Introduction to Nursing

Ethics
PIR BUX JOKHIO
•Nursing is a profession that has its own code
of conduct, its own philosophic views, and
its own place in the health care team. . . .
Nurses work under their own license. That
means that nurses are completely
responsible for their work. —Janet r. Katz, A
Career in Nursing: Is It Right For Me?
Objectives
• Define the terms: ethics, nursing ethics and bio-ethics, value, belief,
morals, attitude, conflict, dilemma, ethical dilemma
• Discuss importance of ethics in nursing
• Review criteria of a profession
• Develop Characteristics of a Professional Nurse
Behavior / conduct
• the way in which one acts or conducts oneself, especially towards
others. "he will vouch for her good behavior“
• In response to a particular stimulus
• Ethical behavior of nurses is a strong relational and contextual
process in which individual and contextual aspects play an important
role.[1] Individual factors such as values, faith, experience,
knowledge, skills, and also contextual factors such as moral
awareness, observation, analysis, and judgment may affect nurses’
ethical behavior and decisions. Nurses rely on education, religious
values, their intuition and feelings, guidelines, standards, colleagues’
support, and the potential consequences of their choices to justify
their decisions.
Attitude
• a feeling or opinion about something or someone, or a way
of behaving that is caused by this
• BELIEF: the feeling of being certain that something exists or is true:
(Cambridge Dictionary)
• Value:- the importance or worth of something for someone:
• Conflict:
an active disagreement between people with opposing opinions or
principles:
• Morality: Standard practices of a society
ETHICS
• Ethics have been internationally recognized as a fundamental part of
the work of nurses.
• The ethical questions that nurses face in their work range from the
clinical issues they face every day with patients (Ulrich et al. 2010) to
specific disease and treatment related decisions (Pavlish et al. 2012,
Winterstein 2012).
• Ethical questions are raised about their collaboration with colleagues
and other professions (Engel & Prentice 2013, Ewashen et al. 2013).
• Nursing professionals from the very early years constructed the
meaning of nursing around ethics and ethical ways of caring,
knowing, and acting.
What are ethics?
• Ethics is a branch of philosophy that explores ideal forms of human
behavior.
• The purpose of ethics is to understand, analyze and distinguish behaviors
and attitudes that are right or wrong (or good and bad).
• Ethics are concerned with right and wrong, while morals refer to individual
behaviors and beliefs. Moral reasoning may be used to inform ethics in
practice, but ethical judgments are generally agreed on by a wider body of
individuals, eliminating the personal perspectives that may influence moral
actions.
• Ethical systems of care rely on a general agreement whereby specific
activities are considered to be beneficial or detrimental to patient
wellbeing. Ethical theories provide a framework for interactions with
clients or service users. From these theories, ethical principles have
developed to guide judgments on how to care for patients.
ETHICS
• Ethics refers to the values and principles concerning defect human
conduct
• Difference between right and wrong conduct
• Study of ideal human behavior or conduct
• Professional ethics refers to the general moral norms that are
acceptable in a certain occupational group (Beauchamp & Childress
2009) to deal with morally ambiguous situation (Frankel 1989) and
thus prevent and avoid, ethical harm (Brecher 2014).
• Creates confidence between professionals and profession and public
 What are nursing ethics?
• Ethical dilemmas are commonly seen in nursing practice, where a decision to
treat a patient may be associated with potential benefits and risks. Weighing up
these up should be guided by an ethical framework or set of principles. Nurses
should understand how ethical principles apply to practice, to ensure that they
comply with the professional values and expectations of their role.
• Application of ethics can be objective or relative, depending. Objective ethical
reasoning implies that a situation has a clear right or wrong course, such as the
decision to administer emergency care to a patient in need. However, it is
important to balance the potential positive and negative effects of a course of
treatment. Relativism in ethical judgments is common in nursing practice, where
there may be pros and cons associated with an action. Examples include the use
of warfarin in patients with atrial fibrillation- warfarin helps prevent blood clots
and stroke, but is associated with many complications and a risk of bleeding.
Balancing the risks and benefits of a treatment course and implementing suitable
precautionary measures are vital to ensure the ethical treatment of patients.
NURSING ETHICS
• “The examination of all kinds of ethical and bioethical issues from the
perspective of nursing theory and practice, which, in turn, rest on the
agreed core concepts of nursing, namely: person, culture, care,
health, healing, environment and nursing itself” (Johnstone ,2008, p.
16).
• Ethics is embedded in practice and all activities of nursing.
PROFESSION
• A profession refers to an occupational group that posses specialized
skills that are based in some way on esoteric knowledge (Abbott
1983). The group responds autonomously, collectively and
collaboratively.
• Professional ethics appear in formal/ethical codes (Frankel 1989),
obligations and perceptions of relationships between colleagues and
with the public (Beauchamp & Childress 2009).
• The aim of the nursing profession is to promote healthy lifestyles to
individuals and communities (International Council of Nurses (ICN)
2012).
PROFESSION
• A profession ethics is closely connected with personal characteristics,
etiquettes, manners (Abbott 1983).
• Professional ethics appear in formal/ethical codes (Frankel 1989),
obligations and perceptions of relationships between colleagues and
with the public (Beauchamp & Childress 2009).
• The aim of the nursing profession is to promote healthy lifestyles to
individuals and communities (International Council of Nurses (ICN)
2012).
• Professional ethics is branch of care ethics
NURSING AS A PROFESSION
• Historically, nursing has been understood as a calling and a vocation
(Robb 1900, Nelson 2000), but modern, secular nursing has
essentially understood itself as a profession and, more recently, as a
practice.
• Profession, the following characteristics are commonly noted: a
unique body of knowledge, altruistic service to society, a code of
ethics, significant education and socialization, and autonomy in
practice, i.e. reasonable independence in decision-making about
practice and control of the work situation and conditions (Freidson
1970, Rutty 1998).
• Professional ethics and codes of ethics are the primary means for
expressing the values and regulating the conduct of professionals in
relation to their clients.
• Professional ethics is a holistic approach to care, including
professional rules and regulations.
• It is based on personal commitment and accountability in the nurse’s
role.
• They involve self respect and self-evaluation and help to form nurses’
respective relationships with patients, nurse managers and other
stakeholders (Vanaki & Memarian 2009).
• It, in nursing. includes the description of professional responsibilities
and duties that support and maintain the societal purpose of the
profession.
• It includes demanding that professionals provide services and carry
out care competently, effectively and in a way that will not cause
avoidable harm to the patient (Johnstone 1989).
• Professional ethics Clinical competence
• Professional ethics ………….Accountability and responsibility ……….
Influence Clinical competency

• Professional ethics Observing rules, regulations and patients rights

• Professional ethics is all about your continual learning

Professional and personal values
• Professional nursing values are human dignity, equality, preventing
suffering, honesty and responsibility.
• They create the basis for nurses’ duties and rights, which help to
achieve the goals of the profession.
• Nurses have professional duties and obligations towards the patient,
the nursing profession, their colleagues, other health professionals
and society (Liaschenko & Peter 2004, Verpeet et al. 2003).
• Nurses’ professional rights are based on legislation and professional
values, and so-called earned rights based on particular education or
experience (Kangasniemi et al. 2010).
• Nurses have the professional right to be respected by society, act as an
advocate for patients and refuse to take part in-patient care if it is against
their own values.
• Professional ethics is also related to an individual’s personal experience of
values (Rassin 2008).
• Professional ethics related to the regulation and codes
• Professional ethics has been guided and documented in legislation,
advisory documents, nursing ethics textbooks and codes and is linked to
the current era and the legislation at that time (Johnstone 1987).
• General legislation defines the aim of the profession on a national and
societal level (Kangasniemi et al. 2010).
• There are also laws focused on nursing and health care (Verpeet et al.
2003). In many countries, national or international advisory documents
help to inform policies, provide a professional identity and regulate the
nursing profession.
Professional Ethics and Codes
• Professional ethics is formulated and condensed in professional codes
(Verpeet et al. 2003), that focus on individual professions. These
codes combine the contents of professional ethics and aim to support
clinical care and guide the professional ethic (Dobrowolska et al.
2007).
• The Society and surrounding culture affect the values of professional
ethics and the way that is implemented, but society also creates an
environment where professional ethics can be maintained and
fulfilled.
• Variations in values emerge when it comes to different generations of
nurses, their position in the workplace and the type of unit they work
in(Rassin 2008).
Professional ethics
• Professional ethics is based on professional and personal
commitment, including rights, duties and responsibilities. They lay
down the values and principles that regulate the conduct of
professionals in relation to their patients and clients, colleagues,
other professions and organization. The aim of professional ethics is
to protect patients and give nurses guidance they need to contribute
to the development of a healthy society. Professional ethics in nursing
is often formulated in codes of ethics. They are related not only to
international nursing values but also reflect national legislation. The
nature of professional ethics in nursing is changing, reflecting the
current era and societal context
Purpose of professional ethics
• This purpose can be divided into the internal and external needs of
the profession. Internally, the main role of professional ethics is to
define ethical ideology and provide nurses with guidance how to work
in a morally accepted way. This includes describing values,
responsibilities and duties (Chadwick & Thompson 2000)
• Combining them with professional rights (Dobrowolska et al. 2007).
The external requirement for professional ethics to provide a ‘trade
description’ for general public, which describes nurses’ rights, duties
and responsibilities, tells people how they can expect to be treated
and cared for by nurses and helps profession to achieve its goals in
society. Rights and duties in professional ethics describe nurses’
responsibilities and expects to execute them in the best interests of
patients (Kangasniemi et al. 2010).
• Ethical dimension of nursing care is an essential element of nursing
practice. Some believe that being a nurse is a moral endeavor and
almost every decision that a nurse makes has a moral dimension.
Nurses are faced with complex situations where they are expected to
provide good care. Good care should be led in a direction that can
enhance the health integrity in physical, emotional, relational, social,
moral, and spiritual dimensions.
• However, there is ongoing concern about the ethical practice of
nurses. It seems that performing ethical practice in the presence of
daily moral dilemmas is difficult. Nurses have a moral commitment
not only to
Moral distress
References
• 1. KANGASNIEMI M., PAKKANEN P. & KORHONEN A. (2015)
Professional ethics in nursing: an integrative review. Journal of
Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12619