10/22/2021

CODE OF ETHICS
 Ethics-A system of morals, values, beliefs, norms and
principles that direct actions as being right or wrong.

 Morals -standards of right and wrong for individual or

community
CODE OF ETHICS  Code of ethics-A list of written statements describing morals,
values, beliefs, norms or principles that direct actions as being
right or wrong.

 Etiquette-a way of behavior/customs or rules governing

behavior regarded as correct in social life.

NURSING ETHICS
CODE OF ETHICS (Cont’d)
 Refers to ethical issues that occur in Nursing practice.
 Nurses have high value and worth.  Nursing ethics, which is a subset of bioethics, is the formal
study of ethical issues that arise in the practice of nursing
 Nursing profession requires integrity of its members and of the analysis used by nurses to make ethical
– they should do what is right regardless of personal judgments
cost. The nurse:-
 maintains patient confidentiality within legal and regulatory
 Ethical codes change as needs and values of the parameters.
society change.  Seeks available resources in formulating ethical decisions.
 Nursing is based on ethical values which respect the dignity,
autonomy and uniqueness of human beings, the privileged
nurse- patient relationship, and the acceptance of personal
accountability for decisions and actions.

The ICN Code of Ethics for Nurses

PURPOSE OF NURSING ETHICS
Four principal elements that outline the standards of ethical
 Inform the public about the minimum standards of the conduct.
profession. Elements of Ethical Code
 Provide a sign of the profession’s commitment to the public it  Nurses and the people
-nurse’s primary professional responsibility is to people requiring nursing
serves. care. The nurse holds in confidence personal information and uses
 Outline the major ethical considerations of the profession. judgment in sharing this information
 Nurses and practice
 Provide ethical standards for professional behaviour. -nurse carries personal responsibility and accountability for nursing
 Guide the profession in self regulation. practice, and for maintaining competence by continual learning
 Remind the nurses of the special responsibility they assume  Nurses and profession
-nurse assumes the major role in determining and implementing
when caring for the sick. acceptable standards of clinical nursing practice, management, research
and education.
 Nurses and co-workers
-nurse sustains a co-operative relationship with co-workers in nursing and
other fields

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ETHICAL DECISION-MAKING: Theories of Ethics

 Should be based on ethical principles rather than on emotions, MORAL PRINCIPLES (Ethical principles)
intuition (feelings), fixed policies or precedent (earlier similar
occurrence).
 Autonomy – right to make one’s own decisions.
1. Utilitarianism theory. The rightness or wrongness of an
action depends on the consequences of the action.  Non- maleficence – ‘do no harm’
Maximize the client’s well being  Beneficence – ‘doing good’ Maximize
2. Deontological theory. An action is right or wrong benefits/minimize harms
independent of its consequences.
 Justice – fairness.
 Balance the client’s need for autonomy with family members’
responsibility for the client’s well being.  Fidelity – to be faithful to agreements and promises.
 Support each family system and enhance family support  Veracity – telling the truth.
system.
 Carry out hospital policies.
 Protect other client’s well being.
 Protect the nurse’s own standards of care.

Decision making ethical dilemma  Legal -relating to the law

 Law -a binding custom or practice of a community
 Ethical dilemma -situations in which there is a  Nurses need to know and apply legal aspects in their many
difficult choice to be made between two or more different roles.
options, neither of which resolves the situation in a  Nurses need to understand laws that regulate and affect nursing
manner that is consistent with accepted ethical practice to ensure that their actions are consistent with current
guidelines. legal principles and to protect the nurse from legal liability.
o Autonomy vs beneficence  Competence in nursing practice is determined and maintained by
 Nurses are required to administer prescribed medicine, but various credentialing methods e.g licensure, certification and
patients, at the same time, can refuse them. accreditation.
o DNR (do not resuscitate)  Nurses act: Chapter 257 of Kenyan constitution - provision for
the training registration, enrolment & licensing of nurses. Also to
o Science vs. spirituality. regulate their conduct & to ensure their maximum participation
 Refusal of blood transfusion in the health care of the community

Legal Aspects of Nursing in Kenya Legal Aspects of Nursing in Kenya

 Negligence (breach of a duty of care which results in damage)
You will be charged with this offence if you do not provide the  A diligent and reflective nurse can reduce the risks of
expected care to a patient or client in the field you were trained malpractice by consistently incorporating the following
in. four elements into her practice:
– Excellent communication skills, with consistent efforts to
elicit and address the expectations and requests of the
 There is no guaranteed way to avoid a medical malpractice suit patient
short of avoiding practicing as a professional nurse. Even the – Sincere compassion for each patient
best nurses have been named as defendants. – Competent practice
 Nursing malpractice -any act or omission by a physician – Accurate and complete charting with notations of any
during treatment of a patient that deviates from accepted deviations from the applicable standard of care with the
norms of practice in the medical community and causes an specific reasons (eg the patient refused chest radiograph
injury to the patient. due to time constraint), and the patient's noncompliance

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Legal Aspects of Nursing in Kenya PATIENT’S BILL OF RIGHTS

The patient has the right to:-
 MISCONDUCT
1. Considerate and respectful care.
Misconduct includes stealing drugs or hospital property, forgery or
2. Obtain from care givers relevant, current and understandable
fraud, coming on duty while drunk, fighting while on duty or use of information concerning diagnosis, treatment and prognosis.
abusive language. 3. Make decisions about the plan of care prior to and during the
 IMPROPRIETY course of treatment and to refuse a recommended treatment or
As a nurse the profession binds you to conduct yourself professionally
plan of care to the extent permitted by law and hospital policy
and to be informed of the medical consequences of this
while on duty or off duty.
action.
If you fight in a bar or anywhere or conduct yourself unprofessionally 4. Have an advance directive e.g. a living will concerning
you will have discredited or shamed the nursing profession and will, treatment.
therefore, be liable to be charged with impropriety.

PATIENT’S BILL OF RIGHTS INFORMED CONSENT

5. Privacy. Case discussion, consultation, examination and

 Is an agreement by a client to accept a course of treatment or a
treatment should be conducted to protect each patient’s
procedure after being provided complete information,
privacy.
including benefits and risks of treatment and prognosis if not
6. Expect all communication and records pertaining his/ her treated by a health care provider.
care will be treated as confidential.
Types:
7. Review records pertaining his/ her medical care and to have
 Express – may be a written or an oral agreement. The greater
the information explained or interpreted as necessary except
the potential for risk to the client, the greater the need for
when restricted by the law.
written permission.
8. Consent or decline to participate in proposed research studies
 Implied – exists when the individual’s non-verbal behavior
or human experimentation affecting care and treatment or
indicates non-verbal behavior e.g taking of vital signs.
requiring direct patient involvement.
9. Be informed of the hospital policies and practices that relate
to patient care, treatment and responsibilities

INFORMED CONSENT (CONT’D) INFORMED CONSENT (CONT’D)

 General guidelines on information required for the client
to make an informed decision include:-
Elements of informed consent
 The purposes of treatment
 Must be given voluntarily.
 What the client can expect to feel or experience
 Must be given by a client or individual with the capacity and
 The intended benefits of the treatment competence to understand.
 Possible risks or negative outcomes of the treatment  The client or individual must be given enough information
 Advantages and disadvantages of possible alternatives to be the ultimate decision-maker.
Exceptions for informed consent
 Minors.
 Persons who are unconscious or injured in such a way that
they are unable give consent.
 Mentally ill persons who have been judged by professionals.

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LEGAL PROTECTIONS IN NURSING

INFORMED CONSENT (CONT’D)
PRACTISE: GOOD SAMARITAN ACTS
Nurse’s role  Good Samaritan acts are laws designed to protect health care
The nurse is not responsible for explaining the procedure but for providers who provide assistance at the scene of an emergency
witnessing the client’s signature on the form. against claims of malpractice unless it can be shown that there
The nurse’s signature according to Sullivan (1998) confirms:- was a gross departure from the normal standard of care or
willful wrongdoing on their part.
 Client gave consent voluntarily
 Signature is authentic
 Client appears competent to give consent.

GOOD SAMARITAN ACTS (CONT’D)

Guidelines for nurses who render emergency care
 Limit actions to those normally considered first aid, if
possible.
 Do not perform actions that you do not know how to do. Other law in Kenya regarding
 Offer assistance, but do not insist
 Have someone go for or call for additional help. health and illness
 Do not leave the scene until the injured person leaves or
another qualified person takes over.
 Do not accept any compensation.

 The Public Health Act (cap 242)

 Mental Health Act Cap (248)
This Act is commonly referred to as the mother Act among the Acts of
Due to exposure to mental health and psychiatric nursing.
Health Professionals.
You will interact with such patients in your practice as a general nurse,
It describes the health delivery services in the country.
midwife and community health nurse.
 Pharmacy and Poisons Act (Cap 244)
 Medical Laboratory Technicians and Technologists Act (1999)
Deals with drug prescription and administration.
 Deals with collection body specimens from patients and clients.
 Medical Practitioners and Dentists Act Cap (253)
Clinical Medicine Act
In community health nursing practice or private nurse practice you will be
This law is related to the medical Practitioners and Dentists Act
expected to diagnose and treat minor ailments, this encroaches on this
because of diagnosing and treating minor ailments.
law.
 Food, Drugs and Chemicals Act
 Narcotic Drugs and Psychotropic Substances (Control) Act 1994
You will be dealing with the nutritional status of the patient. In
While dealing with the dangerous drugs, you will be required to be familiar
addition, you are one of the food handlers in the hospital.
with this law.

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 Children and Young Persons Act

In your practice you will be interacting with babies, children,
adolescents and teenagers. This may be in wards, departments,
clinics, maternity, school health and the community. Remember
children have rights which you must recognise. PROFESSIONALISM IN NURSING
 Workman's Compensation Act PRACTICE
It outlines what you should do in cases of accidents during practice,
with specific focus on how to go about applying for compensation
of the damages caused as a result of the accident

PROFESSIONALISM IN NURSING PRACTICE:

Responsibility & accountability
 Responsibility: PROFESSIONALISM IN NURSING PRACTICE:
– A nursing task/duty (a commitment or expectation to
perform some action) associated with one’s role
 According to the American Nurses Association (ANA,
– Portion of the responsibility can be shared with others
2015), nursing accountability requires nurses to be
involved in the situation (ANA, 2015a)
answerable for their actions and act according to a code of
 Professional nursing accountability is a core aspect ethical conduct. Such ethical conduct includes abiding by
that underpins professional nursing practice –as the principles of beneficence, respect for human dignity,
emphasized by professional organizations and veracity, fidelity, loyalty, and patient autonomy
education agencies

Accountability can be seen throughout all aspects of PROFESSIONALISM IN NURSING PRACTICE:

nursing practice, such as:  Positive attitude toward nursing profession
 Nurses must show compassion and respect for the dignity of the
a) Ensuring/providing safe, quality care individual. He or she is therefore unrestricted by economic status,
personal attributes, or the nature of the disease. For example, a
b) Delegation –giving responsibilities to your subordinate
nurse might not be comfortable with caring for an alcoholic client.
c) Following (and questioning) policy and procedures
However, she is ethically obligated to provide the best and most
d) Practicing within the guidelines of the Nurse Practice Act compassionate care possible.
e) Maintaining confidentiality
 Nurses ought to preserve their own integrity and act competently at
f) Questioning standard of care, provider’s orders all times.
g) Alignment of care to organizational practices, philosophy
 The nurse is responsible for maintaining the reputation of nursing
h) Competence in clinical skills through her practice
i) Lifelong learning- Continuous professional development
(CPD)
j) Patient advocacy (Battié, & Steelman, 2014)

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 If as a family health care provider you test

weddy’s husband and turns to have STI, then
he tells you not to tell weddy. Being weddy’s
primary care provider, what will you do?
Discuss.