Code of Ethics

CHAIR PERSON

DR.K.LALITHA

PROFESSOR & HOD

DEPARTMENT OF NURSING

NIMHANS

PRESENTER

JINTO PHILIP

I MSc PSYCHIATRIC NURSING

NIMHANS

SUBJECT: ADVANCED NURSING PRACTICE

use[Pick the date]

UNIT I: NURSING AS A PROFESSION

TOPIC: CODE OF ETHICS (INC), CODE OF PROFESSIONAL CONDUCT (INC), AUTONOMY AND ACCOUNTABILITY, ASSERTIVENESS, VISIBILITY OF NURSES, LEGAL CONSIDERATIONS

INTRODUCTION

Health care delivery system has undergone notable changes during the last few decades, including increased client participation, shorter hospital stays, and restructuring services to provide care in settings such as outpatient clinics, short-stay units, long-term care and in home-care. For nurses, these changes have contributed to the development of new clinical environment and expanded practice. Nurses today frequently encounter difficult situations involving decisions about the best course of action. Nurses are obligated to provide ethical and legal client care that demonstrates respect for others. Both fundamental principles of health care ethics and laws governing the scope of nursing guide nursing practice in all situations.6

CODE OF ETHICSCode - “A code may be defined as conventionalized set of rules or expectations devised for a specific

purpose.”6

Ethics-Word ethics is derived from the word “Ethos”. It is a Greek word and meaning of this word is customs, character or conduct. It may be related to a person or a profession or a professional body. When we study beliefs and assumptions it is moral philosophy and principles of morality tell us how human beings should behave with each other. Ethics is the branch of philosophy that examines the difference between right and wrong. Ethics are meant for holistic development of a professional.

“The term refers to the consideration of standards of conduct or the study of philosophical ideals of right and wrong behavior”. (American Heritage Dictionary, 2007)5

Code of Ethics-“A specific set of professional behaviors and values the professional interpreter must know and must abide by, including confidentiality, accuracy, privacy, integrity.”3

“What professionals ought or ought not to do, how they ought to comport themselves, what they, or the profession as a whole, ought to aim at…….” (Litchenberg 1996)2

An ethical code is adopted by an organization in an attempt to assist those in the organization called upon to make a decision (usually most, if not all) understand the difference between 'right' and 'wrong' and to apply this understanding to their decision. The ethical code therefore generally implies documents at three levels:

Code of ethics

A code of ethics often focuses on social issues. It may set out general principles about an organization's beliefs on matters such as mission, quality, privacy or the environment. It may delineate proper procedures to determine whether a violation of the code of ethics has occurred and, if so, what remedies should be imposed. The effectiveness of such codes of ethics depends on the extent to which management supports them with sanctions and rewards. Violations of a private organization's code of ethics usually can subject the violator to the organization's remedies. The code of ethics links to and gives rise to a code of conduct for employees.7

Code of conduct (employee ethics)

A code of conduct is a document designed to influence the behavior of employees. They set out the procedures to be used in specific ethical situations, such as conflicts of interest or the acceptance of gifts, and delineate the procedures to determine whether a violation of the code of ethics occurred and, if so, what remedies should be imposed. The effectiveness of such codes of ethics depends on the extent to which management supports them with sanctions and rewards. Violations of a code of conduct may subject the

ETHICAL & LEGAL CONSIDERATIONS IN NURSING

http://en.wikipedia.org/wiki/Code_of_conduct

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http://en.wikipedia.org/wiki/Business_ethics

violator to the organization's remedies which can under particular circumstances result in the termination of employment.7

Code of practice (professional ethics)

A code of practice is adopted by a profession or by a governmental or non-governmental organization to regulate that profession. A code of practice may be styled as a code of professional responsibility, which will discuss difficult issues, difficult decisions that will often need to be made, and provide a clear account of what behavior is considered "ethical" or "correct" or "right" in the circumstances. In a membership context, failure to comply with a code of practice can result in expulsion from the professional organization.7

CODE OF ETHICS FOR NURSES

Ethics gives the professionals various guidelines that how should they behave with each other, with the public and with governments. These are guideline which the professional should follow when they are dealing with their clients or patients. Ethics also tell the public that what they can expect from a professional and tells the professionals that what the public expects from them. Ethics are needed for every profession so that nobility and respect of that profession remains undiminished.

“Nursing ethics refers to ethical issues that occur in nursing practice”4

Nursing is a great profession, giving a healing touch to patients along with taking care of their diseases and maintaining their health. This profession is held in high esteem but this esteem varies in different countries. This difference is not without reasons. In some countries the associations of nurses have their own code of ethics. These associations lay stress on the following of ethical codes. Strict following of the codes in some countries leads to credibility of that profession and esteem of that profession rises automatically. This leads us to believe that there is no alternative to following of the codes of ethics. Ethics are needed both for the nurses as well as the nursing students. For nurses in India the Indian Nursing Council (INC) has laid down code of ethics and professional conduct.

CODE OF ETHICS AND PROFESSIONAL CONDUCT (INDIAN NURSING COUNCIL)

KEY WORDS

Assurance : A promise that you will definitely do something1

Health: A state of dynamic balance of an individual’s ability to perform personally valued roles and responsibilities, to deal and cope with physical, biological, psychological and social stresses and challenges throughout the life while continuing to maintain a sense of well-being.1

Nurse: Nurse is a person who has completed prescribed course in Nursing from an institution recognized by Indian Nursing Council and registered herself/himself under the State Nursing council as Nurse and midwife.


http://en.wikipedia.org/wiki/Professional_responsibility




Nursing: Nursing is a professional service for enabling a person to maintain and sustain health and wellbeing.

Performance criteria: Selected behaviors which illustrate how the standard is achieved.

Practice standards: Set of Activities expected from professional group of workers.

Personal etiquettes: Being polite & soft spoken, honest, sincere, cheerful, dignified, affectionate, compassionate and courteous.

Professional etiquettes: Being attentive listener, keen observer, objective, non-judgmental, empathetic, confident, assertive, disciplined, prompt and efficient.

Professional body or Regulatory body: Indian Nursing Council / State Nursing Council is statutory body which regulates the Nursing Education and practice in India.

Professional Worker: A person who confirms to a level of practice that is expert and ethical after completing an authorized educational programme.

Provider: Same as nurse

Quality Nursing Practice: Quality of nursing practice is achieved when organization’s processes and activities are designed and implemented to meet the needs and expectations of the receiver on a competent, consistent and continuous basis.

Quality Assurance in Nursing: Quality Assurance is a program for formal guarantee for provision of quality nursing care against set standards.

Rationale: Reasoning for the standards.

Receiver: Receiver(s) refer to those individual persons/ families/ groups/ communities who are in need of assistance from Nurse to maintain and sustain their health and well-being.

Standards: Level of performance required for obtaining a specified desired outcome.

Vulnerable: vulnerable persons are those who are disadvantaged due to physical, emotional and social and economic reasons e.g.,

Mentally and physically challenged person. Emotionally traumatized persons. Women, children, marginalized groups.

Well Being: It is an active state of a person with maximum potential by maintaining balance and is at peace with inner and outer world.

Code of Ethics and Professional Conduct (INC)

Introduction


The code of professional conduct for nurses is critical for building professionalism and accountability. Ethical considerations are vital in any area dealing with human beings because they represent values, rights and relationships. The nurse must have professional competence, responsibility and accountability with moral obligations. Nurse is obliged to provide services even if it is in conflict with her/his personal beliefs and values.

Purpose

The purpose of professional conduct is to inform both the nurse and the society of the minimum standard for professional conduct. It provides regulatory bodies a basis for decisions regarding standards of professional conduct.

The code of ethics helps to protect the rights of individuals, families and community and also the rights of the Nurse.

The Use of the Code

Acknowledges the rightful place of Individuals in health care delivery system. Contributes towards empowerment of individuals to become responsible for their health and well-

being. Contributes to quality care. Identifies obligations in practice, research and relationships. Informs the individuals, families, community and other professionals about expectations of a nurse.

Code of Ethics for Nurses in India (INC)

1. The nurse respects the uniqueness of individual in provision of care

Nurse

1.1 Provides care for individuals without consideration of caste, creed, religion, culture, ethnicity, gender, socio-economic and political status, personal attributes, or any other grounds

1.2 Individualizes the care considering the care considering the beliefs, values and cultural sensitivities.

1.3 Appreciates the place of the individual in family and community and facilitates participation of significant others in the care.

1.4 Develops and promotes trustful relationship with individual(s).

1.5 Recognizes uniqueness of response of individuals to interventions and adapts accordingly.

2. The nurse respects the rights of individuals as partner in care and helps in making informed choices

Nurse

2.1 Appreciates individual’s right to make decisions about their care and therefore gives adequate and accurate information for enabling them to make informed choices.


2.2 Respects the decisions made by individual (s) regarding their care.

2.3 Protects public from misinformation and misinterpretations.

2.4 Advocates special provisions to protect vulnerable individuals/groups.

3. The nurse respects individual’s right to privacy, maintains confidentiality, and shares information judiciously.

Nurse

3.1 Respects the individual’s right to privacy of their personal information.

3.2 Maintains confidentiality of privileged information except in life threatening situations and uses discretion in sharing information.

3.3 Takes informed consent and maintains anonymity when information is required for quality assurance/academic/legal reasons.

3.4 Limits the access to all personal records written and computerized to authorized persons only.

4. Nurse maintains competence in order to render Quality Nursing Care

4.1 Nursing care must be provided only by registered nurse.

4.2 Nurse strives to maintain quality nursing care and upholds the standards of care.

4.3 Nurse values continuing education, initiates and utilizes all opportunities for self development.

4.4 Nurse values research as a means of development of nursing profession and participates in nursing research adhering to ethical principles.

5. The nurse is obliged to practice within the framework of ethical, professional and legal boundaries

Nurse

5.1 Adheres to code of ethics and code of professional conduct for nurses in India developed by Indian Nursing council.

5.2 Familiarizes with relevant laws and practices in accordance with the law of the state.

6. Nurse is obliged to work harmoniously with the members of the health team.

Nurse

6.1 Appreciates the team efforts in rendering care.

6.2 Cooperates, coordinates and collaborates with the members of the health team to meet the needs of the people.

7. Nurse commits to reciprocate the trust invested in nursing profession by society


Nurse

7.1 Demonstrates personal etiquettes in all dealings.

7.2 Demonstrates professional attributes in all dealings.

Code of Professional Conduct for Nurses in India (INC)

1. Professional Responsibility and accountability

Nurse

1.1 Appreciates sense of self-worth and nurtures it.

1.2 Maintains standards of personal conduct reflecting credit upon the profession.

1.3 Carries out responsibilities within the framework of the professional boundaries.

1.4 Is accountable for maintaining practice standards set by Indian Nursing Council

1.5 Is accountable for own decisions and actions

1.6 Is compassionate

1.7 Is responsible for continuous improvement of current practices

1.8 Provides adequate information to individuals that allows them informed choices

1.9 Practices healthful behaviour

2. Nursing Practice

Nurse

2.1 Provides care in accordance with set standards of practice

2.2 Treats all individuals and families with human dignity in providing physical, psychological, emotional, social and spiritual aspects of care

2.3 Respects individual and families in the context of traditional and cultural practices and discouraging harmful practices

2.4 Presents realistic picture truthfully in all situations for facilitating autonomous decision-making by individuals and families

2.5 Promotes participation of individuals and significant others in the care

2.6 Ensures safe practice

2.7 Consults, coordinates, collaborates and follows up appropriately when individuals’ care needs exceed the nurse’s competence.


3. Communication and Interpersonal Relationships

Nurse

3.1 Establishes and maintains effective interpersonal relationship with individuals, families and communities

3.2 Upholds the dignity of team members and maintains effective interpersonal relationship with them

3.3 Appreciates and nurtures professional role of team members

3.4 Cooperates with other health professionals to meet the needs of the individuals, families and communities

4. Valuing Human Being

Nurse

4.1 Takes appropriate action to protect individuals from harmful unethical practice

4.2 Consider relevant facts while taking conscience decisions in the best interest of individuals

4.3 Encourage and support individuals in their right to speak for themselves on issues affecting their health and welfare

4.4 Respects and supports choices made by individuals

5. Management

Nurse

5.1 Ensures appropriate allocation and utilization of available resources

5.2 Participates in supervision and education of students and other formal care providers

5.3 Uses judgment in relation to individual competence while accepting and delegating responsibility

5.4 Facilitates conducive work culture in order to achieve institutional objectives

5.5 Communicates effectively following appropriate channels of communication

5.6 Participates in performance appraisal

5.7 Participates in evaluation of nursing services

5.8 Participates in policy decisions, following the principle of equity and accessibility of services


5.9 Works with individuals to identify their needs and sensitizes policy makers and funding agencies for resource allocation

6. Professional Advancement

Nurse

6.1 Ensures the protection of the human rights while pursuing the advancement of knowledge

6.2 Contributes to the development

6.3 Participates in determining and implementing quality care

6.4 Takes responsibility for updating own knowledge and competencies

6.5 Contributes to the core of professional knowledge by conducting and participating in research1

Autonomy

The term autonomy comes from the Greek word autos (meaning ‘self’) and nomos (meaning ‘rule’, ‘governance’ or ‘law’). I.e. autonomy means ‘self-governing’ or “right to make one’s own decisions”. In contemporary discourse it has broad meanings, including individual rights, privacy, and choice. Autonomy entails the ability to make a choice free from external constraints.3

Autonomy basically mean that people should be free to choose and entitled to act on their preferences provided their decisions and actions do not stand to violate or impinge on, the significant moral interest of others. Nurses who follow this principle recognize that each client is unique, has the right to be what that person is, and has the right to choose personal goals. Honoring the principle of autonomy means that the nurse respects a client’s right to make decisions even when those choices seems not to be in the client’s best interest. Adults with capacity (physical and mental) to make healthcare decisions have the right to consent to or refuse treatment. Even if healthcare providers do not agree with a client’s decision, they must respect the client’s wishes (Beauchamp & Childress, 2001)3. Infants, young children, people who are severely mentally handicapped or incapacitated, and people in a persistent vegetative stage or coma do not have the capacity to participate indecision making about their healthcare. For such people, a surrogate decision maker must be identified to act on their behalf.2

National League of Nursing Statement on Patients' Rights

To health care that is accessible and that meets professional standards, regardless of the setting. To courteous and individualized health care that is equitable, humane, and given without

discrimination as to race, color, creed, sex, national origin, source of payment, or ethical or political beliefs.

To information about their diagnosis, prognosis, and treatment including alternatives to care and risks involved in terms they and their families can readily understand, so that they can give their informed consent.

To informed participation in all decisions concerning their health care. To information about the qualifications, names, and titles of personnel responsible for providing their

health care.


To refuse observation by those not directly involved in their care. To privacy during interview, examination, and treatment. To privacy in communicating and visiting with people of their choice. To refuse treatment, medications, or participation in research and experimentation, without punitive

action being taken against them. To coordination and continuity of health care. To appropriate instruction or education from health care personnel so that they can achieve an

optimal level of wellness and an understanding of their basic health needs. To confidentiality of all records (except as otherwise provided for by law or third party payer

contracts) and communications, written or oral, between patients and health care providers. To access to all health records pertaining to them, and the right to challenge and correct their

records for accuracy, and the right to transfer all such records in the case of continuing care. To information on the charges for services, including the right to challenge these. To be fully informed as to all their rights in all health care settings.4

Accountability

“Accountability is the obligation of being answerable for one's own judgments and actions to an appropriate person or authority recognized as having the right to demand information and explanation”. (A dictionary of nursing, 2008)4

Integral to the practice of any profession is the inherent need to be responsible for actions taken and for omissions.

The professional nurse must be proactive and take all appropriate measures to ensure that her own practice is not lacking, remiss, or deficient in any area or way.

Useful proactive measures include:o Maintaining familiarity of relevant, current hospital policies, procedures, and regulations as

they apply to the nurse's practice and specialty area.o Providing for self-audit.o Providing for peer review to assess reasonableness of care in a particular setting for a

particular problem.o Working with local nursing organizations to make certain that local standards of practice are

met.o Examining the quality (accuracy and completeness) of documentation.o Establishing open working relationships with colleagues wherein honest constructive criticism

is welcomed for the greater goal of quality patient care. Local standards of practice normally coordinate with those of nationally accepted standards.

Assertiveness

“Assertiveness is the quality or state of bold or confident self-expression, neither aggressive nor submissive” (Dorland’s medical dictionary, 2007)8

“Assertiveness is the ability to express yourself and your rights without violating the rights of others”9

It means that we have respect both for ourselves and for others. We are consciously working toward a "win-win" solution to problems. A win-win solution means that we are trying to make sure that both parties end up with their needs met to the degree possible. An assertive person effectively influences, listens, and negotiates so that others choose to cooperate willingly.


Specific Techniques for being Assertive

*Be as specific and clear as possible about what you want, think, and feel. The following statements project this preciseness:

a. "I want to..."

b. "I don't want you to...”

*Allow others to complete their thoughts before you speak.

* Make your own decisions based on what you think is right

* Look to friendships as opportunities to learn more about yourself and others and to share ideas.

* Spontaneously and naturally enter into conversations using a moderate tone and reasonable volume of voice.

* Try to understand the feelings of others before describing your own.

* Try to avoid harm and inconvenience by talking out your problems before they occur or finding rational means for coping with unavoidable harm or inconvenience.

* Face problems and decisions squarely.

* Consider yourself strong and capable, but generally equal to most other people.

* Face responsibility with respect to your situation, needs and rights.

On being Non-assertive

* Stay in the back of groups.

* Always stick to the middle-of-the road position.

* Allow others to make decisions for you.

* Always keep your voice low or avoid eye contact to keep from calling attention to yourself

* Verbally agree with others despite your real feelings.

* Bring harm or inconvenience to yourself to avoid harming or inconveniencing others.


* Procrastinate to avoid problems and to keep from making decisions.

* Always consider yourself weaker and less capable than others.

* Always escape responsibility with excuses and "good" reasons.

Problems with being non-assertive

* You may end up with shoddy merchandise and service.

* You bottle up your feelings.

* You are not doing anything to improve a bad situation.

* You get involved in situations you would rather not be in.

* You end up being a "yes" person - having to do all the work while others sit by and watch.

* You run into communication barriers because nobody is willing to say what he or she really wants.9

Visibility

Nurses remain as the “invisible partner in health care". According to a study in about twenty thousand articles published in magazines and newspapers selected in the United States, identifying that nurses were mentioned in only 4% of the articles related to heath, while physicians were present in 43%. Recommendations to give more visibility to the nursing role include the need for professionals to position themselves strategically towards the communication means and also to educate the journalists.

According to Borenstein M. (2002), "We understand by professional image a network of social representations of Nursing which, by means of a set of concepts, affirmations and explanations, reproduces and is reproduced by ideologies originated in the daily social practices internal/external to it. The professional image leads us to professional identity itself, in its intricate network of meanings that intend to be exclusive and, therefore, inherent to that specific profession. Hence, the professional meaning consubstantiates in its own representation of professional identity"11

Legal considerations in nursing

Nursing practice is governed by many legal concepts. It is important for nurses to know the basics of legal concepts, because nurses are accountable for their professional judgments and actions.

“Laws are rules or standards of human conduct established by government through legislative bodies and interpreted by court to protect the rights of the citizens.”

Functions of law in nursing

It provides a framework for establishing which nursing actions in the care of clients are legal. It differentiates nurse’s responsibilities from those of other professionals. It helps establish boundaries of independent nursing action. It assists in maintaining a standard of nursing practice by making nurses accountable under the law.4


Sources of Laws

Three kinds of laws have the potential to affect nursing practice:

Civil law generally governs actions by one individual or corporation against another. E.g. A client or family member sues the nurse or nurse’s employer for malpractice because of a claim of client injury caused by nursing care.

Criminal law involves actions by the state against an individual by the state against an individual for violations of criminal statutes. E.g. drug diversion, client assault, mercy killing etc.

Administrative law involves actions by state administrative agencies against individuals or organizations. E.g. administrative agencies govern the practice of nursing through boards or commissions of nursing in each state.6

Regulation of nursing practice

Credentialing

Credentialing is the process of determining and maintaining competence in nursing practice. It includes:

Licensure: Licensures are legal permits a governmental agency grants to individuals to engage in the practice of a profession and to use a particular title.

Registration: it is the listing of an individual’s name and other information on the official roster of a governmental or non-governmental agency. Nurses who are registered are permitted to use the title “Registered Nurse”.

Certification: certification is the voluntary practice of validating that an individual nurse has met the minimum standards of nursing practice in specialty areas such as MCH nursing, gerontology etc.

Accreditation: Accreditation is a process by which a government or private agency appraises and grants accredited status to institutions, programmes, or services that meet predetermined structure, process, and outcome criteria.

Legal roles, rights and responsibilities of nurses

Role-Provider of service

Responsibilities:

To provide safe and competent care commensurate with the nurse’s preparation, experience, and circumstances.

To inform clients of consequences of various alternatives and outcomes of care. To provide adequate supervision and evaluation of others for whom the nurse is responsible. To remain competent.

Rights:


Right to adequate and qualified assistance as necessary. Right to reasonable and prudent conduct from clients, e.g., provision of accurate information

as required.

Role-Employee or contractor for service

Responsibilities:

To fulfill the obligations of contracted service with the employer. To respect the employer. To respect the rights and responsibilities of other health care providers.

Rights:

Right to adequate working conditions (e.g. safe equipment and facilities) Right to compensation for services rendered. Right to reasonable and prudent conduct by other health care providers.

Role-citizen

Responsibilities:

To protect the rights of the recipients of care.

Rights:

Right to respect by others of the nurse’s own rights and responsibilities. Right to physical safety.

Standards of care

Informed consent

“Informed consent is an agreement by a client to accept a course of treatment or a procedure after complete information, including the risks of the treatment and facts relating to it , has been provided by a health care professional”

The doctrine of informed consent has become a fundamentally accepted principle governing the relationship between professional nurses and all other health care providers and patients.

Informed consent relates to the patient's right to accept or reject treatment by a nurse or any other health care provider and is a right of all legally competent adults or emancipated minors.

In the majority of circumstances, informed consent is obtained for medical or surgical procedures to be performed by physicians. Therefore, the duty to inform the patient of alternative treatments, the nature of the procedure, the benefits, and potential risks is the physician's. Oftentimes, especially when the patient is hospitalized, the nurse is required to witness the patient's signature before the procedure. It is prudent for the nurse to note witness to signature directly next to the patient's signature.

Emancipated minors are individuals who are under age 18 and married, or are parents of their own children, or are self-sufficiently living away from the family domicile with parental consent.


In the case of a minor, informed consent would be obtained from the legal guardian. In the case of individuals incapable of understanding medical treatment issues, informed consent

must be obtained through a responsible person such as a guardian. The nurse has the duty to verify that the physician or other health care provider has explained each

treatment or procedure in a language the patient (or the responsible person) can comprehend, that he has warned the patient of any material risks, dangers, or harms inherent in or collateral to the treatment, and has advised the patient of available alternatives. This enables the patient to make an intelligent and informed decision and choice about whether to undergo treatment.

The informed consent should be obtained before rendering the treatment or performance of the procedure.

The nurse must document that the informed consent was obtained and that the patient understood the information.

The informed consent should be obtained in the presence of a witness.5

Torts and crimes

Crime: A crime is an act committed in violation of the public(criminal) law and punishable by a fine or imprisonment.

Tort: A tort is a civil wrong committed against a person or a person’s property. Torts are usually litigated in the court by civil action between individuals. Torts may be classified as intentional or unintentional.

Unintentional torts

Negligence: is the misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent practitioner.

Malpractice: is a professional negligence, that is , negligence that occurred while the person was performing as a professional.

Intentional torts

Assault: is the threat of touching another person without his or her consent.

Battery: battery is the actual carrying out of such a threat. E.g. a nurse may be sued for battery if he or she fails to obtain consent for a procedure.

Defamation: is communication that is false, or made with a careless disregard of the truth, and results in injury to the reputation of the person.

Fraud: fraud is the willful, purposeful misinterpretation of self or an act that may cause harm to a person or property.

Invasion of privacy: disclosing confidential information to an inappropriate third party subjects the nurse to liability for invasion of privacy, even the information is true.

False imprisonment: prevention of movement or unjustified retention of a person without consent may be false imprisonment.


Legal protection in nursing practice

Good Samaritan Acts

Good Samaritan acts are laws designed to protect healthcare providers who provide assistance at the scene of an emergency against the claims of malpractice unless it can be shown that here was a gross departure from the normal standards of care or willful wrongdoing on their part.

Guidelines for nurses who choose to render emergency care are:

Limit actions to those normally considered first aid as possible. Do not perform actions that you do not know how to do. Offer assistance, but do not insist. Do not leave the scene until the injured person leaves or another qualified person takes over.6

Legal precautions for Nurses

Function within the scope of your education, job description and area of nursing practice. Follow the procedures and policies of the employing agency. Build and maintain good rapport with the clients. Always identify the clients, particularly before initiating major interventions. Observe and monitor the client accurately. Communicate and record significant changes. Promptly and accurately document all the assessment and care given. Be alert when implementing nursing interventions and give each task your full attention and skill. Perform procedures appropriately. Follow 5 rights while administering medications. When delegating responsibilities, make sure that the person who is delegated a task understands

what to do and that the person has the required knowledge and skill. Protect clients from injury. Report all incidents involving clients. Always check any order that a client questions and ensure that verbal orders are accurate and

documented appropriately. Know your strengths and weaknesses. Maintain your clinical competence.4

Conclusion

Addressing ethical problems in clinical practice is a moral obligation that fosters empowerment for all nurses. It increases the nurse’s satisfaction about what they can achieve for the clients to whom they provide care. Nurses achieve personal and professional success by identifying ethical problems and legal responsibilities in clinical practice and using their knowledge skills to bring about resolution.6

BIBLIOGRAPHY

1. Code of Ethics and Professional Conduct. Indian Nursing Council. New Delhi. Page 1-17

2. Ford Gary G. Ethical Reasoning for Mental Health Professionals. New Delhi: Sage Publications;2006.Page 1-13


3. Johnstone, Megan- Jane. Bioethics: A Nursing Perspective. 4TH edition. Australia:Elsevier;2004. Page 18-46

4. Kozier, Erb, Berman, Burke. Fundamentals of Nursing: Concepts, Process and Practice.6TH edition. Singapore: Pearson Education (Pte.Ltd); 2003.Page 70-83

5. Pattricia.A.Potter, Anne Griffin Perry, Moshy. Basic Nursing:Essentials for Practice. 6TH edition. St.Louis,Missouri: Elsevier;2008. Page 67-70

6. Ruth F. Craven, Constance J. Hirnle. Fundamentals of Nursing: Human Health and Function.5 TH edition. Philadelphia: Lippincott Williams & Wilkins; 2007. Page 87-106

7. www.en.wikipedia.org/wiki/Assertiveness

8. www.encyclopedia.com

9. www.medical-dictionary.thefreedictionary.com/assertive

10. www3.interscience.wiley.com/journal/119304526/abstract?CRETRY=1&SRETRY=0

11. www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692007000200002


http://www3.interscience.wiley.com/journal/119304526/abstract?CRETRY=1&SRETRY=0

http://www.medical-dictionary.thefreedictionary.com/assertive

http://www.encyclopedia.com/

http://www.en.wikipedia.org/wiki/Assertiveness

Code of Ethics

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