CONTENT

TOPIC: ETHICAL AND CULTURAL

ISSUES IN NURSING
INDRODUCTION
Ethics includes personal behaviours and issues of character e.g. kindness, tolerance and generosity.
Ethic is derived from the word ETHOS - ethos as defined by Bernard Harding compromises distinction
attitudes, which characterize the cultural outlook of professional group. Ethics are the distinction
between right and wrong, based on a body of knowledge, not just based on opinions. Ethics in
nursing is a set of moral codes of professional behaviours towards holistic care. The ethical code is a
set of guidelines formulated by the members of profession with the help of specialists in the field of
nursing leaders, advocate lawyers at times members from the society.

ETHICS:
Ethics is a system of moral principles, and rules of conduct recognized in respect to a
particular class of human actions or to a particular group of people’’.
Or
Ethics is a branch of philosophy dealing with values related to human conduct with respect to
the rightness and wrongness of certain actions and to the goodness and badness of the
motives and ends of such actions.

Purposes of Code of Ethics in Nursing

 Standards for the behaviours of nurse and provide general guidelines for nursing action in
ethical dilemmas.
 The code helps to distinguish between right and wrong at a given time, especially, when
alternatives appear just as satisfactory.
 The code enables a correct decision and a uniform decision within the groups.
 Helps to protect rights of individuals, families and
community and also the right of the nurse.

Uses of Code of Ethics

 Acknowledge the rightful place of individual in health care delivery system.
 Constitutes towards empowerment of individual to become responsible for their health and
well being.
 Contributes to quality care .
 Identifies obligations in practice, research and relationships.
 Inform the individual, families, community and other professionals about expectation of
nurse.

Ethical Principles
1. Ethical principles of respect and autonomy
2. Respect for a person involves: - level of understanding of another person or empathy
and reducing exploitation. Autonomy:- person's independence, self determining action
allow the patient to make decision.
2. Principle of beneficence
Activity seeking benefits, promotion of good. The duty to do balance between benefits and
harms, Paternalism is an undesirable outcome of beneficence, in which the health care
provider decides what is best for client and attempt to encourage the clients to act against
his or her own choices.

3. Principle of justice
Basic principle is that each person has equal right to the liberty available to everyone.
4.Principle of veracity
The obligation to tell the truth.
5. Principle of fidelity
The duty to do what one has promised

Ethical dilemma
 An ethical dilemma occurs when there is conflict between two or more ethical
principles.
 No correct decision exists. The nurse must make a choice between two that are
equally unsatisfactory.
 Such dilemmas may occur as a result of differences in cultural or religious beliefs.
 Ethical reasoning is the process of thinking through what one ought to do in an
orderly and systematic manner to provide justification actions based o

INTERNATIONAL CODE OF NURSING ETHICS

The international code of ethics for nurses was firs adopted by the International Council of
Nurses (ICN in 1953.The fundamental responsibility of the nurse is four fold that is to
promote health, to prevent illness, to restore health, and to alleviate sufferings. The need
for nursing is usually universal. It is unrestricted by considerations of nationality, race, creed,
colour, age,sex, politics or social status. The introduction to the code gives a general
description of
1. What the nurse does the fourfold responsibility of promoting health, preventing illness,
restoring health and alleviating sufferings.
2. How nursing service should be given unrestricted by nationality, race, creed, colour, age,
sex, politics or social status, co ordination with related group.
3. To whom services are given the individual, family and community.
The body of code is divided into 5 sections.

1. Nurses and People

The major change is in the terminology, the earlier term patient has been replaced by that
of people which makes the nurse's responsibilities broader and the area and the scope of
nursing is extensive beyond the care of sick institutions. Further the code directs the nurses
to respect as person's value, customs and religious beliefs. The nurse is expected to learn
the accepted patterns of the behaviour of the community and not acceptable to them. All
personal information entrusted to the nurse must be held in confidence or shared only with
careful judgment.

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 judgement
regarding individual competence when accepting and delegating responsibility.

3. Nurses and Profession

nurse assumes major role determining and implementing acceptable standards clinical
nursing practice, management, research and education. nurse active developing core
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.

4. Nurses and Co-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. Nurse and Society

A nurse should participate and share responsibility with other citizens and other health
professionals in promoting effects to meet the health needs of public local, state, national
and international. She could recognize and perform the duties of citizenship and be well
aware of laws and regulations which affect the practice of medicine and nursing.

Code of Ethics for Nurses in India

The nurse respects the uniqueness of individual in provision of care.
Nurse:

 Provides care for individual without consideration of caste, creed, religion, culture,
ethnicity, gender, socio-economic and political status, personal attributes, or any
other ground
  Individualize the care considering the beliefs, values and cultural sensitivity.
 Appreciates the place of individual in the family and community and facilities,
participation of significant others in the care.
 Develop and promotes trustful relationship with individuals.
 Recognizes uniqueness to response of individuals to interventions and adapts
accordingly.
2. The nurse respect the rights of individuals as partner in care and help in making
informed choice
Nurse:

 Appreciates individuals’ right to make decision about their care and give accurate
information for enabling them to make informed choices.
 Respects the decisions made by individuals regarding their care.
 Protects the public from misinformation and misinterpretations.
 Advocates special provisions protect vulnerableindividuals/groups.

3.The nurse respects individual's right privacy maintains confidentiality and share
information judiciously.
Nurse:

 Respects individuals'right to privacy of their personal information.

 Maintains confidentiality of privileged information except life discretions sharing
information.
 Takes informed consent maintains anonymity when information required
academic/legal reasons.
 Limits access computerized to authorize persons only.

4.Nursing maintains competence in order render quality Nursing care

 Nursing care must be provided by registered nurse.

 Nurse strives maintain quality nursing and upholds the standard care.
 Nurse values containing education, initiates and utilize all opportunities for self
development.
 Nurse values research adhering to ethical principles.
5. The nurse is obliged to practice within framework of ethical, professional, legal
boundaries.
Nurse:

 Adheres to code of ethics, a code of professional conduct for nurses in India

developed by Indian nursing council.
 Familiarizes with relevant laws and practices in accordance with the law of the state.
6. Nurse is obliged to work harmoniously with members of the health team.

 Appreciates the team efforts in rendering care.

 Cooperates, coordinates and collaborates with members of the health team to meet
the needs of people. .
7. Nurse is obliged to reciprocate the trust invested in nursing profession by society.

Nurse:

 Demonstrate personal etiquette in all dealings.

 Demonstrate professional attributes in all dealings.

CODES OF PROFESSIONAL CONDUCTFOR NURSES

The Code of professional conduct both advise nurses and tell the public what they can
expect of a nurse in terms of the professional role. It also provides a yardstick for evaluating
the conduct of nurses.
Most nurses will have already internalised many of its fundamental values and core
principles, and treat their patients with respect and build relationships of trust. The Code
supports this by reflecting and articulating the values and principles at the heart of
competent nursing. 7

1.Professional responsibility and accountability

Nurse:

 Appreciates sense of self worth and nurtures it.

 Maintains standards of personal conduct, reflecting credit upon the profession.
framework
 Carries out responsibilities within the of the professional boundaries.
 Is accountable for maintaining practice standards set by Indian Nursing Council.
 Is accountable for own decisions and actions.
 Is compassionate.
 Is responsible for continuous improvement of current practices.
 Provides adequate information to individuals that allow them informed choices.
 Practice healthful behaviours.
2 Nursing practice
Nurse:

 Provides care in accordance with set standards of practice.

  Respects individuals and families in the context of traditional and cultural practices
promoting healthy practices and discouraging harmful practices.
 Treat all individuals and families with human dignity in providing physical,
psychological, emotional, social and spiritual aspects of care.
 Promotes participation of individuals and significant others in the care.
 Ensures safe practice.
 Consult, coordinates, collaborates and follows up appropriately when individuals
care needs exceed the nurse's competence.

3. Communication and interpersonal relationship

Nurse:
 Establishes and maintains effective interpersonal relationships with individuals,
families and communities.
 Upholds the dignity of team members and maintains effective interpersonal
relationship with them.
 Appreciates and nurtures professional role of team members.
 Cooperates with other health professionals to meet the needs of the individuals,
families and communities.

4. Valuing human being

Nurse:
 Takes appropriate action to protect individuals from harmful unethical practice.
 Considers relevant facts while taking conscience decisions in the best interest of
individuals.
 Encourages and supports individuals in their right to speak for themselves on issues
affecting their health and welfare.
 Respects and supports choices made by individuals.

5. Management
Nurse:
 Ensures appropriate allocation and utilization of available resources.
 Participates in supervision and education of students and other formal care providers
 Uses judgment in relation to individual competence while accepting and delegating
responsibility.
 Facilitates conductive work culture in order to achieve institutional objective.
 Communicates effectively following appropriate channels of communication.
 Participates in evaluation of nursing services.
 Participates in policy decisions, following the principle of equity and accessibility of
services.
 Participates in performance appraisal.
  Works with individuals to identify their needs and sensitizes policy making and
funding agencies for resources allocation.

6. Professional advancement
Nurse:
 Ensures the protection of the human rights while pursuing the advancement of
knowledge.
 Contributes to the development of nursing practice.
 Participates in determining for upholding own knowledge an competencies.
 Contributes to care professional knowledge by conducting and participating in
research.

cultural issues in community health nursing:

KEY CONCEPTS OF CULTURAL ISSUES:
 Demographic and sociocultural variations of diverse groups.
 Variations in biological, social, environmental and communication phenomena.
 Education , practice, and research issues that influence culturally competent care.
 Inherent in nursing is respect for life, dignity, and rights of man. It is unrestricted by
considerations of nationality, race, creed, colour, age, sex, politics or social status.
 The nurse, in providing care, promotes an environment in which the values, customs
and spiritual beliefs of the individual are respected.
 Each registered nurse is accountable for his/ her practice, and, in the exercise of
professional accountability shall take account of the customs, values and spiritual
beliefs of patients/ clients.
 Individualized programmes of nursing care are designed to accommodate the
psychological, social, cultural and spiritual needs of clients, as well as their biological
needs.
 Providing culturally appropriate nursing care can be very challenging , requiring
much thought and caring concern, and a willingness to learn from those we nurse.

REASONS FOR CULTURAL COMPETENCE:

 Nurse’s culture often differs from client’s.
 culturally incompetent care is ineffective.
 Culturally incompetent care is more costly.

Cultural competence in nursing education:

 Beliefs and practices of various cultural group.
 Disease prevalence and mortality rates.
 Cultural factors related to situations such as birth and death.
 Specific culture- bound syndromes.
 Roles and responsibilities of family members.

Principles of culturally competent care:

 Care designed for specific client.
 Care based on uniqueness of person’s culture.
 Care includes empowerment strategies.
 Care is provided with sensitivity for the uniqueness of the client.
Standards for culturally competent and congruent care:
 Consumers of diverse cultures have a right to have tran cultural care
 standards used to protect and respect their generic values, beliefs and
 practices and to have health personnel incorporate.
 Nurses providing care to diverse culture or subcultures have a moral
 obligations to be prepared in trans cultural nursing to provide
 knowledgeable, sensitive and research based care to the culturally diggerent.
 Providing culturally competent and congruent care should reflect the
 caregivers ability to assess and use culture specific data without biases,
 prejudices, discrimination, or related negative outcome.

Conclusion
Nurses are expected to familiarise themselves with the Code of ethics to ensure that the
standards are incorporated in their practise. Nurses are also expected to uphold exemplary
standards of conduct while undertaking their professional role. Because nurses must have the
trust of the public to undertake their professional role, they must also have a high standard of
behaviour in their personal lives.
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