Code of ethics & professional conduct

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 out-patient clinics, short stay units, long-term care and in
home care. For nurses, these changes have frequently encounter difficult situations involving
decisions about the best course of actions. 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.

Code of ethics

Code-“A code may be defined as conventionalized set of rules or expectations devised for a
specific purpose.”

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Code of ethics: “A specific set of professional behaviors and values the professional interpreter
must know and must abide by, including confidentiality,accuracy,privacy,intergrity.

An ethical code is adopted by an organization in an attempt to assist those in the

organizations called upon to make a decisions (usually most,if not all) understand the difference
between ‘right’ or ‘ wrong’ and to apply this understanding to their decisions.The ethical code
therefore generally implies documents at three levels:

1.Code of ethics:A code of ethics often focuses on social issues.It may set out general principles
about an organization’s beliefs of matters, such as mission, quality, privacy or 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 or rewards.Violations
of private organizations 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.

2.Code of conduct(employee ethics): A code of conduct is a document to influence the

behavior of employees.They set out the procedures to be used in specific ethical situations, such
as conflict 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
imposed.Violations of a code of conduct may subject the violator to the organizations remedies
which can under particular circumstances result in the termination of employement.
3.Code of practice(professional ethics): A code of ethics is adopted by a governmental or non-
governmental organization to regulate that profession.A code of practice may be styled as a code
of professional responsibilities, which will discuss 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.

CODE OF ETHICS

CODE OF CONDUCT

CODE OF PRACTICE

LEVEL OF ETHICAL CODE

I.C.N. Code of Ethics for Nurses(1973)The fundamental responsibility of the nurse is

four fold : to promote health, to prevent illness , to restore health and to alleviate
suffering.Nurses render services to the individuals, the family and the community and co-
ordinate their services with those of related groups.

NURSES AND PEOPLE:The nurse’s primary responsibilities is to those people who require
nursing care.The nurse in providing care, promotes an environment in which the values, customs
and spiritual beliefs of the individual are respected .The nurse holds in confidence personal
informations and use judgment in sharing his information.

NURSES AND PRACTICE:The nurse carries personal responsibility for nursing practice and
for maintaining competence by continual learning. The nurse maintains the highest standards of
nursing care possible with in the reality of a specific situation. The nurse uses judgment in
relation to individual competence when accepting and delegating responsibilities.The nurse
when acting in a professional capacity should at all times maintain standards of personal conduct
which credit upon the profession.
NURSES AND SOCIETY:The nurses with other citizens the responsibility for initiating and
supporting action to meet the health and social needs of the public.

NURSES AND CO-WORKERS:The nurse maintain a co-operatives relationship with co-

workers in nursing and others fields.The nurse takes appropriate action to safeguard the
individual when his care is endangered by a co-worker or any other person.

NURSES AND THE PROFESSION:The nurse plays the major role in determining and
implementing desirable standards of nursing practice and nursing education. The nurse is active
in developing a core of professional organization, participates in establishing and maintaining
equitable social and economic working conditions in nursing.

Code of Ethics for Nurses in India(INC)

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

 Provides care for individuals without consideration of caste, creed, religion, culture,
ethnicity, gender, socio-economic and political status, personal attributes, or any other
grounds.
 Individualizes the care considering the care considering the beliefs, values and cultural
sensitivities.
 Appreciates the place of the individual in family and community and facilitates
participation of significant others in the care.
 Develops and promotes trustful relationship with individual(s).
 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

 Appreciates individual’s right to make decisions about their care and therefore gives
adequate and accurate information for enabling them to make informed choices.
 Respects the decisions made by individual(s) regarding their care.
 Protects public from misinformation and misinterpretations.
 Advocates special provisions to protect vulnerable individuals/groups
3)The nurse respects individual’s right to privacy, maintains confidentiality and shares
information judiciously.Nurse

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

 Maintains confidentiality of privileged information except in life threatening situations
and uses discretion in sharing information.
 Takes information consent and maintains anonymity when information is required for
quality assurance/academic/legal reasons.
 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.Nurse

 Nursing care must be provided only by registered nurse.

 Nurse strives to maintain quality nursing care and upholds the standards of care.
 Nurse values continuing education, initiates and utilizes all opportunities for self
development.
 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 frameworks of ethical professional and
legal boundaries.Nurse

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

 Appreciates the team efforts in rendering care.

 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

 Demonstrates personal etiquettes in all deal

 Demonstrates professional attributes in all dealings.
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CODE OF ETHICS FOR NURSES

Ethical Principles: (INC)

1. Principle of autonomy: it refers to a person’s independence. As a principle of bioethics,

autonomy represents an agreement to a respect the patient’s right to determine a course of action.
2. Principle of justice: it refers to fairness. Basic principle is that each person has equal right to the
liberty available to everyone.
3. Principle of veracity: the obligation to tell truth.
4. Principle of fidelity: the duty to do what one has promised.
5. Principle of respect: it involves level of understanding of another person or empathy and
reducing exploitation.
6. Principle of beneficence: activity seeking benefits, promotion of good. The duty to do balance
between benefits and harms, in this health care provider decides what is best for the client.
7. Principle of nonmaleficene : refers to the fundamental agreement to do no harm. This principle
guides decisions about new or controversial technologies.
8. Principle of responsibility: it refers to the execution of duties associated with a nurse particular
role.
9. Principle of accountability: it refers to the ability to answer for nurse’s actions. The nurse must
balance accountability to the patient, the profession, the employing institution and society.
10. Principle of confidentiality: the health care providers require that those who are having access to
personalhealth information not disclose the information to a third party without patient consent.
11. Principle of competence:refers to specific knowledge and skills necessary to perform a task. In
the practice of nursing competence ensures the provision of safe nursing care.
12. Principle of judgment : it refers to the ability to form an opinion or draw sound conclusions.
Code of Professional Conduct (INC)

Introduction:

The code of professional conduct for nurses is critical for building professionalism and
accountability. Ethical consideration 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 Professional Conduct for Nurses in India (INC)

1. Professional Responsibility and accountability.

Nurse.
 Appreciates sense of self-worth and nurtures it.
 Maintains standards of personal conduct reflecting credit upon the profession.
 Carries out responsibilities with the framework of the professional boundaries.
 Is accountable for maintaining practice standards set by Indian Nursing Council.
 Is accountable for own decisions and actions.
 Is compassionate.
 Is responsible for continuous improvement of current practices.
 Provides adequate information to individuals that allows them informed choices.
 Practices healthful behaviour.
2. Nursing Practice.

Nurse.
 Provides care in accordance with set standards of practice.
 Treats all individuals and families with human dignity in providing physical,
psychological, emotional social and spiritual aspects of care.
 Respects individual and families in the context of traditional and cultural practices
and discouraging harmful practices.
 Presents realistic picture truthfully in all situations for facilitating autonomous
decision-making by individuals and families.
 Promotes participation of individuals and significant others in the care.
 Ensures safe practice
 Consults, coordinates, collaborates and follows up appropriately when
individual’s care needs exceed the nurse’s competence.

3. Communication and Interpersonal Relationships.

Nurse.
 Establishes and maintains effective interpersonal relationship with individuals,
families and communities.
 Upholds the dignity of team members and maintains effective interpersonal
relationships with them.
 Appreciates and nurtures professional role of team members.
 Cooperates with other health professionals to meet the needs of the individuals,
families and communities.
4. Valuing Human Being.

Nurse
 Takes appropriate action to protect individuals from harmful unethical practice.
 Consider relevant facts while taking conscience decisions in the best interest of
individuals.
 Encourage and support individuals in their right to speak for themselves on issues
affecting their health and welfare.
 Respects and supports choices made by individuals.
5. Management.

Nurse.
 Ensures appropriate allocation and utilization of available resources.
 Participates in supervision and education of students and other formal care
providers.
  Uses judgment in relation to individual competence while accepting and
delegating responsibility.
 Facilitates conduce work culture in order to achieve institutional objectives.
 Communicates effectively following appropriate channels of communication.
 Participates in performance appraisal.
 Participates in evaluation of nursing services.
 Participates in policy decisions, following the principle of equity and accessibility
of services.
 Works with individuals to identify their needs and sensitizes policy makers and
funding agencies for resource allocation.
6. Professional Advancement.

Nurse.
 Ensures the protection of the human rights while pursuing the advancement of
knowledge.
 Contributes to the development.
 Participates in determining and implementing quality care.
 Takes responsibility for updating own knowledge and competencies.
 Contributes to the core of professional knowledge by conducting and
participating in research.

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.

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 of
client’s wishes (Beauchamp & Childress, 2001). 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.

National League of Nursing Statement on Patient’s 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, sources 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 understands, so that
they can given 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 and services, including the right to challenge these.
 To be fully informed as to all their rights in all health care settings.

Accountability

“Accountability is the obligation of being answerable for one’s own judgments and action
to an appropriate persons or authority recognized as having the right to demand information and
explanation”. (A dictionary of nursing, 2008)
  Integral to the practice of any profession is the inherent needs 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 measure 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)

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

It means that we have respect both for ourselves and for others. We are consciously working
towards 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 bases 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 copying with unavoidable harm or inconvenience.
 Face problems and decision 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.

 Your 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
wants.

Visibility

meaning: A quality or fact of, degree of being visible

 Degree of exposure of public notice

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 health, 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”

LEGAL CONSIDERATION

Legal aspects in nursing

Introduction:Knowledge of legal aspects in nursing is absolutely essential for each nurse tp

safeguard self and client from legal complication .Consumers are becoming incresasingly aware
of their legal rights in the health care.It is essential therefore,a nurse should know her legal right
and professional boundaries.

Nursing legislation:The first nursing law created was that of nursing registration in 1903 and
they have evolved and expanded over the years to create a thick book which must be studied
today by aspiring nurses.Laws and regulations as they affect nurse in India are controlled by state
legislation as state registration act and a central act, the Indian nursing council act, which was
enacted in 1947:and amended in 1957.
 LEGAL IMPLICATION ARE AS FOLLOWS

TORTS ASSAULT BATTERY

NEGLIGENC
MALPRACTICE FRAUD
E

FALSE INVASION LEGAL

IMPRISONMENT OF PRIVACY DOCUMENTS

TORTS:Torts are when others interfere in individuals privacy,mobility,property or personal

interest.

ASSAULT:Assault occurs when a person puts another person in fear of harmful or offensive
contact.The victim fears and believes that harm harm will result as a result of threat

BATTERY:It is an intentional touching of another body without the others consent

NEGLIGENCE:It is conduct that falls below the standard of care that a reasonable person
ordinarily would use in a similar circumstances or it is described as lack of proper care and
attention carelessness

MALPRACTISE:Failure to meet the standard of acceptable care which result in harm to

another person

FRAUD:It result from a deliberate deception intended to produce unlawful gains .

FALSE IMPRISONMENT:It occurs when a client is not allow to leave a health care facility
when there is no legal justification to detain the client or when restraining devices are used
without an appropriate clinical need.

INVASION OF PRIVACY:It includes violating confidentiality intruding on private client or

family matters ,and sharing client information with unauthorized person.

LEGAL DOCUMENTS:(a)Advance directives :written document recognized by law that

provides direction concerning the provision of care when a person is unable to make his or her
own treatment choice.
(b)Do not resuscitate orders:Written order by a physician when a client has indicate a desire to
be allowed to die if the client stops breathing or the clients heart stops beating.

(c)Informed consent:It is clients approval to have his or her body touched by a specific
individual.

Bibliography

 Professional adjustment & ethics for nurses in India,6th edition,Pp-5-6.

 BT Basavanthapa,Nursing administration,1st edition,2007,jaypee brothers publishers,Pp-
10-13.
 Kozier,Erb,Berman,burke.fundamental of nursing:Concepts,Process and Practice,6th
edition,Pearson education(Pte.Ltd);2003.Pp-70-83.
 Pattrica.A.Poter,Anne Griffin Perry,Moshy,basic nursing: essentials for practice,6th
edition,St.Louis,Missouri:Elsevier.2008,Pp-67-70.
 Basher P. Shebeer, khan S. Yaseen, ‘A concise text book of Advanced Nursing Practice’
Edition first (2012), EMMESS Medical Publishers. Pp – 9-19.
 www.scribd.com/doc/35504312/code of ethics
 CLASS PRESENTATION

SUBJECT: ADVANCE NURSING PRACTICE

TOPIC: CODE OF ETHICS

CODE OF PROFESSIONAL CONDUCT

AUTONOMY AND ACCOUNTABILITY

ASSERTIVENESS

SUBMITTED TO:RESPECTED MRS. ARCHNA GARG

(VICE PRINCIPAL AND ASSOCIATE PROFESSOR)

SUBMITTED BY

BHARTI

ROLL NO 2

MSC IST

SHRI GURU RAM DASS COLLEG OF NURSING,HOSHIARPUR