codeo ofe ethics in nursing.pptx

DEFINITON
ACODE OF ETHICS IS AFORMAL
STATEMENT OF GROUP’S IDEALS
AND V
ALUES

PURPOSES
 STANDARDSFORTHEBEHA
VIOURSOF
NURSE&PROVIDEGENERALGUIDELINES
FORNURSINGACTION
 HELPSTO DISTIGUISHBETWEEN
RIGHT&WRONG
 ENABLESACORRECTDECISION
 PROTECTTHERIGHTSOFINDIVIDUAL

USES
 Acknowledges the rightful place of
delivery
in health care
Individuals
system.
 Contributes
individuals to become responsible
towards empowerment of
for
their health and well-being.
 Contributes to quality care.
 Identifies obligations in practice,
research and relationships.
 Informs
community
the individuals, families,
and other professionals
about expectations of a nurse.

ETHICAL PRINCIPLES
RESPECT&AUTONOMY
BENEFICENCE
JUSTICE
VERACITY
FIDELITY

ETHICAL DILEMMA
Occurs when there isconflict
between two or more ethical
principles.
No correct decision exists.
Ethical reasoning

INTERNATIONAL CODE OF NURSING ETHICS
 THEICN CODE OFETHICSFOR NURSES
 An international code of ethics for nurses was first adopted by the
International Council of Nurses (ICN) in 1953. It has been revised and
reaffirmed at various times since, most recently with this review and
revision completed in 2005.
 PREAMBLE
 Nurses have four fundamental responsibilities: to promote health, to
prevent illness, to restore health and to alleviate suffering. The need for
nursing is universal.
 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 socialstatus.
 Nurses render health services to the individual, the family and the
community and co-ordinate their services with those of related groups.

THE ICNCODE
The ICN Code of Ethics for Nurses has four principal elements that outlinethe
standards of ethical conduct.
ELEMENTSOFTHECODE
1. NURSESANDPEOPLE
•Thenurse’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.
•The nurse ensures that the individual receives sufficient information on which
to base consent for care and relatedtreatment.
•The nurse holds in confidence personal information and uses judgement 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 from depletion, pollution, degradation anddestruction

2.NURSESANDPRACTICE
•The nurse carries personal responsibility and
accountability for nursing practice, and formaintaining
competence by continual learning.
•The nurse maintains a standard of personal healthsuch
that the ability to provide care is not compromised.
•The nurse uses judgement regarding individual
competence when accepting and delegating
responsibility.
•The nurse at all times maintains standards ofpersonal
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 compatiblewith
the safety, dignity and rights ofpeople

3. NURSESANDTHEPROFESSION
•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 organisation,
participates in creating and maintaining safe, equitable
social and economic working conditions in nursing.

4. NURSESANDCO-WORKERS
The nurse sustains a co-operative
relationship with co-workers 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.

5. NURSESANDSOCIETY
Participate and share responsibility with
other citizens &other health
professionals.
Recognize and perform the dutiesof
citizenship
Aware of laws and regulations which
affect the practice of medicine and
nursing.

INC CODEOFETHICSFORNURSESIN INDIA
I) Thenurserespectstheuniquenessof individual
in provisionof care
1.1 Provides care for individuals without
consideration of caste, creed, religion, culture,
ethnicity, gender, socio-economic and political
status,personalattributes,or anyother grounds

I) The nurse respects the uniqueness of
individual in provisionof care
1.2 Individualizes the care considering the
care considering the beliefs, values and
cultural sensitivities.

I) The nurse respects the uniqueness of
individual in provisionof care
1.3 Appreciates the place of the individual
in family and community and facilitates
participation of significant others in the
care.

in provisionof care
4.Develops and promotes trustful relationship
with individual(s).
5.Recognizes uniqueness of response of
individuals to interventions and adapts
accordingly.

in provisionof care
1.5 Appreciates the place of the individual in
family and community and facilitates
participation ofsignificant othersin the care.

2)The nurse respects the rights of individuals as
partner in care and helps in making informed
choices
1.Appreciates individual’s right to make decisions
about their care and therefore gives adequate
and accurate information for enabling them to
makeinformed choices.

2) Thenurserespectstherightsofindividuals aspartner in
careandhelpsin making informed choices
2.Respectsthedecisionsmadebyindividual (s)regarding
their care.
3.Protects public from misinformation
and misinterpretations.
4.Advocates special provisions to protect
vulnerable individuals/groups.

3) The nurse respects individual’s right to privacy, maintains
confidentiality, andsharesinformation judiciously.
1.Respects the individual’s right to privacy of their personal
information.
2.Maintains confidentiality of privileged information except
in life threatening situations and usesdiscretion in sharing
information.

4) Nursemaintainscompetencein order torender Quality
Nursing Care
1. Nursingcaremustbeprovided onlybyregistered nurse.
2.Nurse strives to maintain quality nursing care
and upholdsthestandardsof care.
3.Nursevaluescontinuing education,initiates andutilizes all
opportunities for self development.

4) Nursemaintainscompetencein order torender Quality
Nursing Care
4.4 Nursevaluesresearchasameansofdevelopmentof
nursing professionandparticipates in nursing research
adheringtoethical principles.

5)Thenurseisobligedtopractice within theframework of
ethical, professionalandlegal boundaries
1.Adherestocodeofethicsandcodeofprofessional
conductfor nursesin India developedbyIndian Nursing
council.
2.Familiarizeswith relevant lawsandpracticesin
accordancewith thelaw ofthe state.

6)Nurseisobligedtowork harmoniouslywith themembers
ofthehealth team.
1. Appreciatestheteameffortsin rendering care.
2.Cooperates,coordinatesandcollaborateswith the
membersofthehealth teamtomeettheneedsofthe
people.

7)Nursecommitstoreciprocate thetrust investedin nursing
professionby society
1. Demonstratespersonaletiquettesin all dealings.
2. Demonstratesprofessionalattributes in all dealings.

INC CODEOFPROFESSIONALCONDUCTFOR
NURSESIN INDIA
1. ProfessionalResponsibilityand accountability
1. Appreciates sense of self-worth and nurtures it.
2.Maintains standards of personal conduct reflecting credit
upon the profession.
3.Carries out responsibilities within the framework of the
professional boundaries.

NURSESIN INDIA
4.Is accountable for maintaining practice standards set by
Indian Nursing Council
5. Is accountable for own decisions and actions
6. Is compassionate
7.Is responsible for continuous improvement of current
practices

NURSESIN INDIA
8.Provides adequate information to individuals that allows
them informed choices
9. Practices healthful behavior

NURSESIN INDIA
2. Nursing Practice
1.Provides care in accordance with set standards of
practice
2.Treats all individuals and families with human dignity in
providing physical, psychological, emotional, social and
spiritual aspects of care
3.Respects individual and families in the context of
traditional and cultural practices and discouraging
harmful practices

NURSESIN INDIA
2. Nursing Practice
4.Presents realistic picture truthfully in all situations for
facilitating autonomous decision-making by individuals
and families
5.Promotes participation of individuals and significant
others in the care
6. Ensures safe practice
7. Consults, coordinates, collaborates and follows up
appropriately when individuals’ care needsexceedthe
nurse’s competence.

NURSESIN INDIA
3. Communication andInterpersonal Relationships
1.Establishesandmaintainseffectiveinterpersonal
relationship with individuals, familiesand communities
2.Upholdsthedignity ofteammembersandmaintains
effectiveinterpersonal relationship with them
3.Appreciatesandnurtures professionalrole ofteam
members
4.Cooperateswith otherhealth professionalstomeetthe
needsoftheindividuals, familiesand communities

NURSESIN INDIA
4. Valuing Human Being
1.Takesappropriate actiontoprotectindividuals from
harmful unethical practice
2.Considerrelevant factswhile taking consciencedecisions
in thebestinterest ofindividuals
3.Encourageandsupportindividuals in their right tospeak
for themselvesonissuesaffecting their health and welfare
4. Respectsandsupportschoicesmadebyindividuals

NURSESIN INDIA
5. Management
1.Ensuresappropriate allocation andutilization of
available resources
2.Participatesin supervisionandeducationofstudentsand
otherformal care providers
3.Usesjudgmentin relation toindividual competencewhile
acceptinganddelegating responsibility
4.Facilitatesconducivework culture in order toachieve
institutional objectives

NURSESIN INDIA
5. Management
5.Communicateseffectivelyfollowing appropriate channels
of communication
6. Participatesin performance appraisal
7. Participatesin evaluationofnursing services
8.Participatesin policy decisions,following theprinciple of
equityandaccessibilityof services
9.Workswith individuals toidentify their needsand
sensitizespolicy makersandfunding agenciesfor resource
allocation

NURSESIN INDIA
6. ProfessionalAdvancement
1. Ensures the protection of the human rights while pursuing the
advancement of knowledge
2. Contributes to the development
3. Participates in determining and implementing qualitycare
4. Takes responsibility for updating own knowledge and
competencies
5.Contributes to the core of professional knowledge by
conducting and participating in research

AUTONOMY &ACCOUNTABILITY
Autonomy means that individual are able
to act themselves to the level of their
capacity
Accountability is the process that
mandates that individuals are answerable
for their actions and have anobligation to
act.
Attributes of accountability:
answerability& responsibility

ACCOUNTABILITYOFNURSING PERSONNEL
 Provide safe &therapeutic environment
 Deliver competent &personalized care
 Maintaining adequate supplies of material in the
ward
 Maintaining accurate and up to date records
 Maintaining good IPR
 Protect client’s legal rights& privacy
 Work within ethical& legal boundaries
 Keep pace with changing health needs& developing
technology
 Delivering care as per standards
 Delegating responsibility appropriately
 Contribute to development of profession

ASSERTIVENESS
 Tool for expressing ourselves confidently
 Way of saying yes or no in an appropriateway
 Benefits:
 Less friction &conflicts
 Increased self respect
 Enhances self esteem
 Increased productivity at work &home
 Less stress at work

AIMSOF ASSERTIVENESS
 Find the best possible solution for all people.
 Increases chances of our needs being met
 Allows to remain control
 Brings self confidence
 Have more friends
 Reduced stress
 A-S-E-R-T MODEL:
 See chart

STRATEGIESFORIMPROVING
ASSERTIONATWORK
 ASK
 BRINGENERGYTOTHEJOB
 GETYOUREMOTIONS UNDERCONTROL
 FINDAGOOD PLACETO T
ALK
 TIMING IS IMPORTANT
 EFFECTIVEASSERTIONREQUIRESALISTENER.

TECHNIQUESFORBEINGASSERTIVE
 . Identify your personal rights, wants and needs.
 . Identify how you feel about a particular Situation
 Be direct
 Own your message
 Avoid assumptions about others thinking
 Avoid statements that begins with "why","you".
 Ask for feedback
 Stop apologizing all the time
 Learn to take a compliment
 Act confident even if you don't feel confident
 Feel free to say no
 Evaluate your expectation

VISIBILITYOFNURSES
Aquality or fact of , degree of being visible
Degree of exposure to public notice
Nurses themselves are responsible when they
don't take a stand neither to correct the
distorted images not for the visibility of the
roles they have performed in their health
care.

LEGALCONSIDERATIONS
 1st nursing law :Nursing registration- 1903
 Indian nursing council act: enacted in 1947
 Amended in 1957
 LEGALIMPLICATIONS:
 Torts: Torts are when others interfere in individuals'
privacy
 Assault: Assault occurs when a person puts another
person in fear of a harmful or offensivecontact
 Battery: It is an intentional touching of another's
body without the other's consent
 Negligence: it is described as lack of proper care and
attention carelessness.

 Malpractice: Failure to meet the standards of
acceptable care which results in harm toanother
person.
 Fraud: It results from a deliberate deception
intended to produce unlawful gains.
 False imprisonment: It occurs when a client is not
allowed 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 persons.

Legal documents: it comprised:
a)Advance directive: Written document
recognized by law that provides directions
concerning the provision of care when a person
is unable to make his or her own treatment
choices.
b)Do not resuscitate orders: Written order by a
physician when a client has indicated a desireto
be allowed to die if the client stops breathing or
the client's heart stops beating.
c)Informed consent: It is clients' approval [or
that of the clients' legal representative to have
his or her body touched by a specificindividual.

NURSINGLIABILITIESANDPREVENTIVE
MEASURES
 All nursing observations should be noted
carefully, describing accurately
 Patients complaints should be recorded as
accurately and specifically
 Nurse must report through proper channels
 Authorities must be informed regarding any kind of
equipment, materials or supplies, which for any
reasons less than safe for use in the patient's care
 Insurance protection

LEGALRESPONSIBILITY
 Registration
 Licensing is a mandatory procedure for practice of
nursing. Registration aims at protecting patients by
providing qualified nurses. The nurse is responsible to
obtain registration in the respective State Nursing
Registration Council
 LegalLiability/Act Of Negligence
 License of a nurse can be suspended or cancelled for any
act of negligence or mal practice, following a specified
procedure.
 Medico— Legalcase (M.L.C.)
 Amedico) legal case is a patient who is admitted to
the hospital with some unnatural pathology and has tobe
taken care of in concurrence with the police and/or court

 Types of clients which are categorized as MLCin a
hospital are.
 Road traffic accidents.
 Injuries inflicted during brawls/fights, shooting,
bomb blasts etc.
 Suicide.
 Burns.
 Poisoning.
 Rape victim.
 Assault.

NURSESROLEIN AMEDICO-LEGAL CASE

 1. Obtain complete history from patient or significantothers
 2. Inform the police officer/constable on duty in thehospital
and the CMO.
 3. When it is made a MLC,then record it on the patient'scase
sheet with red ink at right hand top corner. .
 4. Do not give any statement about patient's condition to
police, magistrate or media. Only a doctor has to give
information.
 5. When apatient has to be discharged, inform the CMO
only. After clearance from them, he/she can bedischarged.
 6. If a MLCpatient absconds, inform the CM0 and the treating
doctor immediately

 7. No patient can leave against medical advice.
 8. Document the care given to patients timely,
accurately and duly sign the nurse’s notes.
 9. Records and all the documents pertaining to
patient should be handled with care, during the stay
in the hospital. They must be kept safely and should
be handed over to the authorized person as
designated by the hospital authority.
 10. Incase death of a MLC;the body is not to be
handed over to the relatives. It needs to be accurately
labeled and sent to the mortuary. CMO and/ or police
officer should be informed simultaneously.
 11. Appropriately authority must be informed.

 Correct identity
 Anurse/midwife is responsible to make sure that all
babies born in hospital are correctly labeled at birth
and handed over to right parent.
 Unknown/unconscious patients must be labeled as
soon as their identity is known.
 Patients who have to undergo surgery should be
appropriately identified and labeled.
 Site of operation to be correctly marked particularly
where symmetrical sides or organs are there:
 Operation theatre (O.T.): scrub nurse has to see all the
instruments/ swabs are returned. She has to say OKAY'
before closure by the surgeon

 . LeftAgainstMedicalAdvice (L.A.M.A.)
 Inform medical officer in charge. Signatures of both
patients and witness to be taken as per institutionalpolicy.
 Patient'sProperty
 Inform patient on admission that hospital does not take
responsibility of his belongings. If patient is unconscious/ or
otherwise required then a list of items must be made,counter
checked by two staff nurses and kept under safecustody.
.Dying Declaration
 Doctor or nurse should not involve themselves in dying
declaration, in case where police records the dyingdeclaration.
Dying declaration is to be recorded by the magistrate. But if
condition of patient becomes serious then medical officer can
record it along with two nurses it witness. Dying Declaration
can be recorded by the nursing staff with two nurses aswitness
when medical officer is not present. Then the declaration hasto
be sent immediately in a sealed cover to themagistrate.

 Wills
 For this, doctor has to be present her, he can
recode if requested.
 Examination ofrape case
 Female attendant/female nurse must be present
during the examination.
 Artificial human insemination
 Written consent should be obtained from both donor
and recipient.
 Donor and recipient must have the same blood
group. Donor and recipient's identity should be kept
confidential. .
 All related documents should be kept confidential
and safe.

•Poisoncase
•Do not give either verbal or written opinion.
•Do not allow to take photos unless special
permission is granted by appropriate authority.
• Do not give any information to public or press.
• Preserve all evidence of poisoning.
•Collect and preserve all excreta, vomits and
aspirates, seal them immediately and send to
forensic laboratory at the earliest.
.ConsumerProtection Act(l986)
Consumer protection act was passed by parliament
in 1986
RIGHTSOFPATIENT:
See leaflet

 Nursesrole toprevent complications
 1. Review nursing practice periodically. Update
knowledge and improve skill by attending short term
courses, in- service education and continuing
education programmes.
 2. Should have complete knowledge of all rules and
regulations of hospital and know their descriptions
{duties and responsibilities).
 3. Follow nursing practice standards/protocols.
 4. Bea keenobserver.
 5. Written instructions must have rules and code of
practice laid down to ensure the safety and well being
of patients and nurses.

 6. All hospitals must have rules, a code of practice
laid down to ensure the safety and well being of
patients and nurses.
 7. Maintain records and reports of the unit properly.
 8. Follow 6 Rights - right patient, right drug, right
time and right route with right technique and right
of the patient lo know about his/her disease
condition.
 9. Check the treatment order and use professional
judgment before implementing.
 10. Do not exceed the limits of nursing procedure
laid down by statutory bodies.

BIBLIOGRAPHY
•ANNZWEMER(2006), PROFESSIONALADJUSTMENTS&ETHICSFORNURSES
IN INDIA, 6TH EDITION, CHENNAI,B.IPUBLICATIONSPVT.LTD
PAGENO: 95-109, 139-154
•BARBARAKOZIER(2006), FUNDAMENTALSOFNURSING,CONCEPTS,
PROCESS,&PRACTICE,2ND EDITION, NEWDELHI,PEARSONEDUCATION
PAGENO:111-118
•HELENHARKREADER(2009), FUNDAMENTALSOFNURSING- CARINGAND
CLINICALJUDGEMENT,3RD EDITION, U. P,ELSEVIERPUBLICATIONSPAGE
NO: 17-41
•PA
TRICIAAPOTTER,ANNGRIFFINPERRY(2005), FUNDAMENTALSOF
NURSING, 6TH EDITION, NEWDELHI,ELSEVIER PUBLICATIONS PAGENO:
388- 392, 407-419
•SHEBEERP.BASHEER,ACONCISETEXTBOOKOFADV
ANCEDNURSING
PRACTICE, BANGALORE, EMMESSMEDICALPUBLISHERS PAGENO:9-20
•SUZANNEC.SMELTZER(2009), BRUNNER& SUDDARTH’STEXTBOOKOF
MEDICALSURGICALNURSING,11TH EDITION, NEWDELHI,WOLTERS
KLUWER PVT. LTD PAGENO:27-33
•WWW.NURSING WORLD.ORG/.../CODEOFETHICSFOR NURSES
•WWW.ICN.CH/ABOUT-ICN/CODE OFETHICS FOR NURSES
•WWW.DSR.DK/SER/DOCUMENTS/ICN CODEENGLISH.PDF
•WWW.NCBI.NLM.GOV/PUBMED

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