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Chapter 2 Review of Related Literature This section deals with literature and the studies that are relevant to the topic under investigation. The readings are organized under the following headings.

Conceptual Literature The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations (NNAs), representing the more than 13 million nurses worldwide. Founded in 1899, ICN is the worlds first and widest reaching international organisation for health professionals. Operated by nurses and leading nurses internationally, ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce. The ICN Code of Ethics for Nurses, most recently revised in 2012, is a guide for action based on social values and needs. The Code has served as the standard for nurses worldwide since it was first adopted in 1953. The Code is regularly reviewed and revised in response to the realities of nursing and health care in a changing society. The Code makes it clear that inherent in nursing is respect for human rights, including the right to life, to dignity and to be treated with respect. Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is a respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. Nurses render health services to the individual, the

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family and the community and coordinate their services with those of related groups (ICN, 2012). The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct. ELEMENTS OF THE CODE: Nurses and people The nurses primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. The nurse ensures that the individual receives accurate, sufficient and timely information in a culturally appropriate manner on which to base consent for care and related treatment. The nurse holds in confidence personal information and uses judgement in sharing this information. The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. The nurse advocates for equity and social justice in resource allocation, access to health care and other social and economic services. The nurse demonstrates professional values such as respectfulness, responsiveness, compassion, trustworthiness and integrity.

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Nurses and practice The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. The nurse maintains a standard of personal health such that the ability to provide care is not compromised. The nurse uses judgement regarding individual competence when accepting and delegating responsibility. The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance its image and public confidence. The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people. The nurse strives to foster and maintain a practice culture promoting ethical behaviour and open dialogue. Nurses and the profession The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research-based professional knowledge that supports evidence-based practice. The nurse is active in developing and sustaining a core of professional values. The nurse, acting through the professional organisation, participates in creating a positive practice environment and maintaining safe, equitable social and economic working conditions in nursing.

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The nurse practices to sustain and protect the natural environment and is aware of its consequences on health.

The nurse contributes to an ethical organisational environment and challenges unethical practices and settings.

Nurses and co-workers The nurse sustains a collaborative and respectful relationship with co-workers in nursing and other fields. The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person. The nurse takes appropriate action to support and guide co-workers to advance ethical conduct.

Research Literature Foreign Studies Each state has what is called a nurse practice Act. The guidelines and laws outlined in the act pertain to all nurses who are licensed in that particular state. Nurse limitation is one of those laws. Each nurse has a limitation on what he is allowed and trained to do. He must follow the chain of command, especially with the care of patient. If he does not have the authority or knowledge to give a prescription, analyze a laboratory report, or advise the patient on treatment, he may not legally do so. Any wrong information or practice he commits is punished by the law and the patient or family may file a suit against him and the health agency or hospital he works for (Taund, 2012)

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'It is highly significant that what most troubled the nurses who responded were not the socalled "big" or "exotic" bioethical issues such as abortion, euthanasia, organ transplantation, or reproductive technology,' Professor Johnstone said, 'but the "everyday" ethical issues that occur in nursing practice and health care domains. 'It is also significant and disturbing that only 8.3% of the nurses who responded to the survey believed their places of employment provided adequate resources to help them deal with ethics and human rights issues in their nursing practice. The findings of the Victorian study strongly correlate with similar surveys conducted in the USA, Israel and the Netherlands. 'Unlike other research, which tended to provided more of a scholarly critique of the kinds of issues nurses face during the course of their practice, this study has sought to obtain nurses' own views on the degree to which they are involved in ethical issues in the work place; how effectively they have been able to deal with them and the extent to which their formal education has prepared them to deal effectively with ethical and human rights issues,' Professor Johnstone said. The challenge now, suggests Professor Johnstone, 'is to do something about this situation and to find ways that will enable nurses to deal effectively with the ethical issues they encounter during the course of their work' (Johnstone, 2008). Nursing students face a large number of ethical issues, both in their capacity as students and throughout their clinical training. Some issues are specific to nursing, and others are the kinds of issues all students face. Nursing students need to understand these issues, and to know where they can turn for assistance in making these difficult decisions (Arnette, 2008). Educational Ethics- Many students, both nursing and non-nursing, have ethical concerns such as cheating or plagiarism. It can be tempting to use an old paper from a former student or to take the answers to a test that is being offered by another class, for example. These kinds of

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ethical issues can plague a nursing student from the beginning of the educational process until graduation (Arnette, 2008). Informed Consent- In the nursing field and clinical, nurses must secure an informed consent before a procedure is done on the patient. This is true for simple procedures such as IV installation as well as for surgical procedures. There is always the risk that the nurse might not know enough about the procedure to be qualified to obtain that consent. In addition, a nurse might be afraid to ask for consent when told to perform a procedure by the medical professionals instructing the nurse (Arnette, 2008). Document Forgery- Forgery is a serious ethical issue. This involves not only copying a signature, but also signing a document without actually completing the process dictated in the paper. For example, a nursing student might be asked to write notes on a chart of a patient that he has not seen. Writing the notes on a chart after the fact also can be considered document forgery. This can cause difficulty in treating the patient later on, and it can cause people to believe the patient was seen at a time when he really was not seen (Arnette, 2008). Local Studies A 39-year-old homosexual is planning to sue a medical team after he saw in a cellular phone of a friend last Friday a circulated video footage of the operation to extract a perfume canister stuck in his anus during a sexual act. The operation on the man, was done at the Vicente Sotto Memorial Medical Center (VSMMC) last Jan. 3 yet, but the video footage has been circulating through cell phones since then and was even uploaded in the video-sharing web site, YouTube. The video that runs for two minutes and 28 seconds shows an operating team of more than 10 people laughing, with someone shouting instructions while the operation was going on. It

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captures individuals with mobile phones and cameras taking footage of the operation. A brief panning motion shows some of the faces of the people involved in the procedure. Loud cheering and shouting can be heard as the canister that someone describes as a baby is slowly pulled out of the anus. One of the staff even opens the perfume and sprays it around. All the time, the patient whose face is not visible in the video, is unconscious (Philippine Daily Inquirer, 2008). There is a legal and ethical obligation to maintain confidentiality of a patient when it comes to their health information. Nurses owe their patients the duty of confidentiality, but

there are legal exceptions a nurse may encounter when it comes to maintaining the confidentiality of their patients. Confidentiality is how nurses treat private information once it has been disclosed to others or themselves (dyeske1, 2011). A 26-year-old Victoria Deraco died in a government-run hospital after she was given the wrong blood type in a procedure that was supposed to save her life. Deraco had just given birth by caesarean operation when she was transfused with type A blood at the East Avenue Medical Center in December 2004. The procedure was done three times before attending doctors realized that her blood type was B. Due to the mistake, the young mother slipped into a coma and died in January 2005. Her family is now locked in a court battle against doctors, medical personnel and officials of the East Avenue Medical Center to seek justice for Deraco`s death - one of a growing number of horror stories resulting from medical negligence or incompetence in Philippine hospitals (francesdiva, 2010). Negligence in nursing is the failure of a nurse to act as a reasonably prudent person under the same or similar circumstances, which causes or results in harm to the patient (dickydoo, 2011).