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Professional Adjustment,

Nursing Ethics and


Jurisprudence
Ma. Christina B. Celdran – Oraa, RN PhD
Assistant professor
Ateneo de Zamboanga University
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Ethical Concerns in Nursing Practice

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ETHICS - how people make judgment with regards to right and wrong;
making choices best for individual and society; critical reflection about
morality and rational analysis
MORALS – specific ways of behaving or the way that people set out to
accomplish ethical practices (norms, policies); social consensus about
moral conduct for human beings and society (human decency, right and
wrong, proper or improper, cruel or benevolent)
Ethics – human conduct provided by ethical system
Morality/social norms – widely held view or social consensus about the
normal conduct of humans and the society
NURSING CODE OF
ETHICS
Definitions of Terms :
Profession- an occupation or calling requiring advance training and experience in some specific or specialized body of
knowledge which provides service to society in that specific field.
Vocation-an occupation of calling
Ethics-refers to a standard to examine and understand moral life
Morality- refers to social consensus about moral conduct for human beings and society.
Professional Ethics- a branch of moral science concerned with the obligations that a member of the profession owes to
the public.
¤ Branch of moral science which treats of the
obligations to which a member of a profession
owes to the public, to his profession, to his
fellowmen and to his clients.
¤ It embraces the basic principles of right action or
norms of conduct which is honorable in the
practice of a profession.
Bio-Ethics- a specific domain of ethics that focuses on moral issues in the field of health care.
- synonymous term with healthcare ethics and encompass not only questions of equality of life, life-sustaining and
a life-altering techniques
- Principles that govern rights and proper conduct of a person regarding life, biology, & with health professionals
Nursing Ethics- related to all the principles of right conduct as they apply to the profession.
It is concerned with the principle of right conduct as they apply to the nursing profession
Ethics – Rules, Principles that guide nursing
decisions or conduct in terms of the rightness or
wrongness of that decisions or actions. Serves the
purpose of governing conduct to ensure the
protection of individual’s rights.
Importance:
Makes clear why one act is better than
another

Keep an orderly social life by having


agreement, understanding, principles or
rules of procedure

Ethics seeks to point out to men the true


values of life as it attempts to stimulate
the moral sense.
Ethical Dilemma

• Problem in decision making because there is no


correct or wrong choice. This may result in having
to choose an action that violates one’s principle or
value in order to promote another
Utilitarian or Teleological
• The ; "the right thing to do is
the good thing to do"; comes from the greek word
telos or "goal or end"; if the act helps people, then
it is a good one, and if it harm people, then it is a
bad one (Joseph Fletcher)

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Deontological – Comes from the Greek
word DEON which means duty; the ends DOES
NOT justify the means; the acts are the criterion
for the determination of good and not the
consequence.

Intuitionism – people inherently knows


what is right and what is wrong
PRINCIPLES OF
NURSING ETHICS:

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Values, Morals, & Ethics
• Values: are freely chosen, enduring beliefs or attitudes
about the worth of a person, object, idea, or action (e.g.
freedom, family, honesty, hard work) Values frequently
derive from a person’s cultural, ethnic, and religious
background; from societal traditions; and from the
values held by peer group and family
• Values form a basic for Behaviour “purposive
Behaviour”; The purposive behavior is based on a
person’s decisions/choices, and these
decisions/choices are based on the person’s
underlying values.
• Values are and are greatly influenced by
a person’s sociocultural environment.
• People need to feel accepted, and
they need to produce a sense of
individuality.
• Professional values often reflect and expand on
personal values
Basic Ethical Concepts
1. Rights
2. Autonomy
3. Beneficence and
Nonmaleficence
4. Justice
5. Fidelity
6. Veracity
7. The standard of best interest
Basic ethical concepts:

• Rights form the basis of most


professional codes and legal
judgments
• Self-determination rights
• Rights and cultural relativism
• Rights of the unborn
• Rights of privacy and
confidentiality
• Autonomy - States that a person has unconditional
worth and has the capacity to determine his own
destiny. It involves self determination and freedom to
choose and implement one's decision, free from deceit,
duress, constraint or coercion.

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Involves the right of self-determination, independence,
and freedom.

It refers to the right to make one’s own decisions

Respect for autonomy means that nurses recognize the


individual’s uniqueness, the right to be what that person is,
and the right to choose personal goals

Nurses who follow the principle of autonomy respect a client's


right to make decisions even when those choices seem not to
be in the client’s best interest
Respect for people also means treating others with
consideration

In the clinical setting, this principle is violated when a nurse


disregards client's subjective accounts of their symptoms
(e.g. pain)

Patients should give informed consent before tests and


procedures are carried out
• Ex: informed consent; allowing the patient to refuse
treatment if he decides so
• Death and dying
• Right to informed refusal
• Care of the body
• Organ donation (RA 7170)
• Autopsy
• Assisted suicide
• Unauthorized patient’s discharge
• Paternalism – giving care like a good father/mother
of a family
Do not resuscitate/DNR (no code order) an order by the patient’s physician
instructing the w/holding of CPR if the patient goes into cardiac or respiratory
arrest.
Duties of the nurse:
Assure that everyone in the process understands the meaning of DNR
In case of conflict nurse will often act as mediator & help participants
reach some shared understanding.
 Ensure that the following information are documented:
 Patient’s condition
 Prognosis
 Summary of decision making
 Parties involved in the decision making
Future date to review the DNR order
Non-maleficence
• Do not harm; remove harm; • Do not harm; remove harm; prevent
prevent harm harm
• Ra 6675 – generics act • Harm can mean deliberate harm, risk of
1988/medication ; orders, drugs & harm, and unintentional harm.
medication • In nursing, intentional harm is always
• RA 6425 – Dangerous drug act 1972 unacceptable.
• RA 953 – Narcotics drug law • The risk of harm is not always clear
• RA 5921 – Pharmacy act • A client may be at risk of harm during a
nursing intervention that is intended to be
• BON res. No. 8 s. 1994 (sec. 27 art. V helpful (e.g. medication)
ra 7164)
• Ra 9502 - Cheaper medicine bill
; client advocate
 Nurses should implement actions that benefit clients and their
support persons.
 However, in an increasing technologic health care system, doing
good can also pose a risk of doing harm (e.g. intensive exercise
program).
Allocation of goods & services & how or to whom
they are distributed
 Is often referred to as fairness
 Nurses frequently face decisions in which a sense of
justice should prevail (succeed)
 E.g. busy unit, new admission
Equality – Everyone receives the same
Need – Greater services go to those with greater
needs
Merit – Services go to more deserving (used as a
criterion for transplant recipients)
Telling the truth
 As a nurse should I tell the truth when it is known that doing
so will cause harm?
 Does tell a lie when it is known that the lie will relieve
anxiety and fear?
 Should I lie to dying people?
 Fraud – deliberate deception intended to produce
unlawful gain
 Defamation – character assassination verbal or
written
 Libel – written
 Slander – verbal/oral
 Medical record
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FIDELITY:
Loyalty/faithfulness and keep promises
 Nurses have responsibilities to clients, employers, government, society, the
profession, and themselves
 Circumstances often affect which responsibilities take precedence at a
particular time

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• PRIVACY:
• Observing the seal of secrecy
• Privileged communication
• Invasion of privacy
• Hearsay evidence
• Dying declaration or ante mortem statement
• Nurses as witness

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Types of Consequence-Oriented Theories

– states that people choose an action that


will, in any given circumstances, increase the overall good.
– states that the people should act
according to rules that tend to maximize happiness and diminish
unhappiness.
(Agape) seeks general goodwill or love
for humanity. In the final analysis, human needs to determine
what is ethical or not.
6 Guidelines for making an ethical choice:

1. Compassion for people as human beings


2. Consideration of consequences
3. Proportionate goods
4. Priority of actual needs, and ideals or potential needs
5. A desire to enlarge choice and reduce chance
6. A courageous acceptance of the need to make decisions and
the equally courageous acceptance of the consequence of
our decisions.
• Focuses on a care perspectives
• Organized around the notions of
responsibility, compassion (care),
relationships
• The ethics of justice (fairness) is based of the
idea of equality “everyone should receive the
same treatment”. By contrast, the ethics of
care is based on a premise of nonviolence:
that no one should be or
• Process of developing an “ethics of care”
• Stage I: caring for oneself
• Stage II: caring for others Gilligan’s theory
• Stage III: caring for oneself and others
• Each stage ends with a transitional period
(a time when the individual recognizes a
conflict or discomfort with some present
behavior and considers new approaches)
When a person cannot make informed decision,
the health care providers or family make the
decision based on what they believe to be in his /
her best interest.
Four-fold responsibility of a nurse
• BON Res. # 633 s. 1984 ICN Code of Ethics
• Promotion of health
• Prevention of illness
• Alleviation of suffering
• Restoration of health
• Spiritual health –holistic care
• self-transcendence - going beyond self to help others reach self-
actualization (5th Declaration)
• BON Res # 1995 s. 1989 PNA Code of Ethics was promulgated
• Consideration for people as human beings
• Consideration of consequences
• Proportionate good to come from choices
• Propriety of actual needs over ideal or potential needs
• A desire to enlarge choices and reduce chance
• A courageous acceptance of the consequence of the decision.
What are the steps in Ethical
Decision Making?

1. Identify and setting up the ethical problem


2. State the relevant facts
3. Identify the stakeholders
4. Identify options or alternatives
5. Determine the most appropriate action
6. Ethical principles involve
What is Ethical Decision Making?
• When faced with an ethical dilemma the objective
is to make a judgment based on well-reasoned,
defensible ethical principles.
• The risk is poor judgment i.e. a low-quality
decision
• A low-quality decision can have a wide range of
negative consequences
Two Types of Ethical Choices
• Right vs wrong: choosing right from wrong is
the easiest
• Right vs right
• Situation contains shades of gray i.e. all
alternative have desirable and undesirable
results
• Choosing “the lesser of two evils”
• Objective: make a Defensible Decision
Factors that influence EDM

1. Codes for Nurses 1. Legislation


2. The patient’s rights 2. Judicial decisions
3. Social and cultural 3. Funding
attitudes 4. Personal religious and
4. Science and technology philosophic viewpoint
Factors in the work environment that affect EDM

1. Status as an employment
2. Collective bargaining contracts
3. Collegial relationships
4. Authoritarian and paternalistic
background
5. Ethics committees in health care
6. Consumer involvement in health care
A framework for Ethical Decision Making (EDM)

1. Identify and clarify the ethical problem


2. Gather data
3. Identify options
4. Make a decision
5. Act and assess
Some Guidelines for Making Ethical Decisions
1. Choose correct moral language.(Often,
the way in which you initially
conceptualize a situation will affect what
moral conclusions you will make)
2. Be as clear as you can about the facts,
both empirical and philosophical
3. Consider the relevant moral principles
and rules, and make your best judgment.
Discussion Questions
• Is the patient’s decision a rational one?
• What is the difference between withholding and withdrawing life-
sustaining treatment?
• In view of the fact that a potent sedative such as morphine may produce
respiratory depression, should this be given prior to discontinuing the
respirator? Would this constitute active euthanasia?
• Would the situation be different if Mrs. C. had a living will?
• What role could the nurse play in addressing the ethical issues in this
case?
CODE OF ETHICS
FOR NURSES
Ethical codes are systemic guidelines for
shaping ethical behavior that answer the
normative questions of what beliefs and
values should be morally accepted.
• It is a set of Ethical Principles that:
• Is shared by members of the group,
• Reflects their moral judgments over time,
• Serves as a standard for their professional
actions.
It is a systematic guide for developing ethical
behavior.

It answers normative questions of what beliefs and


values should be morally accepted.
NURSING CODE OF ETHICS

It strongly emphasizes the four-fold


responsibility of nurse, the universality of the
nursing practice, the scope of their
responsibilities to the people they serve, to
their co-workers, to society and environment,
and to their profession.
1899 – The International Council of Nurses
(ICN), which has been a pioneer in
developing a code of nursing ethics, was
established.
1900 – The first book on nursing ethics,
Nursing Ethics: For Hospital and Private
Use, had been written by the American
Nursing Leader Isabel Hampton Robb.
 Inform the public about the Minimum Standards of the
Profession and help them understand Professional Nursing
Conduct.
 Provide a sign of the profession’s commitment to the
public it serves.
 Outline the major ethical considerations of the profession.
Provide ethical standards for professional
behavior.
Guide the profession in self-regulation.
Remind nurses of the special responsibility they
assume when caring for the sick.
The PRIMARY VALUE
consideration in nursing ethics has
been the determination of the
focus of nurses’ work.
Professional Regulation Commission on July 23, 2003
States that the is their willingness
to accept a set of professional and ethical principles which they
will follow in the conduct of their daily lives.
The acceptance of these principles requires the maintenance of a
standard of conduct higher than what is required by law.
This code is adopted by the
and the 42
Professional Regulatory Board to cover an
environment of good governance, which
Filipino professionals shall perform their duties.
Executive Order No. 292
• Is the principal law in the study of administrative laws in the
Philippines and was promulgated by then President Corazon
Aquino dated July 25, 1987, otherwise known as the
“Administrative Code of 1987”, which incorporated in a single
document the major structural, functional and procedural
guidelines of governance.
• Professional Regulation Commission (PRC)
• Three main functions
• Executive
• Quasi-judicial
• Quasi-legislative
Functions of the PRC
• To investigate and decide cases against erring examinees and
professionals;
• To formulate and promulgate policies and guidelines on
administrative investigation and professional regulations.
• To implement the laws, regulatory policies and standards; and
• To maintain and promote professional and occupational standards
and ethics.
This implies a to a life of and
in carrying out their professional duties
even at the expense of personal gain.
 Professionals should perform their responsibilities with the highest
sense of integrity and imbued with and .
 They should maintain objectivity, be free from conflicts of interest,
refrain from engaging in any activity that would prejudice their
abilities to ethically carry out their duties nor make any
representations that would likely cause a reasonable person to
misunderstood and be deceived.
A certain level of competence is necessary in
undertaking only those professional services they can
reasonably deliver.
It is their express obligation to keep up with new
knowledge and techniques in their field and upgrade
their level of competence, taking part in a lifelong
continuing education program.
Each professional shall maintain and support one
Professional Organization that promotes a deep
spirit of solidarity and teamwork among its
members.
Professionals shall always carry out their
with due consideration of the broader interest
of the public, serve them with professional concern
consistent with their responsibilities to society and as
Filipinos, contribute to attainment of the country’s
national objectives.
Professionals shall remain open to the challenges of a
more dynamic and interconnected world, rise up to
global standards and maintain levels of Professional
Practices fully aligned with global best practices.
 All professionals shall treat their colleagues with respect and strive to
be fair in their dealings with one another.
 No one group of professionals is superior to or above others.
 All professions perform an equally important, yet distinct, service to
society.
 In the eyes of the Professional Regulation Commission, all Professions
are equal and therefore, every one shall treat other professionals with
respect and fairness.
Is a set of ethical principles that are generally accepted by all
members of a profession.

The code states the group’s expectations and standards of


behavior and serves as guidelines to assist nurses and other
professional groups when conflict or disagreements arises about
correct practice or behavior.

It also set forth ideals of nursing conduct and provides a common


foundation for nurse’s training.

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CODE OF ETHICS

• Written list of a profession’s values & standards of conduct


• Framework for decision making
• General statements
• Offer guidance
• Periodically revised
• Not legally enforceable as laws but consistent violations indicate an
unwillingness by the person to act in a professional manner & license
can be suspended or revoked
Underlying principles

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RESPONSIBILITY – refers to the execution of duties associated with a
nurse’s particular role. It is characterized by RELIABILITY and
DEPENDABILITY
ACCOUNTABILITY – refers to the ability to answer for one’s action.
COMPETENCE – refers to specific skills necessary to perform a task
JUDGMENT – refers to the ability to form an opinion or draw sound
conclusions. Good judgment is learned in the nursing school. Judgment
skills are continuously improved in the practice of the profession.
ADVOCACY – involves giving clients the information they need to make
decisions and then supporting those decisions.
It also implies that the care providers should strive to understand and then
articulate a client’s point of view.
A.Pursuant to Section 3 of the Republic Act
No.877 known as the Philippine Nursing
Law, and Section 6 of PD No. 223 the
amended Code of Ethics for Nurses
recommended and endorsed by the
Philippine Nurses Association was
adopted to govern the practice of nursing
in the Philippines.
A.The Code was adopted under
Republic Act 9173 and
promulgated by the board of
Nursing under Resolution No.220
Series of 2004 last July 14, 2004
ARTICLE 1 PREAMBLE
Health is a fundamental right of every individual
Nurses must have knowledge of man’s cultural, social,
spiritual, psychological, ecological aspects
Respect and confidence to the community
Promote Health

Prevent Illness

Restore Health

Alleviate Suffering

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• Nurses and People • Nurses and the Profession
• Nurses and Practice • Responsibility of the Nurse
• Nurses and Co-Workers to Patient
• Responsibility of the Nurse
• Nurses and the Society
to the Physician
• Contributing members of the
society
• Responsibility of the Nurse
to her Colleagues
• Awareness for the call for
change • Responsibility of the nurse
toward themselves

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THE ICN CODE FOR NURSES (2006) THE UNIVERSAL PRINCIPLES IN
NURSING
 1. Respect for individual values,
1. Nurses and People customs and spiritual beliefs
¤ Nursing Care  Respect for individual freedom to
decide
¤ Respect the rights and , values, and
spiritual beliefs of patient  Confidentiality of information
¤ Informed consent/ information  2. Human life is inviolable
dissemination  Quality and excellence in
¤ Confidentiality the care of the patients are
2. Nurses and Practice the goals of nursing
¤ Responsibility, accountability & practice
maintenance of competence
¤ Standard of care is not compromised
 Accurate documentation of
actions and outcomes of
¤ Maintain standard of personal conduct
delivered care is the
¤ Client safety w/ regard to use of
technology hallmark of nursing
accountability.
3. Nurses and the Profession
 assume the major role in determining and implementing acceptable
standards in practice, management, education and research.
 Be active in developing of core of research based professional knowledge
 Participating in creating and maintaining safe, equitable, social, and
economic working conditions in nursing through professional
organization
 Compliance with by-laws
 Commitment to learning
 Contribution to the improvement of the economy
4. Nurses and Co-Workers
 Cooperation and collaboration
 Patient protection from co-workers or other individuals
 In solidarity with other members of the healthcare team.
 Maintains collegial and collaborative relationship with other healthcare
providers.
IMPLEMENTING RULES IN THE ICN CODE OF ETHICS

1. Nurses shall perform professional duties in conformity with the existing laws and
generally accepted principles of moral and ethical conduct and proper decorum
2. Nurses must know responsibilities in the practice of the profession
3. Solicitation, direct or indirect from patient is repugnant to the honor and dignity of
nursing profession that constitutes unethical conduct
4. Nurses must not allow the use of their names in the promotion of any commercial
products or service
THE INTERNATIONAL COUNCIL OF NURSES

• Inherent in nursing is RESPECT for human life,


including the right to life of dignity, and to be
treated with respect.
• NURSES render health services to the individual,
the family, and the community and coordinate
their services with those of related groups.

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ARTICLE 5:
NURSES, SOCIETY AND EVIRONMENT

Preservation of life, respect for life and


promotion of healthy environment shall be a
commitment of an RN.
Establish linkages with the public in promoting
local, national and international efforts to meet
health and social needs of the people.
AMENDED CODE OF ETHICS FOR NURSES

ARTICLE 7:
ADMINISTRATIVE PENALTIES, REPEALING CLAUSE AND
EFFECTIVITY

The certificate of registration of an RN shall be either


revoked or suspended for violation of this code pursuant
to section 23
nurses worldwide collaborate and
OBJECTIVE: strengthen nursing service, education, and
To provide a medium professional ethics
through which national Composed of national nursing organizations
nurses associations from member countries
share common
PNA became a member in 1929 in Montreal,
interests by working Canada congress
together to develop
the contribution of Meets quadrennially
nursing to the Official organ – International Nursing Review
promotion of health of (4x/yr)
the people and the Headquarters: Geneva, Switzerland
care of the sick
IMPLEMENTING RULES IN THE ICN CODE OF ETHICS

1. Nurses shall perform professional duties in conformity with the


existing laws and generally accepted principles of moral and ethical
conduct and proper decorum
2. Nurses must know responsibilities in the practice of the profession
3. Solicitation, direct or indirect from patient is repugnant to the honor
and dignity of nursing profession that constitutes unethical conduct
4. Nurses must not allow the use of their names in the promotion of any
commercial products or service
Responsibilities of the Nurse
to the Patients
• Give him/her the kind of care his/her condition needs
regardless of his/her race, creed, color, nationality or status.
• The patient’s care shall be based on needs, the physician’s
orders, and the ailment.
• The nurse shall involve the patient and/or his/her family so
that he/she or any of the family can participate in his/her care.
• Know the patient’s Bill of Rights.

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Responsibilities of the Nurse to the Patients

• Be patient advocate. Treat patient in a manner that will show


concern whether the patient is rich or poor.
• Nurses should not leave a patient or any agency without
proper permission or resignation or without relief.
• Nurses should commit themselves to the welfare of those
entrusted to their care.

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MORAL AND SPIRITUAL
RESPONSIBILITIES OF NURSES
When a nurse is confronted with situations where moral judgment is necessary, the
nurse may be guided by the following principles or rules:
 The Golden Rule
 The Principle of Totality
 Epikia
 The Two – fold Effect

Totality - That the whole is greater than any of its parts. Ex: gangrenous foot
Epika – exception to the general rule. Ex: it is a reasonable presumption that the authority making the law
will not wish to bind a person in some particular case, even though the case is covered by the letter of the
law. Ex: a mental patient went berserk and the doctor could not be contracted, the patient mat be restrained
by virtue of epika.
2. Allowing a relative to see a seriously ill patient who expresses the desire to see the former although it is
not visiting hours.
 Defects of nature maybe corrected
 If one is willing to cooperate in the act, no injustice is done to him
 A little more or less does not change the substance of an act.
 The greatest good for the greatest number
 No one is held to the impossible
 The morality of cooperation
 Principle relating to the origin and destruction of life
 The Good Samaritan Law
• That the action may be morally good.
• That the good effect must be willed and the
bad effect merely allowed.
• That the good effect must not come from an
evil action but from the initial action itself
directly.
• That the good effect must be greater than
the bad effect.

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MORAL AND SPIRITUAL RESPONSIBILITIES OF NURSES

One who acts


No one is Defects of
through an
held to the nature may
agent is
impossible be
himself corrected
responsible

The morality
The end does of No one is
not justify the cooperation obliged to
means betray himself

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MORAL AND SPIRITUAL RESPONSIBILITIES OF NURSES

A little more or less does


The greatest good for the
not change the substance
greatest number
of an act

If one is willing to Principle relating to the origin


cooperate, no injustice is and destruction of life
done
Uphold sanctity
of human life Commitment to
God-loving God and people

Provide
spiritual care
God-fearing
THE GOOD SAMARITAN LAW

provides protection to health care providers by ensuring


immunity from civil liability when assistance is provided at
the scene of an emergency and the caregiver does not
intentionally or deliberately inflict injury.

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THE GOOD SAMARITAN LAW

• It is based on the biblical story of a • The role of nurses in providing non-


man who aided an injured person
who was waylaid by thieves and was
judgmental, non-discriminatory care is
left half-dead. based on the story of the good
• A nurse, therefore, who renders first Samaritan
aid or treatment at the scene of an
emergency and who does so within • The NURSE recognizes the spiritual
the standard of care, acting in good
faith, is relieved of the consequences
needs of the patient and gives the
of the act. latter peace of mind and comfort to
face what lies ahead of him/her
PROFESSIONALISM AND BOUDARIES

Embedded in nursing boundaries and moral


obligations of professionalism and practice are
the explicit or implied concepts of respect,
confidentiality, moral courage, cultural
sensitivity, power, and just being a good citizen
of the world.
A. GIVING RESPECT

Giving respect to patients, families, peers and others is a


major concept in relationships, decision-making process
and boundary issues faced by nurses in a minute-by-
minute basis.
Giving respect is defined as the act of
esteeming another, an act that demands we
ourselves have a sense of authenticity, integrity
and self-knowledge.
It demands that we honor the wholeness, the
essence, and the uniqueness of the other.
Respect is foundational ethical principle in critical care and the hallmark of
excellence in critical care practice. Suggestions for demonstrating respect in
clinical care practice professional relationships are delineated as:

 Attending to the whole person


 Engaging authentically with patients in decision-making process
 Fully appreciating patients and their choices
 Communicating effectively
 Remaining free of judgments or exhibiting neutrality in communication and actions.
Violations can occur when these five areas are not honored and maintained by nurses, and nurses are vulnerable to
violations of respect toward patients, families and health care professionals on an everyday basis. Potential
violations include:
 Withholding information or not telling the full truth of a situation with patients, families and professionals
 Acting paternalistically instead of respecting another’s decisions.
 Giving judgment-laden nursing care and advice
 Not attending to the whole person or giving fragmented care.
B. MAINTANINING CONFIDENTIALITY

Maintaining confidentially means that a nurse, by legal and ethical standards,


keeps information private that patients or families have disclosed unless
the information falls under a limit of confidentiality.
Confidentiality is at the core of nurses establishing trusting relationships
with other nurses, patients, families, and others.
C. HAVING MORAL COURAGE
Having a moral courage means that a nurse
overcomes fear by confronting an issue head
on, especially when the issue is a conflict of the
nurse’s core values and beliefs.
Moral courage is having the will to speak out
and do the right thing even when constraints or
forces to do otherwise are present.
Lachman (2007) created a clever acronym to help nurses remember to have moral
courage in situations and to remind nurses of the code of ethics for nurses. The
acronym is CODE which means:

C – Courage to be moral requires:


O – Obligations to honor (What is the right thing to do?)
D – Danger to manage (What do I need to handle my fear?)
E – Expression and action (What action do I need to take to maintain my
integrity?)
He also offered two strategies to help nurses to exhibit moral courage in dangerous situations.
First, nurses must try to soothe their inner feelings so that fear will not trigger careless or
hasty behavior in which nurses would later regret or even passivity with no reaction at all.

Second, nurses must assess the whole scenario while identifying the risks and benefits
involved in standing alone.
D. GIVING CULTURALLY SENSITIVE CARE

Culture refers to integrated patterns of human behavior that include the language,
thoughts, communications, actions, customs, beliefs, values, and/or institutions of
racial, ethnic, religious and/or social groups.
Giving culturally sensitive care, based on nurses applying ethical components of a
trusting relationship with others, means that nurses possess basic knowledge of and
constructive attitudes toward health traditions observed among the diverse cultural
groups found in the setting in which they are practicing.
A – Awareness
S – Sensitivity
K – Knowledge

Communication is integral for a correct understanding


and comprehension of health care treatments,
directives and other exchanges.
E. USING POWER

Power, by definition, means that a group or group or person has


influence over others in an effective way.
Using power is the ability of the nurse to influence persons,
groups or communities by controlling the content of their
practice, the context of their practice, and their competence in
practice.
Nurses are in a prime position to use power
to benefit not only patients, but also the
professional practice of nursing. Power
lies within each nurse who engages
inpatient care, administrative leadership,
teaching and research.
F. BEING A GOOD CITIZEN OF THE
WORLD

Being a good citizen of the world means that


nursing professionals think reflectively about
themselves and others, understand other’s
point of view and promote social justice.