•
Nurse as Educator: Chapter 2
• Although physician is primarily held accountable for prescribing
meds, patient education falls to the nurse
• Federal government got in control of overseeing medical practice
because in the mid-20th century abuses of human rights were
discovered
A Differentiated View of Ethics, Morality and the Law
• Nurses should inform the patients the following:
o Medical diagnosis
o Treatments available
o Expected outcomes of the possible treatments
• Ethical principles pertaining to human rights are based on natural
laws
o Respect for others, truth telling, honesty and respect for life
• Deontology – ethical belief system that stresses the importance
of doing one’s duty and following the rules
• Ethics – guiding principles of behavior
o Ethical – norms or standard behavior accepted by society
which a person belongs
• Moral Values – internal belief system, what one believes is right.
Morality is often expressed through a person’s behaviors
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Ethical Dilemmas – specific type of moral conflict which two or
more ethical principles apply but support mutually inconsistent
course of action
• Legal Rights and Duties – rules governing behavior or conduct
that are enforceable by law under threat of punishment, penalty
(ie: fine, imprisonment)
o Relationship between ethics and law produces such
terminology:
▪ Informed consent, confidentiality, non-maleficence,
and justice
• Practice Acts – documents that define profession, describe the
profession’s scope of practice, and provide guidelines for state
professional boards of nursing regarding standards for practice,
entry into a profession via licensure, and disciplinary actions when
necessary.
o Purpose: to protect the public from unqualified
practitioners and to protect professional title (ie; registered
nurse, occupational therapist, respiratory therapist, physical
therapist)
o Model Practice Act – template for individual states to
follow to minimize variability of professional practice
Evolution of Ethical and Legal Principles in Health Care
• Nursing was before a charity or humanitarian acts of people
o Provided by religious communities
• Physicians and nurses were called as good Samaritans – who
acted in good faith for the most part and were exempt from
lawsuits
• Informed consent – basic tenet of ethical practice of health care,
every adult of sound mind has a right to protect his or her own
body and to determine how it shall be treated
• Code of Ethics for Nurses with Interpretative Statements –
professional values and moral obligations with respect to nursepatient relationship and profession and its mission
o Honor human dignity of all patients and coworkers
o Establish appropriate nurse-patient boundaries, and
focus on interdisciplinary collaboration
•
o Nurse-patient relationship is grounded in privacy and
confidentiality
o Nurse is accountable for personal actions and behaviors
of those persons to whom the nurse has delegated
responsibilities
o Nurse is responsible for maintaining competence,
preserving integrity and safety, and continuing personal
growth
o Nurse has a responsibility to deliver high-quality care to
patients
o Nurse contributes to the advancements of profession
o Nurse participates in global efforts for both health
promotion and disease prevention
o Involvement in professional nursing organizations
supports the development of social policy
Patient’s Bill of Rights
o Communication with healthcare team, treatment, medical
records, privacy and confidentiality
Application of Ethical Principles to Patient Education
• Autonomy – right of self-determination
o It is the nurse’s responsibility to ensure informed decision
making by patients and this includes;
▪ Living wills, durable power of attorney for health
care, designation of a healthcare agent
o Although patient education is not part of the principle of
autonomy it lends credence to the ethical notion of
assisting public to attain greater autonomy when it comes
to health promotion and high-level of wellness
o Another example are decision aids which helps patients in
making informed treatment choices. It includes;
▪ Printed materials, videos, interactive web-based
tutorials
▪ Information about specific health issues, diagnosis,
treatment risks and benefits and questionnaires to
determined whether they need more info
• Veracity – truth telling, it is linked to informed decision making
and informed consent
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•
o Four elements making up the notion of informed consent
that are vital aspects of patient education:
▪ Competence – capacity of patient to make a
reasonable decision
▪ Disclosure of information – requires sufficient
information regarding risks and alternative
treatments and including no treatment should be
provided to the patient to enable him to make a
rational decision
▪ Comprehension – speaks to the individual’s ability
to understand or to grasp intellectually the
information being provided
▪ Voluntariness – patient can make a decision
without coercion or force from others
Confidentiality – personal information that is entrusted and
protected as privileged information via a social contract,
healthcare standard or code, or legal covenant
o Anonymous and confidential are different things;
▪ Anonymous – researchers are unable to link any
subject’s identity in the medical record of that person
▪ Confidential – when identifying materials appear on
subject’s records but can be accessed only by the
researchers
o Confidentiality may only be breached under certain
circumstances;
▪ Patient is a harm to others (ie; patient who tested
positive for AIDS/HIV doesn’t want to tell his/her
partner, the physician has the right to breach
confidentiality by telling the spouse directly or
indirectly)
o Nonmaleficence – defined as “do no harm”, refers to ethics
of legal determinations involving negligence or malpractice
▪ Negligence – conduct which falls below the standard
established by law for the protection of others
against unreasonable risk of harm
Ethics and Value System (Pre-Recorded Lecture)
Values
• Comes from the Latin word “Valere” – measure the worth of
something
• Set of personal beliefs, attitudes about truth and beauty
which may change in time
• These are freely chosen enduring beliefs or attitudes about the
worth of a person, object, idea, or action
Value System
• Organization of a person’s values along a continuum of relative
importance
• Important to an individual
• Value system is progressive;
o experiences – exposed – relationship
• May include professional and personal values
o Personal – those you consider your own
o Professional – those you acquire from a group
• Standards of behavior
Ethics
• Comes from the word “Ethos” – custom or character
• This is a method of inquiry that helps people understand the
morality of human behavior
• These are practices or belief of a certain group and expected
standards of behavior of a group
Bioethics
• Ethics as applied to human life or health
• Ie; decisions about abortion or euthanasia
Morality or Morals
• Denotes what is right or wrong in conduct, character, attitude
and what individuals would do to live together in a society
• This is a human conduct itself in the light of ethics
o When compared to ethics, ethics are desirable types of
human conduct while morals are the human conduct itself
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Nursing Ethics
• Ethical issues that occur in nursing practice
Importance of Values
• It gives definite direction to one’s life
• It serves as a “guiding star” which navigates our lives
o Values give meaning and direction to our existence, shape
our ways of being and acting, integral part of who we are,
guides us in our daily lives, decisions and relations
• It reflects a person’s identity
o Values are central, it goes to the core of us, our decision
and actions flows from our principles, and our values help
to define us
• It motivates behavior
o Values are fundamental beliefs that guide and motivate our
behavior and our choices of what is important in our life
o These are the standards we use to evaluate, observe and
respond to our environment at any level
• Gives meaning to life in fulfilling self-esteem and promotes selfactualization
o Self-esteem encompasses self-confidence, strength,
personal and social acceptance, respect from others
o Self-actualization is closely related to contentedness
• Basis for individual’s position on personal, professional, social,
and philosophical issues
o Your values may differ from other people and so it can
affect your stance on certain issues
o Ie: uphold being punctual, when issues come up relating to
that you can be a strong supporter of it
• Shapes and determines an individual or group decisions to like or
dislike, favor, or disfavor change or not change
o Values are influenced by beliefs and it can come from your
background, education and how you’re brought up in the
family
o As values shape you, it could affect your opinion and
decision
Personal Values
• Family Unity, self-worth, religion, honesty, fairness, love
Professional Values
• Values that are acquired during socialization in their respective
professions
o Ie: core values of nursing, ethical principles
Core Values of a Nurse
There are five values essential for the professional nurse (AACN, 1998)
Altruism: genuine concern for the welfare and well-being of others.
- Nurse’s concern for the welfare of patients, other nurses, and
other health care providers.
- The foundation where our profession rests
Autonomy: right to self-determination
- Nurse respects patients’ rights to make decision for their health
care
Human Dignity: respect for the inherent worth and uniqueness of
individuals and populations
- Nurse values and respects all patients and colleagues regardless
of their race, sex, and religion
Integrity: acting in accordance with an appropriate code of ethics and
accepted standards of practice
- Nurse is honest and provides care based on an ethical framework
that is accepted within the profession.
Social Justice: upholding moral, legal and humanistic principles
- Nurse works to ensure equal treatment under the law and equal
access to quality health care
Four Important Values of Nursing
1. Strong commitment to service
a. Since nursing is service oriented, nurses should be
committed to the job
b. This can be met when employers would provide training
and research, career progression opportunities for nurses
to develop clinical academic careers and evidence-based
research
2. Belief in the dignity and worth of each person
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a. Nurses treat patient in a caring and respectful passion.
b. Mindful of cultural and ethnic differences
3. Commitment to education
a. Care management would improve, roles of nurses would
improve to great quality
4. Professional autonomy
a. Having authority to make decisions and the freedom to act
in accordance to one’s profession
Behaviors that May Indicate Unclear Values
• Ignoring a health professional’s advice
o Ie; a client with heart disease who values hard work
ignores advice to exercise regularly
• Inconsistent communication or behavior
o Ie; a pregnant woman says she wants a healthy baby but
continues to drink alcohol and smoke tobacco
• Numerous admissions to a health agency for the same problem
o Ie; a middle-aged obese woman repeatedly seeks help for
back pain but does not lose weight
• Confusion or uncertainty about which course of action to take
o Ie; a woman wants to obtain a job to meet financial
obligations, but also wants to stay at home to care for an
ailing husband
Ethical Principles
These are the foundation to make moral rules;
Autonomy:
• Refers to the right to make one’s own decisions
o Each client is unique, has the right to be who they are, and
has the right to choose personal goals
o Nurses should respect a client’s right to make decisions
even when these choices seem to the nurse not to be in
the client’s best interest
o Ie; client has already been given the pros and the cons but
still insist her own decision, with this, nurses should respect
the client’s choice
• Respect for autonomy
o Commitment to include clients in decision making in all
aspects of care
o The paperwork of consent that the clients read and sign
illustrates this.
Nonmaleficence:
• Duty to “do no harm”
o Harm may be:
▪ Intentionally causing harm
▪ Placing someone at risk of harm
• Ie: you gave a medication and it has side
effects, nurses should monitor the patient for
the side effects that may arise
▪ Unintentionally causing harm
• Ie; nurse sees a client about to fall out of bed,
nurse grips the hand of the patient.
Beneficence
• It means “doing good”
o Nurses are obligated to do good, that is, to implement
actions that benefit clients and their support persons
o Urge to do good for others to implement actions that may
benefit others
▪ Ie: when a child wants the pill to be crushed and
mixed to his food, even though you know he can
swallow, you take extra effort because to do what
the child wants because you’re will to do good
guides you to help others
Justice
• Frequently referred to as fairness
o Nurses often face decisions in which sense of justice
should prevail
▪ Ie: community nurse who goes house to house
visitations; in the first house he/she encountered a
teenager who needs help, the nurse still decided to
tend the teenager even if the nurse knows that
she/he has a schedule on the next house
▪ Emergency rooms where they practice triage, they
try to prioritize which comes in first
o Seen in equal distribution of resources (fairness)
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Fidelity
• Means to be faithful to agreements and promises
o Nurses have responsibilities to clients, employers,
governments and society as well as to themselves by virtue
of their standing as professional caregivers
• A commitment to fidelity is the reluctance to abandon clients even
when disagreement occurs
• Standards of fidelity also includes obligations to follow through
with the care that you give or offer to the client
Veracity
• Refers to telling the truth
o Should a nurse tell the truth when it is known that it will
cause harm?
o Does a nurse tell a lie when it is known that the lie will
relieve anxiety and fear?
o Benevolent deception – withholding an information when
such revelation would do more harm to an emotionally
unstable or depressed person. Called for by the practitioner
who intentionally withholds information based on his or her
sound medical judgment
Confidentiality
• Refers to an agreement that restricts or limits access to
information
• Privileged communication
o Clients have a right to privacy in the health care system
o Confidential information is also termed as privileged
communication because it is given based on trust.
o Any information gathered by nurses during caring for their
patients should always be treated confidentially. This duty
extends even after the patient’s death
o It can only be revealed when patient’s themselves permits
it, or when the situation is medical legal (stab wound, car
accident), ill of communicable disease and the public is at
risk, lawful order of the court
As a nurse, you advocate for the health, safety and rights of the client
Advocacy – refers to the support of a cause
The functions of the advocacy are to inform, support and mediate
-
Ie; as a nurse, you find a private place for discussion with the
physician about the result of the client’s diagnostic testing
Follow institutional policies and procedures – report any
occurrences of incompetent, unethical, and illegal or impaired
practices of any health care member that has a potential to affect
the health and safety of patient
Nurses must also have professional accountability and responsibility
Accountability – refers to the ability to answer for one’s own actions.
• Responsible for own actions and inaction, commit to do good and
omit bad acts
Responsibility – refers to the specific accountability or liability
associated with the performance of duties of a particular role
• Willingness to respect obligations and to follow through on
promises
• As a nurse, you are responsible for your own actions
CDU-CN Values and Graduate Attributes
Compassion and Courtesy
• Holistic Caring Care and Good Manners
Dedication and Discipline
• Lifelong Learner, Social Involvement, Research and Productivity
Uprightness
• Ethically Responsible (ie; ethical principles)
Competence and Commitment
• Professional Competence, Global Mindset, Technically
Experienced, Critical Thinker, Effective Communicator, Team
Collaborator
Neatness
• Cleanliness
The Influence of Values in One’s Professional and Daily Life
Practices
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•
•
•
•
•
•
Demonstrates understanding of cultures, beliefs and perspective
of others
o Nurse knows that what she values may not be the same as
colleagues and clients but regardless, she still renders her
service
Advocates for patients, particularly the most vulnerable (elderly,
sick)
o Inform, support and mediate
Takes risks on behalf of patients and colleagues
o For the safety of patients and colleagues
Mentors other professionals
o Mentoring through what is going on with the client
Plans care in partnership with patients
o Because the nurse knows that it could add to the quality of
care that she is planning to the patient
Honors the rights of patients and families to make decisions about
health
o Respect for autonomy
Values Clarification Process
This is the process by which people identify (choosing), examine
(prizing), and develop (acting) their own individual values.
• Choosing (Cognitive) – beliefs are chosen freely among
alternatives without pressure after reflecting and considering
consequences
o Person learns about environmental issues; person believes
that there is a need to minimize use of or recycle limited
resources
• Prizing (Affective) – chosen beliefs are cherished and prized
o The person is proud of the belief that he/she has an
obligation to participate in ways of reducing waste
• Acting (Behavioral) – chosen beliefs of a person are affirmed to
others and incorporated, demonstrated consistently in one’s life
o The person participates in the recycling program in the
community and in other activities related to the
environment
Ethical Issues in the Family and Community
• As a nurse, one should explore the values and beliefs regarding
the following:
o Individual’s right to make decision for self
▪ Even if the decision of the client is not favorable to
him/herself, it must be respected
o Abortion
o Passive and active euthanasia (mercy killing)
▪ Never accepted in catholic countries
o Blood transfusion
▪ May be a problem in other religions such as
Jehovah’s witness
o AIDS
▪ Social stigma, should test results be mandatory and
stuff
o Cultural differences
o Spiritual and religious differences
•
•
Nurses are responsible for determining their own actions and for
supporting clients who are making moral decisions.
Nurses can enhance their ethical practice and client advocacy by
clarifying their own values, understanding the values of other
health care professionals, becoming familiar with nursing code of
ethics and participating in ethics committees or rounds
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Rights, Responsibilities and Regulation of Nurses Practice
CLO#1: Define the following terms related to rights, responsibilities, and
regulation of nursing practice.
• Rights – a privilege or fundamental power to which an individual
is entitled unless it is revoked by law or given up voluntarily
o Right to own a property, right to live, right to travel, right to
education
o Every right is equally distributed to everyone but the
acquisition of such depends on the case of the individual,
for instance, everyone has the right to own a property but
not everyone has the privilege to own one
o For every right that you enjoy, there is a corresponding
duty and responsibility to fulfill
• Duties – obligatory task, conduct, service or function that arise
from one’s position (life or in a group)
o This is a higher calling
o Ie: It is the nurse’s duty to uphold the safety of the patient.
• Responsibility – obligation associated with a right
o If one has a right to education, the student or learner has a
responsibility to study
o Stepping stones to fulfill your duties
•
•
•
•
•
•
•
•
•
o Ie: To fulfill the duty of nurses’ of upholding the safety of
the patient, it is their responsibility to administer
medications, assist patients, impart health teaching and
others
Law – sum total of rules and regulations by which society is
governed
o Formalization of a body of rules of action or prescribed
conduct that is enforced by binding legal authority
o Created by people and exits to regulate all persons
Nursing Law (defined in Nursing Practice Acts) – define entry
requirements for the profession (such as graduation from an
approved educational program for nursing), duties and
composition of the (state) board of nursing, scope of practice,
grounds for disciplinary action, license renewal and fees, and
other regulatory rules
Nursing Jurisprudence – branch of law that deals with the study
of nursing laws, lawsuits, liabilities, legal principles, rules and
regulations, case laws and doctrines affecting the nursing practice
Obligation – something that is bound to do; synonymous to duty
or responsibility
Privilege – special right, advantage, or immunity granted or
available only to a particular person or group
o Ie: Not everyone has the privilege to enroll to a private
school but not everyone that goes to a public school is
underprivilege, it depends on the case
Negligence – misconduct or practice that is below the standard
expected of an ordinary, reasonable and prudent person
Malpractice – professional negligence, negligence occurred while
the person was performing as a professional
o Denotes stepping beyond one’s authority with serious
consequences
Power – possession of control, authority, or influence over others.
It is the ability to create, get and use resources to achieve one’s
goal
Empowerment – delegated authority or power given to an
individual
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•
•
•
•
•
Authority – power/right to give orders, make decisions and
enforce obedience
Contract – agreement between 2 or more competent persons, on
sufficient consideration to do or not to do some lawful act
o Work contract
Force Majeure – irresistible force, one that is unforeseen or
inevitable
o Nurse cannot go to work because of flood, flood is
irresistible force that hinders the nurse from going to work
o You cannot be held liable for not arriving to work because
of this natural occurence
Res Ipsa Loquitor “The thing speaks for itself”
o In some cases the harm cannot be traced to a specific
healthcare provider or standard but doesn’t normally occur
unless there has been a negligent act
o Ie: Harm that results when surgical instruments or
bandages are accidentally left in a client during surgery.
▪ The bandages/surgical instruments left inside the
patient is an evidence that harm has been done
o You’ll know that a harm was done to the client because
the client will complain
▪ Ie: sponge was left inside the client’s abdomen, after
the operation, client keeps complaining that his/her
abdomen hurts. An x-ray was produced and it shows
that the sponge was left inside
Respondeat Superior “Let the master answer”
o Master (employer) assumes responsibility for the conduct
of the servant (employee) and can also be held responsible
for the professional negligence by the employee
o Not a shift of liability, more like an extension.
Professional Adjustment – growth of the whole person in the
development of his capabilities to make him fit to assume his
position
CLO#2: Explain the correlation between:
• Right and Responsibility
o Responsibility – obligation associated with the right
•
•
o For instance: if you have the right to work as a nurse after
being hired, it is your responsibility to administer
medications and assist client’s in performing activities of
daily lives
Right and Duty
o Duty – obligatory tasks, conducts, service or function that
arise from one’s position, or may arise from a right
o For instance: the state gives you the right to live, then the
same right gives you the duty to not expose yourself from
danger and also to respect the life of others
Power and Authority
o Power is necessary for authority, once you have the power
authority comes with it
▪ Power also comes with responsibility
o For example: person runs for presidential position. After
winning, he is vested with a political power, same power
that gives him authority to sign bills into law, command
armed forces, and to assign people to respective positions
CLO#3: Discuss the different kinds of rights of man and the
corresponding responsibilities they impose on him as a person, a
member of the family and the community:
• Natural Rights – dictated by nature and not by state
o Comes from the natural law, significant for the person’s
existence
o Concept of natural law asserts that it is natural for humans
to exercise the right to life, liberty, property, freedom of
movement, and to defend themselves against those who
would harm, enslave, or attempt to kill them
▪ Examples:
• Right to preserve life
• Right to love
• Right to be happy
• Right to have a family
• Right to practice religion
• Human Rights – essence of being human
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•
•
o Provides a distinction between us humans and other
species (dogs)
▪ For instance, we have the right to vote but dogs
don’t
o Human beings possess certain qualities that determine
their humanity, basic needs, rational, freedom and mobility,
and social being
Principles of Human Right:
o Inherent – human rights are innate, natural and in born in
every person, these are not granted by any authority
o Universal – has a quality, nondiscriminatory, belongs to
every human being regardless of sex, age, economic
status, ethnicity, religion and others. Every human being is
entitled to the same right
o Inalienable – cannot be taken away, except in specific
circumstances and in accordance to due process
o Indivisible – all human rights; civil, political, economic,
social, and cultural are co-equal and equally important.
They are entitlement to a totality of conditions a person
must have in person to be human and thus cannot be
parted into parts
▪ There’s no hierarchy of rights, every right is equal
and together
o Interrelated and Interdependent – mutually dependent.
There exists a reciprocal relationship among human rights;
enjoyment of one right is dependent on the enjoyment of
the other. So, when on it is violated or deprived, other
rights are compromised as well
Aspects of Human Rights:
o Constitutional rights
▪ Based on a constitutional law – body of rules,
doctrines, and practices that govern the operation of
political communities
• Civil rights – rights which law accords to
private individuals for the purpose of securing
enjoyment of their means and happiness
o Rights against unreasonable searches
and seizures
o Privacy of communication and
correspondence
o Liberty of abode and travel
o Freedom of religion
o Non-impairment of contract
o Right against imprisonment for debt
o Right against involuntary servitude
• Political rights – enable individual to
participate (direct or indirect) in running
affairs of government
o Right of citizenship
o Right of suffrage (right to vote)
o Freedom of speech
o Freedom of press
o Right to form associations not contrary
to law
• Socio-economic and Cultural rights
o Socio-economic – rights which law
confers upon the people to enable
them to achieve social and economic
development, thereby ensuring their
well-being, happiness and financial
security
o Cultural – ensure the well-being of
individuals and foster the
preservation, enrichment and
dynamic evolution of national
culture based on principle of unity in
diversity in a climate of free artistic and
intellectual expression
▪ Right to work
▪ Right to fair wage and safe
working condition
▪ Right to form and join trade
unions
▪ Right to education
▪ Right to take part in cultural life
o Alienable and Inalienable rights
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Inalienable rights – rights that are not transferrable
or capable of being taken away or nullified
• Rights to life, liberty and religion
▪ Alienable rights – transferrable
• Property, citizenship and appeal
o Right of jurisdiction – right of a legal or political agency to
exercise its authority over a person, subject matter, or
territory. Jurisdiction over a person relates to the authority
to try him or her as a defendant
▪ Defendant – person being sued
o Juridical and Nonjuridical rights
▪ Juridical – pertains to the administration of justice.
Rights based on the law, rights that must be
respected, allowed and fulfilled as a matter of strict
justice
• Grocers right to receive the amount you owe
him after shopping some goods
▪ Non-juridical – based on virtue rather than strict
justice. Often founded on the virtue of charity
• Right of poor man to alms. Right of
benefactor to gratitude – out of charity but
based on law
• Community pantry where you can get foods
and other items for free
▪
Regulations in Promoting Safe and Quality Nursing Practice
Philippine Nursing Code of Ethics
• Republic Act 9173 and Board of Nursing Resolution No. 220
Series of 2004
• Article I: Preamble
o Health as the priority – health is considered as a
fundamental right of every individual
▪ Nurse believing in the worth and dignity of each
human being recognizes the primary responsibility to
preserve health at all cost
o Responsibility – responsibility must be assumed –
registered nurses have to gain knowledge and
understanding of man’s cultural, social, spiritual,
psychological, and ecological aspects of illness utilizing a
therapeutic process
▪ Also encompasses the promotion of health,
prevention of illness, alleviation of suffering and the
restoration of health
o Desire for Respect and Confidence – applies to clients,
colleagues, coworkers and members of community.
▪ Having this kind of desire, the nurses provide the
incentive to attain and maintain the highest possible
degree of ethical conduct
• Four Principal Elements in the Nursing Code of ethics
Guides nurses in the practice of their profession, this is also found in the
international council of nurse’s code of ethics.
o Nurses and People (Article II)
▪ Consider individuality and totality of patients –
nurses must render individualized care depending
on the needs of their patients, nurses must also
include not only the physical needs but also giving
consideration to the other aspects such as the
emotional, psychosocial and spiritual needs
▪ Respect spiritual beliefs and practices – nurses
must honor the beliefs and practices of their patients
as these may help in uplifting the patient’s condition,
this is also one of the rights of the patients that must
be respected
▪ Uphold rights of individuals – all patients
regardless of race and socio-economic status must
be treated fairly and justly, their rights must be
catered at all times
▪ Consider culture and values of patients – not only
spiritual beliefs and practices are respected, but also
their culture and values
o Nurses and Practice (Article III)
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▪
Know the definition and scope of nursing
practice – guide nurses on their day-to-day duty as
they administer care to their clients,
▪ Aware of their duties and responsibilities – they
should also be aware of their duties and
responsibilities stated and defined by the Philippine
Nursing Act of 2002
▪ Acquire and develop necessary characteristics –
acquiring and developing necessary competence in
knowledge skills and attitudes to effectively provide
appropriate nursing services through varied learning
situations
▪ Ensure the principles of safe nursing practice
▪ Ensure confidentiality of patient’s records
o Nurses and Co-Workers (Article IV)
▪ Ensures and promote two things:
• Promote solidarity with other members of the
healthcare team in working to the patient’s
best interest
• Ensure maintain a collegial and collaborative
working relationship with colleagues and
other healthcare providers
▪ Maintain professional role and identity
▪ Conform with group activities
▪ Contribute to professional growth and development
of other members of HCT
▪ Participate in professional organizations
▪ Respect rights of co-workers
o Nurses and the Profession (Article VI)
▪ The ff promotes the following:
• Promotes maintenance of loyalty to the
nursing profession and preservation of
integrity
• Promotes compliance with the by laws of the
accredited professional organization which is
the Philippine nursing association
•
▪
▪
▪
▪
promotes commitment to continual learning
and active participation in the development
and growth of the profession
• promotes improvement of the socioeconomic
conditions and the general welfare of nurses
through appropriate legislation
Be members of accredited professional organization
Adhere to the nursing standards
Participate in growth and development of the nursing
profession
Assert the implementation of labor and work
standards
International Council of Nurses; Code of Ethics
- Organization through which nurses all over the world collaborate
in strengthening nursing service, nursing education and
professional ethics
- Composed of national nursing association from each membercountry
- ICN’s Code of Ethics reminds us the four fundamentals’
responsibilities of nurses; promote health, prevent illness, restore
health and alleviate suffering
o Through this, we are once again reminded that the need for
nurses are universal
- Objective: to provide a medium where national nurses
associations may share their common interests
Nightingale Pledge
I solemnly pledge myself before God
and in the presence of this assembly,
to pass my life in purity
and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous,
and will not take or knowingly administer any harmful
drug.
I will do all in my power to maintain
and elevate the standard of my profession,
and will hold in confidence
all personal matters committed to my keeping
and all family affairs coming to my knowledge
in the practice of my calling.
With loyalty will I endeavor
to aid the physician in his work,
and devote myself to the welfare
of those committed to my care.
So, help me God.
Nightingale Pledge
• This remains one of the most significant aspects of nursing in the
history
• Hippocratic oath or a statement that nurses utter in order to prove
their sincerity with their profession
• In front of the experience practitioners, nurses undertake promise
that they would abide by the rules and regulations of nursing care
• Nurses confirm that they will avoid any act that is mischievous
• Rationale: its implementation serves as an honorable oath for the
nurses to make sure that the ideal nurse is created in front of all
so that they could follow the ethical grounds of the field of nursing
Patient’s Bill of Rights: Rights of Patients
Based from the Philippine Department of Health:
⚕ Right to Life – nobody including the government can try to end
your life, it also means that the government as well as the private
12 | P a g e
sectors should take appropriate measures to safeguard life by
making laws to protect people, and in some circumstances taking
step to protect and save lives if life is at risk
o Misdiagnosis, instead of addressing the client’s abdominal
pain you accidentally noted the client’s productive cough.
After a few days, client’s abdomen ruptures, the client
didn’t feel any pain anymore and felt normal. This
endangers the client’s life because of the risk of infection
⚕ Right to Appropriate Medical Care and Humane Treatment –
every person has a right to health and medical care corresponding
to the person’s state of health without any discrimination and
within the limits of the resources, manpower and competence
available for health and medical care at the relevant time
⚕ Right to Informed Consent – patient has a right to a clear,
truthful and substantial explanation in any manner in language
understandable to the patient of all proposed procedures
(diagnostic, preventive, curative, rehabilitative, therapeutic) where
the person who will perform the said procedure shall provide his
name and credentials to the patient, the possibility of any risk to
mortality, side effects, problems related to recuperation and the
probability of success and reasonable risks involved
⚕ Right to Privacy and Confidentiality – privacy of the patients
must be assured in all stages of treatment; patient should be free
from unwarranted public exposure except in the ff;
o When the mental/physical condition is in controversy and
the appropriate court orders him to submit a physical or
mental examination by a physician
o When public health and safety demands
o When patient waives this right in writing
o Privilege communication – only those concerned has the
right to be informed
⚕ Right to Information – patient or legal guardian has the right to
be informed of the result of the evaluation on the nature and the
extend of the patient’s disease and other vital information
⚕ Right to Choose Healthcare Provider and Facility – patient is
free to choose the healthcare provider and facility to serve him
except when the patient is under the care of a service facility or
13 | P a g e
when the public health and safety so demands or when the patient
expressly waives this right in writing
⚕ Right to Self-Determination – patient has the right to avail
himself of any recommended diagnostic and treatment
procedures. Any person of legal age and of sound mind may
make an advanced written directive for physicians to administer
care when the patient suffers from a terminal condition
⚕ Right to Religious Belief – patient has the right to refuse medical
treatment or procedures which may contrary to the client’s
religious beliefs subject to the limitations that may affect his or her
condition
⚕ Right to Medical Records – patient is entitled to a summary of
his or her medical history and condition, patient has the right to
view the contents of the medical records except for psychiatric
notes and other incriminatory information obtained about third
parties with the attending physician explaining its contents
⚕ Right to Leave – patient has the right to leave the hospital or any
healthcare institution regardless of the physical condition provided
with the ff:
o He or she is informed of the medical consequences of his
or her decision
o He or she releases those involved in his or her care from
any obligation relative to the consequences of the decision
o Decision will not endanger public health and safety
⚕ Right to Refuse Treatment and Medical Care – patient has the
right to make decisions about the plan of care prior to and during
the course of treatment and to refuse a recommended treatment
to the extent permitted by law and hospital policy, patients should
also be informed of the medical consequences of this action
o In case of such refusal, the patient is entitled to other
appropriate care and services within the same hospital or
they may choose to transfer to another institution
Note: Every nurses and other healthcare members should take note of
these rights to build good relationships with the clients.
Nurses’ Bill of Rights: Rights of Nurses
Allows nurses to provide adequate care to patients without restrictions.
Right to practice in a manner that fulfills their obligations
Right to practice in environment that allow them to act in
accordance with professional standards
Right to a work environment that supports and facilitates ethical
practice
Right to freely and openly advocate for themselves and their
patients
Right to fair compensation
Right to a safe work environment
Right to negotiate conditions of their employment
Nursing Law
Republic Act 9173 (Philippine Nursing Act of 2002)
- Provides a more responsive profession, repealing the purpose of
R.A 7164 (The Philippine Nursing Act of 1991) and for other
purposes.
- This law declares a state or government to assume responsibility
for the protection and improvement of the nursing profession by
instituting measures that will result in relevant nursing education,
human working conditions, better career prospects and dignified
existence for nurses.
- health services through an adequate nursing personal system in
the Philippines
Board of Nursing (Resolution No. 425 Series of 2003): Rules and
Regulations Implementing the Philippine Nursing Act of 2002 (or
IRR)
- Mandates the Professional Regulatory Board of Nursing (Board),
and the Professional Regulation Commission (Commission) with
the Accredited Professional Organization, the Department of
Health, the Department of Budget and Management, and other
concerned government agencies to formulate necessary rules
and regulations that will effectively implement the provisions
of the Republic Act 9173
Republic Act No. 10912 (Continuing Professional Development Act
of 2016)
14 | P a g e
-
Not only for nurses, also includes other profession regulated by
the PRC
Promote and upgrade the practice of professions in the country
To improve the competence of the professions in accordance with
the International Standards of Practice
Uplifting the general welfare, economic growth and development
of the nation
It also ensures that you and your knowledge stay relevant and up
to date. It uncovers gaps in your skills and capabilities, you will be
more aware of the changing trends and directions in your
profession
CPD Programs – established to achieve the provisions of the law,
development may be achieved through the ff:
• Formal learning
• Informal learning
• Self-directed learning
• Online learning activities
• Professional work experience
Note: participation of the professional to these different programs would
give additional points to one’s profession, in terms of what we call CPD
units. CPD units are required in the renewal of a professional license.
General Requirements to Practice Nursing in the Philippines
Qualifications and Abilities of a Professional Nurse
Professional Preparation
Personal Qualities and
Professional Proficiencies
• Physically and mentally
• Interest and willingness
fit
to work and learn
• Bachelor of Science
• Warm personality and
degree in Nursing
concern for people
• License to practice
• Resourcefulness and
nursing in the country
creativity as well as wellbalanced emotional
condition
•
•
•
•
•
Initiative to improve self
and service
Competence in
performing work
Skills in decision-making
Get license by passing the Philippine Nursing Licensure Exam
(PNLE) – in order to practice profession in the country
If the nurse has all the abilities and qualities mentioned, the
implementation of the four fundamental responsibilities would be
greatly felt by clients and patients
Scope of Nursing Practice (Article VI Section 28 of Republic Act 9173)
• A person shall be deemed to be practicing nursing within the
meaning of this act when he or she singly or in collaboration with
another initiates and performs nursing services to all clients
across the lifespan including individuals, families and communities
in any health care setting;
• Listed below are the duties of the nurse within the scope of its
profession;
o Provide nursing care through utilization of nursing process
o Establish linkages with community resources and
coordination
o Provide health education to individuals, families, and
communities – to improve clients level of understanding
with regards to health
o Teach, guide, and supervise students in nursing education
programs
o Undertake nursing and health human resources
development training and research
Nursing Associations in the Philippines
Philippine Nurses Association (PNA)
- Organized on October 22, 1922 upon the initiation of Mrs.
Anastasia Giron Tupas, the first president was Mrs. Rosario
Delgado
15 | P a g e
-
-
It was then called Filipino Nurses Association, and its journal the
Filipino Nurse, now its journal is called The Philippine Journal of
Nursing.
It was established for the ff purposes;
o Attain optimal level of professional standards
o Work for the welfare of member nurses
o Respond to the changing health needs of the Philippine
society
o Establish linkages with government, national and
international agencies
National League of Philippine Government Nurses
This is a dually incorporated organization of professional nurses
employed by the government of the Philippines, formerly known as the
Department of Health National League of Nurses. Founded on January
16, 1961 by Annie Sand (nursing consultant of DOH) and several chief
nurses of government hospitals in Metro Manila
The following objectives are mainly focused on application of the nursing
practice in the Government sector
• Promote and maintain highest standards of nursing in government
agencies
• Address problems concerning nurses and nursing
• Upgrade professional competence through research, training,
scholarship grants
• Collaborate with government, non-government and other allied
professional groups
• Foster national and international goodwill among nurses
Association of Nursing Service Administrators of the Philippines,
Inc. (ANSAP)
Founded in 1963 at St. Luke’s Hospital by a group of private and public
nursing service administrators. First predicant was Mrs. Rosita A. Furiya,
former chief nurse of Kirino Memorial Medical Center in Quezon City.
Reorganized 10 years later in 1973 with Dr. Perla Sanchez.
Along with the objectives listed below, it also envisions a cohesive and
proactive professional association committed to excellence in nursing. It
is committed to advocate models in leadership skills to transform nursing
leaders to become working enzymes who can respond elegantly to
change and development in nursing leadership and to ensure
sustainability and viability of association
• Provide dynamic leadership in the acquisition of knowledge and
techniques in administration
• Uphold the highest standards of professional ethics to the cause
of nursing
• Initiate programs
• Keep abreast and latest research findings
• Participate and stand courageously in support of vital issues
Occupational Health Nurses Association of the Philippines
(OHNAP)
Organized on November 21, 1950 through initiative of Mrs. Magdalena
Valenzuela of the DOH.
It’s main purpose together with the objective sis to promote friendship
and to organize nurses in industrial and commercial enterprises in to an
industrial nursing unit. Named OHNAP on September 20, 1969
• Contribute to the promotion of public health of industrial workers
and that of his/her family
• Keep up with modern methods and techniques of public health
nursing in general and industrial nursing
• Provide expert nursing guidance for industrial health workers
• Attain good relationship and understanding among industrial
nurses
• Gain support from agencies employing nurses
Operating Room Nurses Association of the Philippines (ORNAP)
Composed of professional nurses working in the operating rooms of the
different hospitals in the Philippines.
• Committed to improve OR management techniques and facilities
• Ensure maximum service to all patients
• Promote professional development, personal growth and wellbeing of its members
16 | P a g e
•
Keeping abreast with new and sophisticated methods in the field
of OR management
Psychiatric nursing Specialists Foundation of the Philippines
(PNSI)
Views mental health and illness as states of adaptation used by the
individuals in coping with the circumstances in life. It also adheres to the
goals of the psychiatric care which is to improve individuals’ competence
in living with himself and others through the use of full potential of each
individual for a full and happy life, the ultimate aim of psychiatric mental
health can be achieve
• Provide therapeutic and supportive services
• Help clients identify and develop inherent potentials
• Undertake research studies in the field of mental health
• Offer educational programs in mental health-psychiatric nursing
Other Nursing Associations:
• Philippine Association of Public Health Nursing Faculty
o Dedicated to the maintenance of high standards of
objectives to standardize and broaden instruction in public
health nursing
• Private Duty Nurses Association of the Philippines
o Fosters importance on private duty nurses particularly
under rates and qualifications
• Association of Deans of Philippine College of Nursing in the
Philippines
o Main purpose is to promote elevate and maintain the
standards of clinical instruction program of nursing students
and to improve nursing service and facilities of clinical
fields in hospital and public health agencies
• Military Nurses Association of the Philippines
o Established to provide a medium for active, inactive and
retired nurses and core officers of the armed forces of the
Philippines where they can express their ideas and
aspirations to better serve the country
• Catholic Nurses Guild
•
o Promote spiritual welfare of the nurses and to aid them in
promoting spiritual welfare of those under their care
Integrated Registered Nurses of the Philippines
o Provide a medium through which Filipino registered nurses
can share their common interest working in a unified
manner to develop contribution of nursing to the health of
Filipino people and to the achievement of the national
health developmental goals
17 | P a g e
•
Takes place during first
20 years of life
Developmental Task – tasks which arises at a certain period in life of an
individual. Tasks that individual should accomplish. These are the
expected tasks a person must achieve.
Successful achievement
Failure
̶
Leads to happiness and
̶
Leads to unhappiness in
success with later tasks
the individual
̶
Disapproval by society
̶
Difficulty with later tasks
Module 4: Stages of Growth and Development
Note: Both growth and development preferred to dynamic processes,
although used interchangeably, these words have diff meanings
Growth – physical change and
Development – increase in
increase in size
complexity of function and skill
• Measured quantitatively
• Progression
• Indicators: height,
• Capacity and skill of person
weight, bone size and
to adapt to environment
dentition
• Qualitative change
• Pattern of physiological
o Changes happen
growth is similar for all
but cannot be
people
measured
o Growth rates vary
• Behavioral aspect of
during diff stages of
growth
growth and
• Ie: ability to walk, talk,
development
run, and think
o Rapid (pre-natal,
• Takes place during the first
neonatal, infancy,
20 years and continues
adolescence stage),
after that
slows down
(childhood), minimal
(adulthood)
18 | P a g e
Developmental Milestone
• Set of functional kills or age-specific tasks most children can do at
a certain age range
• Learned behavior within a specific age
• Learned behavior can be used to assess child’s development at a
particular age
• Major markers of normal development (Pillitteri)
• For example:
o When infant learned how to roll over during the infancy
period
• These are tasks individual has achieved already.
Maturation
• Differentiation and refining of abilities and skills, based on an inborn timetable which is synonymous to the word development
Principles of Growth and Development
1. Growth and development are continuous, orderly, sequential
process influenced by maturational, environmental and genetic
factors
2. All humans follow the same pattern of growth and development
3. Sequence of each stage is predictable, although time of onset,
length of stage, and effects of each stage vary with individual
4. Learning can either help or hinder maturational process
depending on what is learned
a. Aids maturational process through the development of
cognitive abilities
b. A teenager learns how to procrastinate, procrastination will
hinder the child’s maturation
5. Each developmental stage has its own characteristics
a. Ie: Sensorimotor stage; child will learn to coordinate simple
motor tasks (Jean Piaget)
6. Growth and development occur in cephalocaudal direction
a. Starts at the head and moves down to the trunk, legs and
feet, pattern can be seen during infancy when a baby’s
head is still disproportionately large
b. Head is larger than the trunk, later on the extremities will
grow
7. Growth and development occur in a proximodistal direction
a. Starts from the center of the body outwards. Infant can roll
over before they can grasp an object with thumb and 2nd
finger
8. Development proceeds from simple to complex or single acts
to integrated acts
a. Before a child learns to drink and eat from a cup and a
plate (integrated acts), she/he must first a series of single
acts; eye hand coordination, grasping, hand mouth
coordination, mouth lip and tongue coordination, cup
tipping
b. Before a child learns how to run, child must first learn how
to stand and balance
9. Development becomes increasingly differentiated
a. Differentiated – begins with a generalized response and
progresses to scaled specific response
b. Infant’s response to most stuff (hungry, wet diaper) – they
often cry. Adolescents when they feel hungry, they look or
cook food
10. Certain stages of growth and development are more critical than
others
11. Pace of growth and development Is uneven
Factors Influencing Growth and Development
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⭐ Genetics – basic genetic makeup of an individual has already
been casted from the first conception. Inheritance also include
characteristics such as learning styles, manner of walking, talking
and such. Could also inherit disabilities that could affect growth
⭐ Temperament – individual’s characteristic manner of thinking,
behaving or reacting to stimuli in environment
o Easy child – easy going and even-tempered child; open
and adaptable to change and displays mild to moderate
mood that is usually positive
o Difficult child – highly active, irritable and irregular in
habits; adapts slowly to new routines, people, and
situations
o Slow-to-warm up child – reacts negatively and with
intensity to new stimuli, child adapts slowly with repeated
contact unless pressured; child response with mild but
passive resistance to changes in routine
⭐ Family – provides safety and support to the child, major consent in
a child’s life. Involved in their children’s physical and psychological
well-being and development. Socialized through family dynamics.
o
⭐ Nutrition – adequate nutrition is an essential component of growth
and development
o Poor nourished children may not attain their full height
potential.
⭐ Environment – few environmental factors can affect growth and
development, such as; living conditions, socio-economic status
and community
o Socio-economic status – hinders growth and development
because the family doesn’t have enough money to buy
nutritional foods
o Families who live near dumpsites can get diseases which
can hinder one’s growth and development
⭐ Health – illness, injury and congenital conditions can affect growth
and development; being hospitalized is stressful for a child and
can affect coping mechanisms; prolonged hospital stay which can
affect normal processes
o Instead of gaining socializing skills, hospitalization would
confine an individual to the hospital
⭐ Culture – nutritional practices may affect growth rates of an
individual and child rearing practices may influence development
o Child-rearing – bringing up a child or a children
These developmental theories provide a framework for examining,
determining and appreciating development.
•
•
•
Sigmund Freud’s Psychological Development
• Personality develops in five (5) overlapping stages from birth to
adulthood
Stage
Pregenital
Stage
Approximate
Age
Erogenous
Zone”
0-1.5 years
Mouth
•
Oral
•
Anal
1.5-3 years
Anus
Phallic
4-6 years
Genital
Latency
6-puberty
None
Genital
Puberty and
after
Genital
•
Characteristics
Task to be attained
Pleasure accomplished by
exploring mouth and by sucking
Weaning – detach from source of dependence in which in this
stage child must be weaned from breast or bottle
Pleasure accomplished by
exploring organs of elimination
- Pleasure is accomplished by
exploring genitals
• Masturbation
- Child is attracted to parent of
opposite sex
- “Penis Envy”
Pleasure is directed by focusing on
relationships with same-sex peers
and the parent of same sex
Pleasure is directed in development
of sexual relationships
Bowel and bladder control which are essential in toilet training
• Bowel is controlled first before the bladder.
Resolution of Oedipus and Electra Complex is done through
identification with the same parent; male child adopts mannerism
of father and when girl adopts mannerism of mother
• Oedipus Complex – strong emotional attachment of male
child towards mother
• Electra Complex – attachment of female child to father
Engagement in activities, such as sports, schoolwork, and
socialization with same-sex peers
Erik Erikson’s Psychosocial Development Theory
• Theory proposes that life is a sequence of developmental stages
or levels of achievement
20 | P a g e
First three (3) stages (oral, anal, phallic) are called “pregenital
stages”
o The underlying motivation for human development is
Libido a dynamic psychic energy
Must meet needs of each stage in order to move successfully to
the next developmental stage
If person does not achieve satisfactory progression at one stage,
personality becomes fixated at that stage
o Fixation is immobilization or inability of the personality to
proceed to the next stage because of anxiety
(OhAngPangetLangGhad)
Engagement in activities to promote independence such as;
engaging in work or establishing a career
•
•
Eight (8) stages which reflect both positive and negative aspects
of the critical life periods
Each stage signals a task that must be accomplished
•
•
Resolution of the task can be complete, partial or unsuccessful
Successful resolution of each stage supports healthy ego
development
Stage
Age
Infant
Birth-18
months
Toddler
18
months3 years
Central
Task
Trust vs.
mistrust
Autonomy
vs. shame
and doubt
Negative Resolution
Establishment of basic
Suspicious, fearful, mistrust,
senses of trust is
withdrawal, estrangement
essential for development
of healthy personality
•
•
Child develops
autonomy by
making choices
Frequent use of
the word “no”
Limiting choices or harsh punishment
leads to feelings of shame and doubt
Doubts abilities feels ashamed for not
trying
Compulsive self-restraint or
compliance, willfulness and defiance
Preschooler
21 | P a g e
3-5
years
Initiative vs.
guilt
Fantasy and imagination
allow
Positive Resolution (Basic Virtues)
Drive and hope; faith and optimism
Successful resolution requires consistent
caregiver who is available to meet the
infant’s needs
Learning to trust others (results faith and
optimism)
Self-confidence and willpower
Toddler who successfully masters this
stage achieves control and will power.
Child has to be allowed to make choices.
May fear disapproval of own powers
Self-control without loss of self-esteem,
willpower, ability to cooperate and to
express oneself
Direction and purpose
Conflicts often occur between child’s
desire to explore and limits placed on
his/her behaviors which sometimes
leads to frustrations and guilt
Children must be given freedom and
opportunity to initiate motor play. Parents
must answer child’s questions and not
inhibit fantasy or play activity.
Lack of self-confidence, pessimism,
fear of wrong doing, overcontrol and
over restriction of own activity
Learning the degree to which
assertiveness and purpose influence the
environment, direction and purpose,
beginning ability to evaluate one’s own
behavior
School-age
6-12
years
Industry vs.
inferiority
Eager to apply
themselves to learning
socially productive skills
and tools; thrive through
accomplishment and
praise
Important to establish
industry because adult’s
attitude towards work is
traced to successful
achievement of this task
Adolescent
12-20
years
Identity vs.
role
confusion
Preoccupied with
appearance and body
image.
• Who am I?
May feel sense of failure
Method and competence
Without proper support for learning of
new skills or if skills are too difficult,
children develop sense of inadequacy
and inferiority
Encourage efforts to do practical tasks or
make practical things and praise and
reward for the finished results.
A sense of industry is also developed by
Loss of hope, sense of being mediocre, working on projects that result in a feeling
withdrawal from school and peers
of accomplishment
Confused, no focus
Coherent sense of self, plans to
actualize one’s abilities, devotion and
fidelity
Sense of identity is
essential for making adult
decisions such as choice
of vocation or marriage
partner.
Young
Adulthood
Middle Age
22 | P a g e
18-25
years
25-65
years
Intimacy vs. Intimacy is finding the self Loneliness, poor relationships
isolation
and losing oneself in
another.
If not able to establish companionship
and intimacy, isolation will result due to
fear of rejection and disappointment
Impersonal relationships, avoidance of
relationship, career, or lifestyle
commitments
Generativity Generativity – concern for Shallow involvement with the world in
vs. selfestablishing and guiding
general, selfish, little psychosocial
absorption
growth
Beginning to create, develop, and
manipulate. Developing sense of
competence and perseverance
Devotion and fidelity
In order to successfully resolve this
stage, they must bring together
everything they have learned about
themselves and integrate these different
images into a whole that makes a sense
• Use experiences to create an
identity to which they want to
become (their career and stuff)
Feelings of confusion, indecisiveness,
and possible antisocial behavior
Affiliation and love
Establishing a firm sense of self and
reaching out to others to develop loving,
intimate relationship is the key.
Intimate relationship with another person,
commitment to work and relationships
Production and care (basic strength)
and
stagnation
next generation, receives
gratification
Inability to play a role for the
development of the next generation
results in stagnation.
Stagnation – sense of
boredom and
impoverishment, not
Self-indulgence, self-concern, lack of
assume responsibilities of interests and commitments
this stage
Older Age
65yearsdeath
Ego
integrity vs.
despair
Self-absorption –
preoccupation with one’s
own emotions, interest
and situation
Many older adults review
their lives with
satisfaction even with
their inevitable mistakes
while others see
themselves as failures
with their lives marked by
despair and regret
Contribute to future generations through
good parenthood, teaching and
community involvement
Creativity, productivity, concern for others
Regret, discontent, pessimism
Renunciation and wisdom
People with despair often believe
they’ve made poor choices and wish a
do over
People who attain ego integrity view life
with a sense of wholeness and derive
satisfaction from past accomplishments.
They view death as acceptable
completion of life.
Sense of loss, contempt for others
Acceptance of worth and uniqueness of
one’s own life, acceptance of death
Havighurst’s Developmental Task
• Learning is basic to life and people continue to learn throughout
life.
• He described growth and development as occurring during six
stages each associated with six to ten tasks to be learned.
• He developed the theory in the 1950s, according to him,
developmental task is a task which arises at a certain period in life
of an individual, and successful achievement leads to happiness
and success with later tasks and failure leads to unhappiness in
individual, disapproval by society and difficulty with later tasks
👶 Infancy and Early Childhood
23 | P a g e
1. Walk
1. Take solid foods
2. Talk
3. Control elimination of body waste
4. Sex differences and sexual modesty
5. Achieving psychological stability
6. Forming simple concepts of social and physical reality
7. Relate emotionally to parents, siblings, and others
8. Distinguish right from wrong and developing conscience
🧒 Middle Childhood
1. Physical skills necessary for ordinary games
2. Building wholesome attitude toward oneself as a growing
organism
3. Get along with age-mates
4. Appropriate masculine and feminine social role
5. Develop fundamental skills in reading, writing, calculating
6. Developing concepts necessary for everyday living
7. Develop conscience, morality and values
8. Achieving personal independence
9. Develop attitudes toward social groups and institutions
Adolescence
1. Achieving new and more mature relations with agemates of both
sex
2. Achieving a masculine or feminine social role
3. Accepting one’s physique and using body effectively
4. Achieving emotional independence from parents and other adults
5. Achieving assurance of economic independence
6. Selecting and preparing for occupation
7. Preparing for marriage and family life
8. Developing for intellectual skills and concepts needed for civic
competence
9. Desiring and achieving socially responsible behavior
10. Acquiring a set of values and an ethical system as a guide to
behavior
Early Adulthood
1. Selecting a mate
2. Learning to live with a partner
3. Starting a family
4. Rearing children
5. Managing a home
6. Getting started in an occupation
7. Taking on civic responsibility
8. Finding a congenial social group
Middle Age
1. Achieving adult civic and social responsibility
2. Establishing and maintaining an economic standard of living
3. Assisting teenage children to become responsible and happy
adults
Stages
Age
Significant Behavior
24 | P a g e
4. Developing adult leisure-time activities
5. Relating oneself to one’s spouse as a person
6. Accepting and adjusting to the physiological changes of middle
age
7. Adjusting to aging parents
Later Maturity (elders aging 65 and above)
1. Adjust to decreasing physical strength and health
2. Adjusting to retirement and reduced income
3. Adjusting to death of spouse
4. Establishing explicit affiliation with one’s age group
5. Meeting social and civil obligations
6. Establishing satisfactory physical living arrangements
Jean Piaget’s Cognitive Development Theory
• Refers to the manner in which people learn to think, reason, and
use language and other symbols
• Involves person’s intelligence, perceptual ability and ability to
process information
• Represents an individual’s progression capabilities from illogical to
logical thinking, simple to complex, simple to abstract
• It is an orderly sequential process in which a variety of new
experiences must exist before intellectual abilities can develop.
Use of reflex
0-1
month
Primary circular
reaction
1-4
months
•
•
•
•
•
•
•
•
Secondary circular
reaction
4-8
months
•
•
Coordination and
secondary schemata
8-12
months
Tertiary circular
reaction
Invention of new
means
Preconceptual
12-18
months
18-24
months
2-4 years
Intuitive thought
4-7 years
Concrete operation
7-11
years
25 | P a g e
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Sensorimotor
Use of reflexes (gasping, sucking) – this is involuntary
Repetitious nature of reflexes is the beginning of associations between an act and a sequential response
Ie: when a baby cries and you put a nipple on its mouth, the baby will stop crying and suck on the nipple
Replacement of reflexive behavior with voluntary acts
Sucking habits are developed
Acknowledges objects visually, grasps at objects, and is attracted by sounds
Engages in activity for pleasure of activity
Ie: when a baby cries, in stage 1 he stops when the nipples in his mouth but in this stage, the baby will stop
crying upon hearing the voice of the mother
Primary circular reaction is repeated and prolonged for the response that results
Begins to discover and rediscover external environment unintentionally
o They shake the rattle because they like the noise
“Out of sight, out of mind” from 1st to 6th month – believes that the object only exists when they see it
Object permanence begins (7th to 8th month)
First actual intellectual behavior patterns emerge
Begins to distinguish the ends and means
They begin to discover that hiding an object does not mean that it is gone
Discovers new ways of solving problems by utilizing experimentation (flipping light switches)
Response is still from the environment but intentional
Possess mental images of the environment and utilizes cognitive skills to solve problems
The child’s play time is an imitation of what has been seen leading to pretend play
Uses “egocentric” approach to accommodate the demand of an environment (child’s own viewpoints)
o Egocentric – self-centered, only thinking of oneself
Explores the environment
Language development is rapid
Associate words with objects
Ie: when a kid is sad, will hug a teddy bear, when he sees someone else as sad, will give a teddy bear
Egocentric thinking diminishes, can now see how others sees things
Words express thoughts
Solves concrete problems
Developed conservation, reversibility and seriation
o Conservation – ability to see objects or quantities as remaining the same despite a change in
physical appearance (water poured to a tall glass which makes it look like it has more, but the child
will distinguish that it is the same as the other one in the glass, the beaker is just thin and tall)
o Reversibility – ability to recognize that numbers or objects can be changed and returned to their
original condition (when a water is placed in the fridge it’ll become ice)
Formal operation
11-15
years
•
•
•
o Seriation – mental classification of objects according to quantitative dimension (size, weight, height)
Understands right and left
Uses rational thinking
Reasoning is deductive and futuristic
o Capacity to think with reason
o Ie: cakes and chocolates have high sugar making it bad for health
Lawrence Kohlberg’s Moral Development Theory
• Involves learning what is ought and not ought to be done
• Relating to right and wrong
• Moral Development – This is the pattern of change in moral
behavior with age
• Morality of individual was not the main concern but the reasons an
individual makes when making decision
• Levels and stages are not always linked to a certain
developmental stage or age.
1. Preconventional or pre-moral – children are responsive to
cultural rules and labels of good and bad/right and wrong.
Children interpret these based in terms of the physical
consequences of their actions—punishment or reward
a. Punishment and Obedience
i. Actions are judged in terms of physical
consequences
1. Ie; we make moral judgments based on
obedience and punishment, Finn’s sense of
good and bad is linked to whether he gets
punished or not, he didn’t help his friend
because he didn’t want to be punished for
fighting
b. Individual Instrumental Purpose and Exchange
i. Individual engages in actions that are right to meet
his/her needs
ii. Individual separates his/her own interests from the
interests of the authorities
1. Ie: we are motivated by our interests to
perform actions that meet our needs. Mary
wants to help Tom but knows that she might
be a victim someday if the bullied will get
26 | P a g e
back to her, she also doesn’t see a benefit in
helping Tom so she won’t help him
2. Conventional level – concerned of maintaining the expectations
of the family group or nation and sees these as right. Emphasis of
this level is conformity and loyalty to one’s own expectations as
well as societies’
a. Mutual Interpersonal expectations, Relationships and
Conformity
i. Individual is paying attention to the feelings of others
ii. Individual puts oneself in other person’s shoes
(majority)
1. Ie: represents mutual interpersonal
expectations, relationships and conformity.
Betty sees fight and wants to intervene but
she saw that her friend Tom and Mary just
watching. She wants others to see her as a
good girl conforming to the rules thus not
involving in the fight. Concerned with peer
and group acceptance or the behavior of the
person at this stage
b. Social System and Conscience Maintenance
i. Individual fulfills duties assigned by authority figures,
thus fulfilling obligations set forth by society’s laws
1. Ie; individual fulfills duties assigned by
authority figures thus fulfilling obligations set
forth by society’s laws. When the teacher saw
the fight, he immediately steps in to stop the
fight. He thinks that it is essential to follow the
rules and not doing so could cause chaos and
believes that as a teacher of the school he
has the duty and responsibility to uphold and
reinforce rules to maintain peace and order
2. In this stage individual is concerned with
legalistic orientation, emphasized upholding
of the law order ding one’s duty and obeying
social norms
3. You know that over speeding is against the
law thus you avoid it—here you simply follow
the law or the one set by authority
3. Postconventional – people make effort to define valid values and
principles without regard to outside authority or expectations of
others
a. Prior Rights and Social Contract
i. Commitment to family and work obligations
ii. Individual has a responsibility to consider the moral
and legal point of view in ascertaining what will
provide the greatest good for people
1. You drive within the prescribe limit because
you know that over speeding is prohibited and
also because over speeding poses danger to
your life
b. Universal Ethical Principle
i. An individual follows what is right in accordance with
ethical principles
1. You know that over speeding is against the
law but you are over speeding right now
because your wide is dying; you are doing
this to save the life of your wife
James Fowler’s Spiritual Development Theory
• Development of faith – force that gives meaning to a person’s life,
uses faith as a form of knowing and a way of being in relation to
ultimate environment
• He believes that faith is a relational phenomenon; an active mode
of being in relation to another or others in which we incest
commitment, belief, love, risk and hope
Stage
Age
Weight
27 | P a g e
•
Faith Development – interactive process between person and
environment
Stage
Undifferentiated
IntuitiveProjective
Mythic-Literal
SyntheticConventional
IndividuatingReflexive
ParadoxicalConsolidative
Universalizing
Age
Characteristics
There is a formulation of concepts
0-3 years
about self and environment
Child is introduced to images and
4-6 years
beliefs from trusted people (family,
authorities)
Encompasses symbols, stories,
7-12 years and myths that possess spiritual
meaning
Environment is structures by
Adolescence expectations and judgment of
others
Adult build one’s own spiritual
> 18
system
Adult has awareness of truth from
> 30
many different viewpoints
An individual may not ever reach
this stage, the individual expresses
the principles of love and justice in
their life
Arnold Gesell’s Biophysical Theory
• Considered as the father of child development
• Described development of physical body
• Development is directed by genetics
• Child development is a process of maturation or differentiation
and refining of abilities and skills based on an in-born timetable
Events
Neonates (0- Birth - 1
1st) and
year
Infants (112)
•
•
•
At birth -- .27 – 3.8 kg
5 months of age = 2x
the birth weight
12 months = 3x the
birth weight
Smell, taste, and touch
• At birth – sense of smell and taste are functional shortly after and sense of touch is welldeveloped
• Newborns prefer sweet taste and tend to decrease their sucking in response to liquids with
salty content
Motor Development
• Newborn – turns head from side to side when in prone position and grasps by reflex when
object is placed in palm of hand
• 1 month – infants lifts head momentarily when prone and has a head lag when pulled to a
sitting position
• 4 months – rolls over, sits with support and hold steady when sitting, infant can now
recognize parents’ smile
• 6 months – may sit without support, lifts chest and shoulders off table when prone, bearing
weight on hands and manipulates small objects
• 9 months – creeps and crawls, uses pincer grasp with thumb and forefinger
• 12 months – walks alone with help, can use utensils to feed self and can turn pages of a
book
Social Development
• Newborn – displays displeasure by crying and satisfaction by soft vocalizations and attends
to adult face and voice by eye contact and quieting
• 4 months – babbles, laughs and exhibits increased response to verbal play
• 6 months – starts to imitate sounds, vocalizes one syllable sounds; ma ma, da da
• 9 months – complies with simple verbal commands, displays fear of being left alone, waves
bye bye
• 12 months – clings to mother in unfamiliar situations, demonstrates emotions such as anger
and affection
Nutrition
• Breastfeeding is recommended
• Addition of solid food is not recommended before the 6th month – GIT is not sufficient enough
for complex foods
• Introduction of cereals, fruits, vegetables and meat during the 2 nd 6 months of life provides
iron and vitamins – needs new minerals and other nutrients
• Solid food should be offered one new food at a time
Solitary Play
28 | P a g e
Toddlers
1-3
years
•
•
•
Usually chubby, with
short legs and large
head
Pronounced lumbar
lordosis and a
protruding abdomen
2 years old = 4x their
birth weight
• Plays alone
• Limited interaction with other children
18th months
• Can pick up grains and place them in a receptable
• Can hold spoon and cup
• Can walk upstairs with assistance
2 years
• Can hold spoon and put it into mouth correctly
• Can run
• Gait is steady and can balance one foot
• Can ride a tricycle
3 years
• Most are toilet trained
• 3 years old hearing is at adult level
Nutrition
• Limit milk intake to 2-3 cups per day because it can decrease their appetite
• Often develops food jags
• Should not be offered with low fat or skim milk until age of 2
• Serving finger foods to toddler allows them to eat by themselves
Preschoolers 4-5
years
•
•
•
•
•
29 | P a g e
Physical growth slows
but control of body
and coordination
increases greatly
Tend to grow more in
height than in weight
Appear taller and
thinned than toddlers
Hyperopic or far
sighted
Brain reaches its adult
size at 5 years
Parallel Play
• Playing beside rather than with another child – expands cognitive and psychosocial
development
5 years
• Wash hands, face and brush teeth
• Run skillfully and can jump three steps
• Can balance on their toes and dress themselves without assistance
Nutrition
• Average daily intake of 1800 calories
• Consume about half of the average adult sizes
• Finicky eating habits is the characteristic of a 4 years old
• 5 years old interested in trying new foods
Associative Play
School age
6-12
years
Adolescents
12-18
years
Young
adults
20-40
years
Middle Adult
40-65
years
30 | P a g e
• More social
• Plays together with other, engage in similar if not identical activity
• There is no division of labor or rigid rules
Motor Development
• 6-10 – children perfect their muscular skills and coordination
• 9 – many children are becoming skilled in games of interest (basketball, soccer)
Before puberty, both
sexes have growth spurt
• Girls 10-12 years
• Boys 12-14 years
Nutrition
• Girls may be taller
than boys at 12 years • Developing eating patterns that are independent of parental supervision
6 – thoracic curvature
• Need adequate caloric intake for growth throughout childhood
starts to develop and
• Availability of snacks and fast-food restaurants make it difficult for children to make healthy
lordosis disappears
choices
9-11 – 20/20 vision is
usually well-established
Team Play/Competitive or COmplex
• Can identify an
• Develops from the need for group interaction
unseen object, such
• Involves team games and sports (basketball and soccer)
as pencil or book
simply by touch
(stereognosis)
Puberty is the first stage of adolescence
• Menarche – onset for menstruation
• Ejaculation – expulsion of semen for boys
Both primary (organs) and secondary (differentiate male from female not linked to reproduction) sexual characteristics
develop
Noticeable signs of puberty
• Males – appearance of pubic hair and the enlargement of the scrotum and testes
• Females – appearance of breast buds (thelarche)
• Sudden and dramatic physical changes “adolescent growth spurt
• Growth is fastest for boys at 14 years
Fastest growth for girls is at 12 and they reach their maximum height by 15
• Young adulthood – Early 20s prime physical years
• 25 years old – at most efficient function
• Musculoskeletal system is well developed and coordinated
• Tend to be high-risk takers, placing their high functioning bodies at substantial risk of serios injury
Weight may change as a result of diet and exercise
• Years of stability and consolidation
Mature individual
• Guided by an underlying philosophy of life
• Are open to new experiences and continued growth
• Have quality of self-acceptance
• Assume responsibility for themselves and expect others to do the same
Category
Appearance
Musculoskeletal
System
Cardiovascular
System
Sensory Perception
Metabolism
Gastrointestinal
System
Sexuality
Older Adults
> 65
years
Description
Hair begins to thin, gray hair appears. Skin turgor and moisture decrease, subcutaneous fat
decreases, and wrinkling occurs. Fatty tissue is redistributed, resulting in fat deposits in abdominal
area
Skeletal muscle bulk decreases at age 60. Thinning of intervertebral disk causes decrease in height
of about 1 inch. Calcium loss from bone tissue is more common among postmenopausal women
and muscle growth continues in proportion to use
Blood vessel lose elasticity and become thicker
Visual acuity declines by late 40s, especially for near vision (presbyopia). Auditory acuity for high
frequency sounds also decreases (presbycusis), especially in men. Taste sensations also diminish
Slows and may result in weight gain
Gradual decrease in tone of large intestine may predispose individual to constipation
Hormonal changes take place both sexes
• Menopause – menstruation cease
• Climacteric – changes in sexual responses in men
Integumentary Changes
• Increased skin dryness, skin fragility
• Progressive wrinkling and sagging of the skin
• Brown “age spots” lentigo senilis on exposed body parts
Neuromuscular
• Loss of bone mass, joint stiffness, impaired balance and sarcopenia (reduction of skeletal muscle mass due to aging)
Sensory and Perceptual Changes
• Increased sensitivity to glare and decreased ability to darkness
• Presence of partial or complete glossy white circle around periphery of cornea (arcus senilis)
• Cataracts – clouding of the lens
• Progressive loss of hearing (presbycusis)
• Decreased sense of taste especially sweet
31 | P a g e
•
Decreased sense of smell
Immunologic
• Decreased immune response (immunocompromised) – lowered resistance to infections
MMDST – Metro Manila Development Screening Test
• A simple tool used in early detection of developmental delays in
children below 6 1/2 years old to recognize slow development
• This is modified and standardized by Dr. Phoebe Williams from
original Denver Developmental Screening Test (DDST) by Dr. William
K. Frankenberg
NOTE: The most crucial part is the child’s age because the test has 105
items, knowing the child’s age guides you on what should be assessed
Four Sectors:
• Personal Social – child’s ability to get along with people and to
take care of himself
• Fine Motor Adaptive – child’s ability to see and use his hands to
pick up objects and to draw
• Language – child’s ability to hear, follow direction and speak
• Gross Motor – child’s ability to sit, walk and jump
Materials Needed for MMDST
Before beginning a test, the following must be done:
1. Child can reach the test materials and be given some blocks or a
toy as soon as he sits down
2. Explain the test to the parents
a. Not a diagnostic test but a screening test only
b. Not an IQ test
c. Establish rapport with parent and child
d. Child is not expected to perform all task correctly
32 | P a g e
3. Prepare the test form – test must be given prior to any upsetting
medical/nursing procedures
Test Items
• There are 105 items in MMDST but not all are administered
o Only those that will pass through the line that responds to the
child’s age
• The examiner prioritizes items that the age line passes through
• Examiner should start with personal-social then progressing to the
other sectors
• Items that are footnoted with R can be passed by report
Age and the Age Line
• Age is the most crucial component of the test
• Compute for the exact age of the child during test date
o Subtract the test date with child’s birth date
• After computing, draw the age line in the test form
In this example, the age of the child is 3 years and 3 months that’s why it
is placed in the middle of 3 years and 3 ½
Four Scores:
̶
P – Pass
̶
F – Fail
̶
R – Refuse
̶
N.O. – No opportunity
•
•
A delay is any failure on an item which is completely to the left
of the child’s age line
Failure of an item that is completely to the right of the child’s age line
is acceptable and not a delay
Another example to fully understand the scoring
Considerations:
1. Manner in which test is administered must be exactly the same
as stated in the manual, words or direction may not be changed
2. If the child is premature, subtract number of weeks prematurity
a. But if child is more than 2 years of age during the test,
subtracting is not necessary
3. If the child is shy or uncooperative, caregiver may be asked to
administer the test provided that the examiner instructs caregiver
to administer it exactly as directed in the manual
33 | P a g e
4. If the child is very shy or uncooperative, test may be deferred
Age Calculation
• Birth Date: January 23, 2015
• Test Date: February 28, 2021
Year
2021
- 2015
6 years
•
•
Month
02
01
1 month
Day
28
23
5 days
Birth Date: March 23, 2015
Test Date: February 28, 2021
Year
2021
Month
2020
- 2015
6 years
34 | P a g e
02
03
1 month
Year
2020
- 2015
5 years
Year
2022
- 2017
4 years
Day
2+12
(year) = 14
Month
14
03
11 months
2021
Month
03
06
9 months
28
23
5 days
Day
28
23
5 days
3+12 =15
Day
17
05
12 days