KNOWLEDGE & PRACTICE OF NURSING ETHICS AND LAWS

ORIGINAL ARTICLE
Shrestha S, Jose P

KNOWLEDGE & PRACTICE OF NURSING ETHICS AND LAWS

Shrestha S1, Jose P2

ABSTRACT

INTRODUCTION: Nurses are responsible for the well-being and quality of life of many people, and therefore must meet
high standards of technical and ethical competence. Values are the belief and attitude that influence individual behavior
and process of decision making. Personal values are what nurses hold significant and true for themselves, while
professional ethics involve principles that have universal applications and standards of conduct that must be upheld in all
situations. From the previous study it was found that most of the nurses have the knowledge regarding nursing ethic and
law but have lack of practice.

METERIAL AND METHODS: A descriptive cross sectional study was conducted among the selected nurses of
Universal College of Medical Sciences and Teaching Hospital (UCMS TH) Bhairahawa Nepal. Population for the study
was selected on random basis and total sample size was 60. A self-administered structured questionnaire about knowledge
of nursing ethics and law was devised, tested and distributed to the nurses and practice of same sample was assessed
through checklist by observing the activities of nurses by the researcher herself.

RESULTS: Among the total 60 respondents only 45% had adequate knowledge of ethics and rest of them had inadequate
knowledge regarding nursing ethics whereas most of the respondents i.e. 53% had adequate knowledge of nursing law and
only 46% had inadequate knowledge of it. On the other hand half of the respondents do practice on nursing ethics and law
and another half do less practice. As a whole it has been identified that respondents had more knowledge of nursing law
than that of nursing ethics and half of them do practice on it.

CONCLUSION: Findings of the study showed that knowledge of law was greater than knowledge of ethics. Overall they
had no satisfactory knowledge of ethics and law. Whereas 50% of respondents does adequate practice.

KEYWORD: Ethics, Law, Nursing ethics

1. Nursing Tutor,Universal College of Nursing Sciences, Bhairahawa, Nepal

2. Assistant Professor, Universal College of Nursing Sciences, Bhairahawa, Nepal

For correspondence
Pradap Jose (M.Sc Nursing)
Assistant Professor,
Universal College of Nursing Sciences, Bhairahawa, Nepal
E-mail: [email protected]

Journal of Universal College of Medical Sciences (2014) Vol.02 No.03 Issue 07 30

 KNOWLEDGE & PRACTICE OF NURSING ETHICS AND LAWS
ORIGINAL ARTICLE
Shrestha S, Jose P

INTRODUCTION accountability, duties, participation in the healthcare

environment, advancement of the profession, and
Different patient have different value and belief and nurses collaboration.4
have to think about their value and belief while providing
nursing care to them. If not so then dilemmas may occur when On the other hand law is a system composed of general rules,
different value conflict.1,2 For example client's right to refuse governing conduct and the procedures for solving disputes
treatment may be in conflict and carry out treatment. Nurse when rule are not followed. When laws are broken, it is
can make better moral decision by thinking in advance about punishable by an authority figure. Laws are those rules made
their beliefs and moral value and about the kinds of problem by humans which regulate social conduct in a formally
they may encounter while caring for the patient. Every nurse prescribed and legally binding manner.
patient contact can produce a legal or ethical situation.3
Legal responsibilities are defined as those which a nurse must
Ethics deals with standards of conduct and moral judgment. obey as a law in a professional manner. Legal aspect is defined
The major principles of healthcare ethics that must be upheld an s the activity of the nurse that legally permitted while taking
in all situations are beneficence, non- malfeasance, autonomy, care of the sick patient. Law is final authority to regulate the
and justice. Beneficence means promoting or doing good. activities of all citizens. Nurse need to be aware of this
Nurses work to promote their clients' best interests and strive standard, as well as legal and ethical concept and principles
to achieve optimal outcomes. Non malfeasance means since nurse are accountable for their action in these areas in
avoiding harm. Nurses must maintain a competent practice their professional role. Legal aspect may differ from country
level to avoid causing injury or suffering to clients. The to country depending on their law and code of ethics.5
principle of non- malfeasance also covers reporting suspected
abuse to prevent further victimization and protecting clients A study conducted in USA regarding the difficult patient
from chemically impaired nurses and other healthcare reconceived : an expanded moral mandate showed that
practitioners. Autonomy stands for independence and the between 15 and 60% of patient treated by physician are
ability to be self-directed. Clients have the right of self- considered difficulties. Psychiatric pathology of patient is an
determination and are entitled to decide what happens to them; conventional explanation that the patient are in difficulties .
therefore, competent adults have the capacity to consent to or The possibility of less pathological cause is suggested by
refuse treatment. Nurses must respect the client's wishes, even prevalence of the problem. There is an ethical force to address
if they don't agree with them. Finally, justice requires that all the perception of harm if there are ground to reconceived the
clients be treated equally and fairly. Nurses face issues of 'difficult' patient are reacting to the perception of ill treatment.
justice daily when organizing care for their clients and But ethical stakes make this conflict into the province of the
deciding how much time they will spend with each based on ethical consult service. As the resource for addressing ethical
client needs and a fair distribution of resources. dilemmas, there is a moral mandate to offer assistance in the
resolution of these ethically charged conflicts that is no less
Since nurses address complex ethical and human rights issues pressing than the more familiar terrain of clinical ethics
on a regular basis, the American Nurses Association Board of consultation.6 As the different research regarding ethics and
Directors and the Congress on Nursing Practice first initiated law had been conducted in different country and now by
the code of ethics for nurses in 1985 to delineate the code of conducting this research over here we can get an idea what is
responsibilities and conduct expected of nurses in their the level of knowledge and what are the practices of it in
practice. Nurses are held responsible to comply with the UCMS TH.The main objective of this study was to assess the
standards of ethical practice and to ensure that other nurses knowledge and practice of nursing ethics and law among
also comply. The code was revised in 2001 to include issues of nurses.
advancing nursing science and is based on the opinions and
experience of a wide range of nurses. The ANA approved nine
provisions that address ethical practice issues such as MATERIAL AND METHODS
compassion and respect, the nurse's primary commitment to
The descriptive cross sectional study was conducted in
the patient, patient advocacy, responsibility and

Journal of Universal College of Medical Sciences (2014) Vol.02 No.03 Issue 07 31

 KNOWLEDGE & PRACTICE OF NURSING ETHICS AND LAWS
ORIGINAL ARTICLE
Shrestha S, Jose P

UCMS TH from 30th March to 27th April 2013. Institutional Table 1. Socio demographic characteristics
approval was taken. All the interested registered, staff nurses
Characteristics Frequency Percentage
and axillaries nurse midwifery, were included and all the
Age
community medical assistant, voluntary nurses, nursing
18 to 26 48 80
student and the nurses who are not being registered in nursing
council were excluded from the study. The total sample size 27 to 35 10 16.7

was sixty which was taken on random basis. A structured 36 to 44 1 1.7

questionnaire was used to assess the knowledge of nursing >45 1 1.7
ethic and law and practice was assessed through the checklist.
Marital status
The number of items prepared was 22, 11 related to ethics and
Married 19 31
11 related to law which was filled by the respondent in 30
minutes. Similarly checklist consisted 15 questions which Unmarried 40 66.7

were checked by the researcher herself. Validity was Widow 1 1.7

maintained by sending the questionnaire to experts and Clinical experience

reliability was assessed by conducting pre-test on 10 samples
0 to 9 50 83.3
in Butwal Hospital Private Limited, Butwal.The data was
10 to19 6 10
analyzed by using appropriate descriptive statistics (Mean,
standard deviation). All collected data were arranged in order. 20 to 29 3 5

Coding of the questionnaire was done before entering into the 30 year and above 1 1.7

SPSS for window programmer. All completed data were Education status
arranged, checked, classified, coded and tabulated to make ANM 11 18.3
it clear and scientific. Data were entered in Microsoft excel
BSc/BN NURSING 7 11.7
2007 and analyzed in SPSS version 16. The data were
PCL 42 70
analyzed using frequency, distribution and percentage by
using tables. The data were scored and labeled as adequate Area of practice

knowledge and inadequate knowledge as well as adequate medical/surgical 13 21.7

practice and inadequate practice on ethics and law. Emergency 5 8.3
Association between knowledge and practice of ethic and law
Pediatric 3 5
was also assessed.
Psychiatric 1 1.7

RESULT ICU/CCU 8 13.3

GYE AND OBS 7 11.7

According to the analysis from the total 60 respondents only
Other 23 38.3
45% respondents had adequate knowledge and rest of them
Designation
had inadequate knowledge regarding ethics. On the other hand
from the total 60 respondents 53% of respondents had ward staff 51 85

adequate knowledge of law and other 46.7% of respondents ward in charge 9 15

had inadequate knowledge of law. Whereas 50% of
respondents had adequate practice and other 50% of
Table 1 shows the socio demographic characteristics of the
respondents had inadequate practice of ethics and law. Study
respondents. Most of the respondents were 18 to 26 ages i.e. of
showed that the value of ethics and law was more than 0.05 so
(80%). Among them 66.7% were unmarried. More than 50%
there was no any association between knowledge and practice
of respondent had 0 to 9 year clinical experience and few of
of nursing ethics and law and also no any association between
them i.e. 1.7 % only had 30 years and above clinical
demographic variable and law, but there was association
experiences. Majority of the respondents who involved in
between marital status and knowledge of ethics.
research were more from other area (neurology, major and

Journal of Universal College of Medical Sciences (2014) Vol.02 No.03 Issue 07 32

 KNOWLEDGE & PRACTICE OF NURSING ETHICS AND LAWS
ORIGINAL ARTICLE
Shrestha S, Jose P

minor OT) and very few were from psychiatric and pediatrics. DISCUSSION
21.7% of respondents were from Medical/Surgical and 13.3
were from ICU/CCU. Similarly 85% of respondents were A study conducted in medical students at Barbados generally
ward staff and 15% were ward in charge. understand the importance of ethical knowledge and the
majority answered correctly to questions designed to test how
Figure1: Overall knowledge of ethics they would respond in situations which deal with the nuances
of consent, confidentiality and patient autonomy. There were
substantial minorities of students who were uncertain or
incorrect on the questions pertaining to dealing with relatives,
religious conflict situations and violent patients. The students
responded that they knew little of the law, and were unaware
of codes of conduct other that the Hippocratic Oath.7 Whereas
present study shows that most of the respondents have more
knowledge on law than ethics, whereas half of the respondents
do practice of ethics and law but rest half donot follow ethic
and law.

CONCLUSION
Figure 2: Overall knowledge score of law
According to the data total mean knowledge of ethics was
7.2500; law was 7.3333 and similarly means practice of
respondents was 10.28. Finding of the study showed that
54.00% knowledge of law was greater than knowledge of ethics.
52.00%
50.00% Overall they had no satisfactory knowledge of ethics and law.
48.00% adequate Whereas 50% of respondents does adequate practice.
46.00%
inadequate
44.00%
42.00%
Series1
adequate REFERENCE
inadequate
1. Rai, L., Nursing concept theories and principles, 2011, pg 250.

2. Nursing ethics and legal issues, www.education.com/

reference/article/ nursing ethics.
Figure 3: Overall practice of ethics and law
3. Rai, L., Nursing concept theories and principles, 2011, pg 250.

4. Nursing ethics and legal issues, www.education.com/reference

/article/nursing ethics.

60% 5. Rai, L., Nursing concept theories and principles, 2011, pg 255,
258.
40%
adequate 6. Fiester, A., The difficult patient reconceived an expanded moral
20% mandate for clinical ethics, The American Journal of Bioethics.
inadequate
0% 7. Hariharan, S., et al., Knowledge, Attitude and Practice of health
Series1
adequate care ethics and law among doctors and nurse in Barbados, June
inadequate 2006, BMC Medical Ethics, Volume 7.

Journal of Universal College of Medical Sciences (2014) Vol.02 No.03 Issue 07 33