NURSING ETHICS AND JURISPRUDENCE

INTRODUCTION
Nurses perform hundreds of critical, health-related tasks every day. In some cases, the decisions
they must make test their professional and personal morality. Nurses need to practice
professional humility and flexible thinking. Professional nurses sometimes experience situations
in the workplace that challenge their personal and professional ethics.
Nursing Ethics and Jurisprudence is designed to provide the students with an understanding of
moral practice. It introduces the students to the statutory and common laws as they affect issues,
which form the basis for professional ethics in nursing and medical nursing and the legal
implications of contractual responsibilities in nursing practice.
Ethics of nursing and law are necessary in nursing because nursing is concerned with providing
services that impact human life and health and some of the situations the nurse encounters in
practice pose a dilemma that if not well handled will impact negatively on the client and all that
are concerned. Standards must, therefore, be set to guide the nurse to conduct himself/herself
properly, make adequate decisions and carry out actions that are appropriate and safe for the
client and thus protect herself/himself from litigation. These standards are found in the ethics of
nursing and the laws of the land hence the need for the course.
Morally courageous healthcare professionals, however, find a way to make ethical decisions
even if they are alone in their beliefs. Nurses who exercise this ability strive to behave according
to the nursing code of ethics, regardless of negative personal outcomes that may arise. These
outcomes may include a tainted reputation, personal embarrassment, angst, ostracism by peers,
employer or peer backlash, and career ramifications.

COURSE AIM
The course is designed to provide students with an understanding of moral issues which form the
basis of professional ethics in Nursing and the legal implications of contractual responsibilities
of nursing practice so that they can apply them in all nursing situations in which they are
required.

COURSE OBJECTIVES
The course is based on the underlisted objectives. After going through this course, the students
should be able to:
1. Explain the essentials in moral development and value clarification.
2. Discuss the relevant issues in nursing code of ethics and the regulation of nursing practice.
3. State the rights and responsibilities in client care and the legal roles of nurses.
4. Discuss areas of legal liabilities in nursing and the legal protection for the nurse.
5. Examine ethical problems and the different models for ethical decision making in nursing.
6. Apply the models for ethical decision making in the resolution of ethical dilemmas.

DEFINITION
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ETHICS
1. Is a branch of philosophy that deals with questions of morality, such as what is good and bad,
right, and wrong, and virtuous and non-virtuous.
2. Any system or theory of moral values or principles that guide one’s actions and decisions.
Some examples of ethical theories are utilitarianism, deontology, virtue ethics, and social
contract theory.
NURSE
1. Is a person who has received authorized education, acquired specialized knowledge, skills, and
attitude, and is registered and licensed with the Nursing and Midwifery Council to provide,
promote, prevent, support and restorative care to individuals, families, and communities,
independently and in collaboration with other members of the health team.
Must provide care in such a manner as to enhance the dignity of the profession, safeguard the
health of the individual client/patient and protect the interest of the society.
NURSING ETHICS
1. Nursing ethics is the applied discipline that addresses the moral features of nursing practice.
2. It is a subset of healthcare ethics or bioethics.
3. The examination of all kinds of ethical and bioethical issues from the perspective of nursing
theory and practice
This in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health,
healing, environment and nursing itself (or more to the point, its ultimate purpose), contrary to
popular belief, nursing ethics is not synonymous with an ethic of care.

IMPORTANCE OF NURSING CODES/GUIDELINES

There is a need for ethics in every aspect of our lives, including our careers. But for some
professions, such as nursing, ethics are essential due to the life-and-death responsibilities of
healthcare providers. It is not just patients affected by the decisions nurses make, but also their
families, for the rest of their lives.
Nursing practice has attained status that ethics and jurisprudence govern it.
Understanding ethics and the consequences of their actions can help a nurse make the best
decision when it isn’t always apparent. Ethical principles in nursing provide a framework for
assessing the behaviour of nurses in practice.
1. Allows nurses to carry out their responsibilities in a manner consistent with ethical obligations
and high standards of nursing care.
2. Helps caregivers consider patient needs from several viewpoints and maintain a safe recovery
environment.
3. Remind caregivers to treat all people equitably and individually while protecting them in ways
that may not seem overtly obvious.
4. Helps caregivers to advocate and seek justice for those in their care, and to take full
responsibility for their work as nurses.
5. Helps nurses create a safe, non-judgmental caregiving environment.

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6. Helps nurses’ express empathy through words and actions, while forming strong connections
with their patients.
7. Beneficial to developing strong nurse-patient and interdisciplinary relationships, which is
essential for collaboration and quality patient care.
8. Helps nurses to follow protocol and best practices while treating the patient as an individual
with their own wishes and preferences for care
9. Helps nurses take action to protect patients and themselves when unforeseen danger occurs.
10. Helps foster a dialogue that helps healthcare professionals find personalized and effective
care solutions
11. Assists nurses in making good judgment calls.
12. Encourages healthcare professionals to incorporate these moral guidelines into their personal
lives as well.
13. Healthcare organizations with nurses who exercise ethical nursing principles typically have
higher patient satisfaction scores, employee satisfaction, and lower employee turnover rates

ETHICAL CONCEPTS AND REGULATIONS THAT GOVERN NURSING.

TOPIC 1: VALUE CLARIFICATION.
INTRODUCTION
In providing nursing care, nurses find themselves in situations where sensitive decisions are
made about the best way to treat illness and solve health care problems. Values influence
decisions and actions, and value clarification promotes quality decisions by fostering awareness,
empathy and insight. Value clarification is therefore an important step for nurses in dealing with
ethical problems. This topic examines the definition of value, types of value, how values are
developed, essential nursing values and how to clarify nurses and clients’ values.
OBJECTIVES
At the end of this topic, the students should be able to:
1. Define value
2. Distinguish between the types of value
3. Describe how values are developed
4. Explain the essential nursing values
5. Explain how nurses can clarify their values and help clients to clarify their own values.
MAIN CONTENT
1. Definition of Value
 Value is a freely chosen, enduring belief or attitude about the worth of person, object,
idea or action.
It is a belief about worth that acts as standard to guide one’s behaviour. The worth or value one
ascribes to a person or object will determine how one behaves towards the person or how one
handles the object.
Values are often taken for granted. In the same way that one is not aware of one’s breathing, one
usually does not think about your values. One simply accepts them and acts on them.
 A value set is a small group of values held by an individual.
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People organise their sets of values internally along a continuum from most important to least
important, forming a value system. Value systems are basic to a way of life, giving direction to
life, and form the basis of behaviour especially behaviour that is based on decisions and choices.
 Belief (opinion) is an interpretation or conclusion that you accept to be true.
It is based more on faith than fact and may or may not be true.
Beliefs do not necessarily involve value.
 Attitudes are mental positions of feelings toward a person, object or idea; (e.g. acceptance
of a person, compassion for a person or openness).
Typically, an attitude continues over time, whereas a belief may last only briefly. Attitudes are
often judged as bad or good, positive or negative, whereas beliefs are judged as correct or
incorrect.
Attitudes have thinking and behavioural aspects, but feelings are essentially important
components because they vary greatly among individuals. For example, some clients may feel
strongly about their need for privacy whereas others may dismiss it as unimportant.
2. Types Of Values
There are six (6) basic types of values underlying a person’s interests and motives.
Although each person’s value orientation is a unique blend of these six types of values, one of
the types usually predominates.
Identifying one’s orientation as well as that of others will help one understand how people
perceive situations differently and choose different courses of action and make one better and
able to handle situations that confront one in the course of your work.
The value characteristics are:
TYPES OF RELATED CHARACTERISTICS
VALUE
Theoretical Truth values tend to be empirical, critical, and rational.
Keeps records and works with the facts on ground.
Economic Is interested in what is practical and useful.
He is not interested in irrelevance and does not believe in wasting
resources.
Aesthetic Values beauty, form, and harmony.
He does not like untidiness around him.
He believes that things should be done in an orderly manner.
Social Values human beings in terms of love and is kind, sympathetic and
unselfish.
He enjoys teamwork.
Political Values power.
He is interested in leading and directing. He desires recognition.
Religious Values unity.

3. Developments Of Values

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 An individual is not born with values. Rather values are formed over a lifetime through
information from the environment, family, and society. As a child observes actions, he quickly
learns what has high and low value for family members. For example, if a parent consistently
demonstrates honesty in dealing with others, the child will probably begin to value honesty.
Although people derive values from society and the subgroups of society, they internalise some
or all these values and perceive them as personal values. People need to inculcate societal values
to feel accepted, and they need personal values to have a sense of individuality. Nurses’
professional values are acquired during socialization into nursing. It is within the nursing,
educational programme that the nurse develops, clarifies and internalises professional values.
4. Essential Nursing Values
Specific professional nursing values are stated in nursing code of ethics, in standards of nursing
practice and in the legal system itself. Watson, (1981), outlined four important values of nursing
as follows.
 Strong commitment to service
 Belief in the dignity and worth of each person
 Commitment to education professional autonomy.
In comparison, in 1986, the American Association of college of nursing undertook a project that
included the identification of values essential to the practice of professional nursing. The group
identified seven values and related attitudes and personal qualities and professional behaviour.
Essential nursing values and behaviours are presented thus:
ESSENTIAL ATTITUDES AND PROFESSIONAL BEHAVIOUR
VALUES PERSONNEL
QUALITIES
Having the same Caring, commitment, Gives full attention to the client when giving care.
rights, privileges or compassion, generosity, Assists other personnel in providing care when they
status perseverance are unable to do so. Expresses concern about social
trends and issues that have implication for health care
Equality - Having Acceptance, Provides nursing care based on the individual’s needs
the same rights, assertiveness, fairness, irrespective of personal characteristics Interacts with
privileges, or status self-esteem, tolerance other providers in a non-discriminatory manner.
Expresses ideas about the improvement of access to
nursing and health care
Aesthetics - Appreciation, creativity, Adapts the environment so that it is pleasing to the
Qualities of imagination, sensitivity client. Creates a pleasant work environment for self
objects, events and and others. Presents self in a manner that permits a
persons that positive image of nursing.
provide satisfaction
Freedom - Capacity Confidence, hope, Honours individual’s right to refuse treatment.
to exercise choice independence, openness, Supports the rights of other providers to suggest
self-direction, self- alternatives to
disciplined. the plan of care. Encourages open discussion of
controversial issues in the profession.
Human Dignity - Consideration, empathy, Safeguards individual’s right to privacy, addresses

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Inherent worth and humanness, kindness, individuals, as they prefer to be addressed.
uniqueness of an respectfulness, trusts. Maintains confidentiality of clients and staff. Treats
individual others with respect regardless of their background.
Justice. Upholding Accountability, Documents nursing care accurately and honestly.
moral and legal authenticity, honesty, Obtains sufficient data to make sound judgements
principle inquisitiveness, before reporting infractions of organisational
rationality, policies. Participates in professional efforts to protect
reflectiveness. the public from misinformation about nursing.
Source: Kozier, B. et al. (2015)
Values influence decisions and actions. It is therefore important that values are clarified so that
decisions that are made will be based on clear values and this is in the best interest of the client,
the nurse and the institution.
 List alternatives
 Examine possible consequences of choice
 Choose freely
 Feel good about the choice
 Affirm the choice
 Act the choice
 Act with a pattern
5. Value clarification
Value clarification is a process by which people identify, examine, and develop their own
individual values. A principle of value clarification is that no one set of value is right for
everyone. When people identify their values, they can retain or change them and this act based
on freely chosen, rather than unconscious values. Value clarification promotes
personal growth by fostering awareness, empathy, and insight.
The process has seven steps centered on three main activities.
 Choosing (cognitive)
 Prizing (affective), and
 Acting (behavioural).
Choosing - beliefs are chosen freely without outside pressure from among alternatives after
careful consideration (reflection) of the consequence of each alternative.
Prizing - chosen beliefs are prized with pride and happiness
Acting - chosen beliefs are
 Affirmed to others
 Incorporated into one’s behaviour
 Repeated consistently in one’s life
i. Clarifying the Nurse’s Values
Nurses and nursing students need to examine the value they hold about life, health, illness and
death. One strategy for gaining awareness of personal values is to consider one‟s attitude about
specific issues such as abortion or euthanasia, asking “can I accept this? Can I live with this?”
“What will I do? What should I do in this situation?”

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To encourage health care professional to respect and accept the individuality of clients, some
educators have advised that professionals be “value neutral” and non-judgmental in their
professional role. The nurse has a commitment to tell clients whether the nurse and clients hold
the same value.
The nurse does not assume that her personal values are right and should not judge the clients
values as right or wrong depending on their congruence with the nurse’s personal value system.
This type of thinking enables a nurse to care for a client with different values. For examples, a
nurse who strongly believes that any pre-marital or extramarital sex is wrong may offer
competent and compassionate nursing care to a young prostitute with active sexually transmitted
illness. On the other hand, if the same client, following education, indicates that she is
unconcerned about whom she might infect in future sexual encounters, the nurse is in no way
bound to be non-judgmental about this response.
In this case, it would not be morally permissible for the nurse to view this behaviour with
indifference. Because not all values are equal, nurses may have a moral obligation to respond to
a client’s value that may cause harm to the client and others.
ii. Clarification of Clients’ Values
In order to plan effective care, nurses need to identify clients‟ values as they influence and relate
to a particular health problem. For example, a client with failing eyesight will probably place a
high value on the ability to see. This will inform the type of care the nurse will plan for the
client. When clients hold unclear or conflicting values that are detrimental to their health, the
nurse should use value clarification as an intervention. Examples of behaviours they may
indicate the need for value clarification include:
 Client ignores a health professional’s advice. For example, a client with heart disease
ignores advice to exercise regularly.
 Client exhibits inconsistent communication or behaviour – for example, a pregnant
woman says she wants a healthy baby but continues to drink alcohol and smoke tobacco.
 Client has a history of numerous admissions to health agency for the same problem – for
example, a middle-age obese woman repeatedly seeks help for back pain but does not
lose weight.
 Client is confused and uncertain about which course of action to take – for example, a
woman wants to obtain a job to meet financial obligations but also wants to stay at home
to care for an ailing husband.
 List alternatives: In listing alternatives, make sure that the client is aware of all
alternative actions. Ask, “Are you considering other courses of action?” “Tell me about
them.”
 Examine possible consequences of choice: In examining possible consequences of
choice, make sure that the client has thought about possible results of each action. Ask,
“What do you think you will gain from doing that? “What benefits do you foresee from
doing that?”
 Choose freely: To determine whether the client chose freely, ask, “Did you have any say
in that decision?” “Do you have a choice?”
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  Feel good about the choice: To determine whether the client feels good about the choice,
ask, “How do you feel about that decision (or action)?” Because some clients may not
feel satisfied with their decision, a more sensitive question may be, “some people feel
good after a decision is made, others feel bad, how do you feel?”
 Affirm the choice: To affirm the choice, ask, “what will you say to others e.g. family,
friends etc. about this?”
 Act the choice: To determine whether the client is prepared to act on the decision, ask,
“Will it be difficult to tell your friend about this?”
 Act with a pattern: To determine whether the client consistently behaves in a certain way,
ask. “How many times have you done that before?” or “Would you act that way again?”
When implementing these steps to clarify value, you should assist the client to think each
question through, but you should not impose your personal values. You may offer an opinion
only when the client asks for it and you should do so with great care.
Values influence decisions and actions. It is therefore important that values are clarified so that
decisions that are made will be based on clear values and this is in the best interest of the client,
the nurse and the institution.

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