Ethical Theories

There are two major types of ethical theories that guide values and moral behavior
referred to as deontology and consequentialism.

Deontology is an ethical theory based on rules that distinguish right from wrong .
Deontology is based on the word deon that refers to “duty.” It is associated with
philosopher Immanuel Kant. Kant believed that ethical actions follow universal moral
laws, such as, “Don’t lie. Don’t steal. Don’t cheat. Deontology is simple to apply
because it just requires people to follow the rules and do their duty. It doesn’t require
weighing the costs and benefits of a situation, thus avoiding subjectivity and
uncertainty.The nurse-patient relationship is deontological in nature because it is
based on the ethical principles of beneficence and maleficence that drive clinicians to
“do good” and “avoid harm

Consequentialism is an ethical theory used to determine whether or not an action is

right by the consequences of the action. For example, most people agree that lying is
wrong, but if telling a lie would help save a person’s life, consequentialism says it’s
the right thing to do. One type of consequentialism is
utilitarianism. Utilitarianism determines whether or not actions are right based on
their consequences with the standard being achieving the greatest good for the
greatest number of people. For this reason, utilitarianism tends to be society-centered.
When applying utilitarian ethics to health care resources, money, time, and clinician
energy are considered finite resources that should be appropriately allocated to
achieve the best health care for society.

Principles of ethics in Nursing Practice

Ethics refers to how people think and conduct themselves in terms of right and wrong.
The concept of nursing ethics began to develop in the late 19th century. At the time,
ethics in nursing referred to certain character traits like obedience, physician loyalty,
and high moral character.

As the world and the healthcare industry evolves, so too must nursing ethics
themselves. Nurses face increasingly complex human rights and ethical issues. In
response, the American Nurses Association developed its Code of Ethics for Nurses,
which serves as the standard by which all nurses should practice. It acts as a social
contract between nurses and the general public, helping people understand the
commitment all nurses make to providing safe, evidence-based, high-quality care.

Each member of the profession adheres to a set of core ethical principles in nursing.
The nursing code of ethics helps nurses make good judgment calls, provide high-
quality care, and support patients and their loved ones emotionally, physically, and
mentally. It also helps keep a nurse’s license in good standing. Let’s take a deeper
look at each of the ethics in nursing.

Ethical Principles in Nursing

1. Accountability
2. Justice
3. Nonmaleficence
4. Autonomy
5. Beneficence
6. Fidelity
7. Veracity

1. Accountability

Accountability is chief among the ethical principles in nursing. Each nurse must be
responsible for his or her own choices and actions in the course of patient care. Nurses
who hold themselves accountable often provide higher-quality patient care. They are
more likely to build stronger relationships with patients, thanks to increased trust.
Accountable nurses adhere to their scope of practice and, in many cases, are
greatly appreciated by their colleagues and patients.

2. Justice

Justice plays a significant part in the nursing code of ethics. Every nurse has a
responsibility to make care decisions that are based only on the facts, not on other
factors like the patient’s

 Age
 Ethnicity
 Religion
 Socioeconomic status
 Sexual orientation

To uphold the justice ethical principle, nurses should act as fair and impartial care
givers, which can help patients feel more valued. Treating each patient fairly,
regardless of their circumstances, is essential for helping patients accept and
participate in their own care; this, in turn, often leads to better patient outcomes.

3. Nonmaleficence

You’ve likely already heard of this ethical principle, which is to do no harm.

According to the National Library of Medicine, nursing nonmaleficence echoes
exactly that. Nurses have a critical responsibility to prevent further harm from coming
to all their patients. Each nurse must take action to prevent harm. Nonmaleficence in
nursing is essential to safe, effective patient care that is delivered to the best of a
nurse’s ability.

4. Autonomy

While nurses are guided by best medical practices and standards of care, they must
also support patient autonomy. This means that patients who can make decisions for
themselves must be allowed to do so, even if their decisions go against nursing or
medical expertise. Nurses must advocate for patient autonomy as long as patients are
capable of exercising this right.

5. Beneficence

Beneficence in nursing can be defined as the charity and kindness nurses offer to
other people, which is demonstrated by their actions in the medical setting.
Beneficence means that nurses perform actions intended to benefit others; they act
with the patient’s best interests in mind. In order to act with beneficence in nursing,
each nurse must approach each patient as a unique individual with their own life
circumstances, opinions, and experiences. Beneficence also means that nurses must
put aside their own personal feelings to provide care to the best of their abilities.

6. Fidelity

People want to know they can count on nurses, no matter what. The fidelity ethical
principle can best be described by keeping your word to patients. Nurses should be
honest and loyal to each patient, as this helps the nurse gain trust and fulfill their
professional commitment. Without fidelity, more trusting relationships cannot be
formed, which leads to less positive patient outcomes and less trust in professional
relationships.

7. Veracity

Working in healthcare is challenging for many reasons, and in some cases, nurses
must communicate unpleasant information to a patient. Veracity in nursing is the
ethical principle of being completely open and honest with patients, even if the truth
causes distress. While being completely truthful can be daunting, especially in certain
patient care circumstances, veracity in nursing is important for establishing trust and
strengthening the nurse-patient relationship. Veracity also helps patients become more
autonomous, making decisions for their care based on all relevant, factual
information.

CODE OF ETHICS BY ICN (INTERNATIONAL COUNCIL OF NURSES)

The ICN Code of Ethics for Nurses is a statement of the ethical | values,
responsibilities and professional accountabilities of nurses and nursing students' that
defines and guides ethical nursing practice within the different roles nurses assume. It
is not a code of conduct but can serve as a framework for ethical nursing practice and
decision-making to meet professional standards set by regulatory bodies.

The ICN Code of Ethics for Nurses provides ethical guidance in relation to nurses'
roles, duties, responsibilities, behaviours, professional judgement and relationships
with patients, other people who are receiving nursing care or services, co-workers and
allied professionals. The Code is foundational and to be built upon in combination
with the laws, regulations and professional standards of countries that govern nursing
practice. The values and obligations expressed in this Code apply to nurses in all
settings, roles and domains of practice.

THE ICN CODE

The ICN Code of Ethics for Nurses has four principal elements that provide a
framework for ethical conduct: nurses and patients or other people requiring care or
services, nurses and practice, nurses and the profession, and nurses and global health.

1. NURSES AND PATIENTS OR OTHER PEOPLE REQUIRING CARE OR

SERVICES

1.1 Nurses' primary professional responsibility is to people requiring nursing care and
services now or in the future, whether individuals, families, communities or
populations (hereinafter referred to as either 'patients' or 'people requiring care').

1.2 Nurses promote an environment in which the human rights, values, customs,
religious and spiritual beliefs of the individual, families and communities are
acknowledged and respected by everyone.

Nurses' rights are included under human rights and should be upheld and protected.

1.3 Nurses ensure that the individual and family receive understandable, accurate,
sufficient and timely information in a manner appropriate to the patient's culture,
linguistic, cognitive and physical needs, and psychological state on which to base
consent for care and related treatment.

1.4 Nurses hold in confidence personal information and respect the privacy,
confidentiality and interests of patients in the lawful collection, use, access,
transmission, storage and disclosure of personal information.

1.5 Nurses respect the privacy and confidentiality of colleagues and people requiring
care and uphold the integrity of the nursing profession in person and in all media,
including social media.
1.6 Nurses share with society the responsibility for initiating and supporting action to
meet the health and social needs of all people.

1.7 Nurses advocate for equity and social justice in resource allocation, access to
health care and other social and economic services.

1.8 Nurses demonstrate professional values such as respect, justice, responsiveness,

caring, compassion, empathy, trustworthiness| and integrity. They support and respect
the dignity and universal rights of all people, including patients, colleagues and
families.

2. NURSES AND PRACTICE

2.1 Nurses carry personal responsibility and accountability for ethical nursing
practice, and for maintaining competence by engaging in continuous professional
development and lifelong learning.

2.2 Nurses maintain fitness to practice so as not to compromise their ability to provide
quality, safe care.

2.3 Nurses practise within the limits of their individual competence and regulated or
authorised scope of practice and use professional judgement when accepting and
delegating responsibility.

2.4 Nurses value their own dignity, well-being and health. To achieve this requires
positive practice environments, characterised by professional recognition, education,
reflection, support structures, adequate resourcing, sound management practices and
occupational health and safety.

2.5 Nurses maintain standards of personal conduct at all times.They reflect well on
the profession and enhance its image and public confidence. In their professional role,
nurses recognise and maintain personal relationship boundaries.

2.6Nurses share their knowledge and expertise and provide feedback, mentoring and
supporting the professional development of student nurses, novice nurses, colleagues
and other health care providers.

2.7 Nurses are patient advocates, and they maintain a practice culture that promotes
ethical behaviour and open dialogue.

2.8 Nurses may conscientiously object to participating in particular procedures or

nursing or health-related research but must facilitate respectful and timely action to
ensure that people receive care appropriate to their individual needs.
2.9 Nurses maintain a person's right to give and withdraw consent to access their
personal, health and genetic information. They protect the use, privacy and
confidentiality of genetic information and human genome technologies.

2.10 Nurses take appropriate actions to safeguard individuals, families, communities

and populations when their health is endangered by a co-worker. any other person,
policy, practice or misuse of technology

2.11 Nurses are active participants in the promotion of patient safety.They promote
ethical conduct when errors or near misses occur, speak up when patient safety is
threatened, advocate for transparency, and work with others to reduce the potential of
errors.

2.12 Nurses are accountable for data integrity to support and facilitate ethical
standards of care.

3. NURSES AND THE PROFESSION

3.1 Nurses assume the major leadership role in determining and implementing
evidence-informed, acceptable standards of clinical | nursing practice, management,
research and education.

3.2 Nurses and nursing scholars are active in expanding research-based, current
professional knowledge that supports evidence-informed practice.

3.3 Nurses are active in developing and sustaining a core of professional |values

3.4 Nurses, through their professional organisations, participate in creating a positive

and constructive practice environment | where practice encompasses clinical care,
education, research, management and leadership. This includes environments which
facilitate a nurse's ability to practice to their optimal scope of practice and to deliver
safe, effective and timely health care, in working conditions which are safe as well as
socially and economically equitable for nurses.

3.5 Nurses contribute to positive and ethical organisational environments and

challenge unethical practices and settings. Nurses collaborate with nursing colleagues,
other (health) disciplines and relevant | communities to engage in the ethical creation,
conduct and dissemination of peer reviewed and ethically responsible research| and
practice development as they relate to patient care, nursing and health.

3.6 Nurses engage in the creation, dissemination and application| of research that
improves outcomes for individuals, families and communities.

3.7 Nurses prepare for and respond to emergencies, disasters, conflicts, epidemics,
pandemics, social crises and conditions ot scarce resources. Ihe satety ot those who
receive care and services is a responsibility shared by individual nurses and the
leaders of health systems and organisations. This involves assessing risks and
developing, implementing and resourcing plans to mitigate these

4. NURSES AND GLOBAL HEALTH

4.1 Nurses value health care as a human right, affirming the right to universal access
to health care for all.

4.2 Nurses uphold the dignity, freedom and worth of all human beings and oppose all
forms of exploitation, such as human trafficking and child labour.

4.3 Nurses lead or contribute to sound health policy development.

4.4 Nurses contribute to population health and work towards| the achievement of the
United Nations Sustainable Development Goals (SDGs). (UN n.d.)

4.5 Nurses recognise the significance of the social determinants of health. They
contribute to, and advocate for, policies and programmes that address them.

4.6 Nurses collaborate and practise to preserve, sustain and protect the natural
environment and are aware of the health consequences of environmental degradation,
e.g. climate change. They advocate for initiatives that reduce environmentally harmful
practices to promote health and well-being.

4.7 Nurses collaborate with other health and social care professions and the public to
uphold principles of justice by promoting responsibility in human rights, equity and
fairness and by promoting the public good and a healthy planet.

4.8 Nurses collaborate across countries to develop and maintain global health and to
ensure policies and principles for this.

NMCN CODE OF PROFESSIONAL CONDUCT

The Code of Professional Conduct places the client/patient at the center of Nursing
activities.

The purposes of the Code of Professional Conduct are to:

 Inform Professional Nurses of the Standards of Professional Conduct required

of them in the exercise of their professional accountability and practice.
 Inform the public, other professions and employers, of the standard of
Professional Conduct that they can expect of a Registered Practitioner.
A Nurse is a person who has received authorized education, acquired specialized
knowledge, skills and attitudes, and is registered and licensed with the Nursing and
Midwifery Council to provide promotive, preventive, supportive and restorative care
to individuals, families and communities, independently, and in collaboration with
other members of the health team. The Nurse must provide care in such a manner as
to enhance the integrity of the profession, safeguard the health of the individual
client/patient and protect the interest of the society.

THE PROFESSIONAL NURSE AND THE HEALTH CARE CONSUMER

The Nurse must:

 Provide care to all members of the public without prejudice to their age,
religion, ethnicity, race, nationality, gender, political inclination, health or social
economic status.
 Uphold the health consumer's human rights as provided in the constitution.
 Ensure that the client/patient of legal age of 18 years and above gives
informed consent for Nursing intervention. In case the health consumer is under aged,
the next of kin or the parents can give the informed consent on his behalf.
 Keep information and records of the client confidential except in consultation
with other members of the health team to come up with suitable intervention
strategies or in compliance with a court ruling or for protecting the consumer and the
public from danger.
 Avoid negligence, malpractice and assault while providing care to the
client/patient.
 Relate with a consumer in a professional manner only.
 Not take bribe or gifts that can influence you to give preferential treatment.
 Consider the views, culture and Beliefs of the client/patient and his family in
the design and implementation of his care/treatment regimen.
 Know that all clients/patients have a right to receive information about their
condition.
 Be sensitive to the needs of clients/patients and respect the wishes of those
who refuse or are unable to receive information about their condition.
 Provide information that is accurate, truthful and presented in such a way as to
make it easily understood.
 Respect clients and patients' autonomy, their right to decide whether or not to
undergo any health care intervention even where a refusal may result in harm or death
to themselves or a foetus, unless a court of law orders to the contrary.
 Presume that every patient and client is legally competent unless otherwise
assessed by a suitably qualified practitioner. A patient or client who is legally
competent can understand and retain treatment information and can use it to make an
informed choice.
 Know that the principles of obtaining consent apply equally to those people
who have a mental illness.
 Ensure that when clients and patients are detained under statutory powers (e.g.
Mental Health Act), you know the circumstances and safeguards needed for providing
treatment and care without consent.
 Provide care in emergencies where treatment is necessary to preserve life
without clients/patients consent, if they are unable to give it, provided that you can
demonstrate that you are acting in their best interests.

THE PROFESSIONAL NURSE AND THE NURSING PROFESSION

The Nurse must:

 Attend workshops, conferences, seminars and courses that are recognized by

the Nursing and Midwifery Council of Nigeria and which are relevant to the
profession, at least, once a year.
 Engage in behaviour and activities that uplift the social status and integrity of
Nurses.
 Always appear Neat and decently dressed, without using bogus/dangling
earrings, long and big wigs (all hair do must not extend below the neck level), high
heeled shoes, long painted nails and bogus make up while on duty and in uniform.
 Not fight or steal.
 Be courteous, honest and resourceful.
 Not wear Uniforms and Overall outside the hospital premises.
 Not strap babies/children on her back while in Uniform.
 Provide care, using current evidence based principles and practice and the
Nursing Process.
 Participate in the training of Student Nurses/Midwives and Students of health
related disciplines.
 Co-operates and collaborates with Professional Associations to secure good
Conditions of Service.
 Demonstrate skills and abilities required for lawful, safe and effective
Professional practice without direct supervision.
CODE OF CONDUCT BY ICM

The aim of the International Confederation of Midwives (ICM) is to improve the

standard of care provided to women, babies and families throughout the world
through the development, education and appropriate utilization of the professional
midwife. In keeping with this aim, the ICM sets forth the following code to guide the
education, practice and research of the midwife. This code acknowledges women as
persons with human rights, seeks justice for all people and equity in access to health
care, and is based on mutual relationships of respect, trust and the dignity of all
members of society.

The code addresses the midwife’s ethical mandates in keeping with the Mission, the
International definition of the Midwife, and standards of ICM to promote the health
and wellbeing of women and newborns within their families and communities. Such
care may encompass the reproductive life cycle of the woman from the pre-pregnancy
stage right through to the menopause and to the end of life. These mandates include
how midwives relate to others; how they practise midwifery; how they uphold
professional responsibilities and duties; and how they are to work to assure the
integrity of the profession of midwifery.

The Code

I. Midwifery Relationships

1. Midwives develop a partnership with individual women in which they share

relevant information that leads to informed decision-making, consent to an evolving
plan of care, and acceptance of responsibility for the outcomes of their choices.
2. Midwives support the right of women/families to participate actively in
decisions about their care.
3. Midwives empower women/families to speak for themselves on issues
affecting the health of women and families within their culture/society.
4. Midwives, together with women, work with policy and funding agencies to
define women’s needs for health services and to ensure that resources are fairly
allocated considering priorities and availability.
5. Midwives support and sustain each other in their professional roles, and
actively nurture their own and others’ sense of self-worth.
6. Midwives respectfully work with other health professionals, consulting and
referring as necessary when the woman’s need for care exceeds the competencies of
the midwife.
7. Midwives recognise the human interdependence within their field of practice
and actively seek to resolve inherent conflicts.
8. Midwives have responsibilities to themselves as persons of moral worth,
including duties of moral self-respect and the preservation of integrity.

II. Practice of Midwifery

1. Midwives provide care for women and childbearing families with respect for
cultural diversity while also working to eliminate harmful practices within those same
cultures.
2. Midwives encourage the minimum expectation that no woman or girl should
be harmed by conception or childbearing.
3. Midwives use up-to-date, evidence-based professional knowledge to maintain
competence in safe midwifery practices in all environments and cultures.
4. Midwives respond to the psychological, physical, emotional and spiritual
needs of women seeking health care, whatever their circumstances (non-
discrimination).
5. Midwives act as effective role models of health promotion for women
throughout their life cycle, for families and for other health professionals. f. Midwives
actively seek personal, intellectual and professional growth throughout their
midwifery career, integrating this growth into their practice.

III. The Professional Responsibilities of Midwives

1. Midwives hold in confidence client information in order to protect the right to

privacy, and use judgment in sharing this information except when mandated by law.
2. Midwives are responsible for their decisions and actions, and are accountable
for the related outcomes in their care of women.
3. Midwives may decide not to participate in activities for which they hold deep
moral opposition; however, the emphasis on individual conscience should not deprive
women of essential health services.
4. Midwives with conscientious objection to a given service request will refer the
woman to another provider where such a service can be provided.
5. Midwives understand the adverse consequences that ethical and human rights
violations have on the health of women and infants, and will work to eliminate these
violations.
6. Midwives participate in the development and implementation of health
policies that promote the health of all women and childbearing families.

IV. Advancement of Midwifery Knowledge and Practice

1. Midwives ensure that the advancement of midwifery knowledge is based on

activities that protect the rights of women as persons.
2. Midwives develop and share midwifery knowledge through a variety of
processes, such as peer review and research.
3. Midwives contribute to the formal education of midwifery students and
ongoing education of midwives.

Patient bill of rights

Patient Bill of Rights is a document that provides patients with information on how
they reasonably expect to be treated during the course of their hospital stay. They
simply provide goals and expectations for patient care.
1 - Access to Care

The patient shall be accorded reasonable access to treatment or accommodations that

are available or medically indicated, regardless of race, disability, psychological,
social, cultural, age, sex, sexual orientation, religion, creed, national origin, or
ability/sources of payment for health care decisions. The patient has the right to
exclude any or all family members from their health care decisions. The patient has
the right to treatment for any emergency medical condition.

2 - Respect and Dignity

The patient has the right to considerate and respectful care at all times and under all
circumstances with recognition of his/her personal dignity, values and beliefs. The
patient has the right to wear appropriate personal clothing and religious or other
symbolic items, as long as they do not interfere with diagnosis procedures or
treatment . The practices of the patient’s family members are respected and
accommodated. The patient has the right to be free from restraints of any form that are
not medically necessary. The patient has the right to a prompt and reasonable
response to a question or request. A healthcare facility shall respond in a reasonable
manner to the request of patient’s healthcare provider for medical services.

3 - Security

The patient has the right to a safe and secure environment.

4 - Plan of Care

The patient has the right to participate in the development and implementation on
his/her plan of care. The patient has the right to designate a healthcare surrogate to
assume these responsibilities.
When the patient can not make decisions, a family member or Proxy is identified to
participate in the patient’s care decisions.

5 - Informed Consent

1. The patient has the right to make informed decisions regarding his/her care. To
the degree possible, this shall be based on a clear, concise explanation of his/her
condition and of all proposed procedures, including the possibilities of benefits, risk
of mortality or serious side effects, discomforts, potential benefits, problems related to
recuperation and probability of success. The patient has the right to know who shall
be responsible for authorizing and performing the procedures or treatment. The
patient shall not be subjected to any procedure without his/her voluntary, competent,
and informed consent or that of his/her legally authorized representative. Where
medically significant alternatives for care or treatment exists, the patient shall be
informed. The patient shall be informed if the hospital proposes to engage in or
perform human experimentation or other research/educational projects affecting
his/her care or treatment, and the patient has the right to refuse to participate in any
such activity. Informed Consent for research projects should indicate the name of the
person who provided the information, the date, address and the participant’s rights to
privacy, confidentiality and safety.
2. The patient has the right to obtain from the practitioner responsible for
coordinating his/her care, complete and current information concerning his/her
diagnosis (to the degree known), the potential benefits, risks and alternatives of
proposed treatments or procedures, and any known prognosis including unanticipated
outcomes. This information shall be communicated in terms the patient shall
reasonably be expected to understand. When it is not medically advisable to give such
information to the patient, the information shall be made available to a legally
authorized individual . The patient has the right to refuse this information.

6 - Advance Directives

The patient has the right to formulate advance directives and to have hospital staff and
practitioners comply with these directives.

7 - Patient Participation in the Consideration of Ethical Issues

The patient has the right to participate in ethical questions related to his/her case,
including resolution of conflict, withholding/withdrawing of life-prolonging
procedures, and/or clinical trials. Participation by patient in clinical training programs
or in the gathering of data for research purposes shall be voluntary.

8 - Personal Privacy

The patient has the right, within the law, to personal privacy and confidentiality.

 To refuse to talk with or see anyone not officially connected with the hospital,
including visitors, or persons officially connected with the hospital but not directly
involved in his/her care.
 To be interviewed and examined in surroundings designed to assure
reasonable visual and auditory privacy. This includes the right to have a person of
one’s own sex present during certain parts of a physical examination, treatment, or
procedure performed by a health care professional of the opposite sex and the right
not to remain disrobed any longer than shall be required for accomplishing the
medical purpose of which the patient was asked to disrobe.
 To expect that any discussion or consultation involving his/her care shall be
conducted discreetly and that individuals not directly involved in his/her care shall not
be present without his/her permission.
 To request a transfer to another room if another patient or a visitor in the room
is unreasonably disturbing him/her by their actions.
 To be placed in protective privacy when considered necessary for personal
safety.

9 - Confidentiality of Information

 The patient has the right to inspect and to request an amendment to their
medical record.
 The right to request a restriction on the hospital’s use of the medical record
information, except disclosures as required by law.
 The right to request an accounting of their medical records disclosures except
where exempted or excluded by law or except when omission is permitted by law
 The right to request to receive confidential communications by alternate
means or at an alternative location.
 The right to request to amend their protected health information.
 The right to have his/her medical record read only by individuals directly
involved in his/her treatment or the monitoring of its quality. Other individuals shall
view the record only on the patient’s written authorization or that of his/her legally
authorized representative, or as mandated by law.
 To expect all communications and other records pertaining to his/her care,
including the source of payment for treatment, to be treated as confidential.

10 - Communication

The patient has the right to access people outside the hospital by means of visitors and
by verbal and written communications, within the confines of applicable laws and
regulations.
Hearing, speech, and verbally impaired individuals have the right to access assertive
devices needed to accomplish this communication. When the patient does not speak
or understand the predominant language of the community, he/she shall have access
to an interpreter. This is particularly true where language barriers are a continuing
problem.When the hospital restricts a patient’s visitors, mail, telephone calls or other
forms of communication, the restrictions are evaluated for their therapeutic
effectiveness and these restrictions are fully explained to the patient/family and
determined with their participation. All restrictions are documented in the patient’s
medical record.

11 - Identity

The patient has the right to know the identity, professional status and qualifications of
individuals providing services to him/her and to know which physician or other
practitioner shall be primarily responsible for his/her care. This includes the patient’s
right to know of the existence, of any professional relationship among
individuals/institutions that are treating him/her as well as the relationship to any
other health care or educational institutions involved in his/her care.

12 - Consultation

The patient, at his/her own request and expense, has the right to consult with a
specialist for a second opinion.

13 - Refusal of Treatment

The patient shall have the right to refuse treatment to the extent permitted by law. The
patient’s legally authorized representative shall be granted this right when the patient
is unable to participate in his/her own decisions per hospital policy. The patient also
has the right to refuse treatment and refusal will not compromise his/her access to
services. Any such refusal shall be documented in the patient’s medical record.

14 - Pain Management

All patients have a right to appropriate assessment and management of pain as

follows:

1. At time of initial evaluation the patient shall be informed that relief of pain is
an important part of their care and respond quickly to reports of pain.
2. On initial evaluation and as part of regular assessments the patients will be
asked about presence, quality, and intensity of pain and use this self report as the
primary indicator of pain.
3. The patient will be involved in establishing a goal for pain relief and develop
and implement a plan to achieve that goal along with his/her physician and nurse.
4. The patient/family will be supplied with educational materials about pain upon
admission.

15 - Transfer and Continuity of Care

A patient shall not be transferred to another facility unless he/she has received a
complete explanation of the risks, benefits and alternatives to such a transfer and the
transfer is acceptable to the receiving facility. The patient or his/her legally authorized
representative has the right to be informed by the practitioner responsible for his/her
care of any continuing health care requirements following discharge from the hospital.
Transfer should be made promptly and with every effort to ensure patient safety.
Decisions made regarding patient’s transfers should focus on the patient’s care needs
and should not be solely motivated by economics.
16 - Hospital Charges

The patient has the right to request prior to provision on medical services a reasonable
estimate of charges for such services. Such reasonable estimate shall not preclude the
hospital from exceeding the estimate or making additional charges based on changes
in the patient’s condition or treatment needs.Regardless of the source of payment for
his/her care, the patient has the right to request and receive an itemized and detailed
explanation of his/her total bill for services rendered in the hospital. Patients, who are
eligible for third party insurance coverage including Medicare, have the right to know,
upon request and in advance of treatment, weather the hospital accepts the insurance/
Medicare assignment rate. The patient has the right to timely notice prior to
termination of his/her eligibility of any third party payer for the cost of his/her care.
The patient has the right to be given, upon request, full information and necessary
counseling on the availability of known financial resources for the patient’s health
care.The patient has the right to receive a copy of the itemized bill and an explanation
of charges upon request.

17 - Billing Discrepancies

The patient has the right to a satisfactory completion and resolution of all billing
discrepancy questions. Billing discrepancies may be addressed directly to the Patient
Accounts representative for investigation and resolution.

18 - Hospital Rules and Regulations

The patient shall be informed of the hospital rules and regulations applicable to
his/her conduct as a patient. Patients are entitled to information about the hospital’s
mechanism for the initiation, review and resolution of patient grievances.

19 - Protective Services

The patient has the right to access protective services needed to maintain or assure
their well being. When protective services are appropriate, a written list of names
addresses and phone numbers of pertinent state client advocacy is given to the patient.

20 - Support Services

The patient has the right to know what patient support services are available in the
facility.

21 - Patient Responsibilities

The patient shall be responsible for the following:

1. The patient, to the best of his/her knowledge, shall be responsible for
providing accurate and complete information about present complaints, past illnesses
and hospitalization, medications and other matter relating to his/her health.
2. The patient shall be responsible for reporting unexpected changes in his/her
condition to the responsible practitioner.
3. The patient shall be responsible for communicating that he/she clearly
comprehends the medical plan.
4. The patient shall be responsible for following the treatment plan recommended
by doctors, nurses and other healthcare professionals.
5. The patient shall be responsible for following the rules and regulations that
were given upon admission affecting patient care and conduct.
6. The patient shall be responsible for the consequences if treatment is refused or
if the practitioner’s instructions are not followed.
7. The patient shall be responsible for acknowledging the rights to other patients
and facility personnel.
8. The patient shall be responsible for his/her behavior, control of noise and
number of visitors.
9. The patient shall be responsible for insuring that the property of others shall be
respected.
10. The patient shall be responsible for fulfilling the financial obligations of
his/her healthcare as promptly as possible.

Nurses right

. Full authority for nurses to practice at the top of their license, credentials, and
professional standards without barriers, and in a manner that fulfills their obligations
to society, patients, and communities.
. Continuous access to training, education, professional development, as well as
pathways for nurses to be recognized as leaders and in roles to direct shared decision-
making on nursing practice, resources, staffing concerns and patient safety issues.
. Work and practice in environments that ensure respect, inclusivity, diversity,
and equity with leaders who are committed to dismantling systemic racism and
addressing racist behaviors that negatively impact nurses of color.
. Just care settings that facilitate ethical nursing practice, standards, and care in
accordance with the Code of Ethics for Nurses with Interpretive Statements.
. Safe work environments that prioritize and protect nurses’ well-being and
provide support, resources, and tools to stay psychologically and physically whole.
. Freedom for nurses to advocate for their patients and raise legitimate concerns
about their own personal safety without the fear of retribution, retaliation,
intimidation, termination, and ostracization.
. Competitive compensation consistent with nurses’ clinical knowledge,
experience, and professional responsibilities and that recognizes the value and rigor of
nursing practice.
. Collective and individual rights for nurses to negotiate terms, wages, and work
conditions of their employment in all practice settings