Ethics and Professional
Nursing
Code of Ethics
Profession
Is Nursing a profession, what
are the criteria to define a
profession and who decides?
Profession is defined by
Gruending (1985) as a complex
organized occupation preceded
by long training program.
Professional status
Profession exist for the purpose of meeting
the needs of society.
Professionals contract with society by
promising to meet a set of identified needs
better than any other group of people.
Society grants the profession a monopoly
over these particular service.
Professional status of nursing
Nurses and others have Debate the Professional
status of nursing.
Flexner (1915) evaluated nursing according to
the following criteria:
Involving intellectual operations
Based on science and learning
Self-organization
Altruistic in motivation
He concluded that nursing was not a profession
Optimistically he proposed that occupation could
alter their status by developing these traits
Is nursing a profession
Seven main characteristics:
1.A body of specialized
knowledge
2.Use of the scientific method to
enlarge the body of knowledge
3.Education within institute of
higher education
4. Control profession policy,
professional activity and autonomy
(practical service)
5. Code of ethics (formulation of
policy)
6. Nursing as a lifetime commitment
7. Service to public )continues
growth)
Professional status for nursing
Expertise
Autonomy
Accountability
Authority
Unity
Ethical codes
Competence testing
licensure, credential
Description of the scope of Nursing
Establishment of standards
Expertise
Relate to the characteristics of
having a high level of specialized
skills and knowledge (gained
through long years of study in
academic setting)
Is the primary distinguishing
difference between professionals
and non-professionals
We gain expertise through
Extensive educational
requirements
Intense guided practice
Examination of licensure
Certification
Mandatory continuing education
Is Expertise enough
We have knowledge base that is
continually expanded through
research
Purely claim expertise is not enough
We need mechanism of
accountability (must prove to society
that we are faithful to the promise
the profession makes)
Profession grants us
authority to practice with
a certain measure of
autonomy
Autonomy
Self governing
Two levels
Autonomy of the profession self-regulation
Autonomy of the individual practitioner, self-
determination, responsibility, accountability,
independence and willingness to take risks.
Having the power and authority to
control various aspects of their
work, goals, and choices.
Explicitly and implicitly stated and
reflected in different codes of ethics
for nurses
No other group has the ability to do
the work of nurses---legal restriction
Are you autonomous, even
though you are required to
follow physicians orders
You can’t get to know the
patients (too much work)
Lyon defines autonomous
nursing practice as diagnoses,
and treatment of phenomena
that nurse have self directed
authority to treat
Two different scopes of
practice
1.medical scope requires
physician authority to initiate
treatment
2.autonomus nursing scope
require no authority (feverish
pt)
Nurses might refuse to carry out
physician’s order (incorrect)
Protect patient from
physician’s negligence and
prevent court action against
nurse, physician, or institution
Accountability
Refers to being answerable to
someone for something one
has done
Grounded in various moral
principles, fidelity, respect for
dignity, worth, and self
determination of client
Nurse Accountability ; safe and autonomous
practice
Related to responsibility and answerability
Trust from society gained through expertise
(Autonomy) right given the profession to
regulate practice
Nurse is responsible for all individual
actions done/ judgment made and omission
Mechanisms of accountability
Code of nursing ethics
Standards of nursing practice
Nurse practice act
Nursing theory and practice derived from
nursing research
Education requirements for practice
Advance certification
Mechanisms for evaluation the
effectiveness of performance for nurses
Codes of nursing ethics
Is an explicit declaration of the
primary goals and values of the
profession that indicate the
profession’s acceptance of the
responsibility and trust with
which it has been invested by
society (ANA 1985)
Nurses make an implicit moral commitment
to uphold the values and moral obligations
expressed in their code
Nurse should base their judgment upon
consideration of consequences and universal
moral principles of respect for person
Examples of professional code
of ethics
ANA code of ethics
ICN international council of nurse code
Canadian nurses association code of ethics
Jordanian Nurses Code of Ethics
What does a code of ethics
do
Gives guidance for decision
making about ethical matters
by providing a set of values
that are basic to nursing
practice
What does code of ethics not
do
Provide rules of ethical or moral
behaviors for every circumstances
Offer guidance about which
values should take priority or how
they can be balanced in practice
Standards of nursing practice
Are written documents outlining minimum
expectation for safe nursing care
Should reflect reasonable expectation for
safe nursing care rather than optimal or
ideal care
Standards may describe in detail specific acts
performed by nurses or may outline the expected
process of nursing care
We use standards to guide and evaluate nursing
care
Courts look to standards of nursing practice for
guidance when malpractice cases are deliberated
Basic types of standards of
nursing practice
Internal standards of nursing
practice
External standards of
nursing practice
Internal standards of nursing
practice
Are those developed within the profession of
nursing for the purpose of establishing the
minimum level of nursing care
can be used as yardstick to measure the
practice of individual nurse
determine whether the actions of nurse
accused of malpractice are consistent with
reasonable minimum expectations
Nursing process is an example on internal
standards of nursing practice
They make nurses accountable for ensuring
that each step of the process is followed in
the delivery of nursing process
ANA publishes standards of care for nurses in
advanced or specialty roles such as nurse
practitioners, maternal child nurse
standards of nursing practice
(external)
Consist of guides for nursing care that are
developed by non-nurses, the government,
or institution
These standards describe the specific
expectation of agencies or groups that
utilize the services of nurses
They serve the same function as internal
guidance and evaluation e.g., nurse practice
act
E.g., formal policies and procedures for
individual agencies
Nurse practice acts
Protect the public
Define nursing practice
Describes the boundaries of practice
Establish boundaries for nurses
Protect the domain of nursing
Nurse practice acts are considered a form of
nursing standards
Utilized by courts in determining the
appropriateness of nursing action
Violation can result in either civil or criminal
action
Nursing theory and practice
derived from research
Using the scientific method
Past debate: is nursing body of
knowledge or borrowed from other
science
nursing research increase the
uniqueness by
respond to the needs of society more
knowledgeably and skillfully
Validating nursing as a true profession
Authority
Relates to the state of having legitimate
power (legal)
The authority to practice nursing is granted
by government
It acknowledges the professional's rights and
responsibilities
E.g., nurse practice act, specified entry to
requirements into practice, scope and
standards
granted through : examination and licensure
Unity
Sense of unity among members
Ability of the nurse to organize for the
purpose of fulfilling the profession’s promises
and the relationships that nurses have with
one another
Through unity, nurses can standardized the
professional characteristics of competence,
autonomy, authority, and accountability
Professional associations
Main four elements of the ICN in
nursing
1-nurses and people
2-nurses and practice
3-nurses and co-workers
4-nurses and profession
Nurses and people
Primary responsibility is to people requiring
nursing care
In providing care , nurse promote an
environment in which human rights, values,
customs and spiritual beliefs of family,
individual and community are respected
Sufficient information\ sharing responsibility
Nurse and practice
Nurse carries personal responsibility and
accountability for nursing practice
Maintain competence by continual learning
Maintain the standards of personal health
Ensure the using of technology and scientific
advance
Nurse and co-workers
Sustain cooperative relationships with co-
workers in nursing and others
Take appropriate action to maintain
individual when care is endangered by co-
workers
Nurse and the profession
Nurse play major role in determining and
implementing desirable standards of nursing
practice (management and education)
Developing core of research based
professional knowledge
Participate in creating and maintain equitable
social and economic working condition in
nursing
Thanks
