ETHICS OF NURSING

Ethics, according to Keizer and erb(1987) are the rules or principles. Professional codes of ethics are
formal statement of a group expectation and standard for professional behavior generally accepted by
members of the profession.

PURPOSES OF A NURSING CODE OF ETHICS

To inform the public about the professional minimum standard.

To demonstrate nurse commitment to the public they serve

To outline major ethical consideration of nursing

To provide general guideline for professional behavior

Three nursing organization have had long-standing codes of guide nurses ethical decision making. The
codes differ in specific details but are based on similar principles

INTERNATIONAL COUNCIL OF NURSES

ICN first adopted its code of ethics for nurses in 1953 as a guide for action based on social values and
needs (ICN, 2000) it were reversed in 2000. The code has served as the standard for nurses worldwide
since it was adopted. The ICN code lay emphasis for respect for human rights, including the rights to life,
right to dignity and right to be treated with respect. The code is designed as a guide for nurses in
everyday choices and it support their refusal to participate in activities that conflict with caring and
healing.

THE ICN CODE

The ICN code of ethics for nurses has four principles element that outline the standards of ethical
conducts. ICN states that nurses have 4 fundamental responsibilities.

To promote health.

To prevent illness.

To restore health

To alleviate suffering

ELEMENTS OF CODE

Nurses & principle

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Nurses primary responsibility is to those people that require nursing care

While providing care, the nurse promotes an environment in which the values, customs and spiritual
beliefs of the individual are respected.

Nurses holds in confidence personal information and uses judgment in sharing this information

The nurses ensure that the individual receives sufficient info on which to base consent for care and
related treatment.

Nurses & practice

The nurse carries personal responsibility for making competence by continual hearing

Nurse maintain the higher standards of nursing care possible within the reality of specific situation

Nurse judgment in relation to individuals competence when accepting and delegating responsibility

Nurse when acting in a professional capacity should at all times maintain standards of personal conduct,
which reflect credit upon the profession

NURSES AND SOCIETY

Nurses shares with other citizens the responsibilities for initiating and supporting action to meet the
health are social needs of the public

NURSES AND CO-WORKER

Nurses sustain a co-operative relationship with co workers in nursing and other fields.

Nurse takes appropriate actions to safeguard the individual when his/her care is endanger by a co
worker or any other person.

NURSES AND PROFFESSION

Nurses play the major role in determining and implementing acceptable standards of clinical nursing
practice and education

Nurse is active in developing a core of professional knowledge

Nurse acting through the professional organization help in creating and maintaining safe, equitable
social and economic working conditions in nursing

NURSING ETIQUETTE

The code of behavior (good manners) of nurses associated with Hospital life and tradition.

Importance: Good manners are always suitable they are essential where discipline and
order are desirable for the sake of the patient.

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To the patients

All activities must be patient-centered

Address the patient by his correct name and title

Respect opinion, religion and culture

Walk quietly and quickly

To the visitors

Receive them with courtesy and empathy

Involve them in client care

Obey rules about visitation, allow relation to visit their client as much as possible except when it is going
to constitute an hazard to the client

To senior officers

All senior officers should be addressed by their appropriate titles

It is courteous to stand when one older or senior colleague (to you) enters

Be sure to pass any message received on their behalf e.g telephone call, circular etc.

To colleague

Be a good working mate. Take full share of duty and responsibility.

Share your learning. Discuss special case together to help increase each other knowledge.

Make constructive criticism of each other practice.

To subordinates

Be courteous, considerate and helpful

Create a conducive atmosphere to ensure high level of performance expected of them

To the profession

Behave yourself in public and protect the image of the profession

Serve the public to the best of your ability

To yourself

Keep fit mentally and physically

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Increase your knowledge daily so as to increase the standard of care by an improved performance

Wear your uniform with no excessive jewelry and make up.

ETHICAL PRINCIPLES

Ethics is the science related to moral actions and one’s value system many nurses see ethics as
dealing with principles of morality and what is right/wrong. It is concerned with motives and attitudes
and the relationship of these attitudes to the good of individual.

It has to do with action which caregivers wish people would take, not actions they must take.

Nursing ethics provides the standard s for professional behavior and is the study of principles of right
and wrong conduct for nurses. Nursing ethics states the duties and obligation of nurses to their clients,
other health professionals, the profession and the community.

Ethical principles actually control professionalism in nursing practice. Principles encompass basic
promise from which rules are developed.

Principles are the moral norms that nursing as a profession, both demands and strive to
implement to every day clinical practice. Ethical principles that the nurse should consider when making
decision are as follows:

Respect for persons/people

Respect for autonomy

Respect for freedom

Respect for beneficence

Respect for non-maleficence

Respect for veracity

Respect for justice

Respect for rights

Respect for fidelity

Respect for confidentiality.

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Respect for Persons: Respect for persons not only applies to clinical solutions, but also to all life’s
situation. It directs individuals to treat themselves and others, with a respect inherent to man’s
humanness. It requires recognition on a sense that all mankind shares a common human destiny.

Respect for Freedom: The principle of individual freedom allows the patient to be exempted from
control by others to select and pursue personal health goals. Nurses as a group believes that patient
should have greater freedom of choice with the nation’s health care system- This principles should be
observed by staff nurses when planning patients care and also by nurse manager when leading
subordinates.

Respect for Rights: is an entitlement to behave in certain way under circumstances, such as nurse’s
entitlement to freely express personal beliefs and preferences by voting in a political election or a nurse
manager’s right to give assignments to subordinates. Rights may be mental or legal related to respective
professions which are as follow.

The patient has the rights to every consideration of his or her privacy concerning his/her medical care
programme.

The patient has the right to expect that all communications and record pertaining to his/her care should
be treated as confidential.

The patient has the right to expect reasonably continuity of care.

The patient has the right to examine and receive an explanation of his views regardless of source of
payment.

Respect for Justice: States that equals should be treated the same and unequal should be treated
differently i.e patient with the same diagnosis and health care needs should receives the same care and
those with lesser or greater should receive different care (states that people should be treated equally
and fairly when there are resources to distribute in health care, nurses should allocate them in such a
way that equal share goes to equal receipts.

In health care, the most common concern about justice relates to allocation of resources are services to
clients.

Respect for Autonomy: The principle of autonomy claims that individuals are permitted liberty to
determine their own actions according to plan they have chosen. Freedom to make one’s own decision
is respected under the principle of autonomy. The principle refers to the control individual have over
their own lives. Autonomous decisions should be free of coercion and are based on reason and
deliberation based on adequate information. (This principle comes into play for example, in the
requirement that clients provide information consent before test, procedures or research.

Respect for Beneficence: This is commonly defined as “the doing good”. It states that actions one take
should promote good. It dictates that a person is obliged to help offers to advance their legitimate and
important interest. It requires the balancing of harms and benefits. Professional education provides

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awareness that most nursing interventions are capable of producing undesirable, as well as desirable
patient outcome. Therefore, the nurse is obliged to ascertain each care measure, likelihood of success
and balance the measures probable benefits and risks in other to select intervention’s that maximize
patient’s welfare.

Respect for Non-maleficence: This principle state that one should “do no harm” The nurse should
interpret the term “harm” to mean emotional and social as well as physical injury, many nurses find it
difficult to follow the principles when performing procedures that bring discomfort and pain to patients
e.g while catching a client who is falling, the nurse groups the clients tightly enough to cause bruises to
the client’s arm (unintentional harm)

Respect for Veracity: This concerns “truth telling” and states that individuals should always tell the truth.
It requires professional, caregivers to provide with accurate reality-based information about their health
status and care/treatment prospect. Truth telling is an ethical concern for nurses, because truth is the
basis for mutual trust between patient and nurse and trust is the basis for patient’s hope of benefit from
nursing services. However, truth telling may be difficult in a health care relationship. Some information
that is transmitted from nurse to patients is depressing and frightening bad news about personal health
status.

Respect for Fidelity: Is keeping one’s promises and commitments. The principle of Fidelity holds that a
person should faithfully fulfill his duties and obligation. Fidelity is important in a nurse because a
patient’s hope for relief and recovery rests on evidence of caregivers ability to keep promises – Nurse
managers abide by this principle when they follow through on any promises they have previously made
to employees, such as promised leave, promotion e.t.c and also “I will be right back with you, pain
meditation”.

Respect for confidentiality: This is the duty to respect privileged information. The principle of
confidentiality provides that nurses should respect a patient’s need for privacy and use personal
information about him/her to improve care. Nurses should practice confidentially to decrease patient’s
vulnerability and share from widespread knowledge of personal information divulged during care.

ETHICS &STANDARD OF PRACTICE

Care of belongings

Jewelry, Money and medication should be given to the family members of the patient to take home. If
no family member is present, the valuables may be kept in the hospital safely. Keeping track of a
patient’s personal property is the most different problems in a hospital.

The loss of valued items is unsettling to the patients and can be costly to a hospital policy for the
patient’s valuables. Losing the patients valuable can have a very serious legal implication for both the
hospital and the nurse. Most facilities have a routine for checking and noting all personal items brought
to be worn by a patient. Those items that are not needed can be sent home with family members. This is
perhaps the best safeguard large sum of money and valuable items are usually kept safe in the hospital’s

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administrative office with proper document attesting to their location and values. Deposition of valuable
must be documented in the medical record.

CONFIDENTIALITY

Nurses are legally and ethically obligated to keep information about patients confidential.

They must not discuss a patient’s examination, observation/conversation, diagnosis or treatment with
other patients or staffs not involved in the patient’s care. Only staffs directly involved in a patient’s care
have legitimate access to the records. Patient’s frequently request copies of their medical-records and
they have right to read them. In most situations patient are required to give written permission for the
release of medical information.

Legislation to protect patients privacy for health information, the health insurance portability
and accountability act (HI PAA) governs all the areas of patients information and management of that
information:- HIPAA requires that disclosure or request regarding health information are limited to the
minimum necessary. This include only the specific information required for a particular purpose e.g if
you need a patients number to reschedule appointment, access to the medical records is limited solely
to telephone information.

Sometimes, nurses use health care record for research date gathering, as long as a nurse uses a record
as specified and permission is granted, this is permitted.

When you are a student in the clinical settings, confidentiality and compliance with HIPAA are part of
professional practice, you can only review your patient’s medical record for information needed to
provide safe and effective patient care e.g when you are assigned to care for a patient you need to
review the patient’s medical record and plan of care (you must not share this information with
classmate) except for clinical conferences and do not access the needed records of other patients on the
unit. Access to electronic health records is traceable through user log-in information. Not only is this
unethical to view medical records of other patients but breaches of confidentiality can lead to
disciplinary actions by employers and dismissal from work or nursing school. You must never print
material from an electronic health record for personal purpose/use.

INFORMED CONSENT

This is a person’s agreement to allow something to happen such as surgery or any invasive diagnostic
procedure, based on full disclosure of risk, benefits, alternatives, and consequences of refusing.
Informed consent creates a legal duty for the health care provider to disclose material facts in terms the
patients are able to understand to make an informed choice.

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Failure to obtain consent in situations other than emergencies will possibly result in a claim of battery.
Without informed consent, a patient may bring a lawsuit against the health care provide for negligence.

This is necessary authorization by the patient for any and all types of care, given with full knowledge of
the risk, benefits, costs and alternatives for hospital admission and for invasive or diagnostic procedure.
The consent must be written and signed by the patient or the person legally responsible for the patient.

ELEMENTS OF CONSENTS

To be legally valid, informed consent should involve the following elements

Completeness (disclosure) - Health care consumers need a great deal of information to make educated
decisions and they should be told everything they would consider important in making a treatment
decision.

Comprehension – The patient (or his surrogate decision maker) must understand the explanation. Ask
the patient to describe in his/her own words, the procedure to which he/she is consenting.

Voluntariness – This means that the patient must be free to accept or regret the treatment. He must not
be pressured or coerced to give consent. There must be no actual or implied threat e.g mom, if you do
not let them do this, I am not coming back to see you ever again, otherwise, the consent is not valid.

Competence – The person must have capacity to understand the information and make a choice about
his situation e.g the ability to decide what clothing to wear does not necessarily mean that the person is
competent to decide whether to have a risky surgery. The law assumes that minors are not competent
in this sense. If it is determined that the person is not legally competent, then an adult, parent, a legal
guardian or next of kin can make health care decisions, depending on state’s law.

Generally speaking, a competent adult has the legal right to consent or refuse any treatment.
However this right does not always extend.

End of Life Care

Not all nursing activities can be directed towards promoting or restoring health or preventing disease.

Death is an inevitable consequence of life whether patient dies in hospital or home, the nurse must help
the person to die in dignified and peaceful ways or teach the relatives, friends and family about how
best they can help the person to die in dignity and peace. Nursing activities for the dying are designed to
promote comfort, maintain quality of life and ease the emotional burden of death.

PATIENT’S BILL OF RIGHT

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The bill of rights include the rights and responsibilities of the patient while receiving care in the hospital
and it ranges from “the right to considerable and respective care” to the right to be informed of hospital
policies and practices that relates to patient care, treatments and responsibilities.

Nurses must be familiar with how patient’s rights and responsibilities are defined while carry
from hospital to community.

Kozeer et al (1989) identified the following as the patient’s fight.

The patient has right to considerate and respective care (Nurses can convey respect by listening
carefully and report their concern to appropriate people. (Respect for dignity of each patient).

They have a right to explanation about what will happen, why and when.

They have a right to participate in planning their care.

The patient has the right to obtain from his physician complete current information concerning his
diagnosis, treatment, prognosis in terms the patient can be reasonably expected to understand. (if a
patient ask a nurse this information, the nurse should relay the question to the physician, document the
question and her action in the client’s record).

The patient has the right to receive from his physician, information necessary to give informed consent
prior to the start of any procedure or treatment.

Patient has the right to refuse treatment to the extent permitted by the law and to be informed of the
medical consequences of his action. When the patient refuses treatment, no one has the right to impose
that treatment.

The patient has the right to every consideration of his privacy concerning his own medical care
programme. People vary in what truly considered invasion of privacy and a threat to dignity.

The patient has the right to expect that all communication and records pertaining to his care should be
treated as confidential.

The patient has the right to expect that within its capacity, a hospital must make a reasonable response
to the request of a patient for service.

The patient has the right to be advised if the hospital processes engage in perform human
experimentation affecting his care or treatment. The patient has the right to refuse to participate in such
research projects.

The patient has the right to expect reasonable continuity of care. He has the right to know in advance
what appointment time and when the doctor will be available and adhere.

They have the right to examine and receive an explanation of their bill regardless of source of payment.

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The patient has the right to what hospital rules and regulations apply to his conduct as a patient e.g
visiting hours, eating services.

NURSING & MIDWIFERY COUNCIL (N&MCN)

Amalgamation of the Nursing Council of Nigeria and the Midwifery Board of Nigeria gave rise to Nursing
and Midwifery Council of Nigeria in 1978. Mrs. Cookey was first administrative head and she retired in
1979.

The Nurses Council of Nigeria (N.C.N)

The Nurses ordinance of August 1917 officially ushered in the Nursing and Midwifery Council of
Nigeria with Ordinances empowering her;

To register all the trained Nurses including the student nurses and the School of Nursing.

To prescribe standard control registration and training of Nurses as well as maintenance of discipline.

To keep registration books.

The Midwifery Board of Nigeria: The board was formed in 1930 when the ordinances for it
establishment was made. They were also empowered to perform the roles of N.C.N but for Midwives.
The mergers of the N.C.N & M.B.N roles give way to (N&MCN) role.

HISTORICAL BACKGROUND OF NURSING AND MIDWIFERY COUNCIL OF NIGERIA (N&MCN)

The law that established the N&MCN was first enacted in 1947 through the efforts of a faction of
Nigeria nurses Known as Professional Association of Trained Nurse of Nigeria (PATNON) who were
trained oversea. The group convinced the Nigeria government to regulate the nursing profession in
Nigeria by registration as it is done in other countries. The legislation which was based on the code of
ethics of international council of nurses (ICN), translated the basic principles of the nurse code of ethnic
to enforceable rules of law. The law was amended in 1957, 1959, 1970 and again in 1979, the council
which stated as two bodies, the midwives board and the nursing council later merged into one by
effective body by the enabling decree of 89 of 1979, the N&MCN is the statutory body responsible for
the regulation and control of nursing and midwifery practice in Nigeria.

The council is composed of chairman, secretary General/Registrar, the Education committee,

Disciplinary committee, Registration committee, Computer unit, Accounts units, Person Unit, Transport
Unit and all other representative, all these executives and units work hand in hand to see the smooth
running of the council. N&MCN has many responsibilities, professional ethics and conduct that guide the
members which also extend to other colonies in medical profession like psychiatric nursing, orthopedic
nursing, pediatric nursing, Burns and plastic nursing, public health nursing, theatre nursing etc.

FUNCTION OF NURSING AND MIDWIFERY COUNCIL OF NIGERIA

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Approval of schools for training of nurses and midwives.

Stipulate the minimum standard of knowledge to be attained by persons seeking to become members of
the professions of nursing and midwifery and reviewing those standards from time to time and
circumstances may require

Index, all cadres of nursing and midwifery standards on commencement of their training.

Stipulates the length of training and curriculum that should be followed.

Maintenance of standards of training in school.

Make sure the standards are reviewed and improved in keeping the international standard.

Conduct final qualifying for all cadres of nursing and midwives in Nigeria.

Responsible for registration of Nurses/Midwives.

Maintain Discipline within the nursing and midwifery profession in Nigeria.

Issue and update professional practicing licenses every three years to all cadres of qualified
nurse/midwives.

Issues professional certificates to all cadres of nurses and midwives at the end of their training.

Prosecute illegal training institution.

Organize and conduct mandatory continuing professional education development programmes for all
cadres of nurses & midwives

Conduct and promote researches in relevant areas of nursing & midwifery.

CODE OF PROFESSIONAL CONDUCT OF N&MCN

The N&MCN code of professional conduct standards for nurses

Respect the patient or client as an individual

Obtain consent before given any treatment or care

Protect confidential information

Cooperate with other in the team

Maintain professional knowledge and competence

Be trustworthy

OBJECTIVES OF THE N&MCN

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To set a uniform standard of council

To improve nurses/midwives as professionals through formal and informal education.

To assist individual status to identify their own area of needs to utilize available resources in solving the
problems.

To promote and maintain good relationship between nurse/midwives and other professional.

ROLES OF N&MCN

The functions are stipulated in the Nursing & Midwifery act of 1976. The council is the only legislative
body charged to perform certain functions on behalf of the Federal Government of Nigeria.

To determine who are nurses and midwives

To determine what standard of knowledge and skills are to be attained by person seeking to become
members of the profession

To regulate and control the practice of the profession in all the ramification

To approve training institution and hospitals

To issue and cancel certificate and to arrange for the restoration of nurses and midwives to the registrar
where applicable

To maintain discipline in accordance with the act

To conduct national qualifying examinations for nurses and midwives and appoint examiners

To improve methods employed in the basic and post basic education of nurses & midwives.

NATIONAL ASSOCIATION OF NIGERIA NURSES AND MIDWIVES (NANNM)

On June 25th 1976, at Kaduna NANNM was formed due to the merger of NNA & PATNON.

AIMS & OBJECTIVES

To combine professionalism with unionism. To have all nursing associations under one umbrella i.e
Ophthalmic Nurses Association, association of Psychiatric Nurses of Nigeria, Association of Nigeria Nurse
Educators etc.

FUNCTIONS

To see to the welfare of the members

Serve as mouth organs for all nurses

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It leases between the members

They maintain standard of nursing profession in the community

They discipline offend members

They monitor members activities

They assist in elevating educational standard of their members through seminars, workshops &
symposium.

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