NURSING CODE OF

ETHICS
NORFADZILAH AHMAD (RN, PHD)
DEPARTMENT OF PROFESSIONAL NURSING STUDIES

KULLIYYAH OF NURSING, IIUM

NURSING ETHICS

• Because nurses are accountable for protecting the interests and rights of client, quality
nursing practice involves making ethical decisions
• Each practice setting has its own set of ethical concerns.
• Nurses must balance their ethical responsibilities to each client with their professional
obligations
NURSING CODES OF ETHICS

• Code of ethics a formal statement of a group’s ideals and values

• A set of ethical principles shared by members of a group, reflecting their
moral judgements and serving as a standard for professional actions
 PURPOSES

1. To inform the public about the minimum standard.

2. To provide a sign of the professions.
3. Commitment to the public it serves.
4. To outline the major ethical considerations of the profession.
5. To provide general guidelines for professional behavior.
6. To guide the profession in self-regulation.
7. To remind nurses of the special responsibility they assume when caring for clients.
INTERNATIONAL CODE OF NURSING ETHICS

• The International Council of Nurses (ICN) had developed and adopted

Code of Ethics for Nurses that has four principle elements that outline
the standards of ethical conduct.
i. Nurses and people
ii. Nurses and practice
iii. Nurses and the profession
iv. Nurses and co-workers
THE CODE OF ETHICS FOR NURSES SERVES THE
FOLLOWING PURPOSES:

• It is a succinct statement of the ethical values, obligations, duties,

and professional ideals of nurses individually and collectively.
• It is the profession’s nonnegotiable ethical standard.
• It is an expression of nursing’s own understanding of its
commitment to society.
CODE OF CONDUCT/ETHICS

Examples :
1. American Nurses Association : Code for Nurses
2. Australian Nursing Council Inc. Code of Ethics.
3. California Nurses Association : Code for Registered Nurses.
4. International Council of Nurses : Code for Nurses.
5. Lembaga Jururawat Malaysia : Code of Professional Conduct For Nurses,
1998.
CODE OF CONDUCT-MALAYSIA

• It offers guidelines for professional behavior and practice and

can be used as a standard against which complaints of
professional misconduct are considered.
 APPLICATION OF THE CODE IN NURSING PRACTICES

Mariam is a nurse working in geriatric ward. Mariam’s

Applying the code of
colleagues had noticed that the patients in Mariam’s care were
conduct:
looking uncared for over several shifts and that the wet sheets
Lack of care Professional Nursing
were unchanged and urine bottles not emptied. Mariam was
Practice - Standard of
also spending a lot of time at the nurses’ counter while her
care
patients were left unattended.
Julia is a midwife working in the same hospital where a friend’s
Confidentiality & ex-wife had recently given birth. Although Julia was not involved Abuse of Professional
privacy in the care of the woman, she accessed information about her privileges & skills-
and her baby. Without her consent, Julia provided information to confidentiality
her friend.
Abuse of Professional
Alisa is a nurse who works in a psychiatric ward. While caring for
Professional privileges & skills-
a new patient, Alisa became very close with the patient’s family.
boundaries personal relationship
After several weeks, she had an affair with the patient’s
between the nurse & the
husband.
patient
PROFESSIONAL NURSING CODE OF ETHICS

• Specific applications of more universal moral principles.

• Prescribes moral behavior and actions based on moral principles
in response to patients’ rights (Fry, 1994)
• Professional nurse has a moral obligation to follow the rules in a
code of ethics
• Focus on advocacy, responsibility, accountability & confidentiality
 1. ADVOCACY

• Advocacy is an ethical concept for nursing practice and refers to providing support for a
patient’s right or best interest.
• Latin word advocatus meaning ‘one summoned to give evidence’
• The focus – respect client’s decision & enhance client autonomy
 1. ADVOCACY (CONT.…)

• Three models to describe nurse advocacy for patient:

i. Rights protection model – nurses as defender of patient’s right within the healthcare
system. Nurse informs patients about their right, make certain that rights are
understood & protect patient from infringement of those right.
ii. Values-based model – positions the nurse as the one who discusses patients 'needs
& choices with them & help them reach decisions consistent with their values &
lifestyle, without nurses imposing their personal values & belief.
iii. Respect-for-persons model – the nurse acts to protect dignity, privacy & choices.
 1. ADVOCACY (CONT.…)

• Nurse speaks for or in support of the best interests of the individual client or
vulnerable client population not be harmed by providing health care services
• Code for Nurses states: “the nurse must be alert to and take appropriate
action regarding any instances of incompetent, unethical, or illegal practice by
any member of the health care team or the health care system, or any action
on the part of others that places the rights or best interests of the client in
jeopardy (ANA, 1985).
 2. RESPONSIBILITY
• Nurses bear primary responsibility for the nursing care that their patients
receive and are accountable for their own practice.
• Nursing practice includes independent direct nursing care activities, care as
ordered by an authorized healthcare provider, delegation of nursing
interventions, evaluation of interventions, and other responsibilities such as
teaching, research, and administration.
• In each instance, nurses have the authority and retain accountability and
responsibility for the quality of practice and for compliance with state nurse
practice acts, and standards of care, including The Code of Ethics for
Nurses.
 2. RESPONSIBILITY (CONT.….)

• Nurses are responsible for assessing their own competence. When the needs
of the patient are beyond the qualifications or competencies of the nurse,
consultation and collaboration must be sought from qualified nurses, other
health professionals, or other appropriate resources. Educational resources
should be used by nurses and provided by agencies or organizations to
maintain and advance nurse competence.
 3. ACCOUNTABILITY
• Being answerable to someone for what has been done in the nursing role
• Includes providing an explanation to oneself, the client, the employing agency, and
the nursing profession for what one has done in the role of nurse
• An obligation that has both moral and legal components and implies a contractual
agreement between two parties.
• When a nurse enters into a contractual agreement to perform a service for a client,
the nurse will be held answerable for performing this service according to agreed-
upon terms, within an established time period, and with stipulated use of resources
and performance standards.
• The nurse as contractor is responsible for the quality of the services rendered and is
accountable to the individual client, the health service agency, the nursing
profession, own conscience for what has been done (Fry, 1994).
 4. CONFIDENTIALITY

• Principle of not revealing or divulging certain information and be treated as confidential

• Enables control of disclosure of personal information and limits the access of others to
sensitive information (Fry, 1994)
• Privacy is recognized as a basic human right.
• Code for Nurses states that: “The nurse safeguards the client’s right to privacy by judiciously
protecting information of a confidential nature” (ANA, 1985).
• Because of respect for persons, nurses respect clients’ rights to privacy by maintaining the
moral rule of confidentiality.
 BREACH OF CONFIDENTIALITY
• A breach of confidentiality occurs when a patient's private information is disclosed to a third party
without their consent.
• Example;
➢ Accessing confidential information, in any form, without a "need to know" to perform assigned
duties.Workforce members are prohibited from accessing their own records and records of
family members, relatives and others, unless access is necessary to perform assigned duties.
➢ Assisting an unauthorized user to gain access to secured information
➢ Leaving confidential information unattended in a non-secure area
➢ Disclosing confidential information without proper authorization
➢ Discussing confidential information in the presence of individuals who do not have the "need to
know' to perform assigned duties
➢ Improper disposal of confidential information
➢ Disclosing that a patient or employee is receiving care (except for authorized directory
purposes)
➢ Transferring confidential information in any form without both parties having a need to know
 CONFIDENTIALITY (CONT....)
Disclosure Permitted Disclosure Not Permitted
✓ With consent by patient, may be signed waiver
X When nurse- patient communication is
✓ When information is necessary for other protected by a privileged communication
caregivers to care for a patient
statue or common law
✓ If common law right exists to protect the public
interest (e.g. safety of blood supply, STD) X To relatives, spouse or friends unless consent
✓ If statues require disclosure (e.g suspected elder
given by patient
or child abuse reporting law or X When information is requested by
mandatory reporting of communicable diseases)
unidentified caller
✓ If duty warn an identifiable victim in great
danger warrants disclosure X Unintended disclosure through social media
✓ If court proceedings require disclosure or electronic messaging
 CONFIDENTIALITY (CONT....)

• Consequences of Disclosure Without Permission

i. Exposure to civil suits for breach of confidentiality or invasion of privacy
ii. Disciplinary action by state board of nursing
iii. Job loss because employer would have cause for discharge
iv. Fines for violations or other penalties stated in privacy laws or legislation
 OBJECTIVES

1. Meaning of Patient’s Rights

2. Purpose of Patient’s Bill of Rights
3. Patient’s Bill of Rights during hospitalization
4. Role of nurse in implementing the patients’ bill of rights and the rights in the patients’
bill of rights
 PATIENT’S BILL OF RIGHT

Affirms the basic human rights of all clients who seek health care services to:

1. Receive considerate and respectful care 7. Expect reasonable continuity of care

8. Be informed of institutional regulations
2. Obtain complete medical information
9. Have privacy
3. Receive information necessary for giving
10. Have personal information and medical records
informed consent
treated confidentially
4. Refuse treatment
11. Be provided with information on other institutions
5. Request services
and individuals related to care and treatment
6. Refuse participation in research projects
12. Examine and obtain explanations of financial charges