CODE OF ETHICS (INC),

CODE OF PROFESSIONAL CONDUCT (INC),

AUTONOMY AND ACCOUNTABILITY,

ASSERTIVENESS,

PREPARED BY: VISIBILITY OF NURSES,

MISS DIPTI K. PUNJAL
FIRST YEAR M.Sc. NURSING STUDENT
ROLL NO.: 02 LEGAL CONSIDERATIONS
SUBJECT: ADVANCED NURSING PRACTICE
GIMH
 CODES OF
ETHICS (INC)
 CODE
“A code may be defined as
conventionalized set of rules or
expectations devised for a specific
purpose.”
◦ETHIC is derived from the Greek word ETHOS—
Means – customs or guiding beliefs.
◦Ethics are characteristics of a profession and are called
a “code”.
“Ethics refers to the moral code of nursing & is based
on obligation to service and respect to human life.” 
 Definition
“A code of ethics is a
set of rules about good
and bad behavior.”
(Merriam – Webster)
 “A code of ethics is a
guideline for
performance, standards
and personal
responsibilities.”
(Potter And Perry)
 “A code of ethics is a set of ethical
principles that are accepted by all members
of a profession.”
(MELANIE & EVELYN)
The ethical code generally implies documents at
three levels:
Purposes of code of ethics in nursing
Standards for the behaviors of nurse &
provide general guidelines for nursing action.
Helps to distinguish between right & wrong.
Enables a correct decision and a uniform
decision within the groups.
Protect the rights of individuals, families and
community also the right of the nurse.
THE USE OF CODE
◦ Acknowledges (accept) the rightful place of
individual in health care delivery system.
◦ Contributes towards empowerment to become
responsible for their health & well-being.
◦ Contributes to quality care.
◦ Identifies obligations (morally or legally
bound) in practice, research & relationships.
◦ Informs the individuals, families, community
& other professionals about expectations of a
nurse.
 Who recommends the Code of Ethics for Nurses…
• The International Council For Nurses
(ICN)
• American Nurses Association
• Canadian Nurses Association
• Trained Nurses Association of India
(TNAI)
• Indian Nursing Council (INC)
 ETHICAL
PRINCIPLES
 ETHICAL PRINCIPLES
“The most fundamental universal principle is respect for people.”
1. Principle of Autonomy and Respect
2. Principle of Beneficence
3. Principle of Confidentiality
4. Principle of Do no harm/Non maleficence
5. Principle of Equity/Justice
6. Principle of Fidelity
7. Principle of Veracity
 1. Principle of Autonomy and Respect
“autos” = self
“nomos” = rule
 It is person’s independence and self reliance.
 People should have control on their own lives.
 Individual rights of self determination for making decisions.
 Freedom of choice.
 Informed consent for treatment and for participation in research.
 Right to know procedure, complications, other options.
 Nurse should respect client’s decision and choices.
Respect for a person involves – level of
understanding of another person or empathy and
reducing exploitation.
• Call by name
• Respect as an individual
• Respect their opinion
• Respect relatives
• Especially respect the women in
labour/delivery room
 2. Principle of Beneficence
•It states that the actions one takes
should be in an effort to promote the
good.
•It requires the balancing of harms and
benefits.
3. Principle of confidentiality
◦It is the duty to respect privileged
information.
◦It provide that caregivers should
respect the patients needs for
privacy and use personal
information about him/her only to
improve care.
 4. Principle of Do no harm/Non maleficence

It states that one should do no harm.

 Prevent harm
 Remove harm
 5. Principle of Equity/Justice
• Providing nursing care equally to all as per
needs
• Fairness/unbiased
• Giving equal treatment
• Equal distribution of benefits, costs and even
risk.
• Some time equal distribution is not possible
during emergency, the services are based on
priority.
 6. Principle of Fidelity
It is keeping one’s promises and
commitment.
This principle holds that the
person should faithfully fulfill his
duties and obligations.
Don’t make promises you can't
keep
 7. Principle of Veracity
It means obligation to tell the truth.
It requires professional caregivers to provide
with accurate, reality based information about
their status to the patients.
Truth telling is an ethical concern for nurses
because Truth is the basis for mutual trust
between clients and health professionals.
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.
PREAMBLE
Nurses have four fundamental responsibilities:
To promote health
To prevent illness
To restore health
To alleviate suffering.
֍The need for nursing is universal.
֍Inherent in nursing is a respect for human rights, including
cultural rights, the right to life and choice, to dignity and to
be treated with respect.
֍Nursing care is respectful of and unrestricted by
considerations of age, colour, creed, culture, disability or
illness, gender, sexual orientation, nationality, politics, race
or social status.
֍Nurses render health services to the individual, the family
and the community and coordinate their services.
THE ICN CODE
The ICN Code of Ethics for Nurses
has four principal elements that
outline the standards of ethical
conduct.
 Nurse and
people

ELEMENTS
OF Nurse and
coworkers Elements
Nurse and
practice
THE
CODE
Nurse and
profession
CODE OF ETHICS
FOR NURSES IN
INDIA
 INTRODUCTION
 Indian Nursing Council (INC) has published the code of
Ethics for Nurses in India in year 2006.
 The code of ethics for nurses in critical for building
professionalism & accountability.
 Ethical consideration are vital in any area dealing with
human beings including nursing research because they
represent values, rights & relationships.
 The code of Ethics for nurses in India (2006) are as follows:
1. The nurse respects the uniqueness of individual in
provision of care –
2.The nurse respects the rights of individuals as
partner in care and help in making informed
choices -
3. The nurse respects individual’s right to privacy,
maintains confidentiality, and shares information
judiciously-
4. Nurse maintains competence in order to
render Quality Nursing Care-
5. The nurse if obliged to practice within the
framework of ethical, professional and legal
boundaries-
6. Nurse is obliged to work harmoniously
with members of the health team
7. Nurse commits to reciprocate the trust
invested in nursing profession by society
 CODE OF
PROFESSIONAL
CONDUCT FOR
NURSES IN INDIA
The purpose of professional
conduct:
◦To inform both the nurse and the society of
the minimum standard for professional
conduct.
◦It provides regulatory bodies a basis for
decisions regarding standards of professional
conduct.
1. Professional Responsibility and
accountability –
2) Nursing practice
3) Communication & interpersonal
relationships
4) Valuing human being
5) Management
6) Professional advancement
 AUTONOMY
&
ACCOUNTABILITY
• The term autonomy comes from the
Greek word
autos (meaning ‘self’) and nomos
(meaning ‘rule’, ‘governance’ or
‘law’).
“Autonomy means ‘self-governing’
or “right to make one’s own
decisions”.
Autonomy basically mean that people should be free to choose
and entitled to act on their preferences provided their decisions
and actions do not stand to violate or impinge on, the significant
moral interest of others.
Nurses who follow this principle recognize that each client is
unique, has the right to be what that person is, and has the right to
choose personal goals.
Honoring the principle of autonomy means that the nurse
respects a client’s right to make decisions even when those
choices seems not to be in the client’s best interest.
Adults with capacity (physical and mental) to make healthcare
decisions have the right to consent to or refuse treatment.
Even if healthcare providers do not agree with a client’s decision,
they must respect the client’s wishes (Beauchamp & Childress,
2001).
Infants, young children, people who are severely mentally
handicapped or incapacitated, and people in a persistent vegetative
stage or coma do not have the capacity to participate indecision
making about their healthcare.
For such people, a surrogate decision maker must be identified to
act on their behalf.
 •Accountability is the process that mandates that
individuals are answerable for their actions and have
an obligation to act.
•It involves admitting mistakes rather than blaming
others and evaluating the outcomes of one’s own
actions.
•Attributes of accountability:
 Nursing personnel are accountable for:
 Provide safe & therapeutic environment
 Deliver competent & personalized care
 Maintaining adequate supplies of material in the ward
 Maintaining accurate and up to date records
 Maintaining good IPR
 Protect client’s legal rights & privacy
 Work within ethical& legal boundaries
 Keep pace with changing health needs & developing technology
 Delivering care as per standards
 Delegating responsibility appropriately
 Contribute to development of profession
 ASSERTIVENESS

Assertiveness is a tool for expressing

ourselves confidently and way of saying yes or
no in an appropriate way.
It is a style of behaviour to interact with
people while standing up for your rights.
 DEFINITION

“Assertiveness is the quality or state of bold or confident self-expression,

neither aggressive nor submissive.”

(Dorland’s medical dictionary, 2007)

“Assertiveness is the ability to express yourself and your rights without

violating the rights of others.”
◦ It means that we have respect both for ourselves and for others.
 BENEFITS
Creating health, meaningful relationship
Less friction & conflicts
Increased self-respect
Enhances self esteem
Increased productivity at work.
Less stress at work and sense of well being
In expressively ourselves appropriately, we needn’t hold grudges,
store pent-up emotions
 AIMS OF ASSERTIVENESS
Find the best possible solution for all people.
Increases chances of our needs being met
Allows us to remain in control
Brings self confidence
Have more friends
Reduces stress
Assertiveness model, A-S-E-R-T model

A - Ask for God`s help

S - State the problem
E - Express yourself
R - Request change and feedback
T - Talk it out
 STRATEGIES FOR IMPROVING
ASSERTION AT WORK
Ask
Bring energy to the job
Get your emotions under control
Find a good place to talk
Timing is important
Effective assertion requires a listener
 TECHNIQUES FOR BEING
ASSERTIVE
Identify your personal rights, wants Ask for feedback
and needs Stop apologizing all the time
Identify how you feel about a Learn to take a compliment
particular Situation
Act confident even if you don't
Be direct
feel confident
Own your message
Feel free to say no
Avoid assumptions about others
Evaluate your expectation
thinking
Avoid statements that begins with
"why", "you"
 VISIBILITY OF NURSES
A quality or fact of, degree of being
visible
Degree of exposure to public notice.
The visibility of nursing care can be
measured not only through patient
outcomes but also studying the
existing data of patient care
documentation.
 CURRENT VISIBILITY OF NURSING:

Public view of nursing:

- Based on personal experience
- Consumers not recognize the nurses
- Public values nurses
Nurses view of themselves:
- Response of nursing towards the change
- Not taking the leading role.
 
 Factors affecting visibility:
External factors:
1. Hand maiden role
2. Hierarchical structure
3. Perceived authority and directives of physician
4. Threat of disciplinary actions or loss of the job
 Internal factors:
1.Role confusion
2.Lack of personal confidence
3.Timidity
4.Fear
5.Insecurity
6.Inferiority
 Steps to increase visibility:
Advertising nursing
Role of media
Raise the voice campaign
Power and empowerment
Assertiveness
Advocacy
 Responsibility of a nurse for professional recognition and
visibility:

Take a stand if someone saying wrong about

nursing and nurses warns about the facts that
nursing profession and communicate important
aspects of nursing.
LEGAL CONSIDERATIONS
25
25September 2020
September 2020
Chairperson :
Dr Suresh Sharma

The last President of MCI was

Dr. Jayshreeben Mehta.
 LEGAL ASPECTS IN NURSING:
• Knowledge of legal aspect in nursing is absolutely
essential for each nurse to safe guard self and client from
legal complications.
• Nursing practice is governed by many legal concepts.
• It is important for nurses to know the basics of legal
concepts, because nurses are accountable for their
professional judgments and actions.
 NURSING LEGISLATIONS:
• The first nursing registration: 1903.
• Enacted in 1947
• Amended in 1957.
• Employment as a nurse does not only require a
nursing degree but knowledge of the medical laws
that will apply to you.
 LEGAL IMPLICATIONS
1. Crime:

2. Tort:
Intentional torts:  Unintentional torts:
I. Battery I. Negligence
II. Assault II. Malpractice
III. Defamation
IV. Fraud
V. False imprisonment
VI. Invasion of privacy
 LEGAL DOCUMENTS
It comprised:
A.Advance directive
B.Do not resuscitate orders
C.Informed consent
 NURSING LIABILITIES AND PREVENTIVE
MEASURES
All nursing observations should be noted carefully, describing
accurately
Patients complaints should be recorded as accurately and specifically
Nurse must report through proper channels.
Authorities must be informed regarding any kind of equipment,
materials or supplies, which for any reasons less than safe for use in
the patient's care
Insurance protection
Good
Samaritan
Act
 LEGAL RESPONSIBILITY
1. Registration
2. Legal Liability/Act Of Negligence
3. Medico — Legal case (M.L.C.)
 TYPES OF CLIENTS WHICH ARE CATEGORIZED
AS MLC IN A HOSPITAL ARE………..
Road traffic accidents
Injuries inflicted during brawls/fights, shooting, bomb blasts etc.
Suicide
Burns
Poisoning
Rape victim
Assault
 NURSES ROLE IN A MEDICO-LEGAL CASE
1. Obtain complete history from patient or significant others
2. Inform the police officer/constable on duty in the hospital and the CMO.
3. When it is made a MLC, then record it on the patient's case sheet with red ink at
right hand top corner.
4. Do not give any statement about patient's condition to police, magistrate or
media. Only a doctor has to give information.
5. When a patient has to be discharged, inform the CMO only. After clearance
from them, he/she can be discharged.
6. If a MLC patient absconds, inform the CMO and the treating doctor
immediately.
7. No patient can leave against medical advice.
8. Document the care given to patients timely, accurately and duly
sign the nurse’s notes.
9. Records and all the documents pertaining to patient should be
handled with care, during the stay in the hospital. They must be
kept safely and should be handed over to the authorized person as
designated by the hospital authority.
10. In case death of a MLC; the body is not to be handed over to the
relatives. It needs to be accurately labelled and sent to the mortuary.
CMO and/ or police officer should be informed simultaneously.
11. Appropriately authority must be informed.
4. Correct Identity
5. L.A.M.A.
6. D.A.M.A
7. Patient's Property
8. Dying Declaration
9. Wills
10. Examination Of Rape Case
11. Artificial Human Insemination.
12. Poison Case
 13. Consumer Protection Act :1986
Rights of a consumer/patient are:
Right to safety
Right to be informed
Right to choose
Right to be heard
Right to seek redressal
Right to consumer education
 NURSES ROLE TO PREVENT
COMPLICATIONS
1. Review nursing practice periodically. Update knowledge and improve skill
by attending short term courses, in- service education and continuing
education programmes.
2. Should have complete knowledge of all rules and regulations of hospital
and know their descriptions (duties and responsibilities).
3. Follow nursing practice standards/protocols.
4. Be a keen observer.
5. Written instructions must have rules and code of practice laid down to
ensure the safety and well being of patients and nurses.
6.All hospitals must have rules, a code of practice laid down to
ensure the safety and well being of patients and nurses.
7.Maintain records and reports of the unit properly.
8.Follow 6 Rights - right patient, right drug, right time and right
route with right technique and right of the patient to know about
his/her disease condition.
9.Check the treatment order and use professional judgment before
implementing.
10. Do not exceed the limits of nursing procedure laid down by
statutory bodies.