CODE OF

ETHICS

PRESENTED BY:
PRASEEDHA.
S
1ST YEAR MSC NURSING
EMCH COLLEGE OF
NURSING
 DEFINITO
NETHICS IS A FORMAL
A CODE OF

STATEMENT OF GROUP’S IDEALS

AND VALUES
PURPOSE
S
 STANDARDS FOR THE BEHAVIOURS OF
NURSE& PROVIDE GENERAL GUIDELINES
FOR NURSING ACTION
 HELPS TO DISTIGUISH BETWEEN
RIGHT& WRONG
 ENABLES A CORRECT DECISION
 PROTECT THE RIGHTS OF
INDIVIDUAL
 USE
 Acknowledges
S
the rightful place of
Individuals in health care delivery
system.
 Contributes towards empowerment of
individuals to become responsible for
their health and well-being.
 Contributes to quality care.

 Identifies obligations in
practice, research and relationships.
 Informs the individuals, families,
community and otherprofessionals
about expectations of a nurse.
 ETHICAL
PRINCIPLES

 RESPECT &

AUTONOMY
 BENEFICENCE

 JUSTICE

 VERACITY

 FIDELITY
 ETHICAL
Occurs
DILEMMA
when there is
conflict between two or
more ethical principles.
 No correct decision exists.

 Ethical reasoning
INTERNATIONAL CODE OF NURSING
ETHICS
THE ICN CODE OF ETHICS FOR NURSES
 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 2005.
 PREAMBLE
 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 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, colour, creed, culture, disability or illness, gender, sexual
orientation, nationality, politics, race or social status.
 Nurses render health services to the individual, the family and the
community and co-ordinate their services with those of related
groups.
 THE ICN CODE
The ICN Code of Ethics for Nurses has four principal elements that outline
the standards of ethical conduct.
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 sufficient information 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 also shares responsibility to sustain and protect the
natural environment from depletion, pollution, degradation and
 2.NURSES AND PRACTICE
•The nurse carries personal responsibility and
accountability for nursing practice, and for
maintaining competence by continual learning.

•The nurse maintains a standard of personal health

such that the ability to provide care is not
compromised.
•The nurse uses judgement regarding individual
competence when accepting and delegating
responsibility.
•The nurse at all times maintains standards of
personal conduct which reflect well on the profession
and enhance 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
 3. NURSES AND THE PROFESSION

•The nurse assumes the major role in determining and

implementing acceptable standards of clinical
nursing practice, management, research and
education.

•The nurse is active in developing a core of

research- based professional knowledge.

•The nurse, acting through the professional organisation,

participates in creating and maintaining safe, equitable
social and economic working conditions in nursing.
  4. NURSES AND CO-WORKERS

 The nurse sustains a co-operative

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.
 5. NURSES AND
SOCIETY
 Participate and share responsibility
with other citizens & other health
professionals.
 Recognize and perform the duties
of citizenship
 Aware of laws and regulations which
affect the practice of medicine and
nursing.
INC CODE OF ETHICS FOR NURSES IN
INDIA
I) The nurse respects the uniqueness of
individual
in provision of care
1.1 Provides care for individuals without
consideration of caste, creed, religion, culture,
ethnicity, gender, socio-economic and political
status, personal attributes, or any other
grounds
INC CODE OF ETHICS FOR NURSES IN
INDIA
I) The nurse respects the uniqueness
of individual in provision of
care
1.2 Individualizes the care considering the
care considering the beliefs, values and
cultural sensitivities.
INC CODE OF ETHICS FOR NURSES IN
INDIA
I) The nurse respects the uniqueness
of individual in provision of
care
1.3 Appreciates the place of the individual
in family and community and facilitates
participation of significant others in the
care.
INC CODE OF ETHICS FOR NURSES IN
INDIA
I) The nurse respects the uniqueness of
individual
in provision of care
4.Develops and promotes trustful relationship
with individual(s).
5.Recognizes uniqueness of response of
individuals to interventions and adapts
accordingly.
INC CODE OF ETHICS FOR NURSES IN
INDIA
I) The nurse respects the uniqueness of
individual
in provision of care
1.5 Appreciates the place of the individual in
family and community and facilitates
participation of significant others in the care.
INC CODE OF ETHICS FOR NURSES IN
INDIA
2)The nurse respects the rights of individuals as
partner in care and helps in making
informed choices
1.Appreciates individual’s right to make
decisions about their care and therefore gives
adequate and accurate information for
enabling them to make informed choices.
 INC CODE OF ETHICS FOR NURSES IN
INDIA
2) The nurse respects the rights of individuals as partner
in care and helps in making informed choices
2.Respects the decisions made by individual (s) regarding
their care.
3.Protects public from misinformation
and misinterpretations.
4.Advocates special provisions to protect
vulnerable individuals/groups.
 INC CODE OF ETHICS FOR NURSES IN
INDIA
3) The nurse respects individual’s right to privacy,
maintains confidentiality, and shares information
judiciously.
1.Respects the individual’s right to privacy of their personal
information.
2.Maintains confidentiality of privileged information except
in life threatening situations and uses discretion in sharing
information.
 INC CODE OF ETHICS FOR NURSES IN
INDIA
4) Nurse maintains competence in order to render Quality
Nursing Care
1. Nursing care must be provided only by registered nurse.
2.Nurse strives to maintain quality nursing care
and upholds the standards of care.
3.Nurse values continuing education, initiates and utilizes
all opportunities for self development.
 INC CODE OF ETHICS FOR NURSES IN
INDIA
4) Nurse maintains competence in order to render
Quality Nursing Care
4.4 Nurse values research as a means of development of
nursing profession and participates in nursing
research adhering to ethical principles.
 INC CODE OF ETHICS FOR NURSES IN
INDIA
5)The nurse is obliged to practice within the framework
of ethical, professional and legal boundaries
1.Adheres to code of ethics and code of professional
conduct for nurses in India developed by Indian
Nursing council.
2.Familiarizes with relevant laws and practices in
accordance with the law of the state.
 INC CODE OF ETHICS FOR NURSES IN
INDIA
6)Nurse is obliged to work harmoniously with the members
of the health team.
1. Appreciates the team efforts in rendering care.
2.Cooperates, coordinates and collaborates with the
members of the health team to meet the needs of the
people.
 INC CODE OF ETHICS FOR NURSES IN
INDIA
7)Nurse commits to reciprocate the trust invested in nursing
profession by society
1. Demonstrates personal etiquettes in all dealings.
2. Demonstrates professional attributes in all dealings.
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
1. Professional Responsibility and accountability
1. Appreciates sense of self-worth and nurtures it.
2.Maintains standards of personal conduct reflecting credit
upon the profession.
3.Carries out responsibilities within the framework of the
professional boundaries.
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
1. Professional Responsibility and accountability
4.Is accountable for maintaining practice standards set by
Indian Nursing Council
5. Is accountable for own decisions and actions
6. Is compassionate
7.Is responsible for continuous improvement of current
practices
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
1. Professional Responsibility and accountability
8.Provides adequate information to individuals that allows
them informed choices
9. Practices healthful behavior
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
2. Nursing Practice
1.Provides care in accordance with set standards of
practice
2.Treats all individuals and families with human dignity in
providing physical, psychological, emotional, social and
spiritual aspects of care
3.Respects individual and families in the context of
traditional and cultural practices and discouraging
harmful practices
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
2. Nursing Practice
4.Presents realistic picture truthfully in all situations for
facilitating autonomous decision-making by individuals
and families
5.Promotes participation of individuals and significant
others in the care
6. Ensures safe practice
7. Consults, coordinates, collaborates and follows up
appropriately when individuals’ care needs exceed
the nurse’s competence.
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
3. Communication and Interpersonal Relationships
1.Establishes and maintains effective interpersonal
relationship with individuals, families and
communities
2.Upholds the dignity of team members and maintains
effective interpersonal relationship with them
3.Appreciates and nurtures professional role of team
members
4.Cooperates with other health professionals to meet the
needs of the individuals, families and communities
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
4. Valuing Human Being
1.Takes appropriate action to protect individuals from
harmful unethical practice
2.Consider relevant facts while taking conscience decisions
in the best interest of individuals
3.Encourage and support individuals in their right to speak
for themselves on issues affecting their health and welfare
4. Respects and supports choices made by individuals
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
5. Management
1.Ensures appropriate allocation and utilization of
available resources
2.Participates in supervision and education of students and
other formal care providers
3.Uses judgment in relation to individual competence while
accepting and delegating responsibility
4.Facilitates conducive work culture in order to achieve
institutional objectives
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
5. Management
5.Communicates effectively following appropriate channels
of communication
6. Participates in performance appraisal
7. Participates in evaluation of nursing services
8.Participates in policy decisions, following the principle of
equity and accessibility of services
9.Works with individuals to identify their needs and
sensitizes policy makers and funding agencies for
resource allocation
 INC CODE OF PROFESSIONAL CONDUCT FOR
NURSES IN INDIA
6. Professional Advancement

1. Ensures the protection of the human rights while pursuing the

advancement of knowledge
2. Contributes to the development
3. Participates in determining and implementing quality care
4. Takes responsibility for updating own knowledge
and competencies
5. Contributes to the core of professional knowledge
by conducting and participating in research
 AUTONOMY &
ACCOUNTABILITY
 Autonomy means that individual are
able to act themselves to the level of
their capacity
 Accountability is the process that
mandates that individuals are answerable
for their actions and have an obligation
to act.
 Attributes of accountability:
answerability& responsibility
ACCOUNTABILITY OF NURSING PERSONNEL
 Provide safe & therapeutic environment
 Deliver competent & personalized care

 Maintaining adequate supplies of material in the

ward
 Maintaining accurate and up to date records

 Maintaining good IPR

 Protect client’s legal rights& privacy

 Work within ethical& legal boundaries

 Keep pace with changing health needs&

developing technology
 Delivering care as per standards

 Delegating responsibility appropriately

 Contribute to development of profession

 ASSERTIVENESS

 Tool for expressing ourselves confidently

 Way of saying yes or no in an appropriate
way
 Benefits:

 Less friction & conflicts

 Increased self respect

 Enhances self esteem

 Increased productivity at work & home

 Less stress at work

 AIMS OF
 Find the ASSERTIVENESS
best possible solution for all people.
 Increases chances of our needs being met

 Allows to remain control

 Brings self confidence

 Have more friends

 Reduced stress

 A-S-E-R-T MODEL:

 See chart
 STRATEGIES FOR IMPROVING
ASSERTION AT WORK
 ASK

 BRING ENERGY TO THE JOB

 GET YOUR EMOTIONS UNDER CONTROL

 FIND A GOOD PLACE TO TALK

 TIMING IS IMPORTANT

 EFFECTIVE ASSERTION REQUIRES A

LISTENER.
TECHNIQUES FOR BEING
A.SSERTIVE
 Identify your personal rights, wants and needs.
 . Identify how you feel about a particular Situation
 Be direct
 Own your message
 Avoid assumptions about others thinking
 Avoid statements that begins with "why", "you".
 Ask for feedback
 Stop apologizing all the time
 Learn to take a compliment
 Act confident even if you don't feel confident
 Feel free to say no
 Evaluate your expectation
 VISIBILITY OF NURSES
 A quality or fact of , degree of being visible
 Degree of exposure to public notice
 Nurses themselves are responsible when
they don't take a stand neither to correct
the distorted images not for the visibility of
the roles they have performed in their
health care.
 LEGAL
CONSIDERATIONS
 1st nursing law : Nursing registration- 1903
 Indian nursing council act: enacted in 1947
 Amended in 1957

 LEGAL IMPLICATIONS:

 Torts: Torts are when others interfere in individuals'

privacy
 Assault: Assault occurs when a person puts
another person in fear of a harmful or offensive
contact

Battery: It is an intentional touching of
another's body without the other's consent
 Negligence: it is described as lack of proper care and
 Malpractice: Failure to meet the standards of
acceptable care which results in harm to
another person.

Fraud: It results from a deliberate
deception intended to produce unlawful
gains.
 False imprisonment: It occurs when a client is not
allowed to leave a health care facility when there is
no legal justification to detain the client or when
restraining devices are used without an appropriate
clinical need.
 Invasion of privacy: It includes violating
confidentiality intruding on private client or family
matters, and sharing client information with
unauthorized persons.
 Legal documents: it comprised:
a)Advance directive: Written document
recognized by law that provides directions
concerning the provision of care when a
person is unable to make his or her own
treatment choices.
b)Do not resuscitate orders: Written order by a
physician when a client has indicated a desire
to be allowed to die if the client stops breathing
or the client's heart stops beating.
c)Informed consent: It is clients' approval [or
that of the clients' legal representative to have
his or her body touched by a specific
individual.
NURSING LIABILITIES AND
PREVENTIVE MEASURES
 All nursing observations should be
noted carefully, describing accurately
 Patients complaints should be recorded
as accurately and specifically
 Nurse must report through proper
channels
 Authorities must be informed regarding any kind of
equipment, materials or supplies, which for any
reasons less than safe for use in the patient's care
 Insurance protection
 L
 Registration
EGAL

RESPONSIBILITY
Licensing is a mandatory procedure for practice
of nursing. Registration aims at protecting patients by
providing qualified nurses. The nurse is responsible to
obtain registration in the respective State Nursing
Registration Council
 Legal Liability/Act Of Negligence

License of a nurse can be suspended or cancelled for
any act of negligence or mal practice, following a
specified procedure.
 Medico — Legal case (M.L.C.)

A medico) legal case is a patient who is admitted
to the hospital with some unnatural pathology and has
to be taken care of in concurrence with the police
 Types of clients which are categorized as MLC in a
hospital are.
 Road traffic accidents.

Injuries inflicted during brawls/fights,
shooting, bomb blasts etc.
 Suicide.

 Burns.

 Poisoning.

 Rape victim.

 Assault.
NURSES ROLE IN A MEDICO-LEGAL
CASE

 1. Obtain complete history from patient or significant others
 2. Inform the police officer/constable on duty in the hospital
and the CMO.
 3. When it is made a MLC, then record it on the patient's
case sheet with red ink at right hand top corner. .
 4. Do not give any statement about patient's condition
to police, magistrate or media. Only a doctor has to give
information.
 5. When a patient has to be discharged, inform the
CMO
only. After clearance from them, he/she can be
discharged.
 6. If a MLC patient absconds, inform the CM0 and the
treating doctor immediately
 7. No patient can leave against medical advice.

8. Document the care given to patients
timely, accurately and duly sign the nurse’s
notes.

9. Records and all the documents pertaining to
patient should be handled with care, during the
stay in the hospital. They must be kept safely and
should be handed over to the authorized person as
designated by the hospital authority.
 10. Incase death of a MLC; the body is not to be
handed over to the relatives. It needs to be accurately
labeled and sent to the mortuary. CMO and/ or
police officer should be informed simultaneously.
 11. Appropriately authority must be informed.
 Correct identity
 A nurse/midwife is responsible to make sure that all
babies born in hospital are correctly labeled at
birth and handed over to right parent.

Unknown/unconscious patients must be labeled
as soon as their identity is known.
 Patients who have to undergo surgery should be
appropriately identified and labeled.

Site of operation to be correctly marked
particularly where symmetrical sides or organs are
there:

Operation theatre (O.T.): scrub nurse has to see all
the instruments/ swabs are returned. She has to say
OKAY' before closure by the surgeon
 . Left Against Medical Advice (L.A.M.A.)
 Inform medical officer in charge. Signatures of
both patients and witness to be taken as per institutional
policy.
 Patient's Property

 Inform patient on admission that hospital does not

take responsibility of his belongings. If patient is
unconscious/ or otherwise required then a list of items must
be made, counter checked by two staff nurses and kept
under safe custody.
. Dying Declaration
 Doctor or nurse should not involve themselves in dying
declaration, in case where police records the dying
declaration. Dying declaration is to be recorded by the
magistrate. But if condition of patient becomes serious then
medical officer can record it along with two nurses it witness.
Dying Declaration can be recorded by the nursing staff with
 Wills

For this, doctor has to be present her, he
can recode if requested.
 Examination of rape case

Female attendant/female nurse must be
present during the examination.
 Artificial human insemination

 Written consent should be obtained from both donor

and recipient.
 Donor and recipient must have the same blood
group. Donor and recipient's identity should be
kept confidential. .

All related documents should be kept
confidential and safe.
•Poison case
•Do not give either verbal or written opinion.
•Do not allow to take photos unless special
permission is granted by appropriate authority.
• Do not give any information to public or
press.
• Preserve all evidence of poisoning.
•Collect and preserve all excreta, vomits and
aspirates, seal them immediately and send to
forensic laboratory at the earliest.
.Consumer Protection Act(l986)
Consumer protection act was passed by parliament
in 1986
RIGHTS OF PATIENT:
See leaflet
 Nurses role to prevent complications

1. Review nursing practice periodically. Update
knowledge and improve skill by attending short term
courses, in- service education and continuing
education programmes.

2. Should have complete knowledge of all rules
and regulations of hospital and know their
descriptions
{duties and responsibilities).
 3. Follow nursing practice standards/protocols.

 4. Be a keen observer.

 5. Written instructions must have rules and code of

practice laid down to ensure the safety and well being
of patients and nurses.

6. All hospitals must have rules, a code of
practice laid down to ensure the safety and well
being of patients and nurses.
 7. Maintain records and reports of the unit
properly.

8. Follow 6 Rights - right patient, right drug,
right time and right route with right technique
and right of the patient lo know about his/her
disease condition.

9. Check the treatment order and use
professional judgment before implementing.
 10. Do not exceed the limits of nursing procedure
laid down by statutory bodies.
 BIBLIOGRAPH
Y
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TH

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•WWW.NURSING WORLD.ORG/.../CODE OF ETHICS FOR NURSES
•WWW.ICN.CH/ABOUT-ICN/CODE OF ETHICS FOR NURSES
•WWW.DSR.DK/SER/DOCUMENTS/ICN CODE ENGLISH.PDF
•