The ANA code of ethics as described in the book of Conceptual Foundations as: ANA’s Code of Ethics for Nurses, 2001 * 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. * 2. The nurse’s primary commitment is to the person, whether an individual, family, group, or community. * 3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. * 4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.
* 5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. * 6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
* 7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. * 8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. * 9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy. (Ceasia, Friberg p. 285)
In the broadest sense, ethics are the principles that guide an individual, group, or profession in conduct. Although nurses do make independent decisions regarding patient care, they are still responsible to the profession as a whole in how those decisions are made. From the earliest concept of nursing, the proper behavior and conduct of a nurse was closely scrutinized. Florence Nightingale wrote of specific issues of conduct and moral behavior. The Nightingale pledge that was composed in 1893 by nursing instructor Lystra Gretter includes the vow “to abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug.”
Over the last 100 years, nursing has evolved into a very complex professional field. Nurses are now faced with life and death decisions, sometimes on an hourly basis. Medical care has advanced to the point that new technology with its potential benefit or harm to a patient changes constantly. Although the private conduct of a nurse is no longer controlled by the employer, the effects of that lifestyle on the nurse’s ability to think and respond to patients in different situations.
The study of ethics is actually a branch of philosophy. The word ethics is derived from the Greek term ethos which means customs, habitual usage, conduct, and character. The study of ethics has led to the identification of basic concepts including relation of basic concepts including rights, autonomy, beneficence, nonmaleficence, justice, and fidelity. Understanding these concepts assists the nurse with making decisions during difficult situations.
Webster defines a right as “something to which one has a just claim or the power or privilege to which one is justly entitled.” Patient rights have evolved to the point that federal legislation has been passed in the United States to protect a patient’s individual rights. A Patient’s Bill of Rights was initially developed by the American Hospital Association in 1973 and revised in1992. All hospitals are now required by law to inform patients of these rights upon admission to the hospital.
Autonomy comes from the Latin auto meaning “self” and nomy which means “control.” Individuals must be given the rights to assist in their own decision making. This ethical concept has led to the need for informed consent. Sometimes patients’ religious or cultural beliefs lead them to make decisions regarding their own care that may seem controversial or even dangerous. However, the concept of autonomy gives them the right to make those decisions unless they are mentally impaired.
Beneficence means to do good, not harm, to other people. Nonmaleficence is the concept of preventing intentional harm. Both of these ethical concepts relate directly to patient care. In the American Nurses Association Code for Nurses, there is a specific charge to protect patients by specifying that nurses should report unsafe, illegal, or unethical practices by any person. Nurses are often faced with making decisions about extending life with technology, which might not be in the best interest of the patient. Often the concept of weighing potential benefit to the patient against potential harm is used in making these difficult decisions, along with the patient’s own stated wishes. The word justice is closely tied with the legal system. However, the word refers to the obligation to be fair to all people. In 2001, healthcare economics have hospitals and other providers stretching their resources to their limits. Economic decisions about healthcare resources have to be made based on the number of patients who would benefit.
The potential of rationing care to the frail elderly, poor, and disabled creates an ethical dilemma that is sure to become even more complicated in the future. Fidelity refers to the concept of keeping a commitment. Although the word is more closely used to describe a marital relationship, fidelity is the concept of accountability. What is the nurse’s responsibility to his or her patient, employer, society, or government? Privacy and confidentiality are concepts that could be challenged under the concept of fidelity. If a nurse is aware of another healthcare giver who is impaired, but the circumstances are private or confidential, how is the conflict resolved? As a general rule, nurses are employed by a hospital, clinic, or private practice. Decisions that are made about patient care are not totally independent. Every decision creates a ripple effect and touches someone else in the health care field.
One of the purposes of a code of ethics is to help nurses keep perspective and a balanced view regarding decisions. An example of violation of code of ethics is an 18yr old girl comes into the emergency room with her mother and has abdominal pain. The doctor or nurse does not ask the patient if it is ok for the mother to know the entire patient’s information since she is 18 yrs. old. The mother is under the impression that her daughter is not sexually active. When the urinalysis comes back the nurse explains that they are going to do further tests but the abdominal pain is probably due to her being pregnant.
The mother is in the room when the news is told violating the patient’s rights. The professional nursing practices involves working towards the outcomes of safe, quality, evidence based practice and confidentiality. (Styles, A 2008). Overall, I think all nurses try to do the right thing on a daily basis and their decisions are based on a reflection of consequences and moral principles. The ANA helps professional nursing by supporting nurses and providing a framework within which nurses can make ethical judgments and decisions to fulfill their daily responsibilities.
Styles, A. (2008) The professional nursing practice. http://www.buzzle.com/articles/ethics-in-nursing-jobs-and-profession.html Ceasia, Friberg. (2011) The ANA code of ethics.
Conceptual Foundations p.285