Indonesian Nurses’Codes of responses have divided into two thematic
EthicsPerspectives on Nursing Student at
Universitas Muhammadiyah Yogyakarta
Teaching Hospitals
Wulan Noviani1, Fajar Abrori 2
1Lecturer School of Nursing Faculty
Medicine and Health Sciences
2Student School of Nursing Faculty
Medicine and Health Sciences
Universitas Muhammadiyah
Yogyakarta
Email: wulan.n@umy.ac.id
ABSTRACT
Background: Nursing students profession
as a professional candidate in health care
system is commonly faced the dilemma
ethics during their clinical experiences.
Consequently, they should have
knowledge, readiness as well as
competencies to solve the complexity
problems related ethical issues in modern
health care.
Objectives: This studies was conducted to
explore the perspectives and to describe
level of knowledge of nursing student
profession program about nurses ‘codes of
ethics in academic hospital Universitas
Muhammadiyah Yogyakarta, Indonesia.
Methods: Mixed methods with
quantitative and qualitative approaches
were used. Data was collected from 83
nursing student’s profession for
quantitative study and 11 students for
qualitative study who had practiced at 3
teaching hospital of UMY. It was collected
using questionnaires and in-depth
interview during April-June 2016. The data
analyzed using software statistic and
content analysis.
Findings: Seventy one point one percent
(n=83) the knowledge level of nurses
codes of ethics were good in questionnaire
analyzed. The majority nurses and patient
relationship was good (83,1%) and the
minority of nurses and their organization
was good (74,7%). Students qualitative
categories including: definitions of ethics
codes, contents of ethics (nurses and
patients, nurses and practice, nurses and
society, nurses and their colleagues, nurses
and organization). The qualitative result
was good for view of nursing student about
definition and the content of nurse’s ethic
codes.
Conclusion: The perspectives of nurses
ethic codes in nursing student profession is
good in quantitative and qualitative
analysis. Further research should focus on
the implementation of ethic codes of
nurses including assessment and evaluation
methods.
Keywords: perspective, knowledge, ethic
codes, nurses, nursing student
Background
Professional nursing defines as the
effort of promotion, optimalization health
and ability, disease prevention through
diagnosis and treatment for individual,
family, community and population (ANA,
2010). Nurses have responsibilities to
provide high quality of services for patient,
family and society. Nurses have variety of
ethical experiences in professional practice
and they should recognize ethical codes
and they can make good decisions (Zahedi
et all, 2013).
Every nurse that had done their
tasks competently and high integrity
should have several key elements which is
used by as profession guidance such as
accreditation in educational institution,
license system and certification and
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relevant ethic codes (Epstein & Turner, fundamental to nursing practice for
2015). professional nurses and it will be
characterized by defining, defense and
Nursing is the most popular of
improve nursing profession (Nasrullah,
profession it has ethic codes which is
2014).
agreed with each professional group of the
world. For instance, International Council Professional nurse should practice
of Nurses (ICN), American Nurses nursing care using ethic codes in several
Association (ANA) dan Canadian Nurse settings clinics, academic and community.
Association (CAN). The content of ethic Nursing ethic codes have content
codes is how nurses should have ethical guidances which is used by nurses as a
behaviour as a profession and how they basic nursing practice. For instance
should make decision when they have relationship between nurses and patient;
obstacles and prevent ethical problems, nurses and practice; nurses and society;
then their efforts to fulfill professional nurses and co-workers; nurses and
duties (Zahedi et all, 2013). profession (inna-ppni.or.id).

The ICN Code of Ethics for Nurses
has four principal elements that outline the
standards of ethical conduct (International
Council of Nurses, 2012). Every nurse in
modern and developed countries had ethic
codes as a guidance of nursing care
practice fundamentally. Research conduct
of nurses’ ethic codes inIran revealed that
nurses have lack of knowledges. Ethic
codes in nursing revised regularly to repair
the drawbacks when it was practised by
nurses during nursing process, however in
Indonesia revision of ethic codes never
done.
Nursing ethic codes are a written
statement that showed moral, caring,
values and nursing goals. It is
Indonesian nursing ethic codes for
all nursing professional in education,
research, management, clinical care to
shape ethical behaviour nurses’
performance to care patient (Indonesian
National Nurses Association, 2000).
Implementation of nursing ethic
codes is not optimally in Indonesia. It is
scarce about research related to nurses
ethic codes and the application for nurses
unknown. The application of nurses ethic
codes will optimal if it was recognized by
nursing student in the beginning of their
study. Nursing curricula can produce the
best outcome of nurses if it can be
integrated in the system of academic and
a clinic learning.

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 Nurses’codes of ethics is reputed as
foundation of nurses’ ethical knowledge
and as a result of their ethical education.
(Numminen et al, 2013). Nursing students
profession as a professional candidate in
health care system is commonly faced the
dillemma ethics during their clinical
experiences. They should have knowledge,
readiness as well as competencies to solve
the complexity problems related ethical
issues in modern health care.
Research Problems
How is the perspectives of nursing
students profession about Indonesian
Nurses’ Codes of Ethics in Universitas
Muhammadiyah Yogyakarta teaching
hospitals?
Objectives
This studies was conducted to
explore the perspectives and to describe
level of knowledge of nursing student
profession program about nurses ‘codes of
ethics in academic hospital Universitas
Muhammadiyah Yogyakarta, Indonesia.
Methodes
Mixed method with quantitative and
qualitative approaches were used. Data
was collected from 83 nursing students
proffesion for quantitative study and 11
students for qualitative study who had
practiced at 3 teaching hospital of UMY.
Respondent in this study had selected
according to inclusion and exclusion
criterias. Inclusion criterias are nursing
students in profession program, they have
willingness to be respondent, they had
practiced 7 months in UMY teaching
hospitals including RS PKU
Muhammadiyah Yogyakarta, RS PKU
Muhammadiyah Gamping, RSUD Tidar
Magelang). Exclusion criteria are nursing
student in in profession program and they
don not have willingness to be respondent.
It was collected using
qquestionnaires of Indonesian Nurses’
Ethic Codes and in-depth interview during
April-June months 2016. This study was
used structured interview guidance to lead
the interview processes while recorder to
record the result of interview of
respondents. The data analyzed using
software statistic and content analysis.
The processes of data collection
consist of several steps. First of all, this
study was administered ethic letter of
research. Secondly, the respondent had
informed consent. The third step, the
respondent divided into two methodes of
study. In one hand they are filling the
questionnaires include demographic data,
knowledges of Indonesian nurses’ codes of
ethic.
Then data analysis using Descriptive
statistic. On the other hand, 11 students
have Indepth interviewed with structured
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interview guidance. In addition, the result years old with 36 people (43%). The
of interview analysed the contents and it majority respondent came from Javanese
will be thematic analysis. culture with 49 people (60%).
Findings
Table 2. Knowledges Level of
1. Respondent Characteristics
Indonesian Nurses’s Codes of Ethics
Respondent characteristics in this
study is nursing student in profession The level of knowledges of Indonesian
program. The characteristics according Nurses’ Codes of Ethics in nursing student
to ages, gender and ethics, it can see in can see in table 2:
table 1: No Chatagorized Frequencies Percentages
1. Good 59 71,1 %
2. Moderate 24 28,9%
Table 1.Frequencies DistributionNursing
3. Less 0 0%
Student in Profession Program according Total 83 100%
to gender, age and ethnics. Source: Primary Data, 2016
No. Characteristics Frequen- Percen-
According to table 1, it can know that the
cies tages
1. Gender largest respondent has good knowledge
a. Male 25 30%
b. Female 58 70% with 59 people (71.1%), the second rank
2. Ages are moderate level with 24 people
a. 21 years 5 6%
b. 22 years 32 39% (28.9%) and none of them have less level
c. 23 years 36 43%
d. 24 years 6 7% in knowledge about Indonesian ethic
e. 25 years 3 4% codes of nurses.
f. 26 years 1 1%
3. Ethnics
a. Javanese 49 60% Table 3. Knowledges level of Contents
b. Sundanese 7 8% Nurses’s Codes of Ethics
c. Dayaknese 5 6%
d. Melayunese 8 10%
e. Bimanese 5 6% The level of knowledge of nursing students
f. Sasaknese 5 6% had divided into 5 aspects, it can see in
g. Minangnese 1 1%
h. Banjarnese 1 1% table 3:
i. Malukunese 1 1%
j. Betawinese 1 1%
No Nurses’ ethic Chatego- Frequen- Percen-
Source: Primary Data, 2016 codes rized cies tages
1 Nurses and Good 69 83,1%
According to table 1, it can know patient Moderate 14 16,9%
that characteristics of respondent based on 2 Nurses and Good 68 81,9%
practice Moderate 15 18,1%
gender, the majority respondent is female 3 Nurses and Good 65 78,3%
society Moderate 18 21,7%
with 58 people (70%). Most of them are 23 4 Nurses and Good 68 81,9%
co-workers Moderate 15 18,1%

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5 Nurses and Good 62
organization Moderate 21
Source: Primary Data, 2016
According to table 3, it can know that the
majority respondent has good level of
knowledge for every aspect in nurses’
ethic codes. The highest percentages is
“nurses and patients” with
respondent have good knowledge with 69
people (83.1%) while the lowest is “
nurses and profession” with 62 people
(74.7%).
2. Perspectives of Nurses’ Ethic Codes
This study have two themes including
definition and functions of ethics and
contents of nurses’s codes of ethics.
A. Knowledge about definition and
function of nursing ethic codes
Examples of Students Narrative
Comments on Definition
Function Nurse’s Codes of Ethics.
Ethic codes nurse’s is a rules that have
to obey by nurses” (R1)
Nurse’s ethic codes is a matters that
direct nurses related to nurses patient
relationship and society” (R2)
“Nurse’s ethic codes is like a guidance
or limitations what have to do as a
nurses and how to manage the patients
74,7% without enter the other profession”
25,3%
(R4)
Nurse’s ethic codes are a guidance of
us to do nursing action that containing
of ethic codes which is good is like
what?” (R6)
largest
“Nurse’s ethic codes are values or
norms that has committed to manage
our profession to do their obligations
and the contents what have to do and
not”(R9)
B. Knowledge about contents nursing
ethic codes
2.1 Examples of Students Narrative
Comments on Nurses and Patient
Nurses respect the patient, no differences
the ethnic of patients, keep the privacy of
patients” (R2)
and
“Nurse must be fair in view and take care
the patients”(R6)
“Nurses have obligations to make patients
and their feel comfort, building trust and
kindness”(R7)
“Nurses as a patient’s advocate have role
to give advice to patient, maintain mutual
trust relationship and practicing their job
well done. Nurses have responsibility to do
nursing intervention suitable with the
patients “(R9)
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Nurses have to keep privacy of patients
and practice caring “(R10) “Nurses give the health promotion to
improve quality of life and wellness “(R4)
2.2 Examples of Students Narrative
Comments on Nurses and Practice
“Nurses have mutual relationship,
“Nurses up hold professionalism and they providing medical information and
must follow the rules in services” (R2) education. Nurses must be prepared
according to its competence or
“Nurses have responsible to give the best knowledge” (R7)
service since hospital admission until the
“Society is the priority for the intervention,
patient get heal” (R5)
health education and empowerment to
improve health level” (R9)
Nurses in practice have to caring, know
their job description, know their 2.4 Examples of Students Narrative
independent nursing intervention and Comments on Nurses and
collaborate to solve the patient problems” Organization
(R7)
“Organization have to clear the
profession of nurses, the right of nurses”
“Nurses in practices maintain ethical
(R4)
principles such as maleficient, beneficiene,
veracity, justice, do not distinguish the Nurses communicate and support all of
level of economic, ethnic and gender”(R9) the people in Indonesian National Nurses
“Nurses have responsible to keep patient Association for example in prevention
safety “(R10) diseases” (R5)

2.3 Examples of Students Narrative “ All of the nurses have to join in

Comments on Nurses and Society organizational profession and they have to
care about organization of their
“Nurses attitude are good, openness and
contribution” (R7)
ready to help the society. Professional
attitude is mutual relationship” (R1) “Nurses have to play role in organization
and obey their rules” (R10)
Nurses have to serve society
comprehensively, give the information and
justice” (R3)

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“Nurses should up date their knowledge think that ethic codes are required to guide
because the information of health increase nursing practice and provide professional
significantly”(R11) status and identity. In the present study,
the 79.1% of nurses acquired their
2.5 Examples of Students Narrative
knowledge of ethics in nursing school, and
Comments on Nurses and Co-
53.6% of them acquired their knowledge of
Workers
ethics during work also 40.5% of nurses
“ The relationship between nurses and co- stated that nursing ethic codes is formally
workers should not have problems. Nurses given them (Mohajjel et al, 2013).
have competencies and knowledge itself,
According the Code, the nurses
independent, give patient safety and good
should be sensitive to the ethical
quality of services” (R7)
challenges and do their best to fulfill their
moral duties including informed consent,
“ Nurses and their colleagues should help
respect to privacy and confidentiality of
each other, doing collaboration and
patients/clients, relationship with
coöperation” (R8)
colleagues, efficient performance of the
professional duties, conflicts of interests,
“Nurses have mutual cooperation , keep
ethics in educational activities and
privacy and implement the intervention
protection of participants in research and
appropriate with their competencies” (R9)
consultation with the hospital ethics
committee for decision-making when are
“Nurses should to respect and be a good
confronted with ethical cases (Zahedi et al,
team work with their colleagues” (R10)
2013).

“Nurses know the their competencies to Experience and research have

care or cure, they have to communicate
with good way, give the suggestion for
colleagues” (R11)
Discussion
According to Numminen et al
(2009), nurses’ knowledge and use of the
codes are deficient. However, the nurses
shown that nursing students deliberation of
ethical matters is practically oriented and
connected to their concrete personal
experiences (Numminen et al. 2009), and
that relating ethics education closely to
practical context makes it meaningful to
nurses (Gatsmants et al 1998; Meulensberg
et. Al, 2004; Van der Arend & Smith,
2003; Woods, 2005)

7
 According to Numminen et al
(2009), several studies might add valuable
knowledge of education of the codes in
varying educational systems and health
care contexts revealing strengths as well as
problems area in their teaching. The
quality of teaching the codes aiming at
educating nurses who can provide ethically
high quality care is important (Salvage &
Heidjen 1997; Sasso et al. 2008).
Knowledge of ethic codes is a
priority foundation for nurses to give
nursing care because nurses’ ethic codes is
one of the characteristics of nursing
profession to keen up, maintain, and
increase profession standards that reflected
by all of nurses as a moral value for
patients, society and co workers (Abrori,
2016; Nasrullah, 2014).
Conclusion
The perspectives of Indonesian
nurses’ ethic codes on nursing student
profession is good in quantitative and
qualitative analysis.
Suggestion
Further research should focus on the
implementation of ethic codes of nurses’
including assessment and evaluation
methods on nursing students.
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2. ICN revised 2012. The ICN Codes of
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