CODE OF ETHICS

PRESENTED BY
ANNE SINDIA.P
M.SC [N]1 ST YEAR
CON-PIMS.
INTRODUCTION
Ethics signifies the morals .It is that branch of
philosophy which deals with human behavior and conduct.
The term ethics refers to the study of philosophical ideals
of right and wrong behavior .In nursing profession a code
of ethics provides guidelines for safe and compassionate
care. Nurses commitment to a code of ethics guarantees the
public that nurses adhere to professional practice standards.
DEFINITION OF CODE OF ETHICS :
A Code of ethics is a set of ethical principles that
are accepted by all members of a profession. Codes
serves as guidelines to assist nurses and other
professional groups when questions arise about correct
practice or behavior.
PURPOSES OF CODE OF ETHICS IN NURSING
1. Standards for the behaviors of nurse and provide general
guidelines for nursing action in ethical dilemmas.
2. The code helps to distinguish between right and wrong
at a given time especially when alternatives appear just
at satisfactory.
3. The code enables a correct decision and a uniform
decision within the groups.
4. Helps to protect rights of individuals, families and
community and also the right of the nurse.
USES OF CODE OF ETHICS
1. Acknowledge the rightful place of individual in health
care delivery system.
2. Constitutes towards empowerment of individual to
become responsible for their health and wellbeing.
3. Contributes to quality care.
4. Identifies obligations in practice ,research and
relationships.
5. Inform the individual ,families, community and other
professionals about expectation of nurse.
ETHICAL PRINCIPLES
1. RESPECT AND AUTONOMY
2. BENEFICENCE
3. NONMAEFICENCE
4. JUSTICE
5. VERACITY
6. FIDELITY
7. CONFIDENTIALITY
1.ETHICAL PRINCIPLES OF RESPECT AND
AUTONOMY
Respect for a person involves- level of
understanding of another person or empathy and
reducing exploitation.
Autonomy-person’s independence, self determining
action allow the patient to make decision.
2.PRINCIPLE OF BENEFICENCE

Activity seeking benefits, promotion of good. The

duty to do balance between benefits and harms.
Paternalism is an undesirable outcome of beneficence,
in which the health care provider decides what is best for
the client and attempt to encourage the clients to act
against his or her own choices.
3.PRINCIPLE OF NONMALEFICENCE
Maleficence refers to harm or hurt; thus
nonmaleficence is the avoidance of harm or hurt. The nurse
should interpret the term harm to mean emotional and social
as well as physical injury.
4.PRINCIPLE OF JUSTICE
Basic principle is that each person has equal right to
the liberty available to everyone. This principle of justice
requires treating others fairly and giving persons their
due.
5.PRINCIPLE OF VERACITY
The obligation to tell the truth. It requires professional
caregivers to provide with accurate, reality based
information about their health status and care or treatment
prospect.
6.PRINCIPLE OF FIDELITY
Fidelity is keeping one’s promises or commitments. It
holds that a person should faithfully fulfill his duties and
obligations. Fidelity is important in a nurse because a
patients hope for relief and recovery rests on evidence of
caregivers conscientiousness.
7.PRINCIPLE OF CONFIDENTIALITY
The principle of confidentiality provides that caregivers
should respect a patient need for privacy and use personal
information about him or her only to improve care.
PROFESSIONAL CONDUCT FOR NURSES IN INDIA
1)Professional Responsibility and accountability
Nurse:
 Appreciate sense of self- worth and nurtures it.
 Maintaining standards of personal conduct reflecting credit upon the
profession.
 Carries out responsibilities within the framework of the professional
boundaries.
 Is accountable for maintaining practice standards set by Indian Nursing
Council
 Is accountable for own decisions and actions .
 Is compassionate.
 Is responsible for continuous improvement of current practices.
 Provides adequate information to individuals that allow them informed
choices.
 Practice healthful behaviors.
2)Nursing Practice
Nurse:
 Provides care in accordance with set standards of practice .
 Treats all individuals and families with human dignity in providing
physical, psychological, emotional, social and spiritual aspects of care .
 Respects individual and families in the context of traditional and
cultural practices and discouraging harmful practices.
 Presents realistic picture truthfully in all situations for facilitating
autonomous decision-making by individuals and families.
 Promotes participation of individuals and significant others in the care.
 Ensures safe practice .
 Consults, coordinates, collaborates and follows up appropriately when
individuals’ care needs exceed the nurse’s competence.
3) Communication and interpersonal relationship
Nurse:
 Establishes and maintains effective interpersonal relationship
with individuals, families and communities .
Upholds the dignity of team members and maintains effective
interpersonal relationship with them .
Appreciates and nurtures professional role of team members .
 Cooperates with other health professionals to meet the needs
of the individuals, families and communities.
4)Valuing Human Being
Nurse:
Takes appropriate action to protect individuals from
harmful unethical practice.
 Consider relevant facts while taking conscience
decisions in the best interest of individuals.
 Encourage and support individuals in their right to
speak for themselves on issues affecting their health
and welfare.
Respects and supports choices made by individuals.
5)Management
Nurse:
 Ensures appropriate allocation and utilization of available resources .
 Participates in supervision and education of students and other formal care
providers.
 Uses judgment in relation to individual competence while accepting and
delegating responsibility .
 Facilitates conducive work culture in order to achieve institutional objectives.
 Communicates effectively following appropriate channels of
communication .
 Participates in performance appraisal.
 Participates in evaluation of nursing services .
 Participates in policy decisions, following the principle of equity and
accessibility of services .
 Works with individuals to identify their needs and sensitizes policy makers
and funding agencies for resource allocation.
6)Professional Advancement
Nurse:
 Ensures the protection of the human rights while pursuing the
advancement of knowledge .
 Contributes to the development .
 Participates in determining and implementing quality care .
Takes responsibility for updating own knowledge and
competencies .
 Contributes to the core of professional knowledge by
conducting and participating in research.
AUTONOMY
Definition:
 “Autonomy means that individuals are able to act as
themselves to the levels of their capacity.”
- POTTER AND PERRY

 “Autonomy is one of the ethical principles that refer to

person freedom of choice, a right to be independent and
make decision freely.”
- BARBARA
Aids to autonomy
The approval of society through social contract especially
of midwifery.
Involvement in budget control, standard setting, policy
and decision making.
Quality assurances peer review and editing.
Effects of Independent Practice on
Continuing education
Doctoral programmes
Certification
Expanding roles in Hospital and community
Nurse Practitioners
Clinical Nurse Specialist
Patient Advocate
ACCOUNTABILITY
ACCOUNTABILITY
Accountability means an individual are answerable
for their actions and have an obligation to act. It is one
of the Code of professional conduct and taking
responsibility for their actions.
ASSERTIVENESS
ASSERTIVENESS
Assertiveness is the quality of being self assured and
confident without being aggressive.
Definition
Assertiveness is a tool for expressing ourselves
confidently and a way of saying yes and no in appropriate
way. It is considered as a healthy behavior for all people
against personal powerlessness and results in personal
empowerment.
Aims Of Assertiveness
 Find the best possible solution for all people.
Assertiveness increases the chances of our needs being
met.
Assertiveness allows nurses to remain in control.
Assertiveness brings greater self confidence.
Assertive people have more friends .
 Reduced stress
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 and needs.
 Identify how you feel about a particular Situation.
 Be direct .
 Own your message .
 Avoid assumptions about others thinking.
Avoid statements that begins with "why", "you".
Ask for feedback .
Stop apologizing all the time .
 Learn to take a compliment .
Act confident even if you don't feel confident.
Feel free to say no.
Evaluate your expectation.
VISIBILITY OF NURSES
VISIBILITY OF NURSES
Meaning
A quality or fact of , degree of being visible.
Degree of exposure to public notice .
Capacity of providing a clear un obstructed view.
Definition
“ Visibility is the way a person appears to others or in the
case of a profession, the way that profession appears to other
disciplines and to the general public – the consumers of the
health care”.
IMPORTANCE OF VISIBILITY
Recruitment of students
Enhance public view
Funding for nursing
 Relationship with administrators
Relationship with government agencies
 Profession self identity
STEPS TO INCREASE VISIBILITY
Advertising nursing
Role of media
Nurses for healtheir tomorrow 
Raise the voice campaign
Institute of medicine quality reports 
Power and empowerment 
 Assertiveness 
Advocacy
LEGAL CONSIDERATIONS IN NURSING
INTRODUCTION
The word law is derived from an Anglo – saxon term
meaning that which is laid down or fixed.
Law is the result of the minimum level of shared values
or ethics of a community of people. Law and ethics are
related. Nurses may act in ways that are legal but not ethical.
Both law and ethics are related to politics.
Law means a body of rules to guide human action.
DEFINITION OF LAW
Laws are“ rules of conduct, established and enforced
by authority, which prohibit extremes in behavior so that
one can live without fear for oneself or one’s property”.
- By Sullivan and Decker, 2001
PURPOSES OF LAW
1) Safeguarding the public:
The public safety is guaranteed.
The individual is secure to the event of sickness or
disability with no fear of anxiety of being cared for by a
competent person.
It protects the patients /clients against deliberate injury by
a nurse.
2)Safeguarding the nurse:
It protects the nurses also against the legal action if she
renders right care.
Good rapport
LEGAL DOCUMENTS
It Comprised:
A) Advance directive: Written document recognized by
law that provides directions concerning the provision of care
when a person is unable to make his or her own treatment
choices.
B) Do not resuscitate orders: Written order by a physician
when a client has indicated a desire to be allowed to die if
the client stops breathing or the client’s heart stops beating.
C) Informed consent: It is clients’ approval [or that of the
clients’ legal representative to have his or her body touched
by a specific individual.
LEGAL RESPONSIBILITY
1)Registration:
Licensing is a mandatory procedure for practice of
nursing. Registration aims at protecting patients by
providing qualified nurses. The nurse is responsible to
obtain registration in the respective State Nursing
Registration Council .
2) Legal Liability/Act Of Negligence :
License of a nurse can be suspended or cancelled for
any act of negligence or mal practice, following a specified
procedure.
3) Medico — Legal case (M.L.C.) :
A medico legal case is a patient who is admitted to the
hospital with some unnatural pathology and has to be taken care of in
concurrence with the police and/or court
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
Obtain complete history from patient or significant others .
Inform the police officer/constable on duty in the hospital and
the CMO.
 When it is made a MLC, then record it on the patient's case
sheet with red ink at right hand top corner.
Do not give any statement about patient's condition to police,
magistrate or media. Only a doctor has to give information.
 When a patient has to be discharged, inform the CMO only.
After clearance from them, he/she can be discharged.
If a MLC patient absconds, inform the CM0 and the treating
doctor immediately.
4) Correct Identity:
A nurse/midwife is responsible to make sure that all babies
born in hospital are correctly labeled at birth and handed over
to right parent.
Unknown/unconscious patients must be labeled as soon as
their identity is known.
 Patients who have to undergo surgery should be appropriately
identified and labeled.
 Site of operation to be correctly marked particularly where
symmetrical sides or organs are there
Operation theatre (O.T.): scrub nurse has to see all the
instruments/ swabs are returned. She has to say OKAY' before
closure by the surgeon.
5) Left Against Medical Advice (L.A.M.A.)
Inform medical officer in charge. Signatures of both
patients and witness to be taken as per institutional policy.

6)Patient's Property
Inform patient on admission that hospital does not
take responsibility of his belongings. If patient is
unconscious/ or otherwise required then a list of items must
be made, counter checked by two staff nurses and kept
under safe custody.
7)Dying Declaration :
Doctor or nurse should not involve themselves in
dying declaration, in case where police records the dying
declaration. Dying declaration is to be recorded by the
magistrate. But if condition of patient becomes serious then
medical officer can record it along with two nurses it
witness. Dying Declaration can be recorded by the nursing
staff with two nurses as witness when medical officer is not
present. Then the declaration has to be sent immediately in
a sealed cover to the magistrate.
8) wills:
For this, doctor has to be present her, he can recode if
requested.
9)Examination of rape case :
Female attendant/female nurse must be present during the
examination.
10)Artificial human insemination:
 Written consent should be obtained from both donor and
recipient.
 Donor and recipient must have the same blood group.
 Donor and recipient's identity should be kept confidential.
 All related documents should be kept confidential and
safe.
11) Poison Case:

Do not give either verbal or written opinion.

Do not allow to take photos unless special permission is
granted by appropriate authority.
 Do not give any information to public or press.
 Preserve all evidence of poisoning.
Collect and preserve all excreta, vomits and aspirates, seal
them immediately and send to forensic laboratory at the
earliest.
12) Consumer Protection Act:
It was passed by parliament in 1986 to provide for
better protection of the interest of consumers and focuses
on consumer justice through the establishment of
consumers councils and authorities for the settlement of
consumers disputes and matters connected therewith. The
scope of the act is wide enough to include a vast variety of
services.
RIGHTS OF A CONSUMER/PATIENT ARE
Right to safety
Right to be informed
Right to choose
Right to be heared
Right to seek redressal
Right of 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 programes.
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 lo
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.
JOURNAL ABSTRACT
JOURNAL ABSTRACT
TITLE: Legal Awareness and Responsibilities of
Nursing Staff in Administration of Patient Care in A Trust
Hospital
AUTHOR: Hemanth kumar,2012
METHOD: An open ended questionnaire was
prepared to assess the level of legal awareness among the
nursing staff. The GNM and ANM nursing staff deployed at
the nursing home and general wards only were randomly
screened and specialty nurses were exempted.
 Results: The knowledge on various legal provisions, as
was applicable to nursing, across all categories of nurses
which were under review, was found to be poor. The nursing
staff had poor knowledge on patients’ rights and also on
their legal obligations towards patients. The GNM nurses
fared better than ANM nurses. However, 46.67 % of nurses
were found to be aware about cases of omission or
commission.
Conclusion: This study substantiated the fact that
nurses had poor knowledge on the law that governed their
profession and that in days to come, it would become
increasingly difficult for them to avoid law suits which were
prepared against them, unless remedial actions were taken.