skill. Members acquired special knowledge, by training or by
experience or both, so that they may guide or advice or serve others in that special field.
Profession is an occupation usually involving relatively long and specialized preparation on the
level of higher education and governed by its own professional code and code of ethics. While a
profession is a means of livelihood, and the professional man needs and is justified in demanding
compensation which will permit him to maintain a comfortable living, to perform his work well,
and to contribute enterprise, the ideal of the profession, however is public service, not monetary
gain.

Instruction: From the above brief narrative about profession, write the essential requisites of
profession and immediately below each requisite, write the statement or phrase in above the
narrative that rightly conform to the identified requisite.

I. _______________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
II. ________________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
III. ________________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
IV. _________________________________________________________

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 ____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

KEY CONCEPT: Health care ethics, bioethics, professional ethics

Enabling lesson Learning Outcome II: List four essential characteristics of nurse as a
profession;

Instruction: Answer the question on the space provided.

I. What is the specialized body of knowledge and skills in nursing profession?

______________________________________________________________
II. What is the particular service of nursing profession to the society?
______________________________________________________________
III. What is the standard of education and practice of the nursing profession?
______________________________________________________________
IV. What Philippine law primarily regulates the practice of nursing?
______________________________________________________________
V. Write the four essential characteristics of a profession.
a. __________________________________________________
b. __________________________________________________
c. __________________________________________________
d. __________________________________________________
VI. What are the nursing attributes other than clinical skills?
a. __________________________________________________
b. __________________________________________________

Key Concept: Health Care Ethics

Enabling Lesson Learning Outcome III: Illustrate the importance of health care ethics

Read: Jim Sullivan in his early thirties comes to Dr. Tom’s office for a routine exam in
conjunction with a new job. Dr. Tom starts taking the history. It is obvious that Mr. Sullivan is
grossly overweight. He tells the physician that he does not get any exercise, smokes two packs of
cigarettes a day, and has done so since he was fourteen. He drinks a lot and generally does not
take very good care of himself. Dr. Tom feels he should encourage his patients to change his
lifestyle. He realizes that he is not very likely to change anything simply by telling the patient
that he should not drink as much and should quit smoking. This is a man who is not likely to take
up an exercise routine simply because this physician says so.

Dr. Tom contemplates another approach. He decided to do a chest x-ray, suspecting that
some opacity will appear that will do the trick. He sees nothing terribly alarming on the x-ray.
But notices some spots that would serve his purpose: to shock his patient into changing his
lifestyle. With an air of great alarm he brings the x-ray to his patient saying that the spots
indicate precancerous developments. He says that if Mr. Sullivan stops smoking now, there is
good chance that he can stop this development. But if he keeps smoking he is headed for lung
cancer. Intentionally overstating, Dr. Tom rationalizes that it is true that Sullivan’s chances of
developing cancer is higher in continues to smoke, and that is an innocent, benevolent stretching
of the truth to point to the meaningless spots and exaggerate the probability that the smoking

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would cause cancer. He believes that overstating the risk will benefit his patient. It is the only
thing he can think of that will shock him into a new lifestyle.

1. Is the action of Dr. Tom correct? Start your answer with Yes or No and briefly and
ethically support your answer.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________
2. If your answer is No, what is the best action of Dr. Tom towards Mr. Sullivan? Briefly
and ethically justify your answer.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Rubric:

Unacceptable 0 Marginal 1 Acceptable 2 Exceptional 3 Points

Able to analyze Student show no Student appear to Student demonstrate Student is able to
a situation for awareness of be aware of some understanding of analyze a complex
potential ethical potential ethical ethical problems in major ethical ethical situation and
problems problems in their case study but are problem in the case demonstrate an
response to the not using study and are understanding of
case study appropriate applying the major and subtle
tool/principle to tools/principle they problem/s in the case
analyze the have learned to study
problem analyze the situation
Awareness of No evidence that Student appear to Student is aware of Student is aware of
Code of Ethics the student is aware of the Code the Code of Ethics the code of ethics or
or ethical aware of the Code of Ethics or ethical or ethical principles ethical principles
principles of Ethics or ethical principles but is and use it to when and use it routinely
principles not making use of faced with a to work in a
it as he/she potentially unethical professional and
approach ethical situation ethical manner
problem
Awareness of No evidence that The response to The response to the The student
their the student the case study case study indicates demonstrates ethical
responsibility to considers ethics or indicates that the that the student is and professionalism
work in an professionalism as student do not aware that he/she in his/her response/s
ethical and he/she consider the fully understand have responsibility to the case study
professional case study what it means to to work in an ethical
manner work in an ethical and professional
and professional manner.
manner

3. Illustrate by giving a situational example that shows the importance of ethics in the field
of medical/nursing practice.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________.

Exceeds Meets Does Not Meet

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 3 2 1
Ideas Main Idea is clear Main Idea is stated State the main idea then
Supporting details are clear Some supporting details goes off the topic
Very specific information Some information id left out
Organization Clear introduction, body Introduction body and conclusion No organization
and conclusion Generally clear sequence of events Not readable
Logical sequencing of
events
Style Precise words Some precise words Confusing use of words
Different length of Some words are boring What is being said is not
sentences clear
Engaging
Convention Complete sentence Some error in sentences, punctuation, Many errors
Correct punctuation spelling or grammar Difficult to read
Correct spelling
Correct grammar

Key Concept: Health Care Ethics

Enabling Lesson Learning Outcome IV: show the four basic principles and three basic
common misunderstandings regarding the nature of law;

What are the four Fundamental Principles of Law?

1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________
Read:
To each person an equal share;
To each person according to the need;
To each person according to effort
Patient right to privacy and confidentiality
Patient right to information
Health is a fundamental right of every individual.
The primary responsibility to preserve health at all cost.
Assistance towards a peaceful death shall be his/her obligation

Instruction: From the above list, write the fundamental principle of law and immediately below
thereof, write which statements or phrases from the list conformed to the identified fundamental
principles of law.

I. _______________________________________________
__________________________________________
__________________________________________
__________________________________________
II. _______________________________________________
__________________________________________
__________________________________________
__________________________________________
III. _______________________________________________
__________________________________________
__________________________________________
__________________________________________
IV. _______________________________________________
___________________________________________
___________________________________________

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 ___________________________________________

Sources:

Ethics of Health Care

A Guide for Clinical Practice
Fourth Edition
Raymond S. Edge
J. Randall Groves

Basic of Bioethics
Second Edition
Robert M. Veacth

Philippine Nusrsing law, Jurisprudence and Ethics

13th Edition
Gonzalo S. Robles
Anesia B. Dionisio

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