Health Care Ethics Finals Reviewer
Ethical Consideration in
Leadership and Management
Ethical Leadership involved creating and
supporting a working environment for the
provision of high quality and cost effective
healthcare and ensuring ethical behaviors among
nurses.
Character is the possession of skills and making
visible ethical acts, recognizing ethical issues and
demonstrating features of role modelling,
motivation and authenticity. Conduct convey the
relationship between the ethical standards and
high quality care, supporting ethical acts in daily
practice and implementing sanctions in the case of
ethics violation while performing nursing care.
Ethical leaders are described in nursing literature
as altruistic,
honest, disciplined, efficient, fair, and able to
navigate moral distress experienced by her
department to arrive at a harmonious decisions.
They serve as role models of ethical behavior.
Florence Nigthingale is one of the first nursing
leaders who demonstrated high regard for the
ethical dimension of nursing practice through her
writings in 1860 on the ethical guidelines for
nursing leaders.
 By creating an ethical climate, ethical
leadership leads to positive and effective
outcomes, professional progress and
development of the nursing profession.
 Perceived ethical climate takes place in moral
sensitivity and is related to moral courage.
Also, there was a significant positive
correlation between nurses ethical climates
and their moral courage.
Moral Decision- Making
It is imperative to arrive at an ethical action or
intervention. It would require an ethical
judgement and such judgement needs a basis
a specific reference point, a criteria or,
condition so we can examine, evaluate the
judge and consequently act ethically.
Ethical decision-making confidence develops
from clinical experience and is a core competency
for nurse leaders. No tool exists to measure
confidence levels in nurse leaders based upon an
ethical decision-making framework.
Phases of Competency
1. Knowledge development-Moral sensitivity
2. Knowledge application
3. Creating an Ethical Environment
4. Promoting Social Justice within the health
care system
18 Indicators in the Development of ethical
decision-making confidence scale:
1. Recognize a genuine ethical dilemma in
practice 2. Make a sound ethical decision 3.
Explain ethical decisions using correct ethical
terminology and language
4. Provide a clear statement of the personal values
that guide your ethical decision-making and
practice. 5. Articulate legal guidelines related to
complex ethical issues in patient care.
6. Articulate the difference between ethical
dilemmas, moral distress, issues related to
interprofessional collaboration and
communication, difficult patients.
7. Articulate the definition of moral distress
and provide an example of your experience of
moral distress in your practice.
8. Identify ethical issues in complex patient
care.
9. Apply ethical decision-making models or
structured processes to complex ethical problems.
10. Participate in and/or guide mediation
related to complex clinical problems involving
ethical dilemmas or moral distress.
11. Recognize and manage moral distress in
self and others.
12. 12. Role model collaborative problem
solving in complex clinical problems involving
ethical dilemmas and moral distress.
13. 13.Engage in preventive ethics initiatives
to address the ethical environment in your
practice area. 14. 14. Mentors others to develop
ethical practice behavior.
15. 15. Address barriers to ethical practice
through system changes. 16. 16. Use in
preventive ethical practice through system
changes. 17. 17. Engage in health policy
initiatives supporting social justice.
18. 18. Provide leadership at the unit,
organizational, local, state and federal level for
policy change initiatives to address social justice
issues in the health care.
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ETHICAL DECISION
- is one that engenders trust, and thus indicates
responsibility, fairness, and caring. come from a
place of conscience. For many, conscience is simply
an internal source of reward and punishment. It
should be based on ethical principles and codes
rather than on emotions, thoughts, fixed policies
ETHICAL DECISION MAKING
- requires a review of different options,
eliminating those with an unethical standpoint,
and then choosing the best ethical alternative. The
process is the process of choosing the best
alternative for achieving the best results or
outcomes compliance with individual and social
values, moral, and regulations. Also a process
provides a method for nurses to answer key
questions about ethical dilemmas and to organize
their thinking in a more logical and sequential
manner.
The process of making ethical decisions requires:
Commitment
Consciousness Competency
Good decisions are both ethical and effective:
 Ethical decisions generate and sustain trust;
demonstrate respect, responsibility, fairness,
and caring; and are consistent with good
citizenship.
 Effective decisions are effective if they
accomplish what we want accomplished and
if they advance our purposes. A choice that
produces unintended and undesirable results
is ineffective.
PRINCIPLE OF MORAL DISCERNMENT
To make a conscientious ethical decision one
must do the following:
 Proceed on the basis of a fundamental
commitment to God and to human persons
(including oneself) according to their God-
given and graced human nature.
 Among possible actions that might seem to be
means of fulfilling that commitment, exclude
any that are contradictory to it (or those that
are
intrinsically evil)
 Consider how one’s own motives and other
circumstances may contribute to or nullify the
effectiveness of these other possible actions as
means to fulfill one’s fundamental
commitment.
 Among the possible means not
excluded or nullified, select one by which one
is most likely to fulfill that commitment and
act on it.
PRINCIPLE OF WELLFORMED CONSCIENCE
To attain the true goals of human life by
responsible actions, in every free decision
involving an ethical question, people are
morally obliged to do the following:
 Informed themselves as fully as practically
possible about the facts and the ethical norms.
 Form a morally certain judgement of
conscience on the basis of this information.
 Act according to this well-formed conscience
 Accept responsibility for their actions
CONSCIENCE FORMATION
 The word conscience arises from the Latin,
conscienta, and French, conscience and was
defined as the internal sense of what is right
or wrong, and one’s ability to choose between,
as well as act upon, what one perceives to be
the right thing to do.
 Conscience is in nursing practice is the
cornerstone for ethics relevant to ethical
nursing care.
 In nursing, conscience is broadly perceived as
an authority, a warning signal, demanding
sensitivity, an asset, a burden, inherent in
nursing, and culturally dependent.
 When nurses can follow their conscience
guiding them to provide quality care,
conscience is positively perceived. Nurses
who can follow their conscience are less likely
to encounter conflicts of conscience in
practice. Nurses who can not follow their
conscience report having a troubled
conscience.
 Nurses’ troubled conscience have been
associated with feelings of guilt when
 Nurses’ core beliefs conflict with social or
professional beliefs.
 Nurses can not fulfill their care obligations to
patients due to time constraints
 Nurses are placed in scenarios where they feel
they are working against their conscience.
Key Points on Conscience
Formation
 Making moral decisions demand mature
responsibility
Health Care Ethics Finals Reviewer
 A fully mature and responsible conscience
should be free,
correct, clear, and certain
 Discern what is right and what is wrong
 We must follow our decision only after we
have done our best to search for the truth
regarding the issue facing us
Qualities of conscience
Personal Freedom- should be free from some
obstacles such as fear and anger
Conscience can be described in terms of:
 ObjectiveValue
-correct
-objective
-erroneous
-culpable
-inculpable
 Moralattitude
-Lax
-Strict
-Scrupulous
-Pharisaical
-Clear
-Callous
 Degreeof Certitude
-perplexed
-doubtful -probable
-certain
Ethical Issues in Nursing
Leadership and Management
Nurses frequently encounter difficult
situations involving decisions about the best
course of action. Nurses are expected to provide
not only expanding nursing care but also ethical
and legal client care that demonstrates respect for
others. Nurses confront not only the expanding
role and ever changing clinical environment but
also various ethical or moral problems and
concerns.
Three Categories of Ethical
Competence of Nursing
Leaders
Empathetic Interactions- solution of problems and
wishes; establishing confidence and assurance;
mutual liking and respect; establishing the human
and ethical interaction empathy; cooperation
Ethical Behavior- supportive behavior;
contributory behavior; fair behavior; ethical
behavior toward wrongdoers; ethical behavior
toward patients.
Exalted Manners- honesty; humility; sincerity;
decisiveness and determination good-
temperedness; patience and tolerance
Three main obstacle
1. Ethical problems
2. Cultural Problems
3. Managerial Problems
Moral Distress- in 1984 Adrew Jameton first
coined the term.it is defined as the physical or
emotional anguish that is experienced when we
are prevented from the following course of action
that we believe is right.
MoralOutrage- occurs when nurse knows the
morally correct action and feels a responsibility to
the patient, but institutional or other restraints
make it nearly impossible to follow through with
appropriate action. Occurs with someone else in
the health care setting performs an act the nurse
believes to be immoral.
The Main Categories of Ethical Problems
Identified by Nurse Managers:
Conflictsin practicalsituationsconflicts in practical
situations included situations where there were at
least two different opinions as to what was the
right way to act. Situations where conflicts exists
are obvious and conflicting values are easily
found, and there usually is open discussion
between two or more parties.
Lackof appreciationnurse managers have
perceived some participants being undervalued or
not taken into account when making decisions.
The values included are equality, respect and
regarding to patients human dignity.
Disregard of problemsconsisted of matters that
nurse managers considered wrong but somehow
accepted as existing in the organization culture, or
at least there was nothing active going on to
correct them. These problems are perceived
commonly in the organization also by other
professionals.
Experienced Inadequacynurse managers
described situations where they did not have
enough ways to do the best possible thing. There
were many kinds of obstacles which are very
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difficult to impact: legislative, financial, and
cultural.
Meaning and service value of medical care
Another important area of concern for nursing
leaders is the medical care that is often
rendered to patients in need of medical
attention based on urgency. The value that
underlies the implementation of medical care
can be measured by the improvement of
patients’ outcomes for the cost of achieving
the said desired outcome. With that being
said, the concept of VALUE- BASED
HEALTH CARE is introduced. This concept
and strategy was a result of decades of
research into organizations that have achieved
better outcomes while often lowering costs.
The goal of value-based care
transformation is to enable the health care system
to add more value to patients’ lives. Because value
is created only when a person’s health outcomes
improve, cost cutting descriptions of valuebased
health care are inadequate. Cost reduction is
important, but it is not sufficient: if the true goal of
value-based health care was cost reduction, pain
relievers and compassion would suffice.
Value-basedhealth careis frequently confused
with quality, a nebulous concept that implies a
plethora of virtues and, in health care, frequently
focuses on inputs and process compliance.
Allocation of resources
 Health care requires resources, and resources
in turn entails cost and budgetary
requirements, therefore as a value-based
health care is to be promoted it is imperative
to allocate adequate resources that are cost-
effective to meet the patients’ outcome.
 Value aligns care with how patients
experience their health by focusing on the
outcomes that matter most to patient. Health
outcomes can be described in terms of:
 Capability is the ability of patients to do the
things that define them as individuals and
enable them to be themselves. It is often
tracked with functional measures.
 Comfort is relief from physical and emotional
suffering. In addition to reducing pain,
improving patients’ comfort requires
addressing the distress and anxiety that
frequently accompany or exacerbate illness.
 Calm is the ability to live normally while
getting care. It encompasses freedom from the
chaos that patients often experience in the
health care delivery system, and it is
especially important for people with chronic
and long term conditions.
Issues involving access to care
 Access to health care means having “the
timely use of personal health services to
achieve the best health outcomes”.
 Elements of Access to Heath Care
 Coverage- facilitates entry into the health care
system. Uninsured people are less likely to
receive medical care and more likely to have
poor health status.
 Services- having a usual source of care is
associated with adults receiving
recommended screening and prevention
services.
 Timeliness- ability to provide health care
when the need is recognized
 Workforce- capable, qualified, culturally
competent providers.
Issues on access to healthcare
“Bahala na” mentality drains our health care
system. Shortage of health care workers, limited
access to health care facilities, and high out of
pocket expenses for hospitalization and health care
needs are among the problems that we face
because of “Bahala na” mentality.
TheUniversal Health Care(UHC) policy aims to
resolve these issues. Three article: Increased
Coverage of
Philhealth, Clarification of roles of
Government Agencies, and Health Human
Resources Development.
 Increased Coverage of
Philhealth or the National Health Insurance
Program refers to the automatic inclusion of
Filipino citizens to the health insurance
program. As compared before where there is a
large portion of high out of pocket health care
expenses of the people. It
may not cover 100% of the
hospital billbut it decreased the high out of
pocket expenses.
 Clarification of roles of government agencies.
The law addresses the overlapping roles and
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responsibilities of different health agencies
due to devolved set up. The law clarified these
roles wherein the Department of Health
(DOH) and local government units (LGU) will
be responsible for populationbased
interventions and health services, which
involves immunization and health promotion
programs, while Philhealth will be responsible
for financing individual-based health services.
This will now mean that people will be no
longer have to visit one charitable institution
to another.
. Health Human Resources Developmentthe law
ensures that there will be development of the
health system’s human resources through the
formulation and implementation of the National
Health Human Resource Master Plan, which
ensures that all health professionals have
permanent employment and competitive salaries
as well as the provision for the creation of national
health workforce support system that will aid local
public health systems in addressing human
resource needs while prioritizing deployment in
the Geographically Isolated and Disadvantaged
areas (GIDAs).
 The UHC law also tasks the Education sector
and the DOH to develop existing and new
allied and health-related degrees and training
programs, and to regulate the number of its
enrollees depending on the needs of the
population. The law provides scholarship
grants for graduate and undergraduate allied
and health-related programs, and in return
graduates will be required by law to render at
least three years of return of service with
compensation under the supervision of the
DOH. Incentives will be given to those who
will render an additional two years of return
of service.
ETHICAL ISSUES RELATED
TO TECHNOLOGY AND
DELIVERY OF HEALTH CARE
Data Protection is the act of protecting
information, both sensitive and personal sensitive
to unauthorized access and use.
Security is typically define by three main
attributes: availability, integrity, and
confidentiality.
Availability relates to the prevention of
unauthorized actors withholding information, for
as during a ransomware assault. Confidentiality
and integrity are concerned with information
staying private, undamaged, and undamaged by
malevolent actors.
Protection provides a framework for controlling
access to data, processes, programs, and other
resources.
Implications to Practice
 Healthcare services rely heavily on the open
exchange of information among all
participantswhether the customer, the
healthcare professional, or the health
institution.
 Clients are more likely to offer complete and
accurate data when they are convinced that
their information is safe and secure in the
hands of their healthcare practitioner.
 The majority of the data you process as a
healthcare professional is classified as
sensitive personal information. Data privacy
safeguards guarantee that your client’s
information is safe and secure.
 It ensures that their data is secure at all times
and is not vulnerable to risks and
vulnerabilities such as unlawful access,
processing, sharing, and disclosure. Republic
Act No. 10173 is also known as Data Privacy
Act of 2012 (DPA)
 It protects the privacy of individuals while
ensuring free flow of information to promote
innovation and growth.
 It regulates the collection, recording,
organization, storage, updating, or
modification, retrieval, consultation, use,
consolidation, blocking, erasure or destruction
of personal data.
 It ensures that the Philippines complies with
international standards set
for data protection through
NPC
The National Privacy Commission (NPC) is the
country’s privacy watchdog; an independent body
mandated to administer and implement the DPA,
and to monitor and ensure compliance of the
country with international standards set for data
protection.
 The DPA applies to the
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processing of all types of personal information
and to any natural or juridical person involved
in personal information processing, including
personal information controllers and
processors who, while not located or
established in the Philippines, use equipment
located in the Philippines, or those who
maintain an office, branch, or agency in the
Philippines subject to the immediately
following paragraph: Provided, that the
requirements of Section 5 are complied.
 Appointing a Data
Protection Officer (DPO) is a legal requirement
for personal information controllers (PICs)
and personal information processors (PIPs),
under the Data Privacy Act of 2012.
 Appendix 1 of NPC
Circular 17-01 provides that PICs or PIPs that
are involved in the processing of personal data
that are likely to pose a risk to the rights and
freedoms of data subjects and/or those who
processing are not occasional are subject to
mandatory registration of their DPO’s and
data processing systems.
 Privacy Notice is a statement made to a data
subject that describes how the organization
collects, uses, retains and discloses personal
information. It is sometimes referred to as
privacy statement, a fair processing statement,
or privacy policy.
 Privacy Impact Assessment (PIA) is a process
undertaken and used to evaluate and manage
impacts on privacy of a particular program,
project, process, measure, system, or
technology product of a PIC or PIP. It takes
into account the nature of the personal data to
be protected, the personal data flow, the risks
to privacy and security posed by the
processing, current data privacy best practices,
the cost of the security implementation, and,
where applicable, the size of the organization,
its resources, and the complexity of its
operations.
 Privacy Management Program (PMP) refers
to a process intended to embed privacy and
data protection in the strategic framework and
daily operations of a PIC or PIP, maintained
through organizational commitment and
oversight of coordinated projects and
activities.
 DPA, the consent of the data subject is defined
as any freely given, specific informed
indication of will, whereby the data subject
agrees to the collection and processing of
personal information about and/or relating to
him or her.
CONSENT OF THE DATA
SUBJECT
- To protect privacy, the law requires
organizations to notify and furnish their data
subjects with the following information before
they enter personal data into any processing
system, or at the next practical opportunity:
1. Description of the personal data to be entered
into the system
2. Purposes for which data will be processed
3. Basis for processing, especially when it is not
based on consent
4. Scope and method of the personal data
processing
5. Recipients to whom data maybe disclosed
6. Methods used for automated access by the
recipient and the extent to which such access
is authorized.
7. Identify and contact details of the PIC or its
representative
8. The duration for which data will be stored
9. Existence of the rights of the data subjects
GUIDELINES IN
COLLECTING & ASSESING PERSONAL DATA
- As the commission has often said, health
practitioners and anyone involved in the delivery
of health care services must gather only the
required personal information. Recipients should
not be saddled with personal data obligations that
go beyond the bare minimum, since this would
simply slow the delivery of relief in this time of
need. Access to health data must be granted solely
on a “need-to-know” basis, which implies that
only individuals on the health team must have the
minimum and essential access to execute their
tasks.
What do I need to keep in mind when storing
client’s information?
Health Care Ethics Finals Reviewer
- The DPA and its IRR provides that
personal data shall not be retained longer than
necessary: 1. For the fulfillment of the declared,
specified, and legitimate purpose, or when the
processing relevant to the purpose has been
terminated, 2. For the establishment, exercise or
defense of legal claims; or
3. For legitimate business purposes, which must be
consistent with standards followed by the
applicable industry or approved by appropriate
government agency.
 Likewise, retention of personal data shall be
allowed in cases provided by law.
 For members of the Health and Hospitals
sector, reference may be made to
DOH Memorandum 1996for the Revised
Circular No. 70, series of
Disposition Schedule of Medical Records.
Under the IRR, personal data shall be disposed or
discarded in a secure manner that would prevent
further processing, unauthorized access, or
disclosure to any other party or the public, or
prejudice the interests of thee data subjects. The
DPA penalizes improper disposal of personal
information and sensitive personal information.
BENEFITS AND CHALLENGES
OF TECHNOLOGY
Technology has its advantages on the health care
system primarily om streamlining the services and
makes the workload of health care professionals
lighter and more efficient. Specifically, the three
major benefits of technology in healthcare are as
follows:
1. Improved Care Coordinationimproving
coordination has a long been a goal of healthcare,
serving as a cornerstone of The Joint Commission’s
National Patient Safety Goals program and a
component of meaningful use attestation. Despite
increased focus, care coordination remains a
difficulty for organizations, particularly during
transitions of care, resulting in adequate care
quality and safety.
2. Improved Population Health Management-
population health is a novel term that may be
described as “ the health result of a group of
individuals, including the distribution of such
outcomes within the group.” “Without data on the
health populations you serve”. “ Any population
health initiatives become educated guesses at best.”
according to the survey 35% of all respondents,
including hospital and health system providers,
physicians, and other medical professionals, did not
have adequate access to clinical data from disparate
systems.
3. Improved Patient Educationpatient education used
to be mostly based on written information
regarding illness processes, medications,
medical management,
and self-care teaching instructions. Patients may
now get health information from anywhere,
thanks to the internet and mobile technologies.
Telemedicine advancements now allow people to
consult with a healthcare expert anytime they need
one.
CHALLENGES OF TECHNOLOGY IN
HEALTHCARE 3 CATEGORIES
1. Healthcare Organization
- the expense of technology is one of the most
significant difficulties for enterprises in terms of
installation and subsequent upkeep.
2. Healthcare Providers
- despite the fact that healthcare technology
offers great opportunities to enhance healthcare
outcomes, improper use must be addressed. The
technological imperative relates to the inevitability of
new technology and its necessary character, which
indicates the necessity for adoption for social benefit.
3.Patients
- the implications of the moral obligation bleed
over into the issues that patients face. The necessity to
assure appropriate use of costly equipment ( at least
during the early adoption period) and the moral
obligation to use new technology directly contradicts the
need to protect patient autonomy, as drawn from the
application of personalize to healthcare system.
CURRENT TECHNOLOGY:
ISSUES AND DILEMMA
1) Privacy and Security - the issue of privacy
and security will always be in question once
technology is applied in
the healthcare setting.
2.) . Sociotechnical Health
- Sociotechnical health as to the observation
that issues pertaining to technologies such as
applications of digital health are never solely about the
material technology itself, but about the mutual
dependencies between technologies and the social
arrangements in which they are built and used.
2.1 Application Software - identified that ethical
issues at the level of application .
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2.2 Material Devices and Supply Chains - the actual
material used to build and distribute the devices t
2.3 Infrastructures
- this refers to the hardware and software required to
operate digital devices.
2.4 Individual Health- Related
Practices - digital technologies are used in a variety of
health-related applications
2.5 Interpersonal Relationship
- digital health technologies have the potential to have a
wide range of effects on interpersonal relationships.
2.6 Organizational Policies
- digital technologies have the potential to
dramatically ;alter daily work practices, and thus the
structure and function of organizations.
CONTINUING EDUCATION
PROGRAMS ON ETHICO-
MORAL PRACTICE IN NURSING
A. Lobbying/Advocating for
Ethical Issues in Health Care
 According to MerriamWebster: Advocacy- the act
or process of promoting a cause or proposal.
Lobbying- the act or process of influencing public
officials to promote (something, such as project) or
secure the passage of
(legislation).
Advocacy and lobbying are similar at their core- nurse
advocates or lobbies to raise awareness of an issue- the
actual intent of the act is different.
To advocate is to raise and publicize an issue within a
community, such as making health care a topic of
national debate and media attention. Lobbying is the
process of directing one’s efforts toward individuals in
positions of authority, such as public officials,
politicians, government bodies, and regulatory agencies.
 The code of ethics for nurses requires nurses to
treat all patients fairly and equally, respecting their
“innate dignity, worth, and individual traits
independent of the elements that influence a
person’s health”. Illness, ability, financial state, or
proximity to death have no bearing on a person’s
worth. These issues must be considered in the
provision of just care since they influence the need
for treatment and the allocation of health care.
B. Code of Ethics for Nurses
1. International Code of Ethics
 The ICN Code of Ethics for Nurses is a statement
of the
ethical values, responsibilities
and professional standards of nurses. It guides
everyday ethical nursing practice and can serve as a
regulatory tool to guide and define ethical nursing
practice.
 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.
 Nurses have four fundamental responsibilities: to
promote health, to prevent illness, to restore health
and to alleviate suffering. The need for nursing is
universal.
 Inherent in nursing is a respect for human rights,
including cultural rights, the right to life and
choice, to dignity and to be treated with respect.
Nursing care is respectful of and unrestricted by
considerations of age, color, creed, culture,
disability or illness, gender, sexual orientation,
nationality, politics, race or social status.
ELEMENTS OF THE CODE
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.
 The nurse holds in confidence personal information
and uses judgement in sharing this information.
 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.
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CODE1
a) Practitioners and Managers
 provide care that respects human rights and is
sensitive to the values, customs and beliefs of
people.
 Provide continuing education in ethical issues.
 Provide sufficient information to permit informed
consent to nursing and/or medical care, and the
right to choose or refuse treatment.
 Use recording and information management
systems that ensure confidentiality.
 Develop and monitor
environmental safety in the workplace.
b. Educators and Researchers
 In curriculum include references to human rights,
equity, justice, solidarity as the basis for access to
care.
 Provide teaching and
learning opportunities for ethical issues and
decision making.
 Provide teaching/learning opportunities related to
informed consent, privacy and confidentiality,
beneficence and maleficence.
 Introduce into curriculum concepts of professional
values.
 Sensitize students to the importance of social action
in current concerns.
c. National Nurses Associations
 Develop position statements and guidelines that
support human rights and ethical standards.
 Lobby for involvement of nurses in ethics
committees.
 Provide guidelines, position statements, relevant
documentation and continuing education related to
informed consent to nursing and medical care.
 Incorporate issues of confidentiality and privacy
into a national code of ethics for nurses.
 Advocate for safe and healthy environment.
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 reflects 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 behavior and open
dialogue.
Elements of the Code #2 to:
A. Practitioners and Managers
 Establish standards of care and a work setting that
promotes quality care.
 Establish systems for professional appraisal,
continuing education and systematic renewal of
licensure to practice.
 Monitor and promote the personal health of nursing
staff in relation to their competence for practice.
b. Educators and Researchers
 Provide teaching/learning opportunities that foster
life long learning and competence for practice.
 Conduct and disseminate research that shows links
between continual learning and competence to
practice.
 Promote the importance of
personal health and illustrate its relation to other
values.
c. National Nurses Associations
 Provide access to continuing education, through
journals, conferences, distance education, etc.
 Lobby to ensure continuing education opportunities
and quality care standards.
 Promote healthy lifestyles for nursing
professionals. Lobby for healthy workplaces and
services for nurses.
3. Nurses and the Profession
 The nurse assumes the major role in determining
acceptable standards of clinical nursing practice,
management, research and education.
 The nurse is active in developing a core or
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
organization, 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.
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 The nurse contributes to an ethical organizational
environment and challenges unethical practices and
settings.
Elements of the Code #3 to:
 Practitioners and Managers
 Set standards for nursing practice, research,
education and management.
 Foster workplace support of the conduct,
dissemination and utilization of research related to
nursing and health.
 Promote participation in national nurses’
associations so as to create favorable
socioeconomic conditions for nurses.
b. Educators and Researchers
 Provide teaching/learning opportunities in setting
standards for nursing practice, research, education
and management.
 Conduct, disseminate and utilize research to
advance the nursing profession.
 Sensitive learners to the importance of professional
nursing associations.
c. National Nurses Associations
 Collaborate with others to set standards for nursing
education, practice, research and management.
 Develop position statements, guidelines and
standards related to nursing research.
 Lobby for fair social and economic working
conditions in nursing. Develop position statements
and guidelines in workplace issues.
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.
 To achieve its purpose the Code must be
understood, internalized and used by nurses in all
aspects of their work. It must be available to
students and nurses throughout their study and
work lives.
Elements of the Code #4 to:
 Practitioners and Managers
 Create awareness of specific and overlapping
functions and the potential for interdisciplinary
tensions and create strategies for conflict
management.
 Develop workplace systems that support common
professional ethical values and behavior.
 Develop mechanism to
safeguard the individual, family or community
when their care is endangered by health care
personnel.
b. Education and Researchers
 Develop understanding of the roles of other
workers.
 Communicate nursing ethics to other professions.
 Instill in learners the need to safeguard the
individual, family or community when care is
endangered by health care personnel.
c. National Nurses Associations
 Stimulate co-operation with other related
disciplines.
 Develop awareness of ethical issues of other
professions.
 Provide guidelines, position statements and
discussion for a related to safeguarding people
when their care is endangered by health care
personnel.
Applying the Elements of the ICN Code of Ethics
for Nurses- this four elements of the ICN Code of
Ethics for Nurses: Nurses and the people, nurses
and practice, nurses and the profession, nurses and
coworks, give a framework for the standards of
conduct.
2. Code of Ethics for Filipino Nurses
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, 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 principal basis therefore: All the
principles under the said Code were adopted and
integrated into the Code of Ethics as they apply to the
nursing profession;
Health Care Ethics Finals Reviewer
WHEREAS, the promulgation of the said Code
as a set
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 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, psychological, and
ecological aspects of illness, utilizing the therapeutic
process. Cultural diversity and political and
socioeconomic 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
THE PEOPLE SECTION 4.
Ethical Principles Values, customs, and spiritual beliefs
held by individual shall be respected. Individual
freedom to make rational and unconstrained decisions
shall be respected. Personal information acquired in the
process of giving nursing care shall be held in strict
confidence.
SECTION 5. 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”.
(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.
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).
f. See to it that quality nursing care and practice
meet the optimum standard of safe nursing practice.
g. Insure that modification of practice shall
consider the principles of safe nursing practice. h. 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.
i. 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
Registered Nurses are the advocates of the
patients: they shall take appropriate steps to safeguard
their rights and privileges.
SECTION 9.
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
Registered Nurses are aware that their actions
have professional, ethical, moral, and legal dimensions.
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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 and 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
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 healthcare providers.
SECTION 13. Guidelines to be observed:
REGISTERED Nurses must:
1. Maintain their professional role/identity while
working with other members of the health team.
2. Conform with group activities as those of a health
team should be based on
acceptable, ethico-legal standards.
3. Contribute to the professional growth and
development of other members of the health team.
4. d. Actively participate in professional
organizations.
5. e. Not act in any manner prejudicial to other
professions.
6. 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.
7. g. Respect the rights of their co-workers.
ARTICLE V. REGISTERED NURSES,
SOCIETY, AND ENVIRONMENT SECTION 14.
Ethical Principles a) The preservation of life, respect
for human rights, and promotion of healthy environment
shall be a commitment of a Registered Nurse.
b) 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. Maintenance 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
socioeconomic conditions and general welfare of
nurses through appropriate legislation is a practice
and visionary mission.
SECTION 17. Guidelines to be observed:
REGISTERED Nurses must:
1) Be members of the
Accredited Professional Organization (PNA).
2) Strictly adhere to the nursing standards.
3) Participate actively in the growth and development
of nursing profession.
4) Strive to secure equitable socio-economic and work
conditions in nursing through appropriate
legislation and other means.Assert for the
implementation of labor and work standards.