ETHICS/ETIQUETTES IN NURSING

Ethics is a branch of philosophy that originated in ancient Greece. Ethics involves the
consideration of what is right and what is wrong or what causes good and what causes
harm. Ethics deals with one’s responsibilities (duties and obligation). Ethics look at
human behavior (what people do under what types of circumstances). Ethics are refer to
standard of doing things, while etiquette refer to ways of observing the ethics done in
accordance to the profession body.

CODE OF ETHICS FOR NURSES

Codes of ethics assists members of a professional organization in choosing behavior that

congruent with the values of the profession. They are those general standards and ideals
that members of a group strive to achieve. Code of ethics of an organization can be used
to guide others in determining whether someone acts as or like other individuals would
have in any situation. One hallmark of a profession is the determination of ethical
behavoiur for it members. Several nursing organization have developed codes as
guidelines for ethical conduct. The international council of nurses (ICN) first developed
its ethical code in 1953 and revised it in 2006. The ICN code for (ICN, 2006) emphasized
nursing’s respect for human rights, including the right to life, the right to dignity, and the
right to be treated with respect. The five (5) codes of ethics for nurses are:

i. Nurses and people: the nurse’s primary responsibility is to those people who
require nursing care. The nurse in providing care, promote an environment in
which the values, customs and spiritual beliefs of the individual are respected.
The nurse holds in confidence personal information and uses judgment in sharing
this information.
ii. Nurses and practice: the nurse carries personal responsibility for nursing practice
and for maintaining competence by continual learning. The nurse maintains
highest standard of nursing care possible within the reality of a specific situation.
The nurses uses judgment in relation to individual competence when accepting
and delegating responsibilities. The nurse when acting in a professional capacity
should at all times maintains standards of personal conduct which reflect credit
upon the profession.
iii. Nurses and society: the nurse shares with other citizens the responsibility for
initiating and supporting action to meet the health and social needs of the public.
iv. Nurses and co-worker: the nurse sustains a cooperative relationship with the co-
workers in nursing and other fields. The nurses takes appropriate action to safe
guard the individual when his care is endangered by a co-worker or any other
person.
v. Nurses and profession: the nurse plays the major role in determining and
implementing the desirable standards of nursing practice and nursing education.
The nurse is active in developing a core of professional knowledge. The nurse,
 acting through the professional organization, participates in establishing and
maintaining equitable social and economic working condition in nursing.

The ANA (2008) code for ethical conduct spells out the nurse’s obligation to clients and
society at large. Some of those obligation include maintaining client’s privacy and safety,
improving the standards of nursing care, and assuming responsibility for one’s nursing
actions.

The CAN developed a code of ethics in 1980 and revised it in 2008(CAN, 2008). The CAN
code serves as a guide for professional nurses to assist in working through ethical
dilemmas encountered in all practice setting.

Ethical principles

Ethical principles are tenets that direct or govern actions. They are widely accepted and
generally are based on the human aspects of society. Ethical decision are principled; that
is, they reflect what is best for the client and society. Ethical principle that are examined
in ethical situation are:

i. Autonomy: the principle of autonomy refers to the individual right to choose and
the ability to act on that choice. Autonomy is an individual’s right of self-
determination, independence, and freedom to make an informed decision
regarding their course of treatment, client’s rely on health care providers to
provide them with accelerate, current, and understandable information. Nurses
must respect client’s right to decide and protect those clients who are unable to
decide for themselves. The ethical principles of autonomy reflects the belief that
every competent person has the right to determine his or her own course of
action. The right to free choice rests on the client’s competency to decide.
Informed consent is based on client’s right to decide for themselves. Upholding
autonomy means that the nurse accepts the client’s best interests. Following are
examples of clients autonomous behavior that can impair recovery or treatment:
 Smoking after a diagnosis of emphysema or lung cancer.
 Refusing to take medication.
 Continuing to drink alcohol when one has cirrhosis.
 Refusing to receive a blood transfusion because of religious beliefs.

Limits to client autonomy are only placed when the rights of others are
infringed. For example, a client with a contagious dxs may be placed in
isolation or required by law to take medication to cure three disease to
avoid endangering the wellness of others.

ii. Nonmaleficence: is the duty to cause no harm to others. Harm can take many
forms: physiological, psychological, social, or spiritual. Nonmaleficence refers to
both actual harm and risk of harm. The principle of nonmaleficence helps guide
 decision about treatment approaches; the relevant question is will this treatment
modality cause more harm or more good to the client? Determining whether
technology is harmful to the client is not always a clear-cut decision. Factors
consider include the following:
 The treatment must offer a reasonable prospect of benefit.
 It must not involve excessive expense, pain, or other in convenience.

Nonmaleficence requires that the nurse act thoughtfully and carefully,

weighting the potential risks and benefits of treatment.

iii. Beneficence: is the ethical principle that means the duty to promote good and to
prevent harm. There are two (2) elements of beneficence:
1. Providing benefit.
2. Balancing benefits and harms.

Beneficence require nurse to go beyond nomaleficence and actively “do good” for
clients this is often viewed as the core of nursing practice. The nurse serves as a client
advocate and promotes the rights of the client.

iv. Justice: the principle of justice is based on the concept of fairness. The major
health-related issues of justice involve fair treatment of individual and allocation
of resource distribution. Justice mandates that all person be treated fairly nurses
should treat people impartially without regard to race, gender, medical
diagnosis, marital status, social standing, or religious belief. Access and allocation
of health care resource are involved in this principle. The ethical principle of
justice requires that all peoples be treated equally unless there is a justification
for unequal treatment. The concept specifies that resources should be allocated:
 Equally.
 According to need
 According to individual effort.
 According to the individual’s merit.
 According to the individual contribution to society.
v. Veracity: veracity means truthfulness, neither lying nor deceiving others.
Deception can take many forms: intentional lying, nondisclosure of information,
or partial disclosure of information. Veracity is difficult to achieve and demands
that nurses remain dedicated to telling the truth to clients and not deliberately
misleading them. Telling the truth is sometimes uncomfortable for the nurse.
However, discomfort is not a valid reason for avoiding the truth exceptions to
truth telling are sometimes upheld by the principles of maleficence, when the
truth does greater harm than good. The act of giving placebo medication is an
example of when telling the truth does greater harm than good.
vi. Fidelity: the concept of fidelity which is the ethical foundation of nurse-client
relationships, means faithfulness and keeping promises. Client have an ethical
 right to expect nurses to act in their best interests. As nurse function in the role
of client advocate (a person who speaks up for or acts on behalf of the client),
they are upholding the principle of fidelity. Fidelity is demonstrated when nurses:
 Represent the client’s viewpoint to other member of the health care
team.
 Avoid letting their own personal values influence their advocacy for
clients.
 Support the client’s decision even when it conflicts with the nurse’s
preferences or choice.

RIGHT AND RESPONSIBILITIES OF A NURSE

1. The patient has the right to considerate and respectful care.

2. The patient has the right to and encouraged to obtain from physicians and other
direct caregiver relevant, current, and understandable. Information concenring
diagnosis, treatment and prognosis, exception in emergencies when the patient
lack decision- making capacity and the need for treatment is urgent.
3. The patient has the right to make decision about the plan of care prior to and
during the course of treatment and to refuse a recommended treatment or plan
of care to the extent permitted by law and hospital policy and to be informed of
the medical consequences of this action. In case of such refusal, the patient is
entitled to other appropriate care and services that the hospital provides or
transfer to another hospital.
4. The patient has the right to have an advance directive (such as living will, health
care proxy, or durable power of attorney for health care) concenring treatment
or designating a surrogate decision maker with the expectation that the hospital
will honor the intent of that direction to the extent permitted by law and hospital
policy.
5. The patient has the right to every consideration of privacy care discussion,
consultation, examination, and treatment should be conducted so as to protect
each patient’s privacy.
6. The patient has the right to expect that all communications and records
pertaining to his/her care will be treated as confidential by the hospital, except in
cases such as suspected abuse and public health hazards when reporting is
permitted or required by law.
7. The patient has the right to review the records pertaining to his/her medical care
and to have the information explained or interpreted as necessary except when
restricted by law.
8. The patient has the right to expect that within its capacity and policies, a hospital
will make reasonable response to the request of a patient for appropriate and
medically indicated care and services. The hospital must provide evaluation,
service, and or referred as indicated by the urgency of a case and the patient
 must also have the benefit of complete information and explanations concerning
the need for risks, benefits, and alternative to such a transfer.
9. The patient has the right to ask and be informed of the existence of business
relationships among the hospital, educational institutions; other health care
providers, or payers that may influences the patients treatment and care.
10. The patient has the right to consent to or decline to participate in proposal
research studies or human experimentation affecting care and treatment or
requiring direct patient involvement and to have those studies fully explained
prior to consent. A patient who declines to partipated in research or
experimentation is entitled to the most effective care that the hospital can
otherwise provide.
11. The patient has the right to expect reasonable continuity of care when
appropriate and to be informed by physicians and other caregivers of available
and realistic patient care options, when hospital care is no longer appropriate.
12. The patient has the right to be informed of hospital policies and practices that
relate to patient care, treatment, and responsibilities. The patients has the right
to be informed of available resources for resolving disputes, grievances and
conflicts, such as ethics committee, patient representatives or other mechanism
available in the institution. The patient has the right to be informed of the
hospital charges for services and available payment methods.

Nurse bill of rights

The following nurse bill of rights was adopted by the ANA board of director on June 26,
2001.

 Nurses have the right to practice in a manner that fulfills their obligation to society
and those who receive nursing care.
 Nurses have the right to practice in environments that allow them to act in
accordance with professional standards and legally authorized scopes of practice.
 Nurses have the right to a work environment that support and facilitates ethical
practice, in accordance with code of ethics for nurses and its interpretive
statements.
 Nurses have the right to freely and openly advocate for themselves and their
patients, without fear of retribution(punishment)
 Nurses have the right to fair compensation for their work, consistent with their
knowledge, experience, and professional responsibilities.
 Nurses have the right to a work environment that is safe for themselves and their
patients.
 Nurses have the right to negotiate the condition of their employment either as
individuals or collectively in all practice settings.
 Nurses have the right not to be abused in any form by physicians, pharmacists,
administrators or nursing directors. Any abuse that occurs should be dealt with in a
professional and partial manner by the nurse employer.
 Nurses have the right not be exploited and abused by being floated to areas of
practice that they are not familiar with.
 Nurses have the right to refuse any assignment that they feel is unsafe such as when
a nurse is assigned a patient load he/she feels is unsafe. A nurse is assigned to work
in an area of nursing in which he/she is not familiar, a nurse knows that equipment/
supplies are inadequate or not available.