Nursing Ethics

• Ethics are the moral principles that dictate and govern individual’s behavior and conduct.
• It deals with moral principle of right and wrong conduct, virtue or vices, good or evil guiding
an individual or group such as profession
• Ethical values are essential for all healthcare workers, but ethical principles in nursing are
particularly important given their role as caregivers and due to the peculiarity of nurses’ roles
and responsibilities.
• Nursing ethics is peculiar to nurses, while clinical ethics encompasses all that provide care to
individual and families at the bedside or in health care setting. Nursing ethics is a sub-set of
bioethics and clinical ethics that deals with and focuses on issues arising during the course of
nursing care/nursing practice and of the analysis used by nurses to make ethical judgment
• As nursing care is expanding in scope of practice, assuming a wider responsibilities for
managing care, it is essential that we are fully prepared to recognize the ethical dimensions of
our practices and to participate competently in ethical decision making as we are faced with
varying ethical issues on daily basis being the closest to the service users which ranges from
cost containment that could jeopardize patients welfare, end of life decisions, breech of
patients confidentiality and incompetent, unethical or illegal practices of colleagues and other
service providers
• According to the American Nurses Association (ANA), the nursing code of ethics is a guide for
“carrying out nursing responsibilities in a manner consistent with quality in nursing care and
the ethical obligations of the profession.”
• These are anchored on certain ethical principles which forms the basis for nurses’ decision on
consideration of consequences and of universal moral principles for clinical judgment.
• The most common and fundamental of these principles that are part of the nursing code of
ethics. These principles are ideally what every nurse should be aware of in their daily nursing
practice.
• They should be constants in nursing practice in order to provide the best, safest, and most
humane care to all patients.
1. Autonomy in Nursing
2. Beneficence in Nursing: Maximizing benefits and minimizing harms to participants and
society.
3. Justice: Ensuring fair distribution of benefits and burdens, and protecting vulnerable
populations
4. Non-maleficence: Avoiding harm or causing no harm to participants and society.
6. Veracity: Veracity, also known as truth-telling, is one of the seven ethical principles that
govern nursing. It requires nurses to tell their patients (or the patient's surrogate decision-
maker) the objective truth.
7. Fidelity: faithfulness to a person, belief, or cause. It is demonstrated by being loyal and
supportive. Fidelity in nursing means nurses must remain true to professional promises, such
as the promise to provide high-quality, competent, safe, and efficient patient care
8. Informed Consent: the process in which a health care provider educates a patient about the
risks, benefits, and alternatives of a given procedure or intervention. The patient must be
competent to make a voluntary decision about whether to undergo the procedure or
intervention.
9. Confidentiality and Privacy: Healthcare professionals are ethically obligated to maintain a
patient's privacy and protect their autonomy. Within all communication including written,
verbal, electronic or virtual the highest standards should be maintained with regards to
informed consent and confidentiality.
10. Objectivity and Impartiality: Avoiding bias and conflicts of interest.
11. Transparency and Openness: this involves sharing relevant information, feedback and
expectations in timely, honesty and respectful manner with patient. It also means encouraging
dialogue, listening actively, and addressing concerns or issues promptly.
12. Accountability and Responsibility: Taking responsibility for one's actions and decisions.
13. Respect for Vulnerable Populations: Protecting and involving vulnerable populations, such as
children, prisoners, and pregnant women, in research.
14. Cultural Sensitivity and Inclusivity: Respecting diverse cultures, backgrounds, and
perspectives.
Most common and valued Ethical Principles in Nursing
1. Autonomy: Autonomy is recognizing each individual patient’s right to self-determination and
decision-making. As patient advocates, it is imperative that nurses ensure that patients receive all
medical information, education, and options in order to choose the option that is best for them.
This includes all potential risks, benefits, and complications to make well-informed decisions.
Once the patient has all the relevant information, the medical and nursing team can make a plan
of care in compliance with the medical wishes of the patient. .
It is important that nurses support the patient in their medical wishes and ensure that the medical team is
remembering those wishes. Sometimes, nurses will need to continue to advocate for a patient despite the
wishes being verbalized because the medical team might not agree with those wishes.
Many factors may influence a patient's acceptance or refusal of medical treatment, such as culture, age,
gender, sexual orientation, general health, and social support system
2. Beneficence: Beneficence in nursing is acting for the good and welfare of others and including such
attributes as kindness and charity. The American Nurses Association defines this as “actions guided by
compassion.”

3. Justice: Justice is that there should be an element of fairness in all medical and nursing decisions and
care. Nurses must care for all patients with the same level of fairness despite the individual's financial
abilities, race, religion, gender, and/or sexual orientation.
An example of this is when working at a free flu clinic or diabetes screening clinic. These are open to all
individuals in the community regardless of the previously mentioned factors.

4. Non-maleficence: Non-maleficence is to do no harm. This is the most well-known of the main

principles of nursing ethics. More specifically, it is selecting interventions and care that will cause the
least amount of harm to achieve a beneficial outcome. This ensures the safety of the patient and
community in all care delivery. Nurses are also responsible for reporting treatment options that are
causing significant harm to a patient, which may include suicidal or homicidal ideations.
 Nursing Code of Ethics Interpretive Statements
ICN code of ethics contain 9 provisions, the ANA’s nursing code of ethics and includes
interpretative statements that can provide more specific guidance for nursing practice.
Provisions of the Nursing Code of Ethics
1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique
attributes of every person.
2. The nurse’s primary commitment is to the patient, whether an individual, family, group,
community, or population.
3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
4. The nurse has authority, accountability, and responsibility for nursing practice; makes
decisions; and takes action consistent with the obligation to provide optimal patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to promote
health and safety, preserve wholeness of character and integrity, maintain competence, and
continue personal and professional growth.
6.The nurse, through individual and collective effort, establishes, maintains, and improves the
ethical environment of the work setting and conditions of employment that are conducive to safe,
quality health care.
7. The nurse, in all roles and settings, advances the profession through research and scholarly
inquiry, professional standards development, and the generation of both nursing and health policy.
8. The nurse collaborates with other health professionals and the public to protect human rights,
promote health diplomacy, and reduce health disparities.
9. The profession of nursing, collectively through its professional organization, must articulate
nursing values, maintain the integrity of the profession, and integrate principles of social justice
into nursing and health policy.

The aforementioned nine provisions were implemented to help guide nurses in ethical decision-
making throughout their practice. Unfortunately, nurses are often unable to make complex ethical
decisions based solely on the four principles and nine provisions. In these instances, it is
important to consult the ethics committee before making any major decisions. Often, other
resources are needed when making major ethical decisions. Knowing the nursing code of ethics is
essential for nurses because it will help guide everyday practice and navigate the daily
complexities of the healthcare profession.
• Nurses often use these major ethical principles throughout a shift, even if not fully aware of
them. This may be in form of the following:
 Providing pain medication to a post-operative hip replacement
 Holding the hand of a dying patient who is alone
 Advocating for the patient that wants to end chemotherapy and enter hospice care
Nursing is consistently regarded as the most honest and ethical profession and practicing with
the nursing code of ethics is essential to ensuring that patients and their families receive the care
they have come to know and expect.
• Utilizing the ethical codes of justice, non-maleficence, autonomy, and beneficence on a daily
basis allows nurses to provide the safest and most compassionate care for their patients
International Council of Nurses Code of Ethics
Code of ethics is a set of principles that reflect the primary goals, values, and obligation of the profession. The need
for nursing care is universal, inherent in nursing services is a respect for human rights, including cultural right, right
to life and choices, dignity and respect. Nursing care is respectful, unrestricted by consideration for age, color, creed,
culture, disability, illness, gender, nationality, races or social status and provides services to individual, families and
communities. According to ICN (2021), individual who becomes a nurse is expected not only to adhere to the moral
norms of the profession but also to embrace them as part of what it means to be a nurse with the tradition of being
self-reflective, enduring and distinctive
Nurses’
. code of ethics serves the following purposes:
 It is a succinct statement of the ethical obligations and duties of every individual who enter the nursing
profession
 It’s the profession non-negotiable ethical standard
 It is an expression of nurses own understanding of their commitment to the society
Hence, to achieve its purposes, the code of ethics for nurses must be made available for students and
nurses throughout their study and work lives.
It recommends that nursing students:
- Study the standard under each elements of the code
- Reflect continuously on what each standard means to them
- Think about how they can apply ethics in their own nursing domain(practice, education, and
management)
- Discuss the code with co-workers and others
- Use a specific examples from experience to identify ethical dilemma and standards of conduct as outlined
in the code
- Identify how they would resolve the dilemma
- Work in groups to clarify ethical decisions making and reach a consensus on standards of ethical
conflicts
- Collaborate with their national nurses association, co-workers, and others in continuous application of
ICN stipulated four basic fundamental responsibilities of nurses to individual and the society at large which
include;
 Health promotion
 Illness prevention
 Health restoration
 Suffering alleviation
ICN code of ethics for nurses has four principal elements that outlines the standard of ethical conducts for
nurses
 Nurses and people: Nurses’ primary responsibility is to people receiving nursing care, hence mandated to
demonstrate professional values such as respectfulness, responsiveness, compassion, trustworthy and
integrity
 Nurses and nursing practice: the nurse is expected to carry personal responsibility and accountability for
nursing practice and maintain competence by continuous learning, maintain standard of professional
conduct which reflect well on the profession and enhances its image and public confidence
 Nurses and the profession: nurses assume major role in determining and implementing acceptable standard
of clinical nursing practice, management ,research and education
 Nurses and co-workers: Nurses sustain a collaborative and respectful relationship with co-workers in
nursing and other fields by taking appropriate action to safeguard individuals, families and communities
when their health is endangered by a co-workers or any other person