This brief introduction to Nursing Ethics is intended to help nurses working in clinical settings improve their ethical standards in nursing practice.

1. Gugsa Nemera ( PhD )
Jimma University
School of Nursing
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2. Objective
After this session, the participants
are expected to apply the
fundamental ethical principles and
professional codes of conduct in
their nursing practice. to
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3. Introduction
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4. Think-Pair-Share
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Value
Belief
Attitude
Behavior
Moral
Morality
Ethics

5. Value
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Freely chosen, enduring beliefs or attitudes about the
worth of a person, object, idea, or action (e.g., freedom,
family, honesty, hard work)
Form a base for Behavior

6. The drives of individual value
Value
Culture
Religious
background
Societal
traditions
Peer
groups
Family
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7. Professional values
Often reflect and expand on personal values
• Altruism
• Autonomy
• Human dignity
• Integrity
• Social justice
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8. Values clarification
• The process of becoming more conscious of and naming
what one values or considers worthy.
• Nursing Values
o Strong commitment to serve
o Compassion
o Belief in the dignity and worth of each person
o Commitment to education
o Autonomy
o Value-natural way (i.e. Being nonjudgmental)
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9. Belief
• True assumptions or convictions about some thing.
• Bridge over to our behavior
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10. Attitude
• A persistent tendency to feel and behave either
favorably or unfavorably towards some objects,
persons or events
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11. Behavior
• Result of a person’s values, attitudes, and beliefs
• Action or reaction to a situation, group or person
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12. Human conduct
Three kinds of judgment applied to human conduct:
1. Acts that a human being SHOULD perform
2. Acts that a human being SHOULD NOT perform
3. Acts that allow the human being a CHOICE of
either performing it or not performing it.
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13. Character
• The mental and moral qualities distinctive to an
individual
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14. Morality
• A personal standards of right and wrong
• An individual’s own code for acceptable behavior
• Arise from an individual’s conscience
• Learned
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15. Moral distress
• Inability to follow personal moral beliefs because of
institutional or other restriction
• Distress occurs when the nurse violates a personal moral value
and fails to fulfill perceived responsibility.
Share your experiences
• How many of you felt moral distress before? why
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16. Moral outrage
• Occurs when someone else in the health care setting performs an
act the nurse believes to be immoral.
• Nurses do not participate in the act.
• Nurses not responsible for wrong but perceive that they are
powerless to prevent.
SHARE YOUR EXPRIENCE
• How many of you have seen this? Why you were powerless? Any
attempt? To what extent? Were you morally, right? How ?
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17. Ethics
• Comes from the Greek word “ethos,” meaning character, different
thing to different people
• The study of ideal human behaviour and ideal ways of being
• Deals with the “rightness” or “wrongness” of human behavior
• Standards of right and wrong
• Not religion or law
• Concerned with the motivation behind the behavior
• Practices , beliefs, and standards or behavior of a particular group
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18. Nursing Ethics
• Deals with moral problems or challenges that the
nurse and face
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19. Fundamental
Ethical Principles
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20. 20
Breakout: Brainstorming
questions
What are the
fundamental
principles of
ethics?
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21. Fundamental Principles of Ethics
Ethical principles Central concept
Autonomy Self-determination
Beneficence Doing good
Non-maleficence Avoiding harm
Veracity Truth-telling
Confidentiality Keeping secret
Fidelity Keeping promises
Justice Treating people fairly
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22. 1.Autonomy
• The freedom to make decisions about
oneself
• The right to self-determination
• Must have the capacity to make decisions
independently:
o Developmental considerations
o Health-related challenge
• Involves Informed consent
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23. Breakout
Informed consent?
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24. Informed consent
A process by which a patient/client or
legal representative gives their consent
about the proposed intervention/care
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25. Breakout
Informed consent
Who cannot give
consent?
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26. Those who can't
consent
Legally underaged
Mentally
incapacitated
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27. Obtaining consent:
Responsibility of
Nurses/Midwives
1. Witness
2. Accurately record all
discussions and decisions
relating to obtaining consent
3. Advocacy
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28. Breakout
Informed consent
Who should obtain
consent?
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A person performing a procedure
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29. Breakout
Informed consent
Forms of consent?
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30. Forms of Consent
1. Written consent
 If the treatment or care is risky, lengthy
or complex
2. Verbal consent
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31. 2.Beneficence
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“Doing good”
for others
Maximizing
benefit
Meeting
Biological
Psychological
Social needs.

32. 3.Nonmaleficence
• Above all, do not harm, either
unintentionally or deliberately
• Balance risk and benefit
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33. 4.Veracity
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Implies “truthfulness”
Nurses need to be truthful to their
clients
Nurses must not withhold the whole
truth from patients, even if they believe
the truth will cause distress.
A patient always has the right to know
about diagnoses and care options

34. 5.
Confidentiality
Anything stated to nurses by
patients must remain
confidential
Safeguarding the client’s
information, health
and privacy
Maybe violated if it
o May inflict harm to
themselves or others
o Permits for the information to
be shared
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35. 6.Fidelity
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keeping a promise to fulfill all
commitments
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36. 7. Justice
• Every individual must be treated
equally, fairly, and consistent with the
rights of the individual
• Patients should not be discriminated
against based on personal
characteristics, beliefs, or values
• This requires nurses to be
nonjudgmental
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Ethical/Moral dilemmas

38. Ethical/Moral
dilemmas
• A situation that requires an individual to
choose between two equally unfavorable
alternatives, neither of which resolves
the situation in an ethically acceptable
fashion
• Conflict between one individual’s rights
and those of another or between one
individual’s obligation and the rights of
another
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39. Ethical Dilemmas
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40. Ethical Dilemmas
• Occurs when a problem exists
between ethical principles
• Deciding in favor of one principle
usually violates another
• Both sides have “goodness” and
“badness” associated with them
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41. Moral/ethical dilemma Example#1
• Treating or terminating impaired fetuses with
Down’s syndrome or spina bifida?
• Right to keep confidentiality and right to keep the
public from hazards
• Should we tell the truth always?
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42. • Sophie is jailed at a Nazi concentration camp with
her two young children. One day, she is confronted
by a Nazi soldier who offers her the following
choice: He says, “I am going to shoot one or both of
your children. You tell me which one to shoot, or I
will shoot them both.” What should you do if you
are Sophie?
Moral/ethical dilemma Example#2: Sophie’s choice
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43. Do have any moral dilemmas you
encounter in everyday life?
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44. How do you
resolve a moral
dilemma?
• What sorts of duties,
preferences, or values
do you appeal to?
• Is it always a matter of
the consequences or
results?
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45. Ethical Decision-
Making Process
The process of choosing the best
alternative for achieving the best results
or outcomes compliance with individual
and social values, morals, and regulations
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46. Ethical Decision-Making
Process Framework
1. Step One: Describe the problem
2. Step Two: state the Ethical dilemma
3. Step Three: Clarify Values
4. Step Four: Gather your information
5. Step Five: Review Code of Ethics and ethical principles
6. Step Six: Determine the options
7. Step Seven: Select a course of action
8. Step Eight: Put your plan into action.
9. Step Nine: Evaluate the results.
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47. Clinical Ethics Grid system/model
1. Review the ethical principles
2. Medical indications:
• Patient medical problem, history, diagnosis, and goals
of treatment.
3. Patient preference for treatment
4. Quality of life:
• What are the prospects, with or without treatment, for a
return to the patient's normal life?
5. Contextual factors:
• Are there family issues that might influence treatment
decisions
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48. Potential Malpractice Situation in Nursing
1. Medication error( violating the 5’s )
2. Forgetting surgical materials inside operation site
3. Injuring patient with therapeutic appliances
4. Failure to rescue patient fall
5. Ignoring a client's complaints
6. Incorrectly identifying clients
7. Mishandling of client’s property( jewelry, money, eye
glasses and dentures)
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49. Legal Safeguards For Nursing Practice
• Having legal contract
• Documentation ,record Keeping and reporting
• Work in according to scope of practice stated in NPA
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50. Maintaining Standards of Nursing
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1. Standards of Care 2. Standards of Performance

51. NURSING STANDARDS OF CARE
“Nursing Standards of Care”
pertain to professional nursing
activities that are demonstrated
by the nurse through the nursing
process
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52. Nursing standards of care
1. Standard I: Assessment
2. Standard II: Nursing Diagnosis/Problem Identification
3. Standard III: Outcome Identification
4. Standard IV: planning
5. Standard V: Implementation/intervention
 Standard V-A: Intervention-Therapeutic Alliance
 Standard V- B: Intervention-Counseling
 Standard V-C: Intervention- Self-Care Activities
 Standard V-D: Intervention- Psychobiological Interventions
 Standard V-E: Intervention- Health Teaching
 Standard V-F: Intervention- Case Management
 Standard V-G: Intervention-Health Promotion and Health Maintenance
 Standard V-H: Intervention-Therapeutic Environment, As Appropriate
6. Standard VI: Evaluation
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53. Standards of Professional
Performance
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Standard 1:
quality of care
Standard 2:
performance
appraisal
Standard 3:
education
Standard 4:
collegiality
Standard 5:
collaboration
Standard 6:
research
Standard 7:
resource
utilization

54. Nurse Practice Act (NPA)
• A rule and regulation which is developed by board/council of nurses
and affirmed by the parliament to makes decision on nursing for
nurses
• Most important legal statute or legislative act for regulating nursing
practice.
• Define nursing practice and establishes the standards of nursing
profession.
• Can be presented in general statement which needs interpretative
statement
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55. NPA
• Ethiopia has no NPA but governed by health
professional act? developed by FMoH
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56. Nursing code of ethics
A system of principles concerning actions of
nurses in his/her relationship with:
Patients
Patients’ family members
Other health care providers
Policy makers
Society as a whole
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57. Principles of nurses’ Code of Conduct
1. Quality and excellence
2. Continuous professional development
3. Human rights
4. Equitable access to quality healthcare
5. Compliance with Code of ethics and conduct
6. Honesty and integrity
7. Relationships with others
8. Information
9. Informed consent
10. Confidentiality
11. Conflict with moral and ethical beliefs
12. Delegation to and supervision of staff
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58. Top 10 Qualities of a Professional and Ethical Nurse
1. Communication skills
2. Emotional stability
3. Empathy
4. Flexibility
5. Good attention to detail
6. Interpersonal skills
7. Physical endurance
8. Problem solving skills
9. Quick response
10. Respect
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