Nursing Ethics

February, 2018
 Objectives
• Define: values, attitudes, beliefs, ethics
• Discuss Essential Nursing Values
• Discuss the process of value clarification
• Define morality
• Discuss the moral principles
• Explain the International Council of Nursing (ICN) code of
ethics and it’s purpose
• Discuss Bahrain National Code of Professional Conduct
 Values

• Are enduring beliefs or attitudes about the worth of a

person, object, idea, or action & usually they influence
decisions & actions .
 Beliefs (opinions)
• Are interpretations or conclusions that people accept as
true.
• Are based on faith than fact
• Judged as correct or incorrect.
• “if I study hard I will get a good grade” belief that does
not involve values
• “good grades are really important to me, I must study
hard to obtain good grades”, involves both belief and
value.
 Attitudes

• Are mental positions or feelings toward a person,

object, or idea. E.g. acceptance, compassion,
openness)

• Judged as bad or good, positive or negative whereas

beliefs judged as correct or incorrect.

• An attitude last over time, whereas a belief may last

only briefly.
 Personal Values
• Although people derive values from society
and their individual subgroups, they
internalize some or all of these values.
• People need societal values to feel accepted
and they need personal values to have a sense
of individuality.
 Professional Values
Nurses’ professional values are acquired
during socialization into nursing from:
• codes of ethics
• nursing experiences
• teachers
• peers
 Essential Nursing Values
• Altruism is a concern for the welfare & well-being of
others. In professional practice it is reflected by the
nurse’s concern for the welfare of patients, other
nurses & other health care providers.

• Autonomy is the right to self-determination. It is

reflected when the nurse respects the patients’ right
to make decisions about their health care.
 Essential Nursing Values

• Human dignity is the respect for the inherent worth &

uniqueness of individuals & populations. It is reflected when
the nurse values and respects all patients and colleagues.

• Integrity is acting in accordance with an appropriate code of

ethics & accepted standards of practice. It is reflected when
the nurse is honest & provides care based on an ethical
framework that is accepted within the profession
 Essential Nursing Values

• Social justice is acting in accordance with

fair treatment regardless of economic status,
race, ethnicity, age, citizenship, disability, or
sexual orientation.
 Values Clarification

• Is the process by which people identify,

examine and develop their own individual
values.

• A principle of values clarification is that no

one set of values is right for everyone.
 Valuing Process
• Thinking, feeling and behavior that they
termed “choosing”, “prizing” and “acting”
(Raths, Harmin, and Simon, 1978)
 Values Clarification
• Choosing (cognitive) Beliefs are chosen
– Freely, without outside pressure
– From among alternatives
– After reflecting and considering consequences
• A person learns about energy resources,
production and consumption; the green house
effect and other environmental issues,
including ways to minimize use of and to
recycle limited resources.
 Values Clarification Cont’d
• Prizing (affective) chosen beliefs are prized
and cherished
• The person is proud of the belief that he or
she has an obligation to participate in some
way in reducing environmental waste
 Values Clarification Cont’d
• Acting (behavioral) chosen beliefs are
– Affirmed to others
– Incorporated into one’s behavior
– Repeated consistently in one’s life
• The person participates in the city recycling
program for household waste, uses public
transportation rather than driving a personal car
when possible, helps organize recycling in the
workplace and is active in legislative and political
activities related to environmental issues
 Clarifying the Nurse’s Values
• Nurses and nursing students need to reflect
on the values they hold about life, death,
health and illness.
• Nurses hold both personal and professional
values.
• One strategy for gaining awareness of
personal values is to consider attitudes about
specific issues such as abortion or euthanasia.
 Clarifying the Nurse’s Values Cont’d

• “Can I accept this, or live with this?”

• “What would I do or want done in this situation?”
• Nurses values are influenced by culture,
education and age.
• However, research shows that fundamental
professional nursing values of human dignity,
equality, and prevention of suffering have not
varied over time or across groups (Snellman &
Gedda, 2012).
 Clarifying Client Value
List alternatives:
• Make sure that the client is aware of all alternative
actions. “Are you considering other courses of action?”

Examine possible consequences of choices:

• Make sure that the client has thought about the possible
results of each action. “what do you think you will gain
from that?”

Choose freely:
• To determine whether the client chose freely, ask “Did
you have any say in that decision?”
 Clarifying Client Value
Feeling about the choice:
• Some clients may not feel satisfied with their decision.
“How do you feel about your decision?”

Affirm the choice:

• Ask “How will you discuss this with others (family,
friends)?”

Act with a pattern:

• To determine whether the client consistently behaves in a
certain way, ask “How many times have you done that
before?”
 Morality
• Private personal standards of what is right and
wrong in conduct.
 Morality and Law
• Nurses should distinguish between morality and
law.
• Laws reflect the moral values of a society and
they offer guidance in determining what is moral.
• An action can be legal but not moral
– An order for full resuscitation of a dying client is legal,
but one could still question whether the act is moral.
• An action be moral but illegal
– If a child at home stops breathing, it is moral but not
legal to exceed the speed limit when driving to the
hospital
 Morality and Religion
• Nurses should also distinguish between
morality and religion as they relate to health
practices
– Female circumcision
– Blood transfusion
– Abortion
– Sterilization
– Contraceptives
– Safer sex counseling
 Moral Principles
Autonomy:
• The right to make own decisions.
• The client/family may expect the healthcare provider to
respect their right to refuse a treatment.

Nonmaleficence:
• The duty to “do no harm.”
• Discussion of advance directives and issues such as CPR
may be viewed as physically and emotionally harmful to
the client.
 Moral Principles
Beneficence:
• Doing good.
• The client/family may expect health care providers to
promote client well-being and hope and provide
treatment that will help prolong life.
Justice:
• Fairness.
• A nurse making home visits finds one client tearful and
depressed, and knows she could help by staying for 30
more minutes to talk. However, that would take time from
her next client, who has diabetes and needs a great deal
of teaching and observation.
 Moral Principles
Fidelity:
• Faithful to agreements and promises.
• Nurses often make promises such as “I’ll be right back
with your pain medication”

Veracity:
• Telling the truth.
• Clients may not value truth-telling for life-threatening
conditions, because this may eliminate hope and,
therefore, hasten death. Family members may request
that the client not be told of his or her diagnosis.
 Moral Principles
Accountability:
• “answerable to oneself” and others for one’s own actions.

Responsibility:
• “the specific accountability or liability associated with the
performance of duties of a particular role”.
 Nursing Ethics
• Is the method of inquiry that help people to
understand the morality of human behavior .
• Are the practices or beliefs of a certain group.
• Are the expected standards of moral behavior of
particular group
• Bioethics
– Ethics as applied to human life or health

Nursing Ethics
– Is the ethical issues that occur in nursing practice.
 Code of Ethics
Is a formal statement of a group’s ideals &
values. It is a set of ethical principles that:
1. Is shared by members of the group
2. reflects their moral judgments over time
3. serves as a standard for their professional
action.

Nurses are responsible for being familiar

with the code that governs their practice.
 International Council of
Nurses (ICN)
• Established in 1899. Nurses from great
Britain, USA, & Canada were the founding
members.

• The council is a federation of national

nurses associations, such as the ANA.

• The first code of ethics in 1953, the most

recent revisions in 2012.
 ICN’s Mission

• To represent nursing worldwide

• Advancing the profession

• Influencing health policy

 Purposes of Nursing Codes of
Ethics

1. Inform the public about the minimum standards of the

profession & help them understand professional
nursing conduct.

2. Provide a sign of the profession’s commitment to the

public it serves.

3. Outline the major ethical considerations of the

profession.
 Purposes of Nursing Codes of
Ethics

4. Provide ethical standards for professional

behavior.

5. Guide the profession in self- regulation.

6. Remind nurses of the special responsibility they

assume when caring for the sick.
 ICN Code of Ethics
Nurses have four fundamental
responsibilities:

1. Promote health
2. Prevent illness
3. Restore health
4. Alleviate suffering
 ICN Code of Ethics
• Inherent in nursing is 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 family

and the community and co-ordinate their services with those
of related groups.
ICN Code of Ethics

Nurses have four principal elements

that outline the standards of ethical
conduct:
• Nurses and people.
• Nurses and practice.
• Nurses and profession.
• Nurses and co-workers.
 ICN Code of Ethics
NURSES AND PEOPLE

• The nurse’s primary professional responsibility is to people

requiring nursing care.

• In providing care, the nurse promotes an environment in

which the human rights, values, customs & spiritual beliefs
of the individual, family & 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 & related
treatment.
 ICN Code of Ethics
NURSES AND PEOPLE Cont’d
• The nurse holds in confidence personal information & uses judgment in
sharing this information.

• The nurse shares with society the responsibility for initiating &
supporting action to meet the health & 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.
 ICN Code of Ethics
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 judgment regarding individual competence

when accepting and delegating responsibility.
 ICN Code of Ethics
NURSES AND PRACTICE Cont’d
• The nurse at all times maintains standards of
personal conduct which reflect well on the
profession and enhance 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 for promoting ethical behavior and open
dialogue.
 ICN Code of Ethics
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.

• The nurse is active in developing and sustaining a core of

professional values.
 ICN Code of Ethics
NURSES AND THE PROFESSION Cont’d

• The nurse, acting through the professional organization,

participates in creating and maintaining safe, equitable
social and economic working conditions in nursing.

• The nurse practices to sustain and protect the natural

environment and is aware of its consequences on health.

• The nurse contributes to an ethical organizational

environment and challenges unethical practices and settings.
 ICN Code of Ethics
NURSES AND CO-WORKERS

• The nurse sustains a co-operative relationship with

coworkers in nursing and other fields.

• The nurse takes appropriate action to safeguard

individuals, families and communities when their health
is endangered by a coworker or any other person.

• The nurse takes appropriate action to support and guide

coworkers to advance their ethical conduct.