Code Of Ethics.docx

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INDEX INTRODUCTION DEFINITION & MEANING PURPOSE TERMINOLOGY CODE OF ETHICS EVOLUTION OF CODE OF ETHICS ELEMENTS OF CODE OF ETHICS USES ETHICAL CONSIDERATION ETHICAL PRINCIPLE INDIAN CODE OF ETHICS CODE OF PROFESSIONAL CONDUCT ASSERTIVNESS LEGAL CONSIDERATION NURSING LIABILITES LAW LEGAL IMPLICATIONS DO & DON`T RIGHT OF CONSUMER LEGAL RESPONSIBILITY VISIBILITY OF NURSES NURSE ROLE SUMMARY BIBLIOGRAPHY

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CODE OF ETHICS INTRODUCTION Nursing has a code of ethics that defines by which nurse provide care to the clients. In addition, nurse incorporates their own values into practice. The code of ethics for nurse with interpretive statements provide a guide for carrying out nursing responsibility that provide quality nursing care and provides for the ethical obligations. The word ethics comes from the Greek word ‘ethos’ meaning customs or guiding beliefs. Ethics are characteristics of a profession and are called a ‘code’. the code of ethics will state what kind of conduct is expected from the members of a profession , what are the responsibilities of its members towards those whom they serve, their co workers , the profession and the society as a whole. When a person become a member of a profession, he accepts the responsibility of living up to the code of that profession. It should be understood that a code of ethics is not a strict set of rules. Ethic include personal behaviors and issues of characters, e g Kindness, tolerance and generosity. ethics are distinct between right and wrong based on a body of knowledge, not just based on opinion. Ethics in nursing is a set of guidelines formulated by the members of profession with the help of profession with the help of specialist in the field of nursing leaders , advocate lawyers at times members of the society.

An international code of ethics for nurses was first adopted by the (International council of nurses) ICN in 1953. The need of nursing code is universal.  Inherent in nursing is a aspect for human rights , the rights to life and choice to dignity and to be treated with respect .Ethical codes are systematic guidelines for shaping ethical behavior that answer question of what beliefs or values should be accepted.

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DEFINITION: A Code of ethics is a formal statement of group`s ideas and values. MEANING OF ETHICS A Branch of philosophy, means different to all, originally ethics is the study of ideals human behavior and ideal way of being. A Ethics is a systematic approach to understand , analyzing and distinguishing matters of rights and wrong , good and bad and admirable and deplorable as they exist along & related to well being.

PURPOSES          

Standards for the behaviors' of nurses & provide general guidelines for nursing action. Helps to distinguish between right and wrong. Enables a correct decision. Protect the rights of individuals. Guide professional behavior Helps teacher to teach what must be taught in the education of the nurse. Helps to prevent a nurse from practicing if his/her conduct is poor. To protect a nurse who is falsely accused of doing something wrong. Acknowledge 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 obligation in practice, research and relationship.  Informs the individuals, families, community and other profession about expectation of a nurse.

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TERMINOLOGY

1. PROFESSION A Profession is derived from a word profess means to proclaim something publicly profession means something better than people they serve & who need their services.

2. CODE OF ETHICS Within any given profession, a code of ethics serves as a mean of self regulation and a source of guidelines for individual behavior and responsibility.

3. PROFESSIONAL CODE OF ETHICS They are a system rule and principles by which that profession is expected to regulate its member and demonstrate its responsibility to society.

4. ETHICS: Moral principles that govern a person`s behavior or the conducting of an activity or branch of knowledge that deals with moral principles.

5. LAW: Law is a system of rules that are created and enforced through social or governmental institutions to regulate behavior. 6. LEGAL RESPONSIBLITIES: A measure of mental capacity, used in deciding the extent to which a person can be held accountable for a deed.

7. LEGAL ISSUES: Issue of law is a legal question which is the foundation of a case or a point on which the evidence is undisputed, the outcome of which depends on the court interpretation of law. 8. ACT: Taken action or to do something.

9. LEGISLATION: The process of making or enacting law.

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CODE OF ETHICS According to International council of nurses TO ALLEVIATE SUFFERING

TO PROMOTE ILLNESS

TO RESTORE HEALTH

TO PREVENT ILLNESS

NEED OF NURSING     

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RESPRCT OF DIGNITY UNIVERSAL PROTECT RIGHTS OF MAN INHERENT IN RESPECT OF LIFE RESPECT OF DIGNITY

NURSING CODE OF ETHICS Nursing ethics states that duties & obligation of nurses to their clients, other obligations of nurses to their clients, other health professional, the professionals, the profession and the community. Nursing ethics provide standards for professional behaviour & is the study of principles of right & wrong conducted for nurses.

EVOLUTION OF ICN CODE OF ETHICS Nursing profession uses codes for nurses ethical concepts applied to using as it guide for professional conduct. This code is adopted & published by ICN. The first such code of ethics, called the International code of nursing ethics International Council of nurses at Sao Paulo, Brazil in 1953(first code was adopted).  Later revised in Frankurt, Germany in 1965 & then become known as ICN code of ethics.  Most recent revision in 1973 took place in Mexico & result in the presence code for nurses.  It has been revised and reaffirmed at various time since, most recently with review & revision completed in 2005.

ELEMENTS OF THE CODE NURSE & PEOPLE  Primary responsibilities of nurse is to provide care to needy.  Nurse provides care; promote an environment in which values, costumes and spiritual beliefs are respected.

NURSE

& PRACTICE

 The nurses carries personal responsibility for nursing practice for maintaining competence by continuing learning.  The nurses uses judgment in relation to individuals competence when accepting & delegating & delegating responsibilities. NURSES & SOCIETY  NURSES share the responsiblites for initating & supporting action to meet the health and needs of the public

NURSES & COWORKERS 6

Nurses sustain a cooperative relation with coworkers in nursing & other field. Nurses take appropriate action to safeguard individuals when his care is endanger.

USES:    

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Acknowledge the rightful place of individuals in health care delivery system. Contribution towards empowerment of individuals to become responsible for their health & well being. Contributes to quality care. Informs the individuals, families, community & other professional about expectation of a nurse.

ETHICAL ISSUES

. UNCERTAINITY: INDIVIDUAL IS UNSURE ABOUT WHICH IS MORE APPLIED & PROBLEM IS UNCLEAR.

DISTRESS: INDIVIDUALS KNOW THE RIGHT THING BUT THE ORGANIZATION CONSTRAINT MAKE DIFFICULT TO TAKE THE RIGHT ACTION.

OUTRAGE: INDIVIDUAL WITTNESS IMMORAL ACT BUT FEELS POWERLESS TO STOP IT.

ETHICAL DILEMMA: CHOOSING BETWEEN TWO OR MORE UNDESIRABLE ALTERNATIVE & ATTEMPT TO SELECT LEAST DAMAGING ONE.

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ETHICAL PRINCIPLES AUTONOMY; FREEDOM OF CHOICE OR ACCEPTING ONE`S CHOICE. INFORMED CONSENT IS DIRECTLY RELATED TO AUTONOMY SO PATIENT CONSENT IS REQUIRED FOR: ACTION BENEFICENCE TREATMENT . TAKEN SHOULD BE IN

VERACITY:OBLIGATION TO TELL TRUTH

FIDELITY: KEEP PROMISE & COMMITMENTS

EFFORT TO PROMOTE THE GOOD.

NON-MALIFECENCE

JUSTICE: EQUALITY & FAIRLY

NO ONE SHOULD BE HARM (HARM MEANS EMOTIONAL, SOCIAL & PHYSICAL INJURY)

ACCOUNTABILITY

CONFIDENTALITY:

ANSWERABLE FOR ACT

DUTY TO RESPECT PRIVILGED INFORMATION

A

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RESPECT FOR PERSON  It direct individuals to treat themselves and other with a respect inherent to man`s humanness.  It requires recognition on a sense that all share a common human dignity.

ACCOUNTABILITY  Accountability refers to ability to answer one`s own action. The nurses balance accountability to client, the profession, the employer & the society.  Accountability means being answerable for acts carried out in performance of one`s professional role.  Domain of accountability.  Professional accountability  Organizational accountability  Legal accountability.  Individual accountability.  RESPECT FOR FREEFDOM

RESPECT FOR AUTONOMY  Autonomy is defined as freedom to make prudent & binding decision consistent with scope of one`s practice.  Freedom to implement decision respect for another`s autonomy is fundamental to respect /practice health care.  Serve to justify the inclusion of client in all aspect of decision making regarding health care.

 Nurses as a group believe that patient should have a greater freedom of choice within the nations health care system.  Principle should be observed by staff nurses when planning patient care, by nurse manager when planning patient care, by nurse manager when leading sub –ordinates.

BENEFICENCE  Beneficence refers to take positive reaction to help others. The practice of beneficence encourage the urge to do good of others.  Commitment to beneficence helps to guide difficult decision where in benefits to a treatment may be challenged by risk to clients well being or dignity.

NON-MALEFICENCE 10

Non – maleficence is the avoidance of harm or hurt. In health care ethics it is important to remember that ethical practice involves not only the will to do good , but also the equal commitment to do no harm. It promotes a continuing effort to consider potential harm even when it is necessary to promote health.

VERACITY  Veracity concern truth feeling & in- corporation concept that individuals should always tell the truth.  It requires professional care given to provide accurate, reality based information about their health status & care of treatment.

JUSTICE  Issues that person should be treated equally & fairly.  Justice means that treating others fairly & giving persons their due.

FIDELITY  Keeping one`s promise or commitment fidelity holds a person should faithfully fulfil his duties & obligation

CONFEDENTALITY  Care giver should respect a patient need for privacy & use personal information about him or her to improper care.

CODE OF ETHICS FOR NURSES IN INDIA THE nurses respect the uniqueness of individuals in provision of care.

1.    

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 Provide care for individual without consideration of caste, creed, religion, culture, ethnicity, gender, socioeconomic & political status, personal attributes or any other ground.  Individuals care considering the beliefs, values & cultural sensitivities.  Develops and promotes trustful relationship with individuals.  Recognizes uniqueness of response of individuals to intervention & adopts accordingly.  Appreciates the place of individuals in family & community. NURSES respect the right of individuals as partner in care & help in making informed choices. Appreciate individual rights to make decision about their care & therefore give adequate and accurate information for enabling them to make informed choices. Respect the individual decision regarding care. Protect public from misinformation & misinterpretation. Advocate special provision to protect vulnerable individuals /group.

2. NURSES respect individual right to privacy, maintain confidentiality & information judiciously.  Respect the individual right to privacy of their professional information.  Maintain confidentiality of privileged information except in life threatening conditions.  Take informed consent & maintain annoyminity when information is required for quality assurance /academic /legal reason.  Limit the access to all personal records written and computerized to authorized person only. 4. Nurses maintains competence in order to render quality nurses care    

Only registered nurses must provide nursing care. Nurses strive to maintain quality nursing care & upholds standards of care. Nurse values continuing education, initiates & utilizes all opportunities for self development. Nurses values research as a means of development of nursing research adhering to ethical principles. 5. Nurse is obliged to practice within the frame work of ethical, professional & legal professional &legal boundaries.  Adhere to code of ethics & code of professional conduct for nurses in India developed by Indian nursing council  Familiarizes with relevant laws& practice in accordance with the law of the state.

6. Nurse commits to reciprocate the trust invested in nursing profession by society.  Demonstrate personal etiquettes in all dealings,  Demonstrate professional attributes in all dealings.

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CODE OF PROFESSIONAL CONDUCT;

MAINTAIN PROFESSIO NAL STANDARD IMPROVE CURRENT PRACTICE

SELF WORTH PROFESSIO NAL RESPONSIB LITY & ACCOUNTA BILITY

AVOID HARMFUL PRACTICE

COMPASSIONATE FOLLOW INDIAN NURSING COUNCIL

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MUST PROVIDE CARE IN RELATED TO STANDARD PRACTICE

RESPECT INDIVIDUAL& FAMILY ALONG WITH THE CULTURE & TRADITION

NURSING PRACTICE

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RESPECT HUJMAN DIGNITY

ENSURE SAFE PRACTICE

CONSULT COORDINATE COLLABORATION

ASSERTIVNESS Assertiveness is not a particular form of control .it is not a power. It is better described as art of confident clear honest & direct communication. Assertiveness is non-aggressive non-defensive &non –manipulative & do not interfere with other people freedom to take decision. CHARACTERISTICS      

Self presentable Ability to share Good attitude towards work Fearless expression Straight forwardness Self control

ASSERTIVNES COMMUNICATION It is way of communication that allow people to express themselves, direct ,honest& appropriate way that don’t infringe on another person`s right.         

ASSERTIVE BEHAVIOUR Standing up for one`s right no matter what circumstances are. Correcting situation when one`s right are violated. Seeking respect & understand for one`s feeling about particular situation. Interacting in a mature manner with those found to be offensive, defensive, aggressive, hostile, blaming attacking. Verbal ‘I’ statement, where individual tell others how they feel about others a situation, circumstances or the behaviors of others. Taking risk of being misunderstood as aggressive, abrasive or attacking. Being able to protect ones right while protecting & respecting the rights of others. Risk Taking behavior that is not ruled by fear of rejection or disapproval but is directed by rational belief that “ I deserve to stand up for my rights”. Rational thinking & self affirmation of personal worth respect & rights.

LEGAL ASPECTS IN NURSING: Professional nurse understand the legal limits influencing daily practice. Nurse must understand law to protect client`s right. It help to understand what is expected by our society from nursing care providers. The purpose for legal knowledge for nurses are;  To understand the legal responsibilities in nursing practice. 15

 

To understand what the legal responsibilities can be enforced. To understand what area of nursing practice can mostly create logical problems.

LAW: Law means body of rules to guide human action. Law defined as the sum total of manmade rules and regulations by which society is governed in a formed or binding manner. Sources of law 1. Constitutional law: It is a system of fundamental law or principles that govern a nation, society, corporation or another aggregate of individual. SATUTORY LAW: it is passed by legislative body or parliament of state in accordance with constitutional law. It regularize, relationship between citizen and state, between individuals and group and between individuals and other. Ex. State statue are the nurse practice act. These nurse practice act describe and define the legak boundaries of nursing practice with each other. Types of statutory law:  Criminal law  Civil law  Criminal law It prevents harm to society and punishment for crimes FELONY: felony is a crime of a serious nature that has penalty of imprisonment for greater than 1 year or even death. MISDEMANOR: Misdemeanor is a less serious crime that has a penalty of a fine or imprisonment for less than 1 year. CIVIL LAW: It protect the rights of individual person with in our society and encourage fair and equitable treatment among people. 2. REGULATORY LAW OR ADMINISTRATIVE LAW: It is created by administrative bodies such as state boards of nursing when they pass rules and regulations. Ex, regulatory law is due to report in completed or unethical nursery conducted to the state board of nursing. 3. COMMON LAW: It is created by judicial decision made in the courts when individual legal cases are decided ex. Common law is informed consent and the client right to refuse treatment. LEGAL ASPECT RELATED TO NURSING IN CENTRAL LEVEL:

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The Indian nursing council is only legislation related to nursing. It prescribes curriculum for nursing education and recognize qualification of institution with teaching program for nursing

STATE LEVEL The State government control through state nurses registration act . It prescribe rules of conduct to take disciplinary action and to maintain registration for nurse, midwifes and others.

LEGAL CONSIDERATION  FIRST nursing law, Nursing registration-1903  Indian nursing council act enacted in 1947.  Amended in 1957

LEGAL IMPLICATIONS  TORTS: Torts are Legal wrong made against a person.  TYPES OF TORT It may be classified into intentional and unintentional torts. 1. INTENTIONAL TORTS They are willful acts that violate another`s right .example are assault, battery, invasion of privacy and defamation of character. Assault: Assault occurs when a person put another person in fear of a harmful or offensive contact. The law protects client who are afraid of harmful contact. It is an assault for a nurse to threaten to give a client an injection or to threaten to restrain a client for an x-ray procedure when the client has refused to do so. A. BATTERY: Intentional touching of another`s body without other`s consent. The contact can be harmful to client and cause an injury or it can be merely offensive to the client`s personal dignity. Example; client give consent for appendectomy & physician perform tonsillectomy.

B. INVASION OF PRIVACY The tort of invasion of privacy protect the client`s right to be free from unwanted intrusion into his or her private affairs. 17

Example; release of a clients medical information to an unauthorized person, such as member of the press or the client`s employer. C. DEFAMATION OF CHARACTER; Defamation of character is the publication of false statements that result in damage to a person reputation these are two types: 1. Slander defamation is in the form of spoken words. 2. Libel defamation is in the form of written words.

 UNINTENTIONAL TORTS A. NEGLIGENCE: Negligence is conducted that fails below the standard of care. The standard of care is established by law for the protection of other an unreasonably great risk of harm. For examples:  Medication error that result in injury to client.  Intravenous therapy errors resulting in infiltrations or phlebitis.  Burns to clients caused by equipment, bathing or spills of hot liquids and foods.  Fails resulting in inquiry to clients.  Failure to use antiseptic when required .  Errors in sponge instruments or needle counts in surgical cases.  Failure to give a report or giving an incomplete report, to an oncoming shift.  Failure to adequately monitor a client`s conditions.  Failure to notify a physician of a significant change in a client`s status. B. MALPRACTICE: Failure to meet standards of acceptable care which result in harm to another person. C. BREACH OF IDEAS: Breach of duty may occurs when a nurse fails to act in accord with the standards of care. An act of commission or omission of the nurse may constitute a breach of the standard of care. D. FRAUD: It result from a deliberated deception intended to produce unlawful gain. E. FALSE IMPRISONMENT: Occur 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. ex. Telling a client not to leave the hospital until the bill is not paid. F. FRAUD: fraud result from a deliberate deception intend to produce unlawful gain. Example fraudulent billing practice include overcharging for services and billing services that were not provided. G. INVASION OF PRIVACY: Includes violation confidentiality, intruding on private client or family matters & sharing client information with unauthorized person.

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H. SAFETY: The promotion of physical safety is one of the most important responsibilities of the nurse. There are four areas regarding client safety in which nurse are legal RISK I. Failure to monitor client status.  Medication errors  Falls  Use of restrain

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SOME DO & DON`T  Do document all unusual incidences.  Do keep current year license to practice.  Do follow policies & procedures.  Do protect patient`s from injury themselves.  Do not accept money or gift from patient`s.  Do not give advice that is contrary to doctor`s or the nursing care plan.  Do not witness a patient`s will.  Do not work as a nurse without license. LEGAL RIGHTS OF NURSE  Right of appointing and assigning.  Right of quality control.  Right of using equipment.  Right to care public.  Right for observation and reporting.  Right for record keeping. RIGHTS OF A CONSUMER        

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Right of safety. Right to be informed. Right to choose Right to be heard Right to consumer education Poison care Artificial human insemination Dying declaration.

LEGAL DOCUMENTS a) ADVANCE DIRECTIVE: Written document recognized by law that provide direction concerning provision of care when a person is unable to make his or her own treatment of choices. b) DO NOT RESUCITATE ORDERS. : Written orders by a physician when clients has indicated a desire to allowed to die if client stops breathing or client`s stop breathing or client`s heart stop beating. c) INFORMED CONSENT: It is client`s approval for that of client`s legal representation to have his own or her body touched by a specific individuals. LEGAL RESPONSIBILITY: Legal responsibility in nursing means to practice nursing within the guidelines laid down by law of centre/ state, statutory bodies and policy.  Registration: licensing is mandatory, helps in protecting patients by providing qualified nurse. The nurse should register as per state nursing act.  Legal liability/ act of negligence: license of a nurse can be suspended or cancelled for any act of negligence or malpractice.  Medico legal cases: a patient admitted with some unnatural pathology and has to be taken care of in concurrence with police/court.  Road traffic accident  Injuries due to fights, shooting, bombs, blast etc.  Suicide  Burn  Poisoning  Rape victim  Assault NURSE ROLE IN SUCH CASES:  Obtain complete history.  Inform police/ constable on duty.  Record on patient sheet with red ink at right hand top  When pt is discharge inform CMO.  If patient abscond inform the CMO immediately and treating doctor.  No patient can leave against medical advice.  Document accurately & duly sign the nurses note.  Record all document and carefully handled.  Do not handle dead body to relatives In case of death of MLC patient  CORRECT IDENTITY: all baby born in hospital are correctly labeld at birth and handed over to right patient.  Unknown pt should be labeld as soon as identity is known  Site of operation should be marked correctly.  LAMA: Inform medical officer incharge. signature of both patient and relative should be taken.  Patient`s property: inform pt that hodpital will not take care of their belonging. If pt is unconscious make list of pt articles counter check by two nurse and the keep them safely. 21

 DYING DECLARATION: nurse should not involve herself . it is done by magistrate. But in emergency medical officer can record it with two nurses as witness.  RAPE VICTIM: Female attendant should be present during examination.  ARTIFICAL HUMAN INSEMINATION:  Written consent from both donor & recipient.  Same blood group  Confidential & safe recording   POISON CARE:  Do not give verbal or written order.  Do not allow for photos unless permission by authorities.  Do not give information to public or press  Preserve all evidence of nursing.  Collect & preserve all excreta, vomits and aspirations & send them to forensic laboratory at earliest.

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NURSING LIABILITES & PREVENTIVE MEASURES All nursing observations should be noted carefully, accurately. Patient`s complaint should be recorded as accurately & specifically. Nurse must report through proper channel. Authorities must be informed regarding any kind of equipment, materials or supplies, which for any reason less than safe for use in patient`s care Insurance protection

VISIBLITY OF NURSES   

       

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A quality or fact of degree of being visible. Degree of exposure to public notice. Nurse themselves are responsible when they don’t take a stand neither to correct the distorted images not for visibility of role they have performed in health care

NURSES ROLE TO PREVENT COMPLICATIONS Review nursing practice periodically update knowledge & improve skill by attending short term course. Should posses all knowledge and facts all rules & regulations of hospital & know descriptions. Follow nursing practice standards /protocol. Be a keen observer. Written instruction must have rules & code of practice to ensure safety & well being of patients. Maintain records & report of unit properly. Check the treatment order & use professional judgment. Follow all rights.

SUMMARY: A code of ethics is a formal statement of group ideas and values. A branch of philosophy means different to all, the study of ideas human behavior and ideal way of being.

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BIBLIOGRAPHY: 1. Vestal k. w nursing management & issues 2nd ED. Philadelphia Lippincott 1995 page no. 87-100. 2. Bowman Michael the professional nurse 1st edition. London chap man & hall 1995 page no 64-84. 3. Potter , Patricia A. fundamental of nursing 7th edition Elsvier 2009 page no 9,315 4. Annzwemer professional adjustment for nurses in India 6th edition (2006) page no 139-145.

5. Barbara kozier (2006) fundamentals of nursing, concept process & practice 2nd edition New Delhi page no 111-118. 6. Suzzane c. smelter (2009) Brunner & suddharth`s text book of medical surgical nursing 11th edition , New Delhi page no 2733. 7. http // www.ncbi.nin. nim. Ningov/pubmed. 8. http // www.bella online. Com / articles/art. 9. http // www.123 helpline. com / preview 10. http // www.slide share.net 11. http // www.scrib. Com 12. www. Nursing world. org// code of ethics for nurses. 13. www.icn ch/about-icn/ code of ethics for nurses. 14. www.ncbi nim.gov pubmed. 15. www dsrdk /ser document / icn code of English pdf.

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