This document provides an overview of nursing codes of ethics, including their purpose and history. It discusses the International Council of Nurses, which was established in 1899 and has been a pioneer in developing nursing ethics codes. The first nursing ethics book was written in 1900. Nursing codes outline ethical standards and guidelines for nurses, inform the public of nursing standards, and provide direction for self-regulation. The document reviews the Code of Ethics for Filipino Nurses and the American Nurses Association Code of Ethics, noting updates made in 2001.
3. 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 formal statement of a group’s
ideals and values.
4. It is a set of ethical principles that:
(a) Is shared by members of the
group,
(b) Reflects their moral judgments
over time, and
(c) Serves as a standard for their
professional actions.
S
5. It must be noted that no code
can provide absolute or
complete rules that are free of
conflict and ambiguity.
6. BIT OF HISTORY1899 – 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.
7. Nursing codes of ethics have the
following purposes:
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.I
8. 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.
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11. CODE OF GOOD
GOVERNANCE
The Code of Good Governance promulgated
by the Professional Regulation
Commission on July 23, 2003 states that
the hallmark of all professionals 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.
12. This code is adopted by the
professional Regulation
Commission and the 42
Professional Regulatory Board to
cover an environment of good
governance I which Filipino
professionals shall perform their
duties.
13. GENERAL PRINCIPLES
The general principles of the Code of
Good Governance include the
following:
1. Service to Others. This implies a
commitment to a life of sacrifice and
genuine selfishness in carrying out
their professional duties even at the
expense of personal gain.
14. 2. Integrity and Objectivity. Professionals
should perform their responsibilities with
the highest sense of integrity and imbued
with nationalism and spiritual values. 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.
15. 3. Professional Competence. A
certain level of competence is
necessary in undertaking only thise
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.
16. 4. Solidarity and Teamwork. Each
professional shall maintain and
support one professional
organization that promotes a
deep spirit of solidarity and
teamwork among its members.
17. 5. Social and Civic Responsibility.
Professionals shall always carry out
their professional duties 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.
18. 6. Global Competitiveness.
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.
19. 7. Equality of All Professions. 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.
21. WHEREAS, the Board of Nursing
(BON) has the power to promulgate a
Code of Ethics for Registered Nurses
in coordination and consultation with
the accredited professional
organization (Sec. 9, (g), Art III of
(Republic Act) No. 9173, known as
the “Philippine Nursing Act of 2002);
22. WHEREAS, in the formulation of the
Code of Ethics for Registered Nurses,
the Code of Good Governance for the
Professions in the Philippines was
utilized as the principal basis thereof:
All the principles under the said Code
were adopted and integrated into the
Code of Ethics as they apply to the
nursing profession;
23. WHEREAS, the promulgation of
the said Code as a set of
guidelines, regulations or
measures shall be subject to
approval by the Commission
(Sec. 9, Art. II of R.A. No. 9173);
and
24. WHEREAS, the Board, after
consultation on October 23, 2003
at Iloilo City with the accredited
professional organization of
registered nurses, the Philippine
Nurses Association, Inc.
25. (PNA), and other affiliate organizations
of Registered Nurses, decided to
adopt a new Code of Ethics under the
afore-mentioned new law;
NOW, THERFORE, the Board hereby
resolved, as it now resolves, to
promulgate the hereunder
Code of Ethics for Registered Nurses:
26. ARTICLE I
PREAMBLESECTION 1.
Health is a fundamental right of every
individual. The Filipino registered nurse,
believing in the worth and dignity of each
human being, recognizes the primary
responsibility to preserve health at all cost.
This responsibility encompasses
promotion of health, prevention of illness,
alleviation of suffering, and restoration of
health. However, when the foregoing are
not possible, assistance towards a
peaceful death shall be his/her obligation.
27. SECTION 2.
To assume this responsibility,
registered nurses have to gain
knowledge and understanding of
man’s cultural, social, spiritual,
physiological, psychological, and
ecological aspects of illness, utilizing
the therapeutic process. Cultural
diversity and political and socio-
economic status are inherent factors
to effective nursing care.
28. SECTION 3.
The desire for the respect and
confidence of clientele,
colleagues, co-workers, and the
members of the community
provides the incentive to attain
and maintain the highest possible
degree of ethical conduct.
29. ARTICLE II
REGISTERED NURSES AND
PEOPLESECTION 4.
Ethical Principles
a. Values, customs, and spiritual beliefs held
by individuals shall be respected.
b. Individual freedom to make rational and
unconstrained decisions shall be
respected.
c. Personal information acquired in the
process of giving nursing care shall be
held in strict confidence.
G
30. SECTION 5.
Guidelines to be observed:
REGISTERED Nurses must
a. consider the individuality and totality of patients
when they administer care.
b. respect the spiritual beliefs and practices of
patients regarding diet and treatment.
c. uphold the rights of individuals.
d. take into consideration the culture and values of
patients in providing nursing care.
However, in the event of conflicts, their welfare and
safety must take precedence.
31. ARTICLE III
REGISTERED NURSES AND
PRACTICESECTION 6.
Ethical Principles
1. Human life is inviolable.
2. Quality and excellence in the care of the
patients are the goals of nursing practice.
3. Accurate documentation of actions and
outcomes of delivered care is the hallmark
of nursing accountability.
32. SECTION 7.
Guidelines to be observed:
REGISTERED Nurses must
a. know the definition and scope of nursing
practice which are in the provisions of R.
A. No. 9173, known as the “Philippine
Nursing Act of 2002” and Board Res. No.
425, Series of 2003, the “Rules and
Regulations Implementing the Philippine
Nursing Act. of 2002”, (the IRR).
33. b. be aware of their duties and
responsibilities in the practice of their
profession as defined in the
“Philippine Nursing Act of 2002” and
the IRR.
c. acquire and develop the necessary
competence in knowledge, skills,
and attitudes to effectively render
appropriate nursing services through
varied learning situations.
34. d. if they are administrators, be
responsible in providing favorable
environment for the growth and
developments of Registered Nurses
in their charge.
e. be cognizant that professional
programs for specialty certification
by the BON are accredited through
the Nursing Specialty Certification
Council (NSCC).
35. f. see to it that quality nursing care and
practice meet the optimum standard
of safe nursing practice.
g. insure that modification of practice
shall consider the principles of safe
nursing practice. if in position of
authority in a work environment, be
normally and legally responsible for
devising a system of minimizing
occurrences of ineffective and
unlawful nursing practice.
36. h. if in position of authority in a work
environment, be normally and legally
responsible for devising a system of
minimizing occurrences of ineffective and
unlawful nursing practice.
i. ensure that patients’ records shall be
available only if they are to be issued to
those who are professionally and directly
involved in their care and when they are
required by law.
37. SECTION 8.
Ethical Principle
4. Registered Nurses are the
advocates of the patients: they shall
take appropriate steps to safeguard
their rights and privileges.
A
38. Guidelines to be observed:
REGISTERED Nurses must
a. respect the “Patients’ Bill of Rights” in the
delivery of nursing care.
b. provide the patients or their families with
all pertinent information except those
which may be deemed harmful to their
well-being.
c. uphold the patients’ rights when conflict
arises regarding management of their
39. SECTION 9.
Ethical Principle
5. Registered Nurses are aware that
their actions have professional,
ethical, moral, and legal dimensions.
They strive to perform their work in
the best interest of all concerned.
40. SECTION 10.
Guidelines to be observed:
REGISTERED Nurses must
a. perform their professional duties in
conformity with existing laws, rules
regulations, measures, and generally
accepted principles of moral conduct and
proper decorum.
b. not allow themselves to be used in
advertisement that should demean the
image of the profession (i.e. indecent
exposure, violation of dress code, seductive
behavior, etc.).
41. c. decline any gift, favor or hospitality which
might be interpreted as capitalizing on
patients.
d. not demand and receive any commission,
fee or emolument for recommending or
referring a patient to a physician, a co-
nurse or another health care worker; not
to pay any commission, fee or other
compensations to the one referring or
recommending a patient to them for
nursing care.
e. avoid any abuse of the privilege
relationship which exists with patients
and of the privilege access allowed to
their property, residence or workplace.
42. ARTICLE IV
REGISTERED NURSES AND
CO-WORKERSSECTION 11.
Ethical Principles
1. The Registered Nurse is in solidarity with
other members of the healthcare team in
working for the patient’s best interest.
2. The Registered Nurse maintains collegial
and collaborative working relationship with
colleagues and other health care
providers.
43. SECTION 12.
Guidelines to be observed:
REGISTERED Nurses must
a. maintain their professional role/identity
while working with other members of the
health team.
b. conform with group activities as those of
a health team should be based on
acceptable, ethico-legal statndards.
c. contribute to the professional growth and
development of other members of the
health team.R
44. d. actively participate in professional
organizations.
e. not act in any manner prejudicial to other
professions.
f. honor and safeguard the reputation and
dignity of the members of nursing and
other professions; refrain from making
unfair and unwarranted comments or
criticisms on their competence, conduct,
and procedures; or not do anything that
will bring discredit to a colleague and to
any member of other professions. PRC-
BN
g. respect the rights of their co-workers.
45. ARTICLE V
REGISTERED NURSES, SOCIETY,
AND ENVIRONMENTSECTION 13.
Ethical Principles
1. The preservation of life, respect for
human rights, and promotion of healthy
environment shall be a commitment of a
Registered Nurse.
2. The establishment of linkages with the
public in promoting local, national, and
international efforts to meet health and
social needs of the people as a
contributing member of society is a noble
concern of a Registered Nurse.
46. SECTION 14.
Guidelines to be observed:
REGISTERED Nurses must
a. be conscious of their obligations as
citizens and, as such, be involved in
community concerns.
b. be equipped with knowledge of
health resources within the
community, and take roles in primary
health care.
47. c. actively participate in programs,
projects, and activities that
respond to the problems of
society.
d. lead their lives in conformity with
the principles of right conduct
and proper decorum.
e. project an image that will uplift
the nursing profession at all
times.
48. ARTICLE VI
REGISTERED NURSES AND THE
PROFESSIONSECTION 15.
Ethical Principles:
1. Maintenance of loyalty to the nursing
profession and preservation of its integrity
are ideal.
2. Compliance with the by-laws of the
accredited professional organization
(PNA), and other professional
organizations of which the Registered
Nurse is a member is a lofty duty.
O
49. 3. Commitment to continual learning
and active participation in the
development and growth of the
profession are commendable
obligations.
4. Contribution to the improvement of
the socio-economic conditions and
general welfare of nurses through
appropriate legislation is a practice
and a visionary mission.
50. SECTION 16.
Guidelines to be observed:
REGISTERED Nurses must
a. be members of the Accredited
Professional Organization (PNA).
b. strictly adhere to the nursing standards.
PRC-BN
c. participate actively in the growth and
development of the nursing profession.
d. strive to secure equitable socio-economic
and work conditions in nursing through
appropriate legislation and other means.
e. assert for the implementation of labor and
work standards.
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51. ARTICLE VII
ADMINISTRATIVE PENALTIES,
REPEALING CLAUSE, AND EFFECTIVITYSECTION 17.
The Certificate of Registration of
Registered Nurse shall either be
revoked or suspended for violation of
any provisions of this Code pursuant
to Sec. 23 (f), Art. IV of R. A. No.
9173 and Sec. 23 (f), Rule III of Board
Res. No. 425, Series of 2003, the
IRR.
52. SECTION 18.
The Amended Code of Ethics promulgated
pursuant to R. A. No. 877 and P.D. No.
223 is accordingly repealed or superseded
by the herein Code.
SECTION 19.
This Code of Ethics for Nurses shall take
effect after fifteen (15) days from its full
and complete publication in the Official
Gazette or in any newspapers of general
circulation.
53. - Done in the City of Manila, this 14th day of
July, 2004.
55. 1926 – “A Suggested Code” was
published in the American Journal
of Nursing (AJN) by the American
Nurses Association (ANA) but
was never adopted.
1940 – “A Tentative Code” was
published in AJN, but again was
never adopted.
1950 – ANA adopted its first official
code.
56. regard to nursing practice.
Significant positions and changes
in the 2001 ANA code included
a(n):
Return to the word “patient” rather
than client.
Application of ethical guidelines to
nurses in all roles, not just clinical
roles.
Concession that research is one but
not the only method contributing to
57. Reaffirmation against the
participation of nurses in
euthanasia.
Emphasis that nurses owe the
same obligations to themselves as
they do to others.
Recommendation that members
who represent nursing associations
are responsible for expressing
nurses values, maintaining
professional integrity, and
participating in the public policy
58. CONTENTS1. 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.
1.1 Respect for human dignity
1.2 Relationships to patients
1.3 The nature of health problems
1.4 The right to self-determination
1.5 Relationships with colleagues and others
59. 2. The nurse’s primary
commitment is to the patient,
whether an individual, family,
group, or community.
2.1 Primacy of patient’s interests
2.2 Conflict of interest for nurses
2.3 Collaboration
2.4 Professional boundaries
60. 3. The nurse promotes, advocates for,
and strives to protect the health,
safety, and rights of the patient.
3.1 Privacy
3.2 Confidentiality
3.3 Protection of participants in research
3.4 Standards and review mechanisms
3.5 Acting on questionable practice
3.6 Addressing impaired practice
61. 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.
4.1 Acceptance of accountability and
responsibility
4.2 Accountability for nursing judgment
and action
4.3 Responsibility for nursing judgment
and action
4.4 Delegation of nursing activities
62. 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.
5.1 Moral self-respect
5.2 Professional growth and maintenance
of competence
5.3 Wholeness of character
5.4 Preservation of integrity
63. 6. The nurse participates in
establishing, maintaining, and
improving healthcare environments
and conditions of employment
conducive to the provision of quality
healthcare and consistent with the
values of the profession through
individual and collective action.
6.1 Influence of the environment on moral
virtues and values
6.2 Influence of the environment on
ethical obligations
6.3 Responsibility for the healthcare
64. advancement of the profession
through contributions to practice,
education, administration, and
knowledge development.
7.1 Advancing the profession through
active involvement in nursing and
healthcare policy
7.2 Advancing the profession by
developing, maintaining, and
implementing professional standards in
clinical, administrative, and educational
practice
7.3 Advancing the profession through
65. 8. The nurse collaborates with
other health professionals and the
public in promoting community,
national, and international efforts
to meet health needs.
8.1 Health needs and concerns
8.2 Responsibilities to the public
66. 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.
9.1 Assertion of values
9.2 The profession carries out its collective
responsibility through professional
associations
9.3 Intra-professional integrity
9.4 Social reform
68. 1953 – ICN adopted its first code of ethics
for nurses.
The code has been revised and reaffirmed
many times. The four principal elements
contained in the ICN code involved
standards related to nurses and people,
practice, the profession and co-workers.
These elements in the ICN code form a
framework to guide nursing conduct along
with practice applications for practitioners,
managers, educators, researchers and
national nurses’ associations.
69. ELEMENTS OF THE CODE
1. 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 and spiritual beliefs of the
individual, family and community are
respected.
70. • The nurse ensures that the individual
receives sufficient information on which to
base consent for care and related treatment.
• The nurse holds in confidence personal
information and uses judgment 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 also shares responsibility to
sustain and protect the natural environment
71. 2. 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.
72. • 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.
73. 3. 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, acting through the professional
organization, participates in creating and
maintaining safe, equitable social and
economic working conditions in nursing.
74. 4. 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 co-worker or any other
person.
From The ICN Code of Ethics for Nurses, International Council of Nurses, 2006, Geneva,
Switzerland: Imprimeries Populaires. Reprinted with permission.
76. 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.
77. 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.
78. 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.
79. 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.
80. 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
81. B. MAINTANINING
CONFIDENTIALITYMaintaining 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.
82. 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.
83. 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?)
84. 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.
85. D. GIVING CULTURALLY SENSITIVE
CARECulture 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.
86. A – Awareness
S – Sensitivity
K – Knowledge
Communication is integral for a
correct understanding and
comprehension of health care
treatments, directives and other
exchanges.
87. E. USING POWERPower, 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
88. 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.
89. 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.