Nursing
ANA Code of Ethics
What came before
Provisions 1-9
What are Ethics
1896-The Nightingale Pledge
Considered the first code of ethics for nurses
Patterned after the Hippocratic Oath
Focus was on the moral purity of nurses
Written by a nurse educator in honor of the ethical example displayed by Florence Nightingale
Often administered at nursing graduations and pinnings
2
Florence Nightingale Pledge
“I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.”
Written to honor Florence Nightingale, not by her
3
1926
1926-A Suggested Code
Elegant, but not specific
1926-published in American Journal of Nursing (AJN)
Provisionally accepted-but not specific at practical level
Never adopted
1940
1940- A Tentative Code
Organized around relationships
Nurse-to-patient, nurse to profession
Emphasized nursing as a profession
1940-publish in AJN and again asked for comments from AJN readers
Never adopted
ANA 1940 Code
“The nurse has a basic concern for people as human beings, confidence in the power of personality for good, respect for religious beliefs of others, and a philosophy which will sustain and inspire others as well as herself.”
Example of code
6
Ethical Codes
Many versions proposed
1950 version was the first to be officially accepted
The Code for Professional Nurses
Enumerated specific provisions
Professional relationships no longer overt organizing framework
1949 Tenative code revised and widely distributed for comments
First official code of ethics
17 succinct provisions
7
ANA 1950
“professional nurses do not permit their names to be used in connection with testimonials in the advertisement of products.”
8
Speaks for itself
Revised in 1956
“Professional nurses assist in disseminating scientific knowledge through any form of public announcement not intended to endorse or promote a commercial product or service. Professional nurses or groups of nurses who advertise professional services do so in conformity with the standards of the nursing profession”
This change due to responses from readers and others
10
1950 Code
“The nurse must adhere to standards of personal ethics which reflect credit upon the profession.”
1960’s bring changes
1960
Shift to how to uphold and enforce the code
Developed guidelines for handling alleged violations of the code
1968
Dropped professional in title-code applied to professional and technical nurse
Dropped reference to private ethics of nurse
No specific mention of physicians
Provisions condensed down to 10
Content of provision generally included explicitly or implicitly
Personal ethics no longer deemed to be the purview of professional scrutiny
12
1970’s Bring more changes
1976-Code of Nurses with Interpretive Statements
Patient participation in care
Nurse autonomy
Nurse as advocate
Use of client in place of patient
Nonsexist language
Clarified the provisions
13
2001
2001 Code of Ethics with Interpretive Statements
Social justice
Recognition of intrinsic worth of all humans
Providing care according to professional standards
Just treatment of the nurse
1995 task force to evaluate need for revision
Changed how revisions to the code and interpretive statements would be approved
Goal was to make the code more elastic so that it did not have to be constantly updated-more general, less specific
Also wanted to address global concerns
14
2001ANA Code
“the need for health care is universal, transcending all individual differences. The nurse establishes relationships and delivers nursing services with respect for human need and values, and without prejudice.”
15
Provision 1
“The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.”
This is a core ethical principle
Professional obligation to move beyond our feelings and recognize the humanity of others and then respond with compassion and respect
Do we respect the person’s right to genuine autonomy?
Is the person better or worse after an encounter with me?
16
Therapeutic use of self
In every human encounter we convey one of three messages-which one do you want to convey?
Go away, my world would be better without you
You are an object, a task to be done, you mean nothing to me
You are a person of worth, I care about you
Provision 2
“The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population”
This provision intentionally singled out to demonstrate its significant importance to the code of nursing
Prov 2
What do I know about the patient?
Situation
Values
Assumptions
My own values affecting my response?
What should I do to be ethical?
18
Provision 3
“The nurse promotes, advocates for, and protects the rights, health, and safety of the patient”
Bedside nurse is agent of change
Responsibility of today’s nurse to participate in decisions about patient care
Active, not passive followers
19
Provision 4
“The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.”
Accountability even when I do not give the direct care
Delegation, nurses cannot delegate making nursing judgments except to another professional nurse
Tasks-yes; Assessment and evaluation-no
20
Delegation is
“….transferring the responsibility for the performance of an activity from one person to another while retaining accountability for the outcome.”
ANA 1995
Provision 5
“The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth”
Provision 5-if do not find happiness in your work, you are not truly a nurse
Can learn all the skills and pass all the tests without fully becoming a nurse, even passing the licensure exam
22
Provision 6
“The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.”
6/-conditions of employment conducive to providing quality care while making it cost effective
Patient and staff safety
Collective action-involved in decision making
Collective bargaining is an option to gain negotiating power
Workplace issues affecting nurses alone (wages, working conditions) or
What affects nursing care and patient welfare
Must attend to ethical environment to improve patient care
Workplace efficacy-resources that allow nurses to advocate for themselves and patient care
Shared governance councils
Ideal world-collaboration
23
Provision 7
“The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.”
Provision 7
Knowledge development, not commitment to doing research-keep up to date in your profession by looking at research
Competent practice-at individual level will impact the workplace
Replacing outdated nursing practice
Lifetime learning!!!!
We’ve always done it that way is never an acceptable response! Be open to change in the workplace
24
Provision 8
“The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.”
Nurse’s responsibility to the public
Regardless of healthcare setting
25
Provision 9
“The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy”