THE ETHICAL PRINCIPLES

CODE OF ETHICS
Code : systematic collection of statutes, body of laws so
arranged as to avoid inconsistency and overlapping ; set of
rules on any subject. Ø
Code of ethics is a set of ethical principles that are accepted by
all members of a profession. (potter & perry )
Code of ethics is a guideline for performance ,standards &
personal responsibilities.
Purposes of Code of Ethics:
1. Set standards for the behaviors of nurse
2. Provide general guidelines for nursing action helps to
distinguish between right & wrong
3. Enables a correct decision protect the rights of individual
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 2012.
An International Code of Ethics( ICN )code of ethics for nurses
has four principal elements that outline the standards of ethical
conduct.

Elements of the ICN Code of Ethics

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.
 The nurse ensures that the individual receives accurate,
sufficient and timely information in a culturally
appropriate manner on which to base consent for care
and related treatment.
 Nurse holds in confidence personal information and uses
judgement in sharing this information. T
 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 advocates for equity and social justice in
resource allocation, access to health care and other
social and economic services. the nurse
demonstrates professional values such as
respectfulness, responsiveness, compassion,
trustworthiness and integrity

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.
 the nurse at all times maintains standards of personal
conduct which reflect well on the profession and enhance
its image and 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. the nurse strives
to foster and maintain a practice culture promoting
ethical behaviour and open dialogue.
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 that supports
evidence-based practice.
 The nurse is active in developing and sustaining a
core of professional values.
 The nurse, acting through the professional
organisation, participates in creating a positive
practice environment and maintaining safe, equitable
social and economic working conditions in nursing.
  The nurse practices to sustain and protect the natural
environment and is aware of its consequences on
health.
 The nurse contributes to an ethical organizational
environment and challenges unethical practices and
settings
4. NURSES AND CO-WORKERS
 The nurse sustains a collaborative and respectful
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.
 The nurse takes appropriate action to support and guide
co-workers to advance ethical conduct
BOARD OF NURSING Board Resolution No. 220 Series of 2004
PROMULGATION OF THE CODE OF ETHICS FOR REGISTERED
NURSES
WHEREAS, the Board of Nursing 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 R.A. No. 9173, known as the “Philippine Nursing
Act of 2002);
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 prinicipal basis
therefor: All the principles under the said Code were adopted
and integrated into the Code of Ethics as they apply to the
nursing profession;
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
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 (PNA),
and other affiliate organizations of Registered Nurses, decided
to adopt a new Code of Ethics under the afore-mentioned new
Law; NOW, THEREFORE, the Board hereby resolved, as it now
resolves, to promulgate the hereunder Code of Ethics for
Registered Nurses:
ARTICLE I
PREAMBLE SECTION
SECTION 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.
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.
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.
ARTICLE II
REGISTERED NURSES AND PEOPLE
SECTION 4
Ethical Principles
1. Values, customs, and spiritual beliefs held by individuals
shall be respected.
2. Individual freedom to make rational and unconstrained
decisions shall be respected.
3. Personal information acquired in the process of giving
nursing care shall be held in strict confidence.

ARTICLE II
REGISTERED NURSES AND PEOPLE
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.
ARTICLE III
REGISTERED NURSES AND PRACTICE SECTION
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.
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).
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.
PRC-BN 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).
g. see to it that quality nursing care and practice meet the
optimum standard of safe nursing practice.
h. insure that modification of practice shall consider the
principles of safe nursing practice.
i. 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.
j. 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
SECTION 8.
Ethical Principle
4.Registered Nurses are the advocates of the patients: they
shall take appropriate steps to safeguard their rights and
privileges.
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 care .
SECTION 10.
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
SECTION 11.
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.). 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.
ARTICLE IV
REGISTERED NURSES AND CO-WORKERS
SECTION 12. 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.
SECTION 13.
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.
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.
g. respect the rights of their co workers

SECTION 14.
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.
SECTION 15.
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 active roles in primary
health care.
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.

ARTICLE VI
REGISTERED NURSES AND THE PROFESSION
SECTION 16.
Ethical Principles:
1. Maintainance 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.
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.
SECTION 17.
Guidelines to be observed:
Registered Nurses must
a. be members of the Accredited Professional
Organization (PNA).
b. be equipped with knowledge of health resources
within the community, and take active roles in primary
health care.
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.
ARTICLE VII
 ADMINISTRATIVE PENALITIES, REPEALING CLAUSE, AND
EFFECTIVITY
SECTION 18
8. 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.
SECTION 19. 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 20. PRC-BN 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. Done in the City of Manila, this 14th day of
July, 2004.

ETHICAL PRINCIPLES INVOLVED IN NURSING

In reality, ethical principles control professionalism in
nursing practice much more than the ethical theories.
Principles encompass basic promises from which rules are
developed. Principles are the moral norms that nursing, as
a profession, both demands and strives to implement in
everyday clinical practice. The ethical principles that a
nurse should consider when making decisions are as
follows:
1. Respect for persons
2. Respect for autonomy
3. Respect for freedom
4. Beneficence (doing good)
5. Non-maleficence (avoiding harm to others)
6. Veracity (truth telling)
7. Justice (fair and equal treatment)
8. Respect for patients’ rights
9. Fidelity (fulfilling promises)
10. Confidentiality (protecting privileged
information)
These principles are discussed in detail.
Respect for the Patient as a Person:  The basic
responsibility of nursing ethics is to respect the patient or
the client as a person or a human being. This is done by
allowing the patients to take decisions based on the
choices available in treatment, addressing them by name
and not by body structure, providing respect for their
privacy, respecting their beliefs and wishes, and striving to
obtain all their rights such as the right to be informed, the
right to get oriented, and the right to refuse or accept
treatment.
Respect for Freedom to Make Choices in the
Patient Care:  Many hospitals never allow the patient to
choose the treatments and are very authoritative.
However, it is unethical. The patient has the freedom to
make choices about the treatment, continue the treatment,
withhold or withdraw the treatment, and get discharged at
any time from the hospital.
Respect for Freedom to Make Choices in the
Patient Care:  Many hospitals never allow the patient to
choose the treatments and are very authoritative.
However, it is unethical. The patient has the freedom to
make choices about the treatment, continue the treatment,
withhold or withdraw the treatment, and get discharged at
any time from the hospital.
Beneficence:  Beneficence means doing good to benefit
others. Being beneficial or doing good is the ultimate goal
of a nurse. When a patient gets admitted to a hospital, it is
the duty of the nurse to alleviate his/her suffering and
discomfort, whether it is physical, psychological, or social,
and to do only good to the patient throughout the period of
his/her hospitalization. Learning procedures while on duty
should be avoided, for example, learning to inject a
patient. In procedures such as the insertion of intravenous
cannula in the patient’s vein, in which the nurse pierces
the patient’s skin, if he/she follows the correct standards
of practice and inserts the needle as per the procedure,
he/she is doing good. Instead, if he/she is learning to
puncture the vein and tries repeated venupuncture in the
same vein, it will harm the patient and should not be done.
Non-maleficence:  
Nonmaleficence is the principle used to communicate the
obligation to do no harm. Emphasizing the importance of this
principle is as old as organized medical practice. Healthcare
professionals have historically been encouraged to do good
(beneficence), but if for some reason they cannot do good, they
are required to at least do no harm. Because of the two sides of
the same coin connotation between these two principles, some
people consider them to be essentially one and the same.
However, many ethicists, including Beauchamp and Childress
(2013), do make a distinction.
A nurse should know about and anticipate the problems
that may occur to the patient during treatment. For
example, the position of a bed-ridden and paralysed
patient should be changed frequently and all the necessary
comfort devices should be provided to him/her.
Otherwise, it leads to formation of bedsores in the patient,
which is difficult to cure. If the nurse never changes the
position, it amounts to doing harm knowingly. Therefore,
all the nursing activity should be directed towards not
doing harm to the patient.
Veracity:  Veracity means telling the truth. A nurse
should never lie in any situation and should be honest and
truthful not only to the institution and patient but also to
the profession. For example, a nurse should never lie
about the diagnosis details. Once the diagnosis is
confirmed, he/she nurse has to reveal the actual diagnosis
made and should not lie for anybody’s sake or favour.
Justice in Providing Nursing Care:  Justice means
being fair to all the patients, providing care to everyone,
and trusting them equally, irrespective of their caste,
creed, religion, sex, age, education, race, socio-economical
status, and marital status. A nurse should not show any
cultural or language preference in patient care.
Respect for Patients’ Rights:  A nurse should always
give respect to the rights of a patient, such as the right to
get respect, the right to be informed, the right to be
oriented, the right to take decisions, and the right to refuse
or accept any treatment. A nurse should be aware of all the
rights of the patient and treat him/her accordingly.
Fidelity:  Fidelity means maintaining promises and being
more trustworthy and fruitful towards the profession. A
nurse should be dedicated and work with full
commitment, keep all the details of a patient safe, and
create a truthful and trustworthy relationship with patient.
Confidentiality:  It is the most important ethical
principle in the nursing profession. It is the duty of a nurse
to keep all the details of a patient and the relevant
documents safe and not reveal anything to other patients,
nurses or anybody unknown.
Respect for Autonomy:  This is a very important
ethical principle, according to which a nurse should gives
complete respect to the patient and allow him/her to take
decisions on his/her own. A nurse should never interfere
in any part of decision-making regarding the treatment
unless the patient asks for it. Moreover, he/she should
never force the patient to choose a treatment method.
Even when the patient asks for help, a nurse should
suggest the best options available, explain the risks and
benefits associated with the treatment, and provide
alternatives if available. While obtaining informed
consent, a nurse should explain the pros and cons of the
procedure and make sure that the patient has understood
the details clearly before getting the signature.
Patient Autonomy: Informed Consent
 Autonomy -One human person precisely as a human
person does not have authority and should not have
power over another person. This means that an individual
should not coerce others or impose their will on others.

Principles of autonomy in health care states that an

institution cannot treat a patient without inform consent of
the patient or her lawful surrogate except in narrowly
defined emergencies .
This principle implies the meaning of respect for the
person for his/her freedom in the context of health care.

PATIENT’S RIGHTS
The term patient is derived from a Latin verb meaning “to
suffer” and has traditionally been used to describe those
who are recipients of care, whereas the term client is
derived from a Latin verb meaning “to lean” connoting
alliance and independence.
A patient has two types of rights—the moral and ethical
rights such as the right to privacy and the legal rights such
as the right to treatment.
  PURPOSE OF EXECUTING PATIENT’S BILL OF
RIGHTS
The following are the purposes of executing the Patient’s
Bill of Rights:
1. To make aware of the patient’s rights and to use
them appropriately when needed.
2. To ensure patient’s dignity and respect and to
improve the self-esteem.
3. To gain the patient’s cooperation and willingness to
participate in the health care system.
4. To legally protect the patient and the health care
providers by adopting the patients’ bill of rights.
5. To improve the patient’s trust, faith, and confidence
towards the health care providers.
6. To help the patient in decision-making regarding the
treatment provided.
7. To keep the records of the patient’s confidential and
exercise privacy while performing any procedure for
the clients.
8. To help coordinate with hospital rules and
regulations.
9. To help ensure and continue the treatment as per
the patient’s interests and beliefs.
10. To help the patient analyse about the available
health resources and their utilization.
 15.4 PATIENT’S BILL OF RIGHTS DURING
HOSPITALIZATION
The Bill of Rights allows the patient to his/her rights
including the following:
Right to Admission:  A patient has the right to know
about the admission details in the out-patient department
(OPD). If the patient wants to know about the procedure of
the OPD, the nurse should clearly explain the details and
make him/her feel comfortable. The patient should be free
from stress throughout his/her hospitalization.
In-patient Department:  When a patient is admitted in
the ward, he/she should be informed about the details of
care to be given to him/her, as a checklist for patient’s
verification. The patient should be informed in advance
regarding the nursing procedures, who will be the nurse,
etc. Informed consent is an important legal documentation
of the patient’s rights, wherein the patient is informed
clearly both orally and in writing about the procedure to be
performed and the signature obtained from the patient or
his/her spouse, parents, or family members.
Privacy:  A patient has the right to privacy, which is a
right that extends to all aspects of his/her care, including
care for his/her personal needs, screens should be
provided during physical examination and the body should
not be exposed unnecessarily.
Moral Privacy:  This is the right to take decisions on
his/her own without the interference of others.
Legal Privacy:  This is the right to check on his/her own
case sheet and reports and the right to choose the
treatment methods.
Violating Privacy:  The patient’s privacy rights should
never be violated. Details of patients should not be
overheard or discussed in front of others.
Right for Attention:  A patient has the right to be
attended immediately when he/she calls and also the right
to be provided information when he/she requests it.
If a patient calls for help but is not attended or is ignored,
the nurse is liable to be sued under the law of negligence.
Right for Choosing the Treatment Methods:  A
patient has full rights to choose the treatment modalities
for his/her illnesses. A nurse should be able to clarify the
patient’s doubts regarding the different kinds of
treatments available, their cost, and their advantages and
disadvantages. The patient has the right to choose or to
refuse the treatment at anytime and should not be forced
or misdirected to choose any treatment method.
Right to Get Orientation of the Hospital:  When a
patient gets admitted to a hospital, the surroundings are
new to him/her, and therefore, a nurse should orient the
patient to all the departments in the hospital. This is
considered to be an important right of the patient to
ensure that he/she does not feel neglected.
Right to Know About the Drugs Administered:  A
patient should be informed about the drugs being
administered to him/her. It is the duty of a nurse to ensure
that the patient is given details such as the dosage of the
drug, the reason why it is administered, the action of the
drug, its side effects, and how it can be taken safely and
also to administer the drug to the patient on time.
Right to Access Documents:  A patient has the right to
access documents and reports when needed. Patient has
the right to access the lab values and to know the normal
or the reference range and also any deviation from the
normal values.
Transcultural Care Rights:  A patient has the right to
get complete nursing care irrespective of his/her caste,
religion, race, age, sex, ethnicity, etc. There should be no
racial discrimination or differentiation shown towards the
patients.
Right to Be Respected Throughout Care and
Hospitalization:  A patient should be respected and
treated with dignity. He/she should be addressed by
his/her name, and not by the color of the dress, physical
features such as height, or bed number.
Right to Get the Bills on Time:  A patient obviously
pays for the care provided to him/her during
hospitalization. Hence, he/she has the right to know about
the related charges, but some health institutions delay the
settlement of bills. The amount should be informed prior,
so that the patient can be prepared to pay at the time of
discharge.
Right to Complain:  A patient has the rights to express
a complaint to the concerned hospital authorities about
problems faced regarding treatment or care or regarding
issues such as lack of respect. Every hospital should have
an opinion box, which is used to obtain the patient’s
feedback about the hospital procedures and the nursing
care.
Right to Get Discharged at Any Time:  A patient has
the right to get discharged from the hospital at any time
he/she wishes before the end of the treatment. He/she
cannot be compelled to stay in the hospital. The expected
length of stay for the illness should be explained clearly to
the patient, but the patient has the right to decide whether
to continue treatment or get discharged from the hospital.
Right to Access the Available Resources from the
Hospital:  A patient should be informed about the
available resources and their importance, for example,
availability of the doctors, specialists, their arrival time,
treatment details, etc. The patient should be informed
about these details before he/she asks for it.
Right to Access the Emergency Services:  A patient
has the right to access the emergency services when
needed.

15.5 ROLE OF NURSES IN IMPLEMENTING THE

PATIENT’S BILL OF RIGHTS
The following are a nurse’s rights and responsibilities in
implementing the Patient’s Bill of Rights:
1. Help the patient to understand about the Patient’s
Bill of Rights and its importance.
2. Provide care equally to all patients without any
discrimination based on race, colour, religion, sex,
nationality, disability, socioeconomical status or age.
3. Provide respectful care in a safe and hygienic
environment to all the patients.
4. Be always alert and prepared to attend to any kind of
emergency. A patient in emergency should be
treated immediately without any delay.
5. Provide adequate needed information about the
health care providers to the patient and orient the
patient as to the details regarding the physicians, the
health care professionals, and the hospital
departments in advance, since the right of the
patient to be informed should be understood and
respected by a nurse.
6. Inform the patient about the procedures, ward
routines, names of health care providers, and the
rights of the patient to choose the physicians who
provide care and to refuse care.
7. Provide complete information about the patient’s
assessment details, treatment and progress.
8. Explain the details of informed consent and the
benefits and risks before getting the patient’s
signature.
9. Explain to the patient about his/her right to choose
treatment modalities and to decide whether or not to
continue treatment.
10. Explain to the patient about his/her right to
refuse to get involved in research activities.
 11. Explain to the patient about his/her right to be
present while taking decisions regarding patient
care.
12. Explain to the patient about his/her right to get
a copy of medical summary regarding all aspects of
treatment from the hospital.
13. Explain to the patient about his/her right to get
bill details in advance.
14. Inform the patient that he/she can lodge a
complaint or give feedback if he/she is not satisfied
with the care provided by the hospital.
15. Explain to the patient about his/her right to
provide authority to his/her family members and
spouse to visit him/her.
16. Explain to the patient about his/her right to
donate the organs after death and record his/her
wish in the donor card that should be provided by
the hospital to the patient.

15.6 BILL OF RIGHTS

The following are the rights mentioned in the Patient’s Bill
of Rights:
1. Right to get needed assistance from the hospital
about using the patient’s rights
2. Right to get treatment irrespective of the patient’s
sex, race, colour, nationality, religion, disability,
socioeconomic status and age
3. Right to get respectful care under a safe and
hygienic environment
4. Right to get immediate care in emergency
situations
5. Right to get informed about the details of health
care providers of the hospital
6. Right to decide the treatment modalities planned
for the patient
7. Right to know and be oriented to the ward
routines and procedures of the hospital
8. Right to know about the patient’s diagnosis,
observation, reports and treatment
9. Right to get the needed information before signing
in the informed consent
10. Right to refuse any treatment provided to the
patient
11. Right to participate or refuse in research and to
withdraw at any stage of the research
12. Right to get copies of medical reports and
summary documents of the patient’s details
13. Right to get bill details of the patient in advance
before discharge
14. Right to keep the reports and details of the
patient confidential
15. Right to get and provide privacy for the patient
throughout hospitalization
16. Right to complain regarding patient care to the
hospital management
17. Right to donate organs and get donor card from
the hospital
18. Right to provide authority for the close family
members/spouse to visit the patient and they
 should be given priority in all aspects to visit the
patient during visiting hours
INFORM CONSENT
 Hipoccrates the ancient Greek physician did not
believe that he needed the consent of patients
when being treated under his care.It was only in the
second half of the 20th century the development of
inform consent in the Unites States was formed into
law .
Inform consent was done most specially for any invasive
procedures such as those involving surgery or treatment
with considerable risk involve .
To disregard inform consent means a law suits .
In 1960 the law has tended to say that the role of the
health care professional requires respect for the
freedom of the client and it demand s inform consent .
Informed consent in regard to a patient’s treatment is a
legal, and ethical, issue of autonomy. At the heart of
informed consent is respecting a person’s autonomy to
make personal choices based on the appropriate appraisal
of information about the actual or potential circumstances
of a situation . Though all conceptions of informed consent
must contain the same basic elements,
Elements of Informed Consent
1.Threshold elements (preconditions)
1. Competence (to understand and decide)
 2. Voluntariness (in deciding)
II. Information elements
3. Disclosure (of material information)
4. Recommendation (of a plan)
5. Understanding (of 3 and 4)
III. Consent elements
6. Decision (in favor of a plan)
7. Authorization (of the chosen plan)
Dempski (2009) presented three basic elements that are
necessary for informed consent to occur:
1. Receipt of information: This includes receiving a
description of the procedure, information about the risks
and benefits of having or not having the treatment,
reasonable alternatives to the treatment, probabilities
about outcomes, and “the credentials of the person who
will perform the treatment” (Dempski, 2009, p. 78).
Because it is too demanding to inform a patient of every
possible risk or benefit involved with every treatment or
procedure, the obligation is to inform the person about
the information a reasonable person would want and need
to know. Information should be tailored specifically to a
person’s personal circumstances, including providing
information in the person’s spoken language.
2. Consent for the treatment must be voluntary: A person
should not be under any influence or be coerced to
provide consent. This means patients should not be asked
to sign a consent form when they are under the influence
 of mind-altering medications, such as narcotics. Depending
on the circumstances, consent may be verbalized, written,
or implied by behavior. Silence does not convey consent
when a reasonable person would normally offer another
sign of agreement.
3. Persons must be competent: Persons must be able to
communicate consent and to understand the information
provided to them. If a person’s condition warrants
transferring decision-making authority to a surrogate,
informed consent obligations must be met with the
surrogate
Key Concept of Inform Consent
1. The patient or appropriate surrogate must be
competent or have decision making capacity.
-be capable of understanding the consequences of
the consent and be free from coercion and undue
influence that would substantially diminish freedom
2. The health care professional ,within the demands of
his or her particular role must provide the necessary
information and make sure that it is understood.
Consent is the written document about any surgical
procedure that is explained by the nurse or surgeon to the
patient, and patient’s family members.
Types of Consent
1. General Consent
This is the kind of formal consent signed by the patient at
the time of admission, where if the patient is conscious
signs, witness signed by the parents or legal guardian,
their consent legally authorizes that the patient should get
standardized care from the physician, the nurse and the
entire perioperative health care team. This consent is to
perform general ward routine activities, not for any
specific invasive procedure.

2. Special Informed Consent

The entire health care team members are directly
responsible in getting the informed consent signed, since
the duty is delegated to the perioperative nurse
practitioner and also the surgeon, any negligence to deliver
the details of informed consent is considered as branch of
duty and responsibilities, getting the document signed is
not enough, but explaining clearly in a understandable
manner about the surgical procedure, the risks, benefits,
alternatives and any extension procedure that can be done
along with the stated one, especially about the anaesthetic
agent given by anaesthesia specialist should speak about
the risk, benefits, care given, alternatives if the circulatory
nurse found that doctor does any extended procedure
without consent immediately she should inform it to the
supervisor or administrative authority about discrepancy.
References:
Aquinas, Thomas (13th c). Summa Theologica II-II, Q. 64, art. 7,
“Of Killing”, in On Law, Morality, and Politics, William P.
Baumgarth and Richard J. Regan, S.J. (eds.),
Indianapolis/Cambridge: Hackett Publishing Co., 1988,
Other References :
https://plato.stanford.edu/entries/double-effect/
https://www.chausa.org/publications/health-progress/article/
april-1995/the-principle-of-cooperation
https://www.consciencelaws.org/religion/religion002.aspx
http://inquisition.ca/en/polit/artic/solidarite.htm

CONCLUSION
The Patient’s Bill of Rights refers to the important rights of
the patient in the health care system. A nurse needs to
know about these rights and should ensure that they are
implemented. These rights help in improving the patient’s
self-esteem and ensure that he/she is treated with respect
and dignity, which paves way for quality care.
ASSIGNMENT :
To be submitted next week in the MS team
“The Operation” by Anne Sexton.
Read the poem reflectively and do the following:
 The Operation 
After the sweet promise,
the summer’s mild retreat
from mother’s cancer, the winter months of her death,
I come to this white office, its sterile sheet,
its hard tablet, its stirrups, to hold my breath
while I, who must, allow the glove its oily rape,
to hear the almost mighty doctor over me equate
my ills with hers and decide to operate.

It grew in her as simply as a child would grow,

as simply as she housed me once, fat and female.
Always my most gentle house before that embryo
of evil spread in her shelter and she grew frail.
Frail, we say, remembering fear, that face we wear
in the room of the special smells of dying, fear
where the snoring mouth gapes and is not dear.
There was snow everywhere.
Each day I grueled through
its sloppy peak, its blue-struck days, my boots
slapping into the hospital halls, past the retinue
of nurses at the desk, to murmur in cahoots
with hers outside her door, to enter with the outside
air stuck on my skin, to enter smelling her pride,
her upkeep, and to lie
as all who love have lied.

No reason to be afraid,
my almost mighty doctor reasons.
I nod, thinking that woman’s dying
must come in seasons,
thinking that living is worth buying.
I walk out, scuffing a raw leaf,
kicking the clumps of dead straw
that were this summer’s lawn.
Automatically I get in my car,
knowing the historic thief
is loose in my house
and must be set upon.
2.
Clean of the body’s hair,
I lie smooth from breast to leg.
All that was special, all that was rare
is common here. Fact: death too is in the egg.
Fact: the body is dumb, the body is meat.
And tomorrow the O.R. Only the summer was sweet.
The rooms down the hall are calling
all night long, while the night outside
sucks at the trees. I hear limbs falling
and see yellow eyes flick in the rain. Wide eyed
and still whole I turn in my bin like a shorn lamb.
A nurse’s flashlight blinds me to see who I am.
The walls color in a wash
of daylight until the room takes its objects
into itself again. I smoke furtively and squash
the butt and hide it with my watch and other effects.
The halls bustle with legs. I smile at the nurse
who smiles for the morning shift. Day is worse.

Scheduled late, I cannot drink

or eat, except for yellow pills
and a jigger of water. I wait and think
until she brings two mysterious needles: the skills
she knows she knows, promising, soon you’ll be out.
But nothing is sure. No one. I wait in doubt.

I wait like a kennel of dogs

jumping against their fence. At ten
she returns, laughs and catalogues
my resistance to drugs. On the stretcher, citizen
and boss of my own body still, I glide down the halls
and rise in the iron cage toward science and pitfalls.

The great green people stand

over me; I roll on the table
under a terrible sun, following their command
to curl, head touching knee if I am able.
Next, I am hung up like a saddle and they begin.
Pale as an angel I float out over my own skin.

I soar in hostile air

over the pure women in labor,
over the crowning heads of babies being born.
I plunge down the backstair
calling mother at the dying door,
to rush back to my own skin, tied where it was torn.
Its nerves pull like wires
snapping from the leg to the rib.
Strangers, their faces rolling lilke hoops, require
my arm. I am lifted into my aluminum crib.

Skull flat, here in my harness,

thick with shock, I call mother
to help myself, call toe to frog,
that woolly bat, that tongue of dog;
call God help and all the rest.
The soul that swam the furious water
sinks now in flies and the brain
flops like a docked fish and the eyes
are flat boat decks riding out the pain.

My nurses, those starchy ghosts,

hover over me for my lame hours
and my lame days. The mechanics
of the body pump for their tricks.
I rest on their needles, am dosed
and snoring amid the orange flowers
and the eyes of visitors. I wear,
like some senile woman, a scarlet
candy package ribbon in my hair.

Four days from home I lurk on my

mechanical parapet with two pillows
at my elbows, as soft as praying cushions.
My knees work with the bed that runs
on power. I grumble to forget the lie
I ought to hear, but don't. God knows
I thought I’d die—but here I am,
recalling mother, the sound of her
good morning, the odor of orange and jam.

All’s well, they say. They say I’m better.

I lounge in frills or, picturesque,
I wear bunny pink slippers in the hall.
I read a new book and shuffle past the desk
to mail the author my first fan letter.
Time now to pack this humpty-dumpty
back the frightened way she came
and run along, Anne, and run along now,
my stomach laced like a football
for the game.
Questions:
1. Analyze the story, symbolism, and feelings conveyed in the poem; discuss and provide
specific examples.

2. Discuss your perception of the quality of healthcare provider patient relationships

reflected in the poem; provide specific examples.