Code of ethics

Code of Ethics and
Legal consideration
NEHA DAGAR
NURSING
TUTOR

INTRODUCTION
 Ethics is an integral part of the foundation of nursing. Nursing has concern
for the welfare of the sick, injured, and vulnerable and for social justice.
Individuals who become nurses are expected to adhere to the ideals and
moral norms of the profession. A code of ethics makes explicit the primary
goals, values, and obligations of the profession.

DEFINITION
 A code of ethics is a set of ethical principles, ideals and values shared by
members of the group, and serves as a standard for their professional
actions.

purposes
• To identify the ethical obligations and duties for every individual who enters
the nursing profession.
• To determine the ethical standard.
• To express understanding of nursing commitment to society.

CODE OF ETHICS FOR NURSES IN
INDIA
 The nurse respects the uniqueness of every individual in provision of care.
 NURSE:
 Provides care without any discrimination
 Respect for human dignity
 Relationships to patients, trustful relationship with individuals.
 The nature of health problems
 The right to self-determination
 Relationships with colleagues and others

 2. The nurse respects the rights of individuals as partner in care and helps
making informed choices.
NURSE:
 Appreciates the individual right to make decisions about his care.
 Respects the decisions made by individuals regarding his care.
 Protects public from misinformation and misinterpretations.
 Advocate special provision to protect vulnerable individuals / groups.

3. The nurse respects individual’s right to privacy, maintains confidentiality,
and shares information judiciously.
NURSE:
 Respect the individual’s right to privacy
 Maintains confidentiality of privileged information except in life
threatening situation.
 Takes informed consent
 Limits the access to all personal records written and computerized to
authorized persons only.

4. The nurse maintains competence in order to render quality nursing care.
NURSE :
 Nursing care must be provided only by registered nurse.
 The nurse strives to maintain quality nursing care and upholds the standard
of care.
 The nurse values continuing education
 Nurses value research as means of development of profession.

5. The nurse is obliged to practice within the framework of ethical,
professional and legal boundaries.
NURSE:
 Adheres to code of ethics and code of professional conduct for nurses
 Familiarize with relevant laws and practices in accordance with the law of
the state.

6. The nurse is obliged to work harmoniously with members of health team.
NURSE:
 Appreciates the team efforts in rendering care
 Co-operates, coordinates and collaborates with member of health team.

7. The nurse commits to reciprocate the trust invested in nursing profession
by society.
NURSE:
 Demonstrates personal etiquettes in all dealings.
 Demonstrates professional attributes in all dealings

Code of professional conduct for
Nurses in India
1. Professional responsibility and accountability
NURSE:
 Appreciates sense of self worth
 Maintains standard of personal conduct
 Carries out responsibilities within the framework of the professional
boundaries.
 Accountable for maintaining practice standards set by Indian Nursing
Council.
 Accountable for own decisions and actions

 Is responsible for continuous improvement of current practices.
 Provides adequate information to individuals that allows them informed
choices.
 Practices healthful behaviour.

2. Nursing practice:
NURSE :
 Provide care in accordance with set standards of practice.
 Treats all individual and families with human dignity.
 Respects individuals and families, promoting healthy practice.
 Presents realistic picture truthfully in all situation
 Promotes participation of individuals and significant others in the care
 Ensure safe practice
 Consults, coordinates, collaborates and follow up appropriately when
individual’s care needs exceed the nurse competence.

3. Communication and interpersonal relationships
NURSE :
 Establishes and maintains effective IPR with individual and families.
 Upholds the dignity of team members and maintains effective IPR
 Appreciates and nurtures professional role of team members.
 Co-operates with the other health professional to meet the needs of
individuals, families and communities

4)Valuing a human being
NURSE:
 Takes appropriates action to protect individuals from harmful unethical
practice.
 Considers relevant facts while taking conscious decisions.
 Encourages and supports individuals in their right
 Respects and supports choices made by individuals

5. Management
NURSE:
 Ensure allocation and utilization of resources.
 Participates in supervision and education of students and other formal care
providers.
 Uses judgement
 Facilitates conducive work culture
 Communicates effectively
 Participates in performance appraisal
 Participates in evaluation of nursing services
 Participates in policy decisions

6. Professional advancement
NURSE:
 Ensures the protection of human rights
 Contributes in the development of nursing practice.
 Participates in determining and implementing quality care.
 Take responsibility in for updating own knowledge and competencies.
 Contributes to core of professional knowledge.

The international council of
nurses(ICN) code of ethics for nurses
 International code of ethics for nurses was first adopted by the
International Council of Nurses( ICN) in 1953.
 Elements of code : it has four principal elements
1. Nurses and people
2. Nurses and practice
3. Nurses and the profession
4. Nurses and co-workers

Accountability
 American nurses association code of ethics states that the accountability is
“to be answerable to oneself and others for one’s own actions”.

Hierarchy of Accountability
 Individual level
 Institutional level
 Professional level
 Societal level

Lines of accountability
 Upward : looking up the line and doing what managers and administration
require.
 Lateral : accountability as a self regulation, in which practitioners are
accountable to and judged by, criteria set by their peers.
 Downward or public accountability: where staff is accountable for/ to
patients.

Types of Nursing Accountability
 Fiscal accountability : this accountability is concerned with financial probity
and the ability to trace and adequately explain expenditure.
 Process accountability : this accountability is concerned with the use of
proper procedures.
 Programmer Accountability : it is concerned with the activities undertaken
and their quality.
 Priorities accountability : this deals with the relevance or appropriateness
of chosen activities.

Accountable to whom
 Nurses are accountable to the nursing council.
 This relates to practicing within scope of practice, according to register or
roll in which your name is entered, and being accountable for professional
conduct.
 The nursing council’s code of conduct for nurses and midwives further
outlines professional accountability in terms of ethics, standards of
practice, rights of patients and justifying public trust and confidence.

Reasons for lack of Accountability
 Job description not available.
 Lack of guidelines, standards and control.
 Authority not specified.
 Overburdened staff due to shortage of staff.
 Lack of adequate training and efficient experience.
 Lack of up to date knowledge, skills and competence.
 Unwilling
 Inadequate supervision by ward managers.
 Outdated policies, protocols and procedures.
 Lack of decision making.

Need for enhancing accountability in
Nursing
 Well defined duties and job description.
 Written policies, protocols and procedure.
 Nursing audit and standards of practice
 Proper delegation of responsibilities.
 Proper training and education of the self.
 Periodical evaluation of each individual’s nursing practice.
 Refine and modify outdated policies and procedures.
 Conducive working environment.
 Availability of adequate number of personnel and resources of patient
care.

ASSERTIVENESS
 DEFINITION :
According to Oxford English Dictionary , it is defined as assertiveness is
behaving in a way that expresses Confidence , importance or power and earns
respect from others.

Characteristics of assertive people
 They feel free to express their feeling, thoughts, and desires
 They are able to initiate and maintain comfortable relationship with others.
 They know their rights.
 They have control over their anger.
 They are willing to compromise with others: rather than always wanting
their own ways and tend to have good self –esteem

Assertive Behavior
 Standing up for one’s right no matter what the circumstances.
 Correcting the situation when one’s rights are violated.
 Seeking respect and understanding
 Interacting in mature manner.
 Those using assertive behavior confront problems, disagreement or
personal discomforts
 Taking the risk of being misunderstood as aggressive, abrasive or
attacking.
 Being able to protect one’s right while protecting and respecting the right
of others.

 Risk taking behavior
 Rational thinking and self affirmation of personal worth, respect and rights.
 A healthy style in which to conduct interpersonal relationship.
 Finding a win –win solution in handling problem.

Visibility of nurses
 Visibility focuses on the image of nursing from the perspectives of how the
profession views its own image and how those outside the profession view
nursing and nurses.

Contemporary Image of Professional
Nursing
 Nursing shortages emerge from the public image of nursing or images of
nursing emerge from nursing shortages.
 People hope that nursing is a vocation, a “calling” that requires education,
commitment and dedication.

Antiquity Image of Nursing
 In painting, a nurse would be portrayed as a women in a religious order or
as a person of wealth performing nursing as an act of Christian mercy.

Victorian image of Nursing
 Nightingale was to the improved healthcare of British soldiers and to the
development of modern nursing, the ever increasingly images of
nightingale occurred solely because she was able to succinctly
demonstrate the aggregate outcomes of nursing practice.
 Nursing emerged at a time of turbulent social change and reform in great
Britain.

Early 20th Century Nursing
 The arrival of nursing as a profession and a “calling” and the central
importance of nurses to hospitals was clearly evidenced in the architecture
of grand and imposing nursing schools that were attached to hospitals.

In 1930s – Nursing as Angel of Mercy
 The white angel clearly portrayed Nightingale’s persistence and head to
head confrontation with medicine.
 Germany’s 1936 stamp commemorated nursing as a symbol of community
service with a larger – than – life nurse compassionately overlooking
people.

The 1940s- Nurse as Heroine
 Nursing was depicted on a 1940 Australian Stamp as a larger than-life
figure looking over a soldier, a sailor, and an aviator; in Costa Rica’s 1945
stamp of Florence nightingale and Edith Cavell.

Nursing in the 1980-1990s
 Artistic view of nursing during this period focused on caring. In the
Vietnam war Women’s Memorial, the central figure is the nurse in battle
fatigues cradling the head of soldier for whom she is providing care.

Enduring public concern with Nursing
 Question asked by people “ can I trust and entrust my life on this nurse?”
Practice
Education Research
Nursing
that is
person
centered,
safe &
effective

The Reality of the Contemporary
Nursing
 The reason for the existence of the modern healthcare institution- the
hospital, the nursing home, the mental hospital, the home care agency- is
to deliver Nursing.

Creating New image in Nursing
 Nurses take themselves seriously, they are highly visible to patients,
families and physicians because they have reclaimed their birthright and
their practice.
 In modern medical climate, nurses supervise assistive personnel and use
their authority to ensure that patient care delivery is excellent.
 In this new world nurses believe in nursing, in self, and in their colleagues.
It is significant to the future of nursing that nurses safeguard nursing’s
public image in local newspapers, television and media dramas and daily
practice.

Legal consideration in Nursing
 The concerned, informed, dedicated professional always strives to
implement the education and competency to successfully accomplish all
tasks, treatments and responsibilities correctly and accurately.
 However, there are rare instances when regardless of the application of the
most strict standard for quality care, variations occur which result in
litigation. To help avoid these instances, it is important to be educated and
informed about current laws, statutes and standards.

Sources of law
 There are basically three sources of law: statutory law, administrative law
and common law.
 Statutory law : is written law set down by legislature. These laws may
originate with National, state or local Municipalities. Cases involved may be
heard in courts where judgements are made to the interpretations of a
stature as it relates to a particular case.
 Administrative law: governs the activities of administrative agencies of
government. Government agency action can include rule making ,
adjudication or the enforcement of a specific regulatory agenda.

 Common law: is also known as case law or precedent, is law developed by
judges through decisions of courts and similar tribunals, as opposed to
civil law set on statutes adopted through the legislative process.

Beneficence and non- maleficence
 It defines actions that promote the well being of others, specifically in
medical field.
 It is further defined as taking action or not avoiding actions that are in the
best interest of patients assigned to a medical professional’s care.

 Another guiding principle of nurses is the principle of non-maleficence,
which defines the phrase “ first, do not harm”.
 Most treatments carry risk of harm and may result if the patient’s medical
outcome without treatment will result in debilitating or terminal results.
 Therefore one of the most important considerations of physicians and
nurses is to ensure that the patient understands all of the risks and
benefits associated with their medical treatment.

Theories of Liability
 It involves the following legal theories:
 International torts involving battery, assault, false imprisonment and
intentional infliction of emotional distress.
 Negligence or gross negligence.
 Negligent infliction of emotional stress.

Four legal elements are:
1. Duty ( established relationship between the plaintiff and the defendant ).
2. Breach of duty ( failure to do what a reasonable and prudent professional
would do under similar circumstances).
3. Damages ( injuries)
4.Causation (an established correlation between the acts of negligence and
injuries).

1.Defences to Negligence
 Important in legal cases are the specific defenses to negligence.
 Contributory negligence acknowledges the patient was irresponsible,
negligent or reckless regarding his or her own healthcare.
 Comparative negligence is a defense in which the legal decision considers
the plaintiff’s negligence against the negligence of the defendant in favour
of comparative negligence.

Good Samaritan Act
 It refers to someone who administers aid in an emergency situation to an
injured person on a voluntary basis.
 Under the good Samaritan laws which grant immunity, if the good
Samaritan errors while administering emergency medical care, he or she
cannot be held legally liable for damages in court.
 However 2 conditions must be met:
1) The aid must be given at the scene of the emergency, and
2) If the “volunteer” has other motives,(being paid a fee/ reward for
recognition and promotion), then the law will not apply.

Tort law
 A tort is a civil wrong committed against a person or property( real or
personal) and is punishable by damages (ie, monetary compensation)
rather than imprisonment.
 There are three basic categories of torts:
1. Intentional torts
2. Negligent torts
3. Strict liability tort
In which liability is assessed instead of fault

Intentional tort
 Means it was known with a high degree of certainty that, harm to another
would result
 Eg is an angry punch in the nose- but is far more likely to result from
carelessness
 More common types of intentional torts are: assault, battery, false
imprisonment, invasion of privacy, disclosure of information, defamation of
character, misrepresentation and fraud and infliction of mental distress.

 Common types of intentional torts include include:
1. Assault – this is the causing of an apprehension of an immediate harmful,
offensive or unauthorized contact to a person and a willful attempt or
threat to injure.
2. Battery – is the harmful, offensive or unauthorized touching of another
person.

3. False imprisonment – an act or failure to act by the defendant that confines
the plaintiff to a confined area. Most actions of false imprisonment involve
psychiatric clients, medical clients who are detained until hospital bills are
settled may claim false imprisonment.
4. Invasion of privacy – it is the intrusion into the personal life of another,
without just cause, which can give the person whose privacy has been
invaded a right to bring the lawsuit for damages against the person or entity
that intruded.

5.Disclosure of information – it occurs when a client’s problems are
inappropriately discussed with any third party
6. Defamation of character – it is an act of communication that causes
someone to be shamed, ridiculed, held in contempt, lowered in estimation of
the community or to lose employment status or earnings or otherwise suffer a
damaged reputation.
7. Misrepresentation and fraud –it can occur when a health professional
misleads a client to prevent the discovery of a mistake in treatment.

8. Infliction of mental/ emotional distress- this includes imposing mental
suffering resulting from painful emotions, such as grief, public humiliation,
despair, shame, wounded pride etc.

Negligent tort
 Means a tort committed by failure to act as a reasonable person to
someone to whom she/he owes a duty, as required by law under the
circumstances.
 There are two degrees of negligence: ordinary and gross.
 Ordinary negligence is failure to do (or not do) under the same
circumstances in the situation in question.
 Gross negligence is more severe and includes the intentional omission of
proper care or the commission of an act constituting the improper delivery
of care.

 Malpractice is very similar to negligence, but it is more specific. Medical
malpractice is the failure of a medical professional to follow the accepted
standards of practice of his/her.
 Malpractice includes four elements :
1. Duty of care is the easiest element to prove, especially for nurses who
practice in a hospital setting.
2. Breach of duty is defined as the failure to adhere to the standard of care
set by the nursing profession , thus departing from a specific duty owed
to the client.

3. The element of injury (also called damages) not only includes physical
harm but also mental anguish and other invasions of the patient’s rights.
4. The element of proximal cause (also called causation) involves the concept
of “ foresee ability” ; that is, a logical link which must exist between the
nurse’s act and the injury suffered.

3.Professional liability
1. Failure to follow a physician’s order: this negligent act can involve the failure of the
nurse to check doctors’ orders before administering a medication to assess for the
modification of the order.
2. Failure to report significant changes in a client’s condition
3. Failure to take correct telephone orders.
4. Failure to report defective equipment.
5. Failure to follow established standard procedure
6. Patient falls.
7. Patient burns
8. Medication errors
9. Sponge and instrument counts

Code of ethics

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