Moral obligations of nurses based on the ICN, UK, Irish and Polish codes of ethics for nurses

A code of professional conduct is a collection of norms appropriate for the nursing profession and should be the point of reference for all decisions made during the care process. Codes of ethics for nurses are formulated by members of national nurses' organizations. These codes can be considered to specify general norms that function in the relevant society, adjusting them to the character of the profession and enriching them with rules signifying the essence of nursing professionalism. The aim of this article is to present a comparative analysis of codes of ethics for nurses: the ICN's Code of ethics for nurses, the U.K.'s Code of professional conduct, the Irish Code of professional conduct for each nurse and midwife, and the Polish Code of professional ethics for nurses and midwives. This analysis allows the identification of common elements in the professional ethics of nurses in these countries.     

Barriers to uptake and use of codes of ethics by nurses

BackgroundFollowing Australia’s adoption of the International Council of Nurses Code of Ethics for Nurses (ICN Code) (2012) on 1st March 2018, a literature review was conducted as a part of the University of Sydney Summer Scholar Program to examine what is already known about the use and implementation of the ICN Code by nurses in an international context. The first part of this literature review explored the origins of professional codes of ethics in nursing, and what nurses perceive their utility and functions to be.AimThis paper seeks to explore why, despite acknowledging the attributes of the various codes, nurses do not necessarily implement them actively in practice. Additionally, this paper examines whether these barriers differ between countries.MethodA literature search was conducted using the CINAHL and Scopus databases. The findings from the selected articles were then organised and synthesised according to the predominant barriers that nurses have identified in relation to their uptake and use of the codes.FindingsThe barriers identified were organised into the following categories: individual attributes of nurses, organisational barriers, the ongoing presence of professional subordination, cultural barriers and educational shortcomings.DiscussionIn light of the barriers identified, it is considered how individual, organisational, professional, cultural and educational factors influence nurses’ application of the values and principles articulated in the various codes.ConclusionAlthough the values and principles embedded in the ICN Code of Ethics (2012) are considered fundamental to ethical nursing practice, the findings from this review suggest that various barriers constrain nurses’ abilities to effectively utilise professional codes of ethics in their decision-making and practice.     

The value of nurses' codes: European nurses' views

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses' opinions of the content and function of codes and their use in nursing practice. A total of 49 focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be 'paper tigers' with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice.     

Ethical practice in nursing: working the in-betweens

BACKGROUND: While contemporary ethical theory is of tremendous value to nursing, the extent to which such theory has been informed by the concerns and practices of nurses has been limited. PURPOSE: With a view to complementing extant ethical theory, a study was undertaken to explore, from the perspective of nurses, the meaning of ethics and the enactment of ethical practice in nursing. DESIGN AND METHODS: Located in the interpretive/constructivist paradigm, using an emergent design, this inquiry employed focus groups to collect the data. Eighty-seven nurses from a wide range of practice settings were interviewed in 19 focus groups of three to nine nurses each. FINDINGS: The nurses described ethics in their practice as both a way of being and a process of enactment. They described drawing on a wide range of sources of moral knowledge in a dynamic process of developing awareness of themselves as moral agents. Enacting moral agency involved working in a shifting moral context, and working in-between their own values and those of the organizations in which they worked, in-between their own values and those of others, and in-between competing values and interests. CONCLUSIONS: Analysis of the experiences and concerns of the nurses offered new understanding of ethics in nursing and direction for the development of ethical theory pertinent to nursing practice.     

New developments in international nursing ethics

This article has described numerous activities in nursing ethics at international levels. It acknowledges the larger context within which nurses practice by focusing on selected issues involved in resource allocation and death and dying, cross-culturally. The questions raised about universally shared moral principles reflects the larger questions of cultural and ethical relativism. The discussions of new developments in international nursing ethics focuses on international conferences, the teaching of nursing ethics, national nursing associations, and other professional groups that are actively involved in health care or nursing ethics. Finally, the development of international nursing ethics research studies is providing new knowledge about the scope of ethics within nursing and the nature of nursing care worldwide. Nurses are involved in some aspects of these new developments in nursing ethics in all countries. As they examine and reflect on ethical principles, virtues, and on an ethics of caring, they bring a new dimension to their work as nurses. This new dimension stands as one of the oldest and most central foundations in professional nursing.     

Professional values and norms for nurses in Belgium

Because of their responsibilities for providing high-quality care, at times when they are continuously confronted with inherent professional and ethical challenges, nurses should meet high ethical standards of practice and conduct. Contrary to other countries, where codes of ethics for nurses are formulated to support those standards and to guide nurses' professional practice, Belgian nurses do not have a formal code of ethics. Nevertheless, professional ethics is recognized as an important aspect in legal and other professional documents. The aim of this article is to illustrate that codes of ethics are not the only professional documents reflecting nurses' values, norms and responsibilities. Other documents can also set out professional nursing ethics, and as such replace codes of ethics.     

How nurses approach ethical problems in Turkey

Previously, nurse's adherence to ethical standards meant obedience to the physician and loyalty to the hospital; now, however, it means following ethical standards and rules set forth by professional codes of ethics. The International Council of Nurses' Code for Nurses (1973) has been the model for professional codes of ethics in countries throughout the world. ⁴ Using ICN's Code as a framework, a study was conducted in 1993 to find out how nurses in Turkey respond to ethical dilemmas. Below, a summary of the findings.     

Professional codes in a changing nursing context: literature review

BACKGROUND: Professional codes played a definitive role during a specific period of time, when the professional context of nursing was characterized by an increasing professionalization. Today, however, this professional context has changed. AIM: This paper reports on a study which aimed to explore the meaning of professional codes in the current context of the nursing profession. METHOD: A literature review on professional codes and the nursing profession was carried out. The literature was systematically investigated using the electronic databases PubMed and The Philosopher's Index, and the keywords nursing codes, professional codes in nursing, ethics codes/ethical codes, professional ethics. CONCLUSION: Due to the nursing profession's growing multidisciplinary nature, the increasing dominance of economic discourse, and the intensified legal framework in which health care professionals need to operate, the context of nursing is changing. In this changed professional context, nursing professional codes have to accommodate to the increasing ethical demands placed upon the profession. Therefore, an ethicization of these codes is desirable, and their moral objectives need to be revalued.     

Historical roots and future perspectives related to nursing ethics

This article traces the evolution of the development and the refinement of the professional code from concerns about the ethical conduct of nurses to its present state as a professional code for all nurses. The importance and the relationship of the Ethics Committee of the American Nurses' Association (ANA) to the development of the code and other ANA programs and structural units is also presented. The recognized need for a code of ethics to establish nursing as a profession has been present throughout the evolution of the professional nursing organization. A distinction between ethical conduct of nurses and a code of ethics for professional nurses has been made by nursing leaders. The code has been refined to reflect nursing's changing relationship to society and the societal concerns of the times.     

Working with a Vietnamese adolescent.

Every day nurses make practice decisions that are based on knowledge drawn from personal, cultural, and scientific sources. Nurses therefore practice from a particular perspective that involves culturally based personal, professional, and societal beliefs and values. Their practice, however, may involve clients whose beliefs and values are culturally different from their own and that of mainstream society. To deal effectively with competing demands in a multicultural society, nurses need to be aware of transcultural nursing concepts and how they influence ethical decision making. Using a problem-solving approach, this article analyzes the practice decisions made by a school nurse when working with a Vietnamese adolescent girl and her family. A case study is presented with background information about the Vietnamese culture, the refugee-immigrant experience, and nursing ethics. Suggestions are offered for future ethical problem solving.     

Nurses' views on ethical codes: a focus group study

AIM: This paper reports a study exploring nurses' views on the 'potential' content and functions of an ethical code for nurses in Belgium. The term 'potential' is used, because Belgian nurses do not have experience with an ethical code. BACKGROUND: Ethical codes have been developed to guide nurses' practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses' views on the content and functions of these codes. The available quantitative studies merely give some information on nurses' (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses' views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code's content could be. METHOD: Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003. FINDINGS: According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses' responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the 'ethical' function of the code, namely guiding nurses' professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent. CONCLUSIONS: It is of utmost importance to take into account nurses' views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses' views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses' expectations and will function optimally.     

Ethics in perioperative practice--values,integrity, and social policy

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this final article of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the ninth provision, which emphasizes the responsibility of professional nursing associations to maintain the value and integrity of the profession. AORN J 76 (Dec 2002) 1047-1053.     

Nursing and genetics: applying the American Nurses Association's Code of Ethics.

A professional code of ethics is essential for behaviors to be reinforced in any discipline. The American Nurses Association (ANA) has established a code of ethics for nurses to use as a framework for making ethical decisions with all aspects of health care delivered to the public. With the explosion of genetic discoveries, nurses and clients are facing new ethical dilemmas. It is important for nurses to understand how to use the ANA Code of Ethics when faced with the many complexities of ethical issues involving genetics and health care. This article illustrates how the ANA Code of Ethics can be applied in nursing practice to establish professional behaviors related to ethical issues and genetics.     

Nurses' responses to ethical dilemmas in nursing practice: meta-analysis

Title. Nurses’ responses to ethical dilemmas in nursing practice: meta‐analysis. Aim. This paper is a report of a study to explore nurses’ responses to ethical dilemmas in daily nursing practice. Background. Concern about nurses’ ethical competence is growing. Most nurses perceived that there were barriers in their work environment to ethical practice, compromising their ability to perform ethically. Since most research focuses on contextual barriers to nurses’ ethical practice, little is known about how nurses involve themselves in ethical decision‐making and action in daily care. Method. A meta‐analysis of nurses’ ethical behaviour was conducted using data from nine studies in four countries (n = 1592 registered nurses). In all studies, the Ethical Behaviour Test was used to measure nurses’ ethical responses, based on an adapted version of Kohlberg’s theory of moral development. Data were analysed using random‐intercept regression analysis. Findings. All groups, except the expert group, displayed a uniform pattern of conventional ethical reasoning and practice. When nurses were faced with ethical dilemmas, they tended to use conventions as their predominant decision‐guiding criteria rather than patients’ personal needs and well‐being. Conclusion. Conformist practice (following conventions rather than pursuing good for the patient) constitutes a major barrier for nurses to take the appropriate ethical actions, as creativity and critical reflection are absent. There is an urgent need to find ways to promote nurses’ ethical development from conventional to postconventional ethical practice. More research is needed to strengthen existing empirical evidence.     

Advocating globally to shape policy and strengthen nursing's influence

The International Council of Nurses is a federation of national nursing associations that works to enable nurses to speak with one voice so as to influence health policy and advance the profession of nursing. In this article the author highlights how nurses can advocate for the nursing profession by coordinating nursing actions to develop both public and healthcare-service policies. He addresses issues that are common in many parts of the world and provides examples drawn from real-life experiences that illustrate how nurses in El Salvador, Rwanda, Paraguay, Papua New Guinea, and Iran have worked in their countries to coordinate their actions and advocate for public and/or healthcare service policies within their countries. He concludes by noting that all nurses must do their part and use a wide range of opportunities creatively, and with clarity of intent, to improve the profession and the lives of the millions of people who depend upon us.     

Role of professional organizations in advocating for the nursing profession

Professional organizations and associations in nursing are critical for generating the energy, flow of ideas, and proactive work needed to maintain a healthy profession that advocates for the needs of its clients and nurses, and the trust of society. In this article the author discusses the characteristics of a profession, reviews the history of professional nursing organizations, and describes the advocacy activities of professional nursing organizations. Throughout, she explains how the three foundational documents of the nursing profession emphasize nursing advocacy by the professional organizations as outlined in the American Nurses Association Code of Ethics for Nurses With Interpretive Statements. The author concludes by encouraging all nurses to engage in their professional organizations and associations, noting how these organizations contribute to the accountability and voice of the profession to society.     

Emotional intelligence and its impacts on the clinical performance of nurses in general public hospitals

Objectives: The nursing profession is considered to be at a high risk of workplace stress, workload, and burnout due to the high job demands. The nurses require the appropriate and prompt coping mechanisms to relieve the effects of stress. The nurses have to be emotionally intelligent to overcome the work-related stress to meet the clinical-based duties. But there is a paucity of the effect of emotional intelligence (EI) on the clinical performance of nurses in the literature. Therefore, the role of dimensions of EI in the improvement of clinical performance of nurses was explored in this study.Methods: A total of 194 nurses with different education levels and experiences were included from various clinical departments and shifts of public hospitals in Iraqi Kurdistan.Results: The mean age of the nurses was 29.44 years, with ages ranging from 23 years to 36 years. The nurses were men (56.70％),married (53.10％), non-smokers (86.10％), physically active (55.70％), and irregular physically active (63.90％). Nurses were able to appraise their own emotions but not the emotions of other nurses. They regulated their own emotions but were weak in regulating the emotions of other nurses. They did not utilize emotions in coming up with new ideas and facing obstacles in clinical settings. Generally,the nurses reported that a little clinical performance is required in medical settings. The levels of interpersonal communication and problem solving were improved with an increasing appraisal and regulating own emotions. The level of problem solving was improved with appraising own emotions and utilizing emotions in facing obstacles.Conclusions: Nurses need to know how to regulate others' emotions and utilize these emotions in coming up with new ideas and facing the obstacles positively in medical settings.     

Ethical Dilemmas and AIDS: Nursing Issues Regarding Rights and Obligations

Nurses and other health professionals deal with many ethical dilemmas daily. The AIDS epidemic has generated enormous controversy affecting the care and treatment of persons with HIV infections. As the epidemic spreads, the ethical issues become more apparent. The AIDS situation highlights the precarious balance between individual rights and the public welfare, patients' rights, and the rights of nurses and their professional obligations. Ethical questions have also been raised concerning equal rights to healthcare resources. The AIDS epidemic has caused hysteria among members of our society, including some people in the nursing profession. Implications for nursing practice and education are outlined to help nurses to make ethical rather than emotional decisions.     

A proposal for a code of ethics for nurse practitioners

PURPOSE: To review established codes for health care professionals and standards of practice for the nurse practitioner (NP) and to utilize these codes and standards, general ethical themes, and a new ethical triangle to propose an ethical code for NPs. DATA SOURCES: Reviews of three generally accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). CONCLUSIONS: A proposal for a code of ethics for NPs is presented. This code was determined by basic ethical themes and established codes for nursing, formulated by the ANA, and for physicians, formulated by the AMA. The proposal was also developed in consideration of the AANP standards of practice for NPs. IMPLICATIONS FOR PRACTICE: The role of the NP is unique in its ethical demands. The authors believe that the expanded practice of NPs presents ethical concerns that are not addressed by the ANA code and yet are relevant to nursing and therefore different than the ethical concerns of physicians. This proposal attempts to broaden NPs' perspective of the role that ethics should hold in their professional lives.     

Nursing resistance as ethical action: literature review

BACKGROUND: Much has been written about nursing as a predominantly female profession whose members display passivity, submission, obedience and powerlessness. Alternatively, some authors have presented evidence of nurses' capacity to exercise power, revealing the possible relationship between powerlessness and ethical compromise. Thus, empowerment strategies for nurses can yield ethical action. AIM: The aim of this paper is to use analysis of the literature to demonstrate how the actions and responses of nurses to ethical concerns are examples of nurses exercising power. METHOD: Empirical studies published in the nursing literature between 1990 and 2003 have been analysed to illustrate how nurses' actions of resistance can ensure that moral values are realized in practice. Foucauldian notions of power relations and feminist ethics provide the theoretical framework. CONCLUSIONS: Nurses were found to resist in situations where they experienced moral conflicts in relation to the actions of health professionals; however, instances were cited where they did not. Consequently, strategies for nursing education and management are proposed to increase nurses' understanding of the potential acts of resistance that they could employ in situations of moral conflict or concern.