BACHELOR OF SCIENCE IN NURSING:

BIOETHICS/HEALTH CARE ETHICS

COURSE MODULE COURSE UNIT WEEK
1 3 3
Code of Ethics for Nursing; Multiple Ethical Obligations; Nurse- Doctors Relations

 Read course and unit objectives

 Read study guide prior to class attendance
 Read required learning resources; refer to unit
terminologies for jargons
 Proactively participate in classroom discussions
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

Personal Laptop/mobile device

Internet connection/device
Reading materials
Paper and Pen for writing
At the end of the course unit 3 (CU3), learners will be able to:
Cognitive:
1. Understand the History and Code of Ethics for Nurses of the Philippines
2. Describe the Code of Ethics of International Council of Nurses.
3. Describe the Multiple Ethical Obligations of Nurses.
4. Discuss the Nurse-Physician Relationship.

Affective:
1. Inculcate the importance of Code of Ethics in nursing profession and clinical practice.
2. Appreciate the importance of Nurse-Physician Relationship in health care environment.
3. Listen attentively during class discussions.
4. Demonstrate tact and respect when challenging other people’s opinions and ideas.
5. Accept comments and reactions of classmates on one’s opinions openly and graciously.

Psychomotor:
1. Apply the concept of Code of Ethics and its principles during class discussion.
2. Participate actively during class discussions.
3. Confidently express personal opinion and thoughts in front of the class.

CODE OF ETHICS FOR NURSING- It is a succinct statement of the ethical obligations and duties
of every individual who enters the nursing profession. It is the profession's nonnegotiable ethical
standard. It is an expression of nursing's own understanding of its commitment to society.
ETHICAL OBLIGATIONS- Ethical obligations are a set of “ought to” standards that define a moral
course of action and draw a line between right and wrong.

OUTLINE:
A. History of Code of Ethics for Filipino Nurse’s
B. Code of Ethics for Nurses of the Philippines
C. Code of Ethics for International Council of Nurses (ICN)
D. Multiple Ethico-Moral Obligations
E. Nurse-Physician Relationship
A. The History of Code of Ethics for Filipino Nurse’s

1922- The Code was formed

1982- PNA approved the COE
October 1983- COE was published
October 21, 1982- The final presentation of the documents.
March 21, 1984- the PRC Board of Nursing adopted the
ICN. BON Resolution no. 633
October 18, 1989- The amended Code of Ethics was
approved by the BON in its resolution no. 1955
October 23, 2003- New COE was presented at the Assembly of Nursing Rep. during the 81st
Foundation. Anniversary, 46th Nurses Week Celebration, and the Annual National Convention
of Nurses in Iloilo City
July 14, 2004- The new COE for Filipino Nurses was finally promulgated. PRC-BON Resolution
no.220.

B. CODE OF ETHICS FOR REGISTERED NURSES (BOARD OF NURSING)

Board Resolution No. 220, Series of 2004 approved last 14th day of July, 2004

CODE OF ETHICS FOR NURSES

WHEREAS, the Board of Nursing (BON) has the power to promulgate a Code of Ethics
for Registered Nurses in coordination and consultation with the accredited professional
organization (Sec. 9, (g), Art III of (Republic Act) No. 9173, known as the “Philippine
Nursing Act of 2002);

WHEREAS, in the formulation of the Code of Ethics for Registered Nurses, the Code of
Good Governance for the Professions in the Philippines was utilized as the principal
basis thereof: All the principles under the said Code were adopted and integrated into
the Code of Ethics as they apply to the nursing profession;
WHEREAS, the promulgation of the said Code as a set of guidelines, regulations or
measures shall be subject to approval by the Commission (Sec. 9, Art. II of R.A. No.
9173); and

WHEREAS, the Board, after consultation on October 23, 2003 at Iloilo City with the
accredited professional organization of registered nurses, the Philippine Nurses
Association, Inc. (PNA), and other affiliate organizations of Registered Nurses, decided
to adopt a new Code of Ethics under the afore-mentioned new law;

NOW, THERFORE, the Board hereby resolved, as it now resolves, to promulgate the
hereunder Code of Ethics for Registered Nurses:

ARTICLE I
PREAMBLE

SECTION 1.
Health is a fundamental right of every individual. The Filipino registered nurse, believing in the
worth and dignity of each human being, recognizes the primary responsibility to preserve
health at all cost. This responsibility encompasses promotion of health, prevention of illness,
alleviation of suffering, and restoration of health. However, when the foregoing are not
possible, assistance towards a peaceful death shall be his/her obligation.

SECTION 2.
To assume this responsibility, registered nurses have to gain knowledge and understanding of
man’s cultural, social, spiritual, physiological, psychological, and ecological aspects of illness,
utilizing the therapeutic process. Cultural diversity and political and socio-economic status are
inherent factors to effective nursing care.

SECTION 3.
The desire for the respect and confidence of clientele, colleagues, co-workers, and the
members of the community provides the incentive to attain and maintain the highest possible
degree of ethical conduct.

ARTICLE II
REGISTERED NURSES AND PEOPLE

SECTION 4.
Ethical Principles
1. Values, customs, and spiritual beliefs held by individuals shall be respected.
2. Individual freedom to make rational and unconstrained decisions shall be respected.
3. Personal information acquired in the process of giving nursing care shall be held in strict
confidence.

SECTION 5.
Guidelines to be observed:
REGISTERED Nurses must
a. consider the individuality and totality of patients when they administer care.
b. respect the spiritual beliefs and practices of patients regarding diet and treatment.
c. uphold the rights of individuals.
d. take into consideration the culture and values of patients in providing nursing care. However,
in the event of conflicts, their welfare and safety must take precedence.

ARTICLE III
REGISTERED NURSES AND PRACTICE

SECTION 6.
Ethical Principles
1. Human life is inviolable.
2. Quality and excellence in the care of the patients are the goals of nursing practice.
3. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing
accountability
SECTION 7.
Guidelines to be observed:
REGISTERED Nurses must
a. Know the definition and scope of nursing practice which are in the provisions of R. A. No.
9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of 2003,
the “Rules and Regulations Implementing the Philippine Nursing Act. of 2002”, (the IRR).
b. Be aware of their duties and responsibilities in the practice of their profession as defined in
the “Philippine Nursing Act of 2002” and the IRR.
c. Acquire and develop the necessary competence in knowledge, skills, and attitudes to
effectively render appropriate nursing services through varied learning situations.
d. If they are administrators, be responsible in providing favorable environment for the growth
and developments of Registered Nurses in their charge.
e. Be cognizant that professional programs for specialty certification by the BON are accredited
through the Nursing Specialty Certification Council (NSCC).
g. Sees to it that quality nursing care and practice meet the optimum standard of safe nursing
practice.
h. Ensure that modification of practice shall consider the principles of safe nursing practice.
i. If in position of authority in a work environment, be normally and legally responsible for devising
a system of minimizing occurrences of ineffective and unlawful nursing practice.
j. Ensure that patients’ records shall be available only if they are to be issued to those who are
professionally and directly involved in their care and when they are required by law.

SECTION 8.
Ethical Principle
4. Registered Nurses are the advocates of the patients: they shall take appropriate steps to
safeguard their rights and privileges.

SECTION 9.
Guidelines to be observed:
REGISTERED Nurses must
a. respect the “Patients’ Bill of Rights” in the delivery of nursing care.
b. provides the patients or their families with all pertinent information except those which may be
deemed harmful to their well-being.
c. upholds the patients’ rights when conflict arises regarding management of their care.

SECTION 10.
5. Registered Nurses are aware that their actions have professional, ethical, moral, and legal
dimensions. They strive to perform their work in the best interest of all concerned.
‘
SECTION 11.
Guidelines to be observed:
REGISTERED Nurses must:
a. performs their professional duties in conformity with existing laws, rules regulations.
measures, and generally accepted principles of moral conduct and proper decorum.
b. not allow themselves to be used in advertisement that should demean the image of the
profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.).
c. declines any gift, favor or hospitality which might be interpreted as capitalizing on patients.
d. not demand and receive any commission, fee or emolument for recommending or referring a
patient to a physician, a co-nurse or another health care worker; not to pay any commission, fee
or other compensations to the one referring or recommending a patient to them for nursing care.
e. avoids any abuse of the privilege relationship which exists with patients and of the privilege
access allowed to their property, residence or workplace

ARTICLE IV
REGISTERED NURSES AND CO-WORKERS

SECTION 12.
Ethical Principles
1. The Registered Nurse is in solidarity with other members of the healthcare team in working
for the patient’s best interest.
2. The Registered Nurse maintains collegial and collaborative working relationship with
colleagues and other health care providers.
SECTION 13.
Guidelines to be observed:
REGISTERED Nurses must
a. maintains their professional role/identity while working with other members of the health team.
b. conform with group activities as those of a health team should be based on acceptable, ethico-
legal standards.
c. contribute to the professional growth and development of other members of the health team.
d. actively participate in professional organizations.
e. not act in any manner prejudicial to other professions.
f. honor and safeguard the reputation and dignity of the members of nursing and other
professions; refrain from making unfair and unwarranted comments or criticisms on their
competence, conduct, and procedures; or not do anything that will bring discredit to a colleague
and to any member of other professions.
g. respect the rights of their co-workers.

ARTICLE V
REGISTERED NURSES, SOCIETY, AND ENVIRONMENT

SECTION 14.
Ethical Principles
1. The preservation of life, respect for human rights, and promotion of healthy environment shall
be a commitment of a Registered Nurse.
2. The establishment of linkages with the public in promoting local, national, and international
efforts to meet health and social needs of the people as a contributing member of society is a
noble concern of a Registered Nurse.

SECTION 15.
Guidelines to be observed:
REGISTERED Nurses must
a. be conscious of their obligations as citizens and, as such, be involved in community concerns.
b. be equipped with knowledge of health resources within the community, and take active roles
in primary health care.
c. actively participate in programs, projects, and activities that respond to the problems of
society.
d. lead their lives in conformity with the principles of right conduct and proper decorum.
e. project an image that will uplift the nursing profession at all times.

ARTICLE VI
REGISTERED NURSES AND THE PROFESSION

SECTION 16.
Ethical Principles:
1. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal.
2. Compliance with the by-laws of the accredited professional organization (PNA), and other
professional organizations of which the Registered Nurse is a member is a lofty duty.
3. Commitment to continual learning and active participation in the development and growth of
the profession are commendable obligations.
4. Contribution to the improvement of the socio-economic conditions and general welfare of
nurses through appropriate legislation is a practice and a visionary mission.

SECTION 17.
Guidelines to be observed:
Registered Nurses must
a. be members of the Accredited Professional Organization (PNA).
b. strictly adhere to the nursing standards.
c. participate actively in the growth and development of the nursing profession.
d. strive to secure equitable socio-economic and work conditions in nursing through appropriate
legislation and other means.
e. assert for the implementation of labor and work standards.
ARTICLE VII
ADMINISTRATIVE PENALITIES, REPEALING CLAUSE, AND EFFECTIVITY

SECTION 18.
The Certificate of Registration of Registered Nurse shall either be revoked or suspended for
violation of any provisions of this Code pursuant to Sec. 23 (f), Art. IV of R. A. No. 9173 and Sec.
23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR.

C.THE INTERNATIONAL COUNCIL OF NURSES (ICN) CODE OF ETHICS FOR NURSES

An international code of ethics for nurses was first adopted by the International Council of Nurses
(ICN) in 1953.
It has been revised and reaffirmed at various times since, most recently with this review and
revision completed in 2012.

Nurses have four fundamental responsibilities:

1. To promote health
2. To prevent illness
3. To restore health
4. To alleviate suffering

What exists in nursing?

Is a respect for human rights
These includes:
Cultural rights
The right to having a life and choice
To have dignity
To be treated with respect
Nursing care is respectful of and unrestricted by considerations of:
Gender and Age
Color and Race
Creed – set of beliefs
Culture
Disability or illness
Social status
Sexual orientation
Nationality
Politics

The ICN Code of Ethics for Nurses has four principal elements that outline the standards
of ethical conduct.
1. Nurses and people
-Nurse’s primary professional responsibility is to people requiring nursing care.
2. Nurses and practice
- Nurses carries personal responsibility and accountability for nursing practice
- Maintaining competence by continual learning.
3. Nurses and the profession
The nurse assumes the major role in:determining and implementing acceptable standards of
clinical nursing practice, management, research and education.
The nurse is active in:
1. Developing a core of research-based professional knowledge.
2. Developing and sustaining a core of professional values.
4. Nurses and co-workers
The nurse sustains a collaborative and respectful relationship with c0-workers in nursing and
other fields.
The nurse takes appropriate action to safeguard individuals, families, and communities when
their health is endangered by a co-worker or any other person.
- The nurse takes appropriate action to support and guide co-workers to advance ethical
conduct.
SUGGESTIONS FOR USE of the ICN Code of Ethics for Nurses
The ICN Code of ethics for Nurses is a guide for action based on social values and needs. It will
have meaning only as a living document if applied to the realities of nursing and health care in
a changing society.

To achieve its purpose the Code must be understood, internalized and used by nurses in all
aspects of their work. It must be available to students and nurses throughout their study and
work lives.

D. Professional Boundaries and Ethico-Moral Obligations for Nurses as Specified by the

ANA Code of Ethics for Nurses with Interpretive Statements (2001)

Clinical Practice Boundaries

Respecting patients’ dignity
Right to self-determination
Delegating tasks appropriately
Practicing good judgment
Accepting accountability in practice
Alleviating suffering
Being attentive to patients’ interests
Working within the nurse practice acts and nursing standards of practice

Professional Practice Boundaries

Maintaining authenticity in all relationships with others such as nurse-to-nurse relationships,
nurse-physician relationships, nurse-to-patient relationships, and multidisciplinary
collaboration.
Addressing and evaluating issues of impaired practice; fraternizing inappropriately with patients
or others;
Accepting inappropriate gifts from patients and families; Confidentiality and privacy violations;
and unhealthy, unsafe, illegal, or unethical environments.
Self-Care and Self-Development Boundaries and Obligations

Participating in self-care activities to maintain and promote moral self-respect,

Professional growth and competence, wholeness of character in nurses’ actions and in
relationships with others, and preservation of integrity.
Advancing knowledge and research through professionalism, practice, education, and
administrative contributions.

E. NURSE- PHYSICIAN RELATIONSHIP

WHAT IS A HEALTH CARE PROFESSIONAL RELATIONSHIP?

As a social being, the human person trends to relate with

others. In establishing relationship, he uses language
which may take variety of forms such as spoken or written
words, gestures, signs, and other. Communication or
interaction is essential to any human relationship.

The relationship among people in health care milieu is

professional. Meaning, it is established in connection with the performance of work as an
occupation that is meant to cater the health care needs of the client. The interaction between
health care practitioners themselves and their clients ought to enhance their professional
relationship.

Since the HCP-client relationship is therapeutic, the interaction must also be therapeutic. This
interaction is processive in nature and character. It may develop even at a more meaningful level
transcending what is merely mechanical into commitment and accountability with love, trust,
concern, and care for each other.
Ten Steps to Improving Physician-Nurse Relationships
Tips for Nurses:
1. Always have the chart in hand when calling a physician.
2. Adopt the SBAR tool as a standard of communication especially telephone conversations.
3. Don’t begin telephone conversations with “I’m sorry to
bother you....”
4.Be prepared for rounds. Anticipate late night problems ahead of time.
5.Use the progress notes to briefly communicate your key concerns/interventions.
6.Confront physicians whose behaviors are degrading by speaking to them in private. State the
behavior and its effect. Ask manager for support if needed.
7.Take the time to thank and acknowledge those physicians with whom you have a good working
relationship.
8.Don’t complain about a doctor to other staff. If you have a problem, speak to the physician in
private.
9.Raise your awareness. Identify those physician behaviors which belittle or diminish you (one-
word answers, no eye contact, interrupting, raised voice, etc.)
10.Further your education by pursuing a BSN or MSN degree

Tips for Physicians:

1.It makes a world of difference to address a nurse by her/his name. If unsure, don’t hesitate to
ask –the mere question denotes recognition.
2.Be a leader, not a commander –recognize that your role enables you to create an atmosphere
where nurses feel comfortable sharing patient concerns and asking questions without feeling
inferior.
3.Be considerate of the nurse- patient interaction when walking into a patient’s room.
4.Discuss the plan of care for complicated patients directly with the nurse–it takes less than 2
minutes to engage the RN and provides an opportunity for education.
5..Participate in joint educational and celebratory events. The ROI (Return on Investment) far
exceeds the time/cost -the benefits are tremendous.
6.If you have a problem with a patient’s care, speak to the nurse involved first; then the charge
nurse.
7.Invite nurses to round with you. Create a welcoming atmosphere.
8.Recognize the difference in education. Volunteer to give at least two minutes in services a
year to staff on your area of expertise or concern.
9.Recognize the nurse’s role at the sharp end: a critical member of the team.
10.Compliment nurses who are doing a great job in public and in private.

https://nurseslabs.com/code-of-ethics-for-registered-nurses/
Code of Ethics for Nurses via Philippine Nurses Association
www.PRC.GOV.PH
2012_ICN_Codeofethicsfornurses_ eng(5).pdf
www.marylandpatientsafety.org

American Nurses Association (ANA), (2001), Code of Ethics for Nurses, American Nurses
Association, Washington, D.C.
https://www.rnspeak.com/nurses-code-of-ethics/
https://www.jacksonvilleu.com/blog/nursing/improving-the-doctor-nurse-relationship/
https://nsuworks.nova.edu/ijahsp/vol10/iss1/2/HealthcareprofessionalRelationship

APPLYING THE ELEMENTS of Code of Ethics for Nurses

The following chart will assist nurses to translate the standards into action.

1. Study the standards under each element of the Code.

2. Reflect on what each standard means to you. Think about how you can apply ethics in your
nursing domain.
3. Discuss the Code with your groups and classmates.
4.Use a specific example from experience to identify ethical dilemmas and standards of conduct as
outlined in the Code.
5. Identify how you would resolve the dilemmas.
6. Collaborate and Work in groups to clarify ethical decision making.