code of nursing ethics by chukwueke v.c

DATE: 7TH -11TH JULY 2014
Every society gears towards attainment of
optimal health of every individual. All known
societies have institutions and various category
of personnel that provide health services for the
prevention of diseases, promotion of health,
treatment of diseases and rehabilitation of
victims of chronic illnesses.
The health care delivery system is made up of
different health professionals who work together
in a team.
Each professional group is guided by internally
enforced codes of practice that members of the
profession must follow which are aimed at
protecting the consumers of the services and
preventing client exploitation as well as preserving
the integrity of the profession. These codes of
practice are referred to as “professional code of
ethics” which are also aimed at ensuring
professionalism. The code of ethics or professional
ethics for nurses was developed as a guide for
carrying out nursing responsibilities in a manner
consistent with quality in nursing care and the
ethical obligations of the profession.
At the end of this presentation participants will be able to .
 Define ethics and code of nursing ethics.
 Discuss the historical background of code of nursing ethics.
 State the types of ethics.
 Explain the principles of nursing ethics.
 Explain the purpose of professional code of ethics / nursing
codes of ethics.
 Discuss the International Council of Nurses (ICN) ethics for
 Discuss the Nursing and Midwifery Council of Nigeria’s code
of nursing ethics.
 Discuss why the revised code of nursing ethics was formulated
• The free online dictionary defines ethics as a
“set of principles of right conduct” a system of
moral values being in accordance with the
accepted principles of right and wrong that
govern the conduct of a profession.
• Berman and Snyder (2012) defines “code of
ethics” as a formal statement of a group’s
ideals and values”. It is a set of ethical
principles that is shared by members of the
group, reflects their moral judgments over
time, and serves as a standard for their
professional actions.
• Ethics is the branch of philosophy concerned
with the meaning of all aspects of human
behavior (
• Berman
described code of nursing ethics as a
formal statement of the ideals and
values of nursing and ethical
principles that serve as standards for
nurses action, concerning a behavior
that is normally right for a nurse in
professional situations.
• The need for an ethical code of nursing was perceived in
the 19th century. Some religious communities prepared
code of practice for their nurses in consonance with their
religious orders called “Rule of life”. According to
Babajide (2001), the origin of modern code of nursing
ethics is closely linked with Florence Nightingale; one of
the earliest nurses who perceived this need in the secular
world. It was based on Hippocratic oath dubbed from the
medical code. Historically, the Western medical ethics may
be traced to guidelines on the duty of physicians as
contained in the Hippocratic oath, the early Christian
teachings, the Jewish thinkers as well as the writings of
Muslim, physicians such as Ishaq, Ali Rahawi who wrote
the first book dedicated medical ethics called ‘conduct of
• By 1893 all expectations from a nurse in that era
were formulated in the present Nurses pledge. This
has also been revised by the Nursing and Midwifery
Council of Nigeria in 2001. The pledge is being
recited by student nurses at the beginning and end of
their training programme as a guide.
• By 1950, the America Nurses Association (ANA) in
agreement with this ideal, took the lead by adopting
for the first time, an elaborate code of ethics for
Nurses. This has been revised several times. The
1985 version is the present.
In 1953, the International Council of Nurses (ICN)
adopted her first code of nursing ethics. This has been
revised too and the 2000 edition is the present one.
The National Association of Nigerian Nurses and
Midwives (NANNM) has also revised hers in 2001.
Professional Nurses Associations of various countries
have either adopted the ICN code of Ethics or
formulated their own professional Nurses Ethics.
There are two types of ethics governing
an individual's life in a society.
These are personal and the professional
Nwonu in NOUN (2008), Kemp, Pilliteri
and Brown (1989) opined that personal
refers to a person's moral principle and
values acquired as the person develops
and matures through life span.
An individual code of behavior might include things
he ought to do, such as: being honest, spending his
time qualitatively in worthwhile activities, helping
and being kind to people and things he ought not
to do, such as: stealing, telling lies, cheating other
people or organization or consciously causing
harm to another. Personal ethics are influenced by
family, religion, education, peer group and vary in
individuals. The same may change or be modified
as a result of age, environment, situational
influence, economic affluence and religious status.
NOUN (2008), Kemp, Pilliteri and Brown (1989)
continues to emphasize and refers to it as the formal
or informal moral responsibilities peculiar to a
profession which are not shared by members of the
The informal professional ethics are unwritten while
the formal ones' are documented ethical codes.
Members do not only agree to subscribe to the ethical
codes to govern their conduct but also monitors other
members of the profession to ensure conformity on
them as well. Failure to conform may earn the
individual a suspension or a dismissal from the
The medical profession is the first
recognized profession in the health care
industry and therefore, the first to develop
a set of professional ethics among the
professions in the health care system. This
code of ethics shares many principles with
other professional ethics such as the
nursing and pharmacy codes of ethics.
Ethics have been part of nursing practice from the
early foundations of modern nursing in the late 19th
century. Nursing ethics shares many principles with
medical ethics because most parts of nursing ethics
have been derived from the medical ethics with
specific modifications in certain areas based on the
peculiarities of nursing practice. The provisions of
the medical ethics which are also similar to those in
the other professions in the health care system
include. Beneficence, non-maleficence, autonomy,
justice, dignity, veracity, confidentiality and fidelity.
Berman and Snyder 2012 also identified them as
principles of nursing ethics.
•Beneficence: This means that the practitioner
(nurse, doctor, pharmacist etc.) should act in the
best interest of the patient. All health care
professionals are therefore, expected to act in the
best interest of the patient. They are to implement
actions that benefit clients and families.
•Non-Maleficience: This means that the health care
professional should do no harm to the patient in
whatever form or way.
• Autonomy: The patient has the right to refuse
treatment offered. He/she has the right to self
governance. This is an indicator for health and
informed consent is implicated.
• Justice: This is concerned with the distribution of
scarce health resources and the decision of who
gets what treatment i.e. the principle of fairness
and equity. For example in a situation where two
patients condition require much attention. She
will need to weigh the facts carefully in order to
divide her time justly among her clients.
• Dignity: This advocates that the patient and the
person treating the patient have the right to
dignity the both should be respected.
• Veracity: Is concerned with the principle of informed consent
where the patient must be fully informed about and be made to
understand the potential benefits and risks of their choice of
treatment. Health care practitioners should be sincere in
dealing with the clients.
• Confidentiality: This refers to keeping secret; all information
obtained about the patient’s state of health except to those
directly involved in the care and the significant others.
Confidentiality relates to the concept of privacy. Information
obtained from an individual will not be disclosed to another.
This has some legal implications in modern day practice of
health care. On no account should the nurse divulge the
patients information to outsiders.
• Fidelity: This means to be faithful to agreements, promises
and commitments. Nurses have responsibility to patients,
employers, government and society as well as themselves.
According to Mitchell (1999) and Berman and Snyder
(2012) they purposes are as follows:
•It sets guidelines to demonstrate levels of minimum
practice required to maintain standards of conducts
within the profession.
•It informs members and the society of the primary
goals and values of the profession.
•Ethical codes provide a sign of the profession’s
commitment to the public it serves.
•It allows the people outside the profession to know the
ways members of that profession are expected to
consistently act.
•Guide the profession in self-regulation
•Outline the major ethical consideration of the
•Provide ethical standards for professional behavior
•Remind nurses of the special responsibility they
assume when caring for the sick.
•It serves as a mark of professional maturity and
•It serves as a frame work to making ethical
decisions as it provides a means of evaluating
alternative course of action.
The nursing ethics are aimed at regulating and
guiding the behavior and conduct of professional
nurses in the course of practicing as nurses and in
dealing with other professionals as well as the
general public. It protects the client from harm
and exploitation. According to Babajide (2001),
the origin of modern code of nursing ethics is
linked with Florence Nightingale who as early as
1857 documented points like providing selfless
service to the needy, avoiding harm to the client,
providing confidentiality and maintaining high
level of personal standard by the nurse.
According to the ICN code of ethics for
nurses (2006) and Kemp et al (1989), the
ICN code of ethics has four principal
elements that outline the standards of
ethical conduct. These elements are
•Nurses and the people
•Nurses and practice
•Nurses and Profession
•Nurses and Co-workers
The international council of nursing (1973) made the
following thirteen (13) declarations in its code of
nursing ethics.
1. The fundamental responsibilities of the nurse are
four (4) folds i.e.
–A. To promote health
–B. To alleviate suffering
–C. To restore health
–D. To prevent illness
2. Nurses at all times should ensure and maintain the
highest standards of nursing care and of professional
•3. The nurse must not only be prepared to practice
but shall maintain skill at consistently high level. This
could be achieved by continuing educational programs
like the MCPDP.
•4. Nurses should hold in confidence all personal
information entrusted to them. Information about
patient’s health should only be made available to
those concerned about his/her care and those that may
be affected by the health condition.
•5. The religion and ethic group of the patient shall be
•6. The nurse shall not recommend or give medical
treatment without medical prescription except on
emergencies/specific cases and should report such
actions as soon as possible to the appropriate
•7. The nurse is under obligation to carry out
physician prescriptions intelligently and to refuse
to participate in unethical procedures. Nurses must
therefore be up-to date in nursing and other health
care related issues.
•8. The nurse should maintain and sustain
confidence in the physician and other members
of the health team and where incompetence or
unethical conduct is exhibited, it should be
exposed but only to the appropriate authority.
•9. Nurses should not permit their names to be
used in connection with the advertisement of
products or any other form of personal
•10. Nurses should co-operate and maintain humorous
relationship with members of other professions and
other nurses. They should avoid unnecessary
misunderstanding, quarrels and conflicts with their
professional colleagues and conflicts with their
professional colleagues and other members of the
health team.
•11. The nurse should adhere to standard of personal
ethics which reflect credit upon the profession. All
forms of professional misconducts within and outside
the healthcare facilities should be avoided.
•12. The nurse shall always adjust to the
environmental changes and patterns of
behaviour of the community in which he/she
lives and practice provided it is not unethical.
•13.The nurse should participate and show
responsibility with other citizens and other
health professionals in promoting efforts to
meet the health needs of the public at local,
national and international levels.
The Nursing and Midwifery Council of
Nigeria (2012) presented a harmonized code
of nursing ethics under four (4) main
1. Nurses and people
2. Nurses and practice
3. Nurses and profession (Professionalism)
4. Nurses and co-workers.
This code of nursing ethics is a statement of the
ethical commitments of nurses and midwives
and sets the ethical standards by which all
cadres of nurses including student nurses in
training to conduct their practice from
frontline clinicians through to nurse educators
and nurse managers. It is intended to empower
the professional nurse practitioners to provide
effective care to individuals, families and
communities. All nurses and midwives
practicing in Nigeria must abide by the
provisions of the code of ethics.
This section demands the followings from the nurse:
1. Decisional capacity:
Consent must be obtained from legally accepted
individual. The nurse must be aware of all legislations
regarding mental capacity and ensure that people who lack
mental capacity to decide remain at the centre of decision
making and are fully safeguarded. Where a client lacks
substitutes as accepted by the law. The nurse must serve as
the client advocate especially where their wellbeing is
being compromised by family members, community or
health professionals e.g. in female genital cutting. The
nurse is not obliged to comply with client's wishes when it
is contrary to the law or when it unnecessarily endangers
his/her life. The nurse must respect the culture, religion
and decision making processes of the clients under their
2. Confidentiality:
Nurses must respect the right of each person to
informational privacy. You must ensure that the
clients are informed about how and why
information is shared by those providing care.
The nurse must advocate for clients requesting
for access to their health record subject to legal
requirements. Person's health information must
only be disclosed to authorized persons unless
there is a substantial risk to others or as legally
This is concerned with health care delivery and health
information management. Nurses must be committed to
the delivery of quality nursing and midwifery care at all
• Nurses must practice as required by the laws and the
provisions of the code of ethics.
• The nurse must have the required knowledge and skills
for safe and effective practice.
• The nurse must continuously update his/her knowledge
throughout the professional career in order to develop
and maintain competence.
• The nurse must recognize and practice within his/her
level of competence and seek help from supervisors and
other competent practitioners where necessary.
• Nurses must also provide care based on available
evidence of best practice.
• Nurses must advocate for sufficient human and
material resources to provide safe and competent
care which must be properly distributed.
• They must contribute to and promote safe and
supportive work environment with respect for
human rights, values, customs and spiritual beliefs
of the people.
• Nurses must maintain high standard of personal
health so that the ability to provide care is not
• Every nurse is personally accountable for
actions and omissions in the course of practice
and must always justify decisions taken.
• Nurses must be committed to keeping clear and
accurate records of assessments, care and
treatment. Records must be completed as soon as
possible after an event has occurred.
•The nurse must not tamper with original records
in any way. All written records must be legible,
dated, timed, signed, counter-checked by nursein-charge or a senior nurse and be securely kept.
• Nurses must contribute to the positive image and development
of the profession.
• The nurse must maintain standards of personal conduct which
reflect well on the profession.
• Nurses must not use their professional status to promote issues
that are not related to health e.g. FGM and advertisements.
• Nurses must participate in the advancement of the profession by
contributing to best practice, education, administration and
• The nurse must actively participate in determining and
implementing acceptable standards of clinical practice,
education, administration and research at all times.
• The nurse must adhere to approved dress policy at all times.
• Nurses must collaborate with colleagues,
professional associations, training institutions
and other groups to present nursing views in
ways that are consistent with their professional
roles and capabilities which are in the interest of
the public.
• The nurse must share responsibility with society
for initiating and supporting actions to meet
health and social needs of the public especially
the vulnerable.
The nurse must refuse any gifts, favours or
hospitality that might be interpreted as an attempt
to gain preferential treatment.
The nurse must not ask for or accept any gifts,
money, loan or undue favour from anyone in
his/her care or any one related or associated with
their clients.
The nurse must clearly establish and actively
maintain clear sexual boundaries at all times with
people in his or her team and members of their
• The nurse must be committed to working effectively as a
member of a team.
• The nurse must work co-operatively within teams and must
respect the rights, skills, expertise and the contribution of
every member of the team.
• Nurses must be willing to share their skills and experience for
the benefit of their colleagues.
• The nurse must assist students and others to develop their
• The nurse must consult with colleagues where and when
necessary and must treat colleagues fairly, with respect and
without discrimination. Where delegation of duty or
responsibility to another person is required, the competences,
knowledge and skills of the person must be ascertained.
• Nurses must ensure that the outcome of delegated task
meet required professional standard. Referral must be
made when it is in the best interest of the client.
• The nurse must act without delay if he/she believes that
he/she or a colleague or anyone else may be putting
someone at risk.
• The nurse must inform someone in authority if he/she
experiences problems working within this code of
ethics or other nationally agreed standards.
• The nurse is justified in using reasonable means to
protect himself/herself against threatened or actual
violence in the course of providing care.
• The nurse must admit mistakes and take all necessary actions
to prevent or minimize harm arising from adverse event.
• The nurse must explain fully and promptly to the persons
involved in an adverse event what has happened and the likely
• The nurse must give a constructive and honest response to
anyone who complains about the care they have received.
Someone's complaint should not prejudice the care you render
to him/her.
• The nurse must seek constructive and collaborative approaches
to conflict resolution and must cooperate with internal and
external investigations when the need arises. The nurse must
take preventive as well as corrective actions to protect persons
from incompetent, unethical or unsafe care.
Nurses growing awareness that ethical
problems arising in their professional;
practice has largely occurred due to
i. Social and technological changes
ii. Nurses conflicting loyalties and
This is the origin so that it can help solve
some ethical dilemma according to Berman
and Snyder (2012).
Social And Technological, Changes
 Social changes such as women organizations and
women's movement have exposed lots of these
changes such as;
• Work places redesigned under managed care.
• The high cost of medical care.
• Issues of fairness especially in the distribution of
resources whether equally or equitably.
• New collegiate system, a change in status of
studentship to start and come at par with other
• Emphasis on research for professionalism.
Social And Technological, Changes
Technology creates new issues that had not existed in the past E.g.
Parenteral feeding
Scan x-ray
Endoscopy etc.
There was no question about whether to allow a premature baby with
low birth weight to die, this was obvious.
Before organ transplantation, death did not require a legal definition
that might still permit viable tissues to be removed and given to other
living persons.
Social And Technological, Changes
Advances in the ability to decode and control the
growth of tissues through gene manipulation, presents
new potential ethical dilemma related to cloning
organisms and altering the course of hereditary diseases
and biological characteristics.
Human experimentation and behavioral control, for
wholistic man were not in existence etc.
Today, with treatment that can prolong and enhance
biological life, several questions arise e.g.
Should we go ahead and do what we can?
Who should be sophisticatedly treated?
iii) Every one or only those who can pay, or only those
who have a chance to improve?
• The code of ethics for nurses is a formal statement of
the ideals and values of nursing and ethical principle
that serve as standard to nurses actions.
• It maintains the trust of the public in the profession
thereby ensuring that the clients continue to enjoy
quality services from the nurses.
• It is designed to encourage professionalism among
nurses and to establish standard of accepted behavior so
that both nurse and the public will understand what is
permissible from members of the profession.
• It also defends the interest of the nurse in the course of
her practice.
• Where it is well applied quality assurance is achieved.
Berman A, Snyders (2008) Kozier and Erb’s Fundamentals of Nursing,
concepts, process and practice, ninth edition, New Jersey; Pearson
Education Inc.
Berman A, Snyders (2012) Kozier and Erb’s fundamentals of Nursing,
concepts, process and practice, ninth edition, New Jersey; Pearson
Education Inc.
Kemp B, B, Pilliteri A, Brown P, (1989), Fundamentals of Nursing A
work for practice second edition, USA, Scott Foreman and company.
Nursing and Midwifery council of Nigeria (2012)
The ICN code of ethics for Nurses (2006), International Connial of
Retrieved 27/6/09. retrieved20th Sept 2013. , management, Ethical Business, Ethics an overview
Retrieved 20th Sept.2013.

similar documents