Ethico-Moral Aspects & Principles in Nursing

Ethico-Moral Aspects of Nursing

• Ethos is derived from the Greek word for character or culture
• Morals involve personal interpretations of good and bad and standards of behavior
• Ethics is the branch of philosophy concerned with right and wrong

Moral Principles

• Golden Rule: Treat others as you would like to be treated
  • Includes treating others kindly and with respect
• Principle of Totality: The whole is greater than its parts
  • Example: Below Knee Amputation (BKA) of a patient with Diabetes Mellitus (DM)
• Epikia: An exception to the general rule
• One Who Acts Through an Agent is Responsible: One is responsible for actions done through an agent
  • Example: Being an instrument to a crime, like recommending someone get an abortion
• No One is Obliged to Betray Himself/Herself: One cannot be forced to self-incriminate
  • In court, a person cannot be forced to answer a question that would incriminate them
• The End Does Not Justify the Means: The means must also be ethical in achieving an end
  • Example: Assisting suicide for chronically ill patients is not justified
• Defects of Nature May Be Corrected: Correcting physical defects is morally permissible
  • Example: Cleft lip/palate
• If One is Willing to Cooperate, No Justice is Done to Him/Her: No injustice occurs with consent
  • Example: A person agreeing to a clinical trial with known possible effects means there is no violation of human rights if those effects occur
• A Little More or Less Does Not Change the Substance of an Act: The act remains the same regardless of quantity
  • Example: Taking a large or small quantity without permission is theft
• No One is Held to the Impossible: No one can be forced to do something which is clearly impossible
  • Example: Guaranteeing a heart transplant patient’s survival is impossible, but attempting the procedure is acceptable
• The Two-Fold Effect: When faced with a situation with both good and bad effects, the basis of action should meet criteria
  • The action itself must be morally good
  • The good effect must be intended, and the bad effect merely allowed
  • The good effect must not come from an evil action
  • The good effect must be greater than the bad effect
• The Greatest Good for the Greatest Number: Decisions should benefit the majority

The Morality of Cooperation

• Formal cooperation in an evil act is never allowed, like abortion even if a doctor commands it

Code of Ethics

• The code of ethics are systematic guides for developing ethical behaviors
• They provide direction for Filipino nurses to act morally
• The code of ethics is not perfect

Code Of Good Governance

• The Code of Good Governance was promulgated on July 23, 2003 by the Professional Regulation Commission (PRC)
• It is a hallmark of all professionals to accept ethical principles
• Principles of the code require maintaining high standards of conduct

General Principles of Code of Good Governance

• Service to others
• Integrity and objectivity
• Professional competence
• Solidarity and teamwork
• Social and civic responsibility
• Global competitiveness
• Equality of all professions
• The Code was adopted after consultation on October 23, 2003, in Iloilo City
• Resolution No 220 series of 2004, last July 14, 2004, Code was adopted under Republic Act 9173

Philippine Nursing Act of 2002

• It is covered in Section 9 Art. III of R.A. No. 9173
• Includes the following articles:
  • Article 1: Preamble (Sections 1-3)
  • Article 2: Registered Nurses & People (SC 4-5)
  • Article 3: Registered Nurses & Practice (SC 6-11)
  • Article 4: Registered Nurses & Co-Workers (SC 13)
  • Article 5: Registered Nurses, Society & Environment (SC 14-15)
  • Article 6: Registered Nurses & The Profession (SC 16-17)
  • Article_7: Administrative Penalties, Reappealing Clause & Effectivity, (SC 18-20)

Article 1: Preamble

• Health is a fundamental right of every individual
• Filipino registered nurses believe in the worth and dignity of each human being
• The primary responsibility of nurses is to preserve health at all cost
• When the above are not possible, assistance towards a peaceful death is the nurse's obligation

Section 2

• Registered nurses have to gain knowledge and understanding of man's aspects of illness
  • This includes cultural, social, spiritual, physiological, psychological, and ecological aspects
• Cultural diversity and political and socioeconomic status are inherent factors to effective nursing care

Section 3

• The desire to have the respect and confidence of clientele, colleagues, coworkers and the community is the incentive to maintain a high degree of ethical conduct

Article 2: Registered Nurses & People

• Section 4
• Ethical Principles
  • Values, customs, and spiritual beliefs held by individuals must be represented
  • Individual freedom to make rational and unconstrained decisions must be respected
  • Personal information acquired during nursing care must be confidential
• Section 5
• Guidelines to be observed. Registered nurses must:
  • Take individuals and totality of patients into consideration when administer care
  • Respect the spiritual beliefs and practices of patients on diet and treatment
  • Uphold the rights of individuals
  • Consider the culture and values of patients in providing nursing care
    • However welfare and safety comes first

Article 3: Registered Nurses and practice

• Autonomy, Fidelity, Veracity are ethical principles
• Human life is inviolable, it must be kept sacred.
• Quality and excellence in patient care are the goals of nursing
• Accurate documentation of actions and outcomes is central to accountability

Section 7

• Registered nurses must define the nursing practice and scope as defined in R.A. No. 9173 known as the “Phillipine Nursing Act of 2002" and Board Res. No. 425, Series of 2003.
• They must be aware of their duties and responsibilities in practice
• Registered nurses must develop necessary competence in skills, attitudes and knowledge to render safe nursing services
• Administrators must provide environments where registered nurses can grow and develop

Section 7 - continued

• Specialized professional programs by the Board Of Nursing must be accredited through the Nursing Specialty Certification Council (NSCC) as well
• Quality nursing care should meet the optimum standard of care of safe nursing care.
• Practice modifications shall consider the principles of safe nursing practice
• Nurses in a position of authority should legally minimize occurrences of ineffective and unlawful nursing
  • Autonomy, Fidelity Beneficence, Non-maleficence & veracity
  • Ensuring Patient Safety
• Patient charts should be available to those directly involved and required by law.
  • Autonomy, Fidelity & Veracity
  • QA - monitor, self-evaluation

Section 8

• Ethical Principle

Section 9

• Guidelines to be observed for ethical principle

Section 10

• Ethical Principle

Section 11, Guidelines to be observed

• Registered nurse shall perform their professional duties in conformity with law, regulations, measures and accepted priciples of moral conduct
• Registered nurse shall not appear in advertisement that demean the image of the profession
• Registered nurse shall decline any favor the might be interpreted as capitalizing on patients
• Registered nurse shall not demand of receive payment for referals
• Registered nurse shall maintain professional abuse within patient's privileged relationship.

Article 4: Registered Nurses & Co-Workers

• RNs should be in solidarity when caring for a patient
• RNs must maintain professional relationships with colleagues and other health care providers

Section 13: Guidelines to be observed

• Nurses must maintain their professional identity while working with members of the health team
• Nurse must conform with acceptable activities
• Nurses should contribute to team growth

Article 5: Registered Nurses, Society & Environment

• Section 14: Ethical Principles:
  • Registered nurses must commit to preserving life, respecting human rights, and promoting a healthy environment
  • Linking with the public to promote local and international health efforts
• Section 15: Guidelines to be observed:
  • Registered nurses must acknowledge their obligations as citizens and be involved in community concerns

Article 6: Registered Nurses & The Profession

• Section 16: Ethical Principles:
  • Maintaining loyalty to the nursing profession and preserving its integrity are ideal
  • Complying with the bylaws of the accredited professional organization (PNA)
  • Commitment to continual learning
  • Registered nurses should contribute to improving socio-economic conditions and welfare of other nurses
• Section 17: Registered Nurses should
  • Be members of PNA
  • Strictly adhere to nursing standards
  • Be active in growth of the nursing profession

Article 7: Administrative Penalties, Clause & Effectivity

• Section 18
  • Suspension of certificate of registration of any code violations to SEC. 23/ Art. IV of R.A. No. 9173
• Section 19
  • R. A. No. 877 and P.D. No. 223 is accordingly repealed or superseded by the herein Code
• Section 20
  • This code of ethics shall take effect after fifteen (15) days of being publicised

Republic Act 9173

• It is the act providing a more responsive profession
• Also known as "The Philippine Nursing Act 2002", and was approved on October 21, 2002
• Includes sections: title, declaration of policy, organization of the board, penal and miscellaneous provisions

Article 3

• The board of nursing shall be of 6 appointed members that are headed by chairperson and are selected by the President of the philippines

Board requirements

• 1. Natural- born citizen
     • 2. PRC
     • 3.MAN, MA Education
     • 4. 10 years of continuous practice; the last 5 years in the Philippines.
     • 5. Not commit any offense involving moral turpitude

Article7

• The President may remove or suspend any member of the Board on the grounds of
• Continued neglect
• Irregularities

Licensure Examination

• Article IV
  • Applicant must pass a written exam
  • Requires RA. No. 8981

Article 6 - Nursing pratice

• The act of nursing happens with in the interaction off ones self and any one they initiate and assist in
• Applies to all including prenatal to adulthood, independant pratctitioners
• It includes: - Innovative approaches - community linkage - supervising nursing students

Article VII - Health

• It is required to establish a specialized nurses training training program such as but limited to critical care and radiology in philipen hospitals