Introduction:Ethics are the rules for correct behavior. Professional ethics for nurses will state the

ideal ways in which a nurse should behave in all relationships including those with the patient, patient’s relatives, co-workers, members of other professions & the pubic. The discussion of the professional adjustment is complete only when ethics are included.Definition:

Ethics is defined as, “Laws of human conduct & duties.” [Haven, 1870]

Ethics is an account of human actions & the goal of ethical deliberations is to judge human actions.

[John, 1969]Ethics is concerned with doing well and avoiding harm.

[Bandman L. Elsie, 1995]Terms used in Ethics:Morals:

Moral refers to the actual standards of conduct observed by individuals.[Jacobs M, 2003]

Professional Ethics:Professional etiquettes are good manners in professional relationship.

[Ann J, 1980]Ethics Dilemma:

An ethical dilemma is a, “Problem that involves two or more morally correct course of action but you can’t do both.

[Black J, 2003]Ethical Problems:

Ethical problems are defined as, “One in which two or more moral norms or principles create a challenge about what to do.”

[Purtillo, 1993]Ethical Issues:

Ethical standards in which the rights of human subjects are protected.[Potter & Perry, 2006]

OrAn issue that involve the core values of practice.

[Harman B, 2006]

Important Ethical Concepts:The important ethical concepts in nursing are as follows:

1. Make sure that the nurses & client are adequately informed.2. Implement care systematically.3. Maintain your nursing knowledge and competence.4. Protect and safeguard your client.5. Upholds the rights of your client.6. Treat client with dignity.7. Administer individualized care.8. Administer client-centered care.

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9. In corporate health teaching & counseling into your plan of care.10. Make sure that all data recorded appropriately & communicated clearly.11. Maintain continuity of care.12. Extend your nursing goals to families & the broader public through collaborative

efforts.[American Hospital Association, 1992]

Principles of Ethics:1. Beneficence (Doing Good).2. Non maleficence (Avoiding harm).3. Autonomy (Self Determination).4. Justice (Treating people fairly).5. Fidelity (Keeping promises).6. Veracity (Truth Teling).7. Confidentiality (Respecting Privileged information).

[American Nurses Association, 1985]1. Beneficence: (Doing Good)

It is viewed as a primary obligation of health care professionals.Beneficence has two aspects:1. Providing Benefits to the patients.2. Weighing and balancing the benefits against any harm that might

be incurred by patient.This involves careful assessment of the actions professional nurse takes in providing care for their patients.2. Nonmaleficence (Avoiding Harm):

It requires that in our patient care we not cause any harm. It highlights the importance that “First of all do no harm” has as a priority over & above that of providing benefits to patients.

3. Autonomy (Self Determination):Respect for patient autonomy is shown by providing patients with the

information they need to make their own decisions about their care.4. Justice (Treating People fairly):

It implies choosing the action that is most fair & equitable after reflecting on the claims or rights of the individuals involved in the decision.

It is applicable to the allocation of scarce resources & development of an optimal level of care for all clients.

5. Fidelity (Keeping promises):It means that the nurse acts in good faith to keep promises made to the client and

does not make promises that cannot be kept.6. Veracity (Truth Telling)

It means truthfulness clients expect that nurses & all health care professionals will be truthful in their communication.

7. Confidentiality:It means that the nurse respects all privileged information about a client.

Code for Nurses:

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The code provides guidelines with respect to the care of individuals and for accountability to individuals, to the profession & to society.American Nurses Association (1985) code for Nurses:

1. The Nurse provides services with respect for human dignity & the uniqueness of the client, unrestricted by consideration of social or

economic status, personal attributes or the nature of health problems.2. The nurse safeguards the client’s rights to privacy by judiciously protecting information

of a confidential nature. 3. The nurses act to safeguard the client and the public when health care and safety are

affected by the incompetence unethical or illegal practice of any person.4. The nurse assumes responsibility and accountability for individual nursing judgments &

actions.5. The nurse maintains competence in nursing.6. The nurse exercises informed judgments & uses individual competences &

qualifications as criteria in seeking consultation, accepting responsibilities and delegating nursing activities to others.

7. The nurse participates in activities that contribute to the ongoing development of the professions body of knowledge.

8. The nurse participates in the professions efforts to implement & improve standards of nursing.

9. The nurse participates in the professions efforts to establish and maintain conditions of employment conducive to high quality nursing care.

10. The nurse participates in the professions efforts to protect the public from misinformation & misrepresentation & to maintain the integrity of nursing.

11. The nurse collaborates with the members of health professions & other citizens in promoting community & national efforts to meet the health needs of public.

Theories of Ethics:The major ethical theories in deciding “Right conduct” are as follows:

1. Teleological or consequentialist Theory: These theories entail the beliefs that good is defined by the Consequences of any actions. The focus of this theory is the result of persons or group’s

actions. The most well known consequentialist theory is the utilitarian

theory, which require an evaluation of the benefits or harms that may occur. Benefits are the results that are advantageous or good, harm involves injury or hurt.

2. Deontological or non consequentialist Theory: It is a theory of ethical inquiry that view actions as right or wrong. Rules of conduct must be autonomous choices by the one acting in the situation. Rules must be freely chosen by the participants in any decision making situation. With in our society social & professional contracts have established many of our

dictates for proper behaviors. These contracts develop & maintain relationship of trust between individuals or groups. Nurses establish relationship with their

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patients in which they jointly agree to work for the accomplishment of shared goals for their care. Nurses also have established relationship with physician that involves a duty to carry out the medical orders.

Ethical System:1. The Recognition of principles & values that are in conflict.2. The Selection of a response to the conflict.3. The Intention to act in a morally correct manner.4. The Performance of the chosen behavior to resolve the dilemma.

Ethical Decision Making Model:Ethical Decision Making:

Ethical decision making in nursing practice requires determining facts, identifying the ethical problem, analyzing options by applying ethical theories & principles and making choices. Because health care is ideally delivered by a team, many ethical decisions should be team based. That team includes not only nurses & other health providers but also client & families.Murphy and Murphy model of ethical Decision Making: (1976)

This model clearly identifies concern for consequences in the process of ethical decision making. It requires assessment, problem identification, identification of decision makers, and exploration of alternatives, decision making evaluation & identification of possible modifications arising from the evaluation

Identify the health Problem

Identify the ethical Problem

State who is involved in making decision

Identify the nurse’s role

Consider as many alternatives as possible.

Consider the long range & short range consequences of each alternative decision

Reach a decision

Consider how this decision fits into your general philosophy of patient care

Follow this situation until the actual results of the decision are visible and use this information to help make future decision.

[Murphy & Murphy, 1976]Role of Ethics Committee:

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One avenue that may be of help to health care providers with moral conflicts is the hospital ethics committee. Purposes of institutional ethics committee:

1. Staff & community education.2. Case consultation & review.3. Development & review of institutional policies on ethical issues.

Nurses in hospitals or agency have developed their own nursing ethics committees that encourages: 1. The education of nurses in ethical decision making.

2. Discussion of ethical issues unique to nursing.3. Involvement of nursing in institutional ethical concerns,

policy making & committee work.Functions of a code for Nurses:

1. The code for nurses provides moral guidelines to nursing practices in accordance with consumer’s health care interest & rights.

2. The code holds nurses accountable for professionally acceptable standards of nursing care.

3. To upgrade the nursing profession thus benefiting both patients & nurse by investing nurses with rights & responsibilities.

4. Upgrading the quality of health care.Role of Nurses in Ethics: In 1992 the ANA released its health care reform agenda of universal health care with an

emphasis on primary care & prevention. The statement recommends a national health insurance programme national co-ordination

of planning for integrated system of health care, new approaches to the delivery of health care services with nurses prepared for roles in primary care, accountability of the professions for monitoring member services, health education, home care, and a national policy on the aged, mentally ill & children.

Role of Nurse in Resolving Ethical Problems:Jameton’s model for resolving Ethical Problems:

1. Identify the problem: What is at issues (Values, conflicts)? What is your relation to the problem? What are the time parameters?

2. Gather Data: Who are the main people involved? What does the patient want? Construct the case story?

3. Identify options: What courses of action are open? What are possible outcomes? What are the potential impacts of outcomes? What future decisions are likely?

4. Think the ethical problem through:

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Consider basic conventional principles Consider basic human values

5. Make a decision: Choose course of action that best reflects your judgments.

6. Act & Assess: Compare the actual outcome with the projected outcome. How would you improve the process the next time? Would you generalize this decision to future situations having similar

characteristics?Summary:

So far I have discussed the definitions, codes for nurses, ethical principles, Theories of ethics, ethical decision making, role of ethics committee, functions of a code for nurses, role of nurse in ethic & the role of nurses in resolving ethical problems.Bibliography:

1. Deloughery L. Grace (1995), “Issues and Trends in Nursing” second Edition, Mosby Publishers, Missouri, pp. 223-244.

2. Bandman L. Elsie (1995), “Nursing Ethics” Third Edition, Appleten Publishers, New Jersey, pp.3-40.

3. Zwemer J.Ann (2006), “Professional Adjustments & Ethics for Nurses in India” 1 st

edition, B.I. Publishers, Chennai, pp.95-98.4. Cooper, M.C. (1991), “Principle Oriented Ethics & the Ethics of Care: A creative

Tension” Journal of Advances in nursing sciences, 14 (2): 22.5. Miedema F.A. (1993), “The Nurse’s Role on the Health Care Ethics Committee, HFC

Forum 5(2): 88.6. Black M. Joyce (2003), “Clinical Management for Continuity of Care” 6th Edition,

Saunders Publishers, Pennsylvania, pp. 39-50.7. Harman Beebe Laurinda (2006), “Ethical Challenges in the Management of Health

Information” 2nd Edition, John & Bartlett Publishers, Massachusetts, pp.3-20.

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