NURSING ETHICS AND PROFESSIONAL ADJUSTMENT

Cherylina Dalilis

I. Definition of Terms
A. Nursing Profession
- a dynamic disclipline – changes constantly
Eg. before = cure and rehab; now = prevention and promotion
- an art and a science of caring for individuals, families and communities geared towars
a. Promotion and restoration of health – maintain good health practices/ rehabilitation
b. Prevention of illness – diagnosis
c. Alleviation of suffering
d. Assisting the client to face death with dignity and peace
- a performance for a fee, salary or other rewards of compensation of professional nursing services rendered to
individuals, families and communities through:
a. Utilization of nursing process – ADPIE
b. Executing health care techniques and procedures, health teachings and administration per written
prescription for treatment
c. Linkages
d. Motivation
e. Supervision of students
f. Administration of nursing services in varied settings
g. Training and research – eg. IV therapy
B. Nursing Adjustment
- the growth of the whole individual and the development of all his capacities (physical, social, emotional, spiritual
aspects)
C. Nursing Ethics and Jurisprudence
- the department of laws which comprises all the legal rules and principles affecting the practice of nursing
Ethics – practical science of the morality of human act
- from the Greek word “Ethos” meaning “moral duty”
- refers to a standard to examine and understand moral life  based on theories, principles and codes of
conduct that a nurse should have
- a critical reflection about morality and rational analysis about it
Profession – an occupation or a calling requiring advanced training and experience in some specific or specialized
body of knowledge which provides service to society in that special field
Morals/Morality – a Greek word “moralis” - meaning social consensus about moral conduct for human being and
Society
- human decency, right or wrong, good or evil, proper or improper, cruel or benevolent acts
- Fletcher – “what you believe is right and good”

II. Nursing as a Profession

A. Criteria of a Profession
P – public service – life-long commitment to the people who preserve practicing what is ethically right for all the
clienteles and yourself
E – education – required for specialization
A – autonomy – we can practice our own profession governed by our own standards and code of ethics and make
decisions
C – code of ethics – theories, principles governing the action of professional nurses
O – organizations – nurses should be members of duly recognized organizations
C – compensation – we are payed with the services we render in terms of cash, terms, rewards, in kind, prestige of
other
S – special preparation and training

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 B. The Professional Nurse
Professional Qualifications
L – license – have license before practicing in the country
D – degree
P – physically and mentally fit
Personal Qualities
S – skills in decision-making, communicating (verbal and non-verbal), and relating with others
C – cooperation – collaboratively work with others
R – resourcefulness – creativity and well-balanced emotional condition
I – interest and willingness to work and learn
I – initiative – ability to improve self and service
 Continuiing Educational Unit – seminars, trainings and updates
P – personality – warm personality and concern for others – TLC
A – active participation involved activity in issues which concerns our profession
C – competence – competency in performing the work through the use of nursing process

C. Nursing Education Programs

1. Philippine Nursing Education Program
a. Undergraduate program
a.1. Old BSN curriculum
 GN curriculum – graduate nurse
Program – 5 years training which includes simultaneous didactics (with lectures
conducted in the hospital) and skills training
- 3 years didactics and 2 years hospital volunteer
 BSN – 3 years program
- 2 years classroom setting and 1 year hospital experience
**focus – prolonged exposure to clinical areas
- with Spanish subjects
- skills, knowledge and attitude is integrated
- PHN is 4 weeks (28 days)
- continued until 1983
a.2. BSN curriculum – 1983 – 1998
**focus – community-based oriented curriculum
- promote and restore health, prevent illness, and alleviate human suffering
1st year – General education subject
2nd year – normal concepts – 2nd sem  nursery, pedia, OB
3rd year – normal and abnormal concepts
4th year – GE, Normal and Abnormal – managerial skills – head nurse elective – field of
specialization
CHED memorandum order 27(1998) – implementation of the AHSE curriculum
a.3. AHSE curriculum – Allied Health Science Education
**main aim – prepare students for any health-related courses
- backed up with CMO 59 s.1996 – mandated a 2-year course on all GE subjects for all
baccalaureate degrees leading to health profession
- after 2 years, they can work as health providers
- 1 to 2 years – GE subjects
- 3rd year – normal and abnormal concepts
a.4. Ladderized program – conducted in Palo, Leyte during Marcos Regime
**2 years – midwifery
**4 years – midwifery and nursing
**6 years – midwifery, nursing and medical doctor
- not allowed to go out of the country without rendering service for 3 years

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 b. Graduate Program
Purposes:
i. To prepare nurses capable of improving nursing care thru advancement of nursing theory and
science
ii. Prepare nurses who are willing to influence the practice and study of nursing through
o Higher level of competence
o Teaching and administering and investigating professional practice
iii. To educate critical and self-directed practitioner
o MSN – specialization
o MAN – more of administration (Dean)
o Non-thesis program – specialization without thesis eg. Masters in Public Health
c. Post Graduate (Doctorate)
- taken by nurses who would like to prepare themselves for positions such as
o Administrator
o Research specialist
o Consultant of nursing service
Research dissertation – collation of different theses
Considerations in taking PhD
C – competency – person in authority with regards to specialization
R – resolved conflict – good decision-making
E – experience – should be of quality
S – scholarship quality
S – self-control
C – creative writing – research
- can explain, stimulate and interpret thinking and action
C – critical thinking
O – objective point of view – deal with the action and not the person
R – recommendation
d. Core Competencies Expected of the Graduate of the BSN Curriculum
i. Nursing Process – know how to utilize correctly and competently and done individually
ii. Communicate effectively – therapeutic use of self, documentation, relationship with others
iii. Management utilization – O and M
- formulation of policies
- independent
iv. Use of research
v. Personal and professional growth

2. Other Countries
a. USA – associate nurse – caregiver
- can work and pursue BSN
- LPN – Licensed Practice Nurse – AHSE
- BSN
b. Canada – after BSN, undergo programs and trainings and pass exam before becoming an RN
c. UK – Nursing and Midwifery Council – regulatory board which regulates your Nursing Education in the UK
d. Australia – same with Canada
e. New Zealand – same with Canada
- 6 months training and education and pass the board exam
f. Middle East – can work as BSN

III.
Code of Ethics for Registered Nurses
A. Definition of Code of Ethics
Code of Ethics – ethical codes provide answers to normative questions of what beliefs and values should be morally
accepted
- a certain direction for nurses to act morally
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 - emphasizes the four-fold responsibility of nurses
P – promotive
P – preventive
R – restorative
A – alleviation of suffering
P – provide spiritual environment
B. History of the Code of Ethics for Filipino Nurses
1929 – Philippines became a member of the ICN (International Council for Nurses) at the ICN Congress which was
held at Montreal, Canada
- ICN – an organization through which all nurses all over the world collaborate in strengthening nursing
services, nursing education and professional ethics
- followed ICN from 1929-1982
1982 – PNA developed a code of ethics for nurses under special committee led by Dean Julita V. Sotejo
- approved by the PNA but not implemented
1984 – Board of Nursing and PRC adopted the Code of Ethics by ICN but added promotion of spiritual environment
as the 5th fold of nurse
1989 – Code of Ethics for Nurses was approved by PRC and PNA
Oct. 25, 1990 – Code of Ethics was promulgated by PNA and was approved by PRC and was recommended for use
through BR 1955 – Code of Ethics for Filipino Nurses

C. Basic and Universal Ethical Principles

A. Basic Ethical Principles
1) Human life is inviolable – by all means, it should not be violated
2) Quality and excellence in the care of patients are the goals of nursing practice – care rendered is of quality and
is coupled with expertise
3) Accurate documentation of actions and outcomes of delivered nursing care is the hallmark of nursing
accountability
4) Nurses are the advocates of the patients
Guidelines
 Know the scope of the nursing practice
 Know your duties and responsibilities – as a staff or administrator
 Take appropriate action to safeguard their rights and privileges – follow the nursing process and
decision-making process
- a systemic rational or method of planning and providing individualized nursing care
Decision-making Process
P – problem – determine what is it all about
- know what decisions we need to make
- know what needs t be given – material, physical, emotional, spiritual
- who are the parties involved
- principles that can be applied – universal and basic ethical principles
- consider the legal institutional concerns
- consider other factors: culture, religion, personality
C – criteria
Guidelines
- what is the desired outcomes
- what needs to be preserved
A – assessment – assess persons, facilities and personnels
P – plan
I – implementation
E – evaluation

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 Principle – a generally-accepted rule of standard that guides
Basic Principles – fundamental/essential principles which guides us in decision-making
-essential rules that guide human persons in their behavior and conduct
1) Principles of Stewardship – involves managing, taking charge or caring for another’s property
Ownership – involves possessions or belongings
Principle of Stewardship claims that:
a. All belongs to God – responsible to take care of the creations
b. We are stewards – we are the caretakers of our own bodies, the Earth and everything on it
Responsibilities:
 Responsible to ourselves
 Responsible to the health of our neighbors and the environment
 Responsible to others
2) Principle of Totality – refers to the whole/wholeness of an individual which includes physical, psychological,
mental, social and spiritual aspects
Claims:
i. Maintains that health life human is not merely a matter of organs but of capacity to function
humanely and of the basis of wholeness
ii. Every person must develop, use, care for and preserve all his parts and function for the sake of
each part
iii. Every person must preserve life and the integrity of our body
iv. Basic capacities which defined personhood are sacrificed only when there is a need to preserve life
v. If a body part or lower function harms the whole, this part or lower function may be sacrificed for
the good of the whole
3) Principle of Double Effect
Claims:
i. An act is foreseen to have good and bad effects
Conditions for Double Effect to be justifiable:
i. Direct freely chosen effect of the act must be morally good while the other indirect may be
physically harmful
ii. The action itself must be good or morally neutral
iii. The foreseen beneficial effect must be equal or greater than the foreseen harmful effect
iv. The beneficial effect must follow from the action at least as immediately as the harmful effect
4) Principle of Legitimate Cooperation
Cooperation – participation of one agent with another to produce a joint affect
Types of cooperation:
a. According to the voluntariness of the secondary agent to cooperate
i. Formal – secondary agent is willing to participate (agreement)
ii. Material – secondary agent does not willingly participate
b. According to the intention or purpose of the secondary agent in cooperating
i. Immediate – the action of the secondary agent is inherently bound to the performance
of the evil action
- with purpose
ii. Mediate – action of the secondary agent is not inherently bound to the performance of
the act
- purpose if different with the action
Condiitions wherein we refuse to cooperate when:
a) The action of the primary agent is morally wrong
b) It involves ourselves in formal cooperation
5) Principle of Solidarity – conceives social authority or leadership in the community as service rather than
domination
Claims:
i. Human communities exist only to share and promote the common good among its
members eg. bayanihan system

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 B. Universal Principles
1) Principle of Autonomy – freedom to choose own decision which is free from:
a. Deceit – free from all lies
b. Duress – free from restraints, constraints, threat or pressure
c. Coersion – free from any force
- from the Greek word “Autos” meaning self and “nomos” meaning governance
- 3 elements:
a. Ability to decide – adequate information and intellectual competence as basis for decision-
making
b. The power to act upon one’s own decision
c. Respect for others’ individual autonomy – self-determination
Restrictions:
a. Patient is not expected to comprehend sufficiently to make an authentic decision
b. Potential harm to others
c. Patient is incompetent
2) Principle of Veracity – truth-telling for both the patient and the health practitioner
Importance:
a. Patient tells the truth – expected that appropriate care is given
b. Practitioners need to disclose factual information – a patient with a good sound basis to exercise
autonomy
c. It enhances the practitioner’s credibility – higher level of truthfulness from the health care provider
Conditions wherein Veracity is not justified:
a. Deception – health worker is required not to tell the truth to the relatives
b. Relatives’ request not to tell the truth to the patient
c. Practitioners intentionally withhold the information because doing so may do more harm
(Benevolent deception)
Conditions wherein Veracity is justified:
a. Patient is not strong enough to tolerate the truth
b. More time is needed to prepare the patient for the unpleasant truth
3) Principle of Beneficence – the act of kindness and mercy that directly benefit the patient considering the patient’s
values and dignity
4) Principle of Non-maleficence – same with beneficence but stated in a negative matter
- do not harm
- one ought not to inflict evil or harm
Eg. not assisting in performing abortion
- do not assist patient to perform suicide
- do not perform euthanasia
- do not give vaccines who may cause ill effect
5) Principle of Confidentiality
- hold in strict secrecy
- important – trusting relationship
- held liable under the patient’s bill of rights
- emphasize the importance of trust that the patient gives us
- once we practice, we allow the patient’s right to be exercised
 practive the right to privacy
- all records and communication related to his care are confidentially treated
6) Principle of Justice
- have fairness, equity and just treatment
- just distribution of scarce resources
Violation of Principle of Justice when:
a. Compensatory justice – seek compensation for a wrong that has been done
b. Retributive justice – equal suffering
- an eye for an eye, a tooth for a tooth

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 7) Priniciple of Role Fidelity
- to practice faithfully within the assigned role
- know your boundaries, designation and specialty
- abide with corresponding responsibilities

Nurses and Practice

Board Resolution No. 220 – basis for RA 9173
Nurse-Doctor Relationship
- good working relationship in order to attain better services for the improvement of the patient’s condition
Guidelines:
1. Help to plan implement patient care – should be a collaborative effort
2. Report patient’s progress promptly
3. If any medical orders were not carried out, do the following:
a. Explore the reason, education
b. Document
c. Notify the physician
4. Familiarize yourself with the doctor’s methods, routines or idiosyncracies
5. Tactfully inform the doctor any complaints against him/her
6. Avoid illegal, incompetent or unethical practice

Ethics Committee
- philosophers, doctors, nurses, lawyers, clergy or social workers
Functions:
 Policy and procedure development – to govern the practice
 Educational role – developmental progress
 Case consultant
 Retrospective case review

Law – sum total of rules and regulations by which society is governed

Essential characteristics of every law:
 The authority or the right to declare that the rule exists
 Rule is pronounced or expressed and that the source can be identified
 A right to enforce the same must be provided
Rule of conduct/essential contents of the law
 Must be issued in writing
 Clear and concise
 Consequences for violation is written

1915 – Act No. 2493 of 1915

- law which regulates the College of Medicine
- act provided for the examination and registration of nurse in the Philippines
- applicants – criteria
 20 years old
 Physically fit/healthy
 Good moral character
- GN program
1919 – Act 2808 – 1st true nursing law
- regulated board of examiners for nurses
1920 – 1st board exam

Legal Aspects and the Nurse

A. Nursing Jurisprudence
B. Nursing Legation – making of laws or body of laws already enacted affecting the practice of nursing
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 Classification of the Law
a. Public Law – a branch of law concerned with the state and its political capacity
- it generally applies to the people off the state
1. Criminal Law – concerned with acts that threatens the society
2. International Law – concerned with the law of nations
3. Political Law – science of government
b. Private Law – statute which relate to private manners that do concern the public at large
1. Civil Law – concerned with protection of a person’s rights
2. Commercial Law – concerned with rights of property or commerce
3. Remedial Law – describes methods of enforcing rights/ obtaining redress
C. Crime – an act committed in violation of a law
D. Tort – is a legal wrong, committed against a person or property independent of a contract which renders the person who
commits it liable for damages in a civil action
E. Homicide – the killing of a human being by another without intention
F. Murder – the unlawful killing of human with intent to kill
G. Infanticide – killing of a child less than 3 days of age
H. Abortion – expulsion of the products of conception before it reaches the age of viability
I. Illegal detention – the unjustifiable detention of a person without legal warrant within boundaries fixed by the defendant by
an act or violation of duty intended to result in such confinement
J. Simulation of birth – a crime committed by one who enters in a birth certification a birth that did not occur
- substitution of one child for another
- falsification of entries in the birth certificate
K. Misdemeanor – is a general name for a criminal offense which does not in law amount to felony
- something has been done but does not know where to classify it
Felony – committed with deceit and fault
- if cannot be classified as misdemeanor
L. Robbery – crime against a person or property
- taking of personal property of another person from him or his presence
M. Assault – is the imminent threat or harmful or offensive body contact
N. Battery – an intentional, unconsented touching of another person
O. Invasion of right to privacy and breech of confidentiality – divulge information
P. Defamation – character assassination
- exchange of remarks between 2 persons is NOT defamation
 Slander – oral defamation
 libel – defamation by written words

Professional Negligence – failure to exercise the degree of care and prudence which a reasonably prudent person would have exercise
in like or similar circumstances
Elements:
 Duty – existence of a duty on the part of the person in charge
 Dereliction of duty – failure to perform the duty
 Danger – foreseeability of harm resulting from failure to meet standards
 Damage – the breech of standard resulted in the injury of the plaintiff
Assessment errors/specific examples of negligence
1. Failure to report observations to attending physicians
2. Failure to exercise the degree of diligence which the circumstances of the particular case demands
3. Mistaken identity
4. Wrong medicine, wrong concentration, wrong route, wrong dose
5. Defects in the equipment such as stretchers and wheelchairs may lead to fall thus injuring the patients
6. Errors due to family assistance
7. Administration of medicine without a doctor’s prescription
Planning Errors
1. Failure to chart pertinent information
2. Failure to use language in NCP that nurses will understand

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 3. Failure to ensure continuity of care
4. Failure to give clear instructions
Intervention errors
1. Failure to interpret and carry out doctor’s orders
2. Failure to perform nursing task correctly
3. Failure to pursue the doctor if he cannot be contacted
4. Failure to report or know suspected deviations from accepted practice

Malpractice – the improper or unskillful care of patient by a nurse

Elements for Professional Negligence or Malpractice sued:

1. Acclaim that the nurse owed the patient a special duty of care
2. Acclaim that the nurse was required to meet a specific standard care
3. Acclaim that the nurse failed to meet the requires standard of care
4. Acclaim that harm or injury result for which compensation is sought

Doctrines to be Applied
1. Doctrine of Res Ipsa Loquitor – let the thing speaks for itself

Benner’s stages of Nursing expertise

N – novice
- 1st 1-2 years of practice
- low expertise and skills
- knowledge of basic skills
A – advanced practitioner
- skills are polished
- 2-3 years of practice
- a little of everything
- less expertise
C – Competent
- skills and knowledge-wise – can be independent and dependent
- 3-4 years of practice
- rotated to different types or areas of the hospital
P – proficient
- 4-5 years of practice
- knowledge to perform skills at random
E – expert
- 6 years and beyond
- have selected area of expertise
- decreased room for errors

Positive Image of a Professional Nurse

Self assessment – ASK
Self awareness – SNOT – knowing yourself (Strengths, Weaknesses, Opportunities, Threats)

Emerging Opportunities
Nursing Association
1. Alumni association – it fosters loyalty among its members
 PNA – organized on Oct. 22, 1922 thru Mrs. Anastacia Geron Tupas
 National League of Government Nurses
 ANSAP
 ADPCN

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Field of Specialization/Opportunities
C – clinic nursing
H – hospital
O – occupational
M – military
P – private duty
P – public
I – independent
E – education

Expanded Roles of Nurses

 Nurse Practitioner – nurse certified by the American Nurses credentialing center such as adult nurse practitioner, family nurse
practitioner
 Clinical Nurse Specialist – has an advanced degree of expertise and is considered to be an expert in a specialized area of
practice. Nurse provides direct client care, educataes, consults, conducts researches and manages care.
 Nurse Anesthetist – carries out pre-op visits, assessments, and administers general anesthesia under the supervision of the
physician and assessment of post-op status
 Nurse Midwife – gives prenatal and post natal care and manages deliveries in normal pregnancies. Conduct pap smear, family
planning and routine breast exam
 Nurse Researcher – investigates nursing problems to improve nursing care to refine and expand nursing knowledge.
Employed in academic institutions, teaching hospitals and research centers
 Nurse Administrators – manage client care, inducting the delivery of nursing services. Functions include budget, staffing and
planning program
 Nurse Educator – employed in nursing programs at educational institutions, and in hospital staff education
 Nurse Entrepreneur – manages health-related business

Guidelines in Choosing the field of Nursing

 Qualifications – position applying for
 Experience – type of experience they require
 Age and physical conditions – positive aspects
 Emotional stability and goals in life

Factors to consider in selecting a field of nursing

 Kind of work
 Availability of work
 Hours of work
 Opportunities for advancement
 Method of entering
 Earning
 Fringe benefits
 Other benefits

Resume
 A relatively short biography
 Should be business-like – Ma’am/Sir
 Use good quality of plain white paper
 With good margin
 2-3 pages
 Should know the person’s background to the test advantage
 Usual form: name, address, tel/cp # at the top
 Llicense registration number
 Education – name and location of school
 Date of graduation/year attended
 CEUs attended

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Work experience
 Title/position
 Name and address of employee
 Date of employment – listed in reverse chronological order
 Description of principal responsibilities for each position

Other
 Membership
 Accomplishment
 Relevant community contribution
 Variations
 Place job objectives first
 Place work history before educational history
 Include brief summary of personal characteristics and special skills

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