Nursing Ethics and Jurisprudence Lecture Notes | Nursing

LECTURE NOTES ON NSC 311 NURSING ETHICS AND JURISPRUDENCE BY MRS MANDAH FLORENCE INTRODUCTION This course is designed to provide nursing students with the understanding of moral issues that form the basis for professional ethics in nursing and medical practice.  It introduce...

LECTURE NOTES ON NSC 311 NURSING ETHICS AND JURISPRUDENCE BY MRS MANDAH FLORENCE INTRODUCTION This course is designed to provide nursing students with the understanding of moral issues that form the basis for professional ethics in nursing and medical practice.  It introduces the student nurse to the constitutional and common laws that affect nursing and the legal implications of such responsibilities in nursing practice.  The purpose of this course is to define the ethical principles and codes of ethics under which the nurse must practice nursing as well to outline issues of jurisprudence that apply to the field of nursing, including state and federal laws that impact nursing and healthcare. At the end of this course the students should be able to : OBJECTIVES OF THE COURSE  Explain the meaning of ethics, concepts and essentials in moral development and value clarification  Discuss the relevant issues in nursing code of ethics and the regulation of nursing practice.  State the rights and responsibilities in client care and the legal roles of nurses.  Discuss areas of legal liabilities in nursing and the legal protection for the nurse.  Examine ethical problems and the different models for ethical decision making in nursing.  Apply the models for ethical decision making in the resolution of ethical dilemmas. WHAT IS ETHICS  Ethics refers to formal set of rules or values which helps people to understand the morality of human behaviour.  It is a branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions  It is the study of the effects of moral principles and standards on human conduct  Business ethics deal with ethics in business, and with the constant process of optimizing profitability in the context of what is right and what is wrong.  Code of ethics are statements of moral principles, treaties on maintaining high ideals, and recorded discussions of moral and ethical issues  Ethics refers to principles or standards that govern or guides the practice of a particular profession.  To regulate the conduct of nursing in Nigeria, the NMCN formulated some ethical codes for nurses and midwives in Nigeria. The ethical codes are summarized under five subdivisions, which include:  The nurse and her appearance  The nurse and her attitude  The nurse and her practice  The nurse and her society  The nurse and other member of the health team WHAT IS VALUE  Value is a belief or attitude about the worth of person, object, idea or action that acts as standard to guide one’s behaviour.  The worth or value you ascribe to a person or object determines how you behave towards the person or how you handle the object.  Value systems are basic way of life as they give direction to life, and form the basis of behaviour especially those that are based on decisions and choices  People are not born with values, rather values are formed over a lifetime through information from the environment, family, and society.  If parents consistently demonstrates honesty in dealing with others, the children will probably begin to value honesty.  People need to inculcate societal values to feel accepted, and they need personal values to have a sense of individuality. Nurse’s professional values are acquired during socialization into nursing. It is within the nursing, educational programme that the nurse develops, clarifies and internalizes professional values.  Specific professional nursing values are stated in nursing code of ethics, and standards of nursing practice and in the legal system itself. VALUES ESSENTIAL TO NURSING PRACTICE  The American Association of college of nursing identified seven values essential to the practice of professional nursing.  These values and ethical principles form the basis of all nursing practice as they provide a framework to help the nurse in ethical decision making.  These essential values and ethical principles include: SEVEN ESSENTIAL VALUES OF NURSING PRACTICE ESSENTIAL ATTITUDES AND PROFESSIONAL VALUES PERSONAL BEHAVIOUR QUALITIES Caring, Gives full attention to the Altruism - commitment, client when giving care. concern for compassion, Assists other personnel in the welfare of generosity, providing care when they others perseverance are unable to do so. Expresses concern about social trends and issues that have implication for health care  Acceptance, Provides nursing care based on the Equality - assertiveness, individual's needs irrespective of Having the fairness, self- personal characteristics Interacts same rights, esteem, tolerance with other providers in a non- privileges or discriminatory manner. Expresses status ideas about the improvement of access to nursing and health care Appreciation, Adapts the environment so that it is Aesthetics- creativity, pleasing to the client. Creates a pleasant Qualities of imagination, work environment for self and others. objects, events sensitivity Presents self in a manner that permits a and persons that positive image of nursing. provide satisfaction Confidence, hope, Honours individual‟s right to refuse Freedom - independence, treatment. Supports the rights of other Capacity to openness, self- providers to suggest alternatives to the exercise choice direction, self- plan of care. Encourages open discussion discipline. of controversial issues in the profession.  Consideration, Safeguards individual‟s Human empathy, right to privacy, dignity- humanness, addresses individuals, as Inherent kindness, they prefer to be worth and respectfulness, addressed. Maintains uniqueness of trusts confidentiality of clients an individual and staff. Treats others with respect regardless of their background Accountability, Documents nursing care Justice. authenticity, accurately and honestly. Upholding honesty, Obtains sufficient data to moral and legal inquisitiveness, make sound judgements principles rationality, before reporting infractions reflectiveness of organisational policies. Participates in professional efforts to protect the public from misinformation about nursing Source: Kozier, B. et al. (2000 Value clarification  Value clarification is a process by which people identify, examine, and develop their own individual values  When people identify their values, they can retain or change them because it helps to promote personal growth by fostering awareness, empathy, and insight.  student nurses should therefore examine the value they hold about life, health, illness and death since this will play a vital role in decision making about the care they render to their clients.  The awareness of personal values helps to consider one’s attitude towards specific issues such as abortion or euthanasia, to decide what to do in particular situation.  Nurses should examine the possible consequences of choice and render their services in a non judgmental way.  It is therefore important that values are clarified so that decisions that are made will be based on clear values which should be in the best interest of the client, the nurse and the institution. MORALS  Morals are values or principles to which one is personally committed.  Morality refers to private, personal standards of what is right and wrong in conduct, character and attitude of an individual.  It consists of essential requirements for people to live together in society.  Moral behaviour is the way a person perceives these requirements and responds to them while  Moral development is the pattern of change in moral behaviour with age.  Moral development is the process of learning to tell the difference between right and wrong, and of learning what ought and ought not to be done. It is a complex process that begins in childhood and continues throughout life  Caring theories judge actions according to a perspective of caring and responsibility.  It is a central force in the client-nurse relationship, and for protecting and enhancing client dignity.  Moral principles are statements about broad, general, philosophic concepts which provide the foundation for moral rules, as specific prescriptions for actions  Principles based theories stress individual rights while caring theories promote the common good or welfare of the group.  Some of the moral principles include: ETHICAL PRINCIPLES  Beneficence: Acting for the good and welfare of others and including such attributes as kindness and charity.  Nonmaleficence: Acting in such a way as to prevent harm to others or to inflict the minimal harm possible.  Autonomy: Recognizing the individual’s right to self-determination and decision-making  Veracity: Being truthful, trustworthy, and accurate in all interactions with others. Autonomy This refers to the right to make one's own decisions.  Nurses follow this principle by recognizing that each client is unique and has the right to be whatever the person is and the right to choose personal goals.  nurses are obliged to honor this principle of autonomy by respecting the client's right to make decisions even when those choices seem not to be in the client's best interest. Non malficience  This is duty to do no harm. This is a complex statement , because in practice clients are exposed to both intentional and unintentional harm.  Although the risk of harm is not always clear it is the responsibility of the nurse to protect the patient from intentional harm.  A client may be at risk of harm during a nursing intervention that is intended to be helpful eg adverse effect of drug administration. Beneficence  Beneficence means to act for the benefit of others, helping them to further their important and legitimate interests,  The generic definition of beneficence is an act of charity, mercy, and kindness  It is an integral part of work ethic as a professional to always and without exception, favor the well-being and interest of the client.  Nurses are therefore obligated to do good by implementing actions that is of benefit to their clients.  Health care professionals have a duty of care that extends to the patient, professional colleagues, and to society as a whole.  This ethics compels all practitioners to act in a way that contributes to the patient's health and well-being and to take care, to refrain from doing anything that would cause harm to the patient. Justice:  This means acting in fairness to all individuals, treating others equally and showing all individuals with the same degree of respect and concern.  Nurses are therefore obliged to treat their clients with utmost degree of respect and care not minding their race, religion, culture or type of illness. When nurses care for a group of patients, care must be given equitably, fairly and justly to each individual. A nurse must not play favorites or compromise care because of personal opinions or beliefs. Veracity Veracity is the act of being truthful, trustworthy, and accurate in all interactions with others. It is one of the ethical principles in nursing practice. The nurse is therefore expected to discharge her duties and all interactions within her working environment with the highest degree of sincerity and uprightness. Fidelity  This is being loyal and faithful to individuals who place their trust in you as a nurse.  It is the ethical principle that helps nurses, to remain true to the professional promises which they made to provide quality, competent care to their patients.  Fidelity in nursing means that nurses must be faithful to the promises they made as professionals to provide competent, safe and quality care to their patients. Integrity/accountability this means acting consistently with honesty and basing actions of moral standards Nurses should have a basic and clear understanding of key ethical principles that govern their professional practice. They should know the Code of Ethics within their profession as well as their own integrity and moral character. Nursing Ethics  Nursing code of ethics is a formal statement of the ideals and values of nursing and ethical principles that serve as standards for nurses‟ actions.  It concerns the behaviour that is normally right for a nurse in professional situations  The Code of Nursing Ethics is a non-negotiable standard of behaviour for nurses which serves as a guide and reminder of nurses' commitment to society.  The code requires nurses to continue with their learning and evidence-based practice.  If societal values and morals change, the code of ethics also may change.  Ethics is an integral part of nursing as it guide nurses to provide quality and effective care to their clients.  It is important to note that professions do not make ethical decisions but it is the individuals that make ethical choices and put it into practice.  It is therefore obligatory that nurses understand all aspect of this course internalize it so as to use it in all their practice. Purpose of Professional Ethics The purpose and rationales for formulating ethics for nurses include that the code is meant to:  Create a code of conduct that reminds a nurse to be conscious of greater demands from her patient  Develop a regulated and acceptable attitude to the patient at all time  Stimulate awareness on the part of the nurse to be more conscious of her societal responsibilities  Facilitate the skill to develop policies/ideas in nursing profession that will improve patient’s care  Encourage compliance with acceptable norms or culture within the community where she is practicing her skill  Promote compliance to the do’s and don’ts of the profession  Set a standard that will be unique and practicable at all times  Provide an ideal framework upon which she can build her ethical decision making Importance of ethics in nursing  It gives the nursing practice, its professional status  It helps the nurse to manage and resolve conflicts that might arise in the discharge of her duties and responsibilities as a nurse  It serves as a guide to both the student nurse and the experienced nurse, hence it is a reference point.  It equips the nurse by instilling confidence and hope in the discharge of her duties  It is a problem solving device for the nurse.  It promotes mutual trust and respect in the management of health care  It promotes accountability in nursing care services  It helps the nurse to weigh other people’s feelings, thoughts or opinions before reaching any decision ETHICS AND LAW  Law is defined as society's formal rules of conduct or action, recognized as enforceable by a controlling authority such as federal or state government;  while ethics refers to a set of moral principles or values that informally govern individuals in a society.  Laws are rules that people must obey in order to be legally appropriate but ethics are rules that people ought to obey so that their conduct is morally accurate and their conscience clear. law and ethics have largely been blended into common standards of professional conduct. The nature of law and ethics is such that they are inextricably intertwined laws enforce the behaviors we are expected to follow, while ethics suggest what we ought to follow, and help us explore options to improve our decision-making  the basis for the modern blending of law and health care professional ethics is that society has become highly legalistic in recent times  Secondly Patients are more aware of their rights as consumers of health care services and are more disposed to assert those rights, including resort to the legal system.  Law reflects the moral values of a society, and they offer guidance in determining what is moral.  Right behaviour is obeying the law and following the rules.  Standard of behaviour is based on adhering to laws that protect the welfare and rights of others. Personal values and opinions are recognized and violating the rights of other is avoided DIFFERENCE BETWEEN LAW & ETHICS BASIS FOR LAW ETHICS COMPARISON MEANING The law refers to a Ethics is a branch of systematic body of moral philosophy that rules that governs the guides people about whole society and the the basic human actions of its conduct. individual members. OBJECTIVE Law is created with Ethics are made to an intent to maintain help people to decide social order and what is right or wrong peace in the society and how to act. and provide protection to all the citizens. WHAT IT IS Set of rules and Set of guidelines regulations ETHICAL ISSUES IN NURSING  Ethics are essential to the integrity of the nursing profession as it helps to ensure a better patient care.  The code of nursing ethics is regularly updated to reflect the numerous challenges encountered by nurses and represents a social contract between nurses and the public.  Many of the ethical issues that occur in nursing are rooted from protecting patients' rights, adequate staffing, advanced decision- making, and quality patient care.  The guidelines are divided into nine provisions that cover topics that include human dignity, confidentiality, moral virtue and healthcare as a right.  ANA stated that each of the provisions covers topics important to the challenges of nursing in the 21st century.  Nurse managers and hospital executives will need to work together to ensure that appropriate ethical decisions are made with their patient's best interests in mind while respecting their patients' wishes.  Some of these ethical issues encountered in nursing include: Informed Consent  Informed consent can sometimes be an ethical battle for nurses especially when patients and their families have not been informed or not understand the treatments used on a relation.  Nurses should therefore ensure that their patients understand the treatment plan to obtain informed consent securely before any procedure  Family members may want to withhold medical information from sick patients to protect their emotions.  However, patients have the right to know about their medical conditions.  ANA advocates for truth telling, or veracity, should be the key factor in nurse-patient relationships. Privacy and Confidentiality  Patient privacy and confidentiality are significant ethical issues if not correctly handled can have legal implications that can result in severe consequences for healthcare professionals.  Nurse managers can cultivate educational environments, in which they regularly discuss ethical issues with the nurses in their units. This will help nurses to learn from the mistakes others have made and discover how best to approach ethical issues and challenges. Patient Decision-Making  Each patient has the right to make their own decisions based on their own beliefs and values  Although a patient's need for autonomy may conflict with care guidelines or suggestions that nurses or other healthcare workers believe is best, but they still have right to refuse medications, treatment, surgery etc.  If a patient chooses not to receive a treatment that could potentially provide a benefit, the nurse must respect that choice. Types of Ethics  The two main types of ethics that governs an individual's life in a society are:  Personal and the professional ethics  Personal Ethics – this is a person's moral principles and values acquired as the person develops and matures through the life span.  It is an individual’s personal code of behaviour which might include things like being honest , spending time in worthwhile activities, helping and being kind to people or things like, stealing, cheating other people or consciously causing harm to others.  Personal ethics are influenced by family, religion, education, peer group and can equally be changed or be modified as a result of age, environmental or situational influence. Professional Ethics This refers to the formal or informal moral responsibilities peculiar to a profession which are not shared by other members of the society. Members subscribe to the ethical codes that govern their conduct and also monitor the activities of its member to ensure conformity with the professional rules. Purposes of Professional Codes of Ethics  The professional code of ethics serves several purposes that help the professionals to provide efficient and effective service and this include:  Professional codes of ethics set guidelines to demonstrate levels of minimum practice required to maintain standards of conduct within the profession.  It inform members and the society of the primary goals and values of the profession  Ethical codes provide signs of the professional commitment to the public it serves.  It allows the people outside the profession to know the ways that members of that profession are expected to consistently act.  They provide evidence to judge the actions of a profession to see whether it is ethical or unethical.  It guides the profession in self-regulation  A code of ethics serves as a framework for making ethical decisions as it provides a means of evaluating alternative course of action.  Ethical code serves as a mark of professional maturity.  Reminds nurses of the special responsibility they assume when caring for the sick  Nurses have a responsibility to themselves, their profession, and their patients to maintain the highest ethical principles.  Nurses at all levels of practice should be involved in ethics review in their targeted specialty area.  It is important to advocate for patient care, patient rights, and ethical consideration of practice.  This is why ethics is introduced at the beginning of nursing school and continue as long as the nurse is practicing. PATIENT’S RIGHT & RESPONSIBILITIES OF CARE  ETHICAL BEHAVIOR Ethical behavior entails acting in ways consistent with what society and individuals typically think are good values; it means commitment to functions and to standards set by the profession.  It guides peoples actions and is expressed below in relation to each basic ethical principle mentioned above.  A few examples include:  1. Respect the uniqueness and dignity of each person, self and others  Protect patient privacy.  Treat all you encounter with respect- patients, their family members and significant others, coworkers.  Preserve your own self-respect and dignity.  Prevent harm and removal of harmful conditions Intervene whenever a patient's safety is at risk  Promote a safe environment, both physically and psychologically.  Monitor the environment for safety hazards.  Act to remove harm or promote benefit  Improve unsafe conditions  Confront and report unsafe practices and errors  Promote benefit by encouraging and assisting measures that promote healing such as post- surgical ambulation and deep breathing, and measures that prevent harm such as regular repositioning of patients at risk for pressure sores  These measures may be specifically ordered to be performed at specific intervals, or it may be the health care professional's responsibility to recognize the importance of these measures and carry them out.  Treat individuals equally  Extend equal respect and courtesy to all individuals you encounter.  Even when treated discourteously, respond in a manner that effectively addresses the behavior without disrespecting the other person. THE PROFESSIONAL CODES OF ETHICS IN NURSING The professional codes of ethics in nursing serves as standards for the behaviour of nurses and provide general guidelines for nursing actions in ethical dilemmas. The introduction to the Code gives a general description into: 1. What the nurse does: The fourfold responsibility of promoting health, preventing illness, restoring health and alleviating suffering. 2.How nursing service should be given: service should be given with respect for life, dignity and rights of mankind, unrestricted by nationality, race, creed, colour, age,sex, politics or social status; coordinated with related groups  To whom service is given: service is given to  the individual, family and community. The professional nurse and the health care consumer  What is the expectations of the consumers of the health service?  Consumers of the health services demands that nurses Provide care to all members of the public without prejudice to their age, religion, ethnicity, race, nationality, gender, political inclination, health or social economic status.  She/he is to uphold the health consumer's human rights as provided in the constitution.  3. Ensure that the client/patient of legal age of 18 years and above gives informed consent for nursing intervention. In case the health consumer is under aged, the next of kin or the parents can gives the informed consent on his behalf  4.Keep information and records of the client confidential except in consultation with other members of the health team to come up with suitable intervention strategies or in compliance with a court ruling or for protecting the consumer and the public from danger THE PROFESSIONAL NURSE AND THE HEALTH CARE CONSUMER  Avoid negligence, malpractice and assault while providing care to the client/patient.  6. Relate with a consumer (patient, family, community etc) in a professional manner only.  7. Not to take bribe or gifts that can influence him/her to give preferential treatment.  8. Consider the views, culture and beliefs of the client/patient and his family in the design and implementation of his care/treatment regimen.  9. Know that all clients/patients have a right to receive information about their condition.  Be sensitive to the needs of clients/patients and respect the wishes of those who refuse or are unable to receive information about their condition  Provide information that is accurate, truthful and presented in such a way as to make it easily understood.  12. Respect clients and patients' autonomy, their right to decide whether or not to undergo any health care intervention even where a refusal may result in harm or death to themselves or a foetus, unless a court of law orders to the contrary.  Presume that every patient and client is legally competent unless otherwise assessed by a suitably qualified practitioner. A patient or client who is legally competent can understand and retain treatment information and can use it to make an informed choice.  14. Know that the principles of obtaining consent apply equally to those people who have a mental illness  15. Ensure that when clients and patients are detained under statutory powers (e.g. Mental Health Act), you know the circumstances and safeguards needed for providing treatment and care without consent.  16. Provide care in emergencies where treatment is necessary to preserve life without clients/patients consent, if they are unable to give it, provided that you can demonstrate that you are acting in their best interests. COMMON ETHICAL DILEMMAS IN NURSING  The term dilemma means a circumstance in which a choice must be made between two or more alternatives that seem equally undesirable. It is a situation in which one must have to make a difficult choice. The most common ethical dilemmas nurses encounter on the job include the following: 1. Patient Freedom versus Nurse Control  Nurses are highly educated and therefore aware of the best clinical course of action when one exists. But what happens when a patient rejects medical advice and makes a decision that may result in less optimal outcomes? While nurses do not sign the Hippocratic Oath, they are still bound by the promise to devote themselves to the welfare of the patients committed to the care, as well as to live up to the standards of the profession  Deception to Save Life; A couple was involved in a traffic accident following which both sustained serious injuries and were admitted to a hospital.  The husband later died, the wife who was driving the car at the time of the accident kept asking about her husband.  If the nurse believes the news of the husband’s death will be an added stress that will interfere with the woman’s recovery, does that belief justifies the nurse lying to the woman that her husband is alive? . Honesty vs. Information  Families will often choose to withhold truthful information to “protect” a patient from emotional distress (e.g. cancer diagnosis). For nurses, this poses another common ethical dilemma:  Does a patient have the right to know everything about their condition, even if sharing the information will cause harm? Is honesty always best?  What if sparing a patient this information can promote happier less stressful final days?  Deciding what information will be shared – along with how and when to share it – can be a difficult part of a nurse’s responsibilities The Minor Dilemma  Working with children presents a unique set of ethical challenges.  Not only must nurses consider the best interests of the patient, but they must balance this against the wishes, beliefs and values of a family.  While patients, families and physicians may be aligned in the ideal world, in the real world ethical issues do arise.  While parents are tasked with difficult decisions too, the nurse’s ultimate responsibility is to the patient  Ethical issues related to privacy can also arise with minors.  While they do have some basic rights to privacy, the law requires disclosure of certain information to parents.  In many cases, this is information that minors do not want disclosed.  In this instance, nurses benefit from an understanding of law, as well as hospital policy. COMMON ETHICAL DILEMMAS IN NURSING CONTD  The Battle of Beliefs  What is science-based, empirical knowledge to a nurse might be completely subjective to a patient with a particular set of religious or personal beliefs.  Certain religions forbid medical procedures which can mean the difference between life and death. For example, in some cultures and religions, blood transfusions – even life saving ones – are unacceptable.  A nurse’s attempts to explain the benefits of the procedure weighed against the risks of opting out can overstep the line. Is it the nurse’s job to support the patient’s right to the decision, or is it their responsibility to do everything in their power to urge them toward a preventable action?  As science continues its onward march, questions related to ethics and human rights are only expected to grow, pertaining to everything from stem cell research to genetic testing. Resource Management  If a patient is in a medically futile, vegetative state, the cost of maintenance is high ( a patient on permanent life support machine).  At what point do you draw the line and redirect these resources to patients for whom they could be truly life-saving?  How do you balance what may be perceived as a financial decision against what is an entirely personal decision to a grieving family? After all, when it comes to clinging to hope for the survival of a loved one, no resource is poorly spent.  Nurses are charged with maintaining a “big picture” perspective while simultaneously dealing with intensely personal situations on a day to day basis. Steps to Ethical Decision Making in Ethical dilemmas  Clarify the ethical dilemma  Gather additional data  Identify options  Make a decision  Act  Evaluate  Patients have the right to the following:  Considerate and respectful care  Be treated with dignity and respect  Obtain complete and current information concerning his/her diagnosis, treatment and prognosis in terms that patients can reasonably understand.  Obtain copies of their medical reports by applying through the appropriate channels  Seek second opinion about their disease or treatment from another Practitioner  Necessary information to give informed consent prior to the start of any procedure.  Refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his/her actions according to the law.  Privacy. The health worker has a duty to sensitise the patient when others are involved. e.g trainees  Expect that all communications concerning him/her shall be treated confidentially.  Expect that within its capacity, a hospital must make reasonable response to the request of the patient.  Reasonable continuity of care.  Has the right to receive an explanation on his/her bill regardless of who is paying  Know what hospital rules and regulations apply to his/her conduct as a patient.  Be informed about what to do in the event of an emergency  Freedom of choice except in the case of emergency care  Obtain any information as to the relationship of his/her hospital to other health care and educational institutions as far as his/her health is concerned.  Know if the hospital proposes to engage in or perform human experimentation affecting his/her treatment.  Withdraw their consent and terminate care at any point or get this done on their behalf by the recognized legal guardian or next of kin RESPONSIBILITIES  Patients have the following responsibilities:  To treat all hospital staff with respect and dignity  To faithfully undergo the AGREED treatment  To follow the health worker’s instructions diligently  To take necessary preventive measures in case of infectious disease according to doctor’s instructions  To be aware that health workers would endeavour to always act in their best interests. However, being human beings, are susceptible to occasional mistakes and lapses  To be aware that ALL procedures and treatment modalities carry varying levels of risk for which health workers are not liable  To make payment for the treatment, wherever applicable, to the hospital promptly  To respect the competence of the health workers to make professional decisions on patients’ care  To be punctual at clinics/hospitals for treatment at the given time  To preserve all the records of their illness  To keep the Hospital Management informed if change of doctors/hospital is desirable/desired. INTERNATIONAL CODE OF NURSING ETHICS  The ICN Code of Ethics for Nurses is a statement of the ethical values responsibilities and professional accountabilities of nurses and student nurses that defines and guides nursing practice within different roles which nurses operate.  It serve as a framework for ethical nursing practice and decision-making to meet professional standards set by regulatory bodies PURPOSE OF THE CODE  The ICN Code of Ethics for Nurses provides ethical guidance in relation to nurses’ roles, duties, responsibilities, behaviours, professional judgment and relationships with patients, other people who are receiving nursing care or services, co-workers and allied professionals.  It is a guide for action based on social values and needs of the patient which acts as a living document applied to the realities of nursing and health care in all settings where nursing care is delivered. The Code is foundational and builds upon in combination with the laws, regulations and professional standards of countries that govern nursing practice.  The values and obligations expressed in this Code apply to nurses in all settings, roles and domains of nursing practice. The ICN Code of Ethics for Nurses has four principal elements that provide a framework for ethical conduct:  nurses and patients or other people requiring care or services,  nurses and practice,  nurses and the profession,  and nurses and global health. Nurses and People  The nurse’s primary responsibility is to those people who require nursing care.  The nurse, in providing care, promotes an environment in which the values, customs and spiritual beliefs of the individual are respected.  The nurse holds in confidence personal information and uses judgment in sharing this information.  The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment  The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public in particular those of vulnerable populations  The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction 2. Nurses and Practices  The nurse carries personal responsibility for nursing practices and for maintaining competence by continual learning.  The nurse maintains a standard of personal health such that the ability to provide care is not compromised  The nurse uses judgment regarding individual competence when accepting and delegating responsibilities.  The nurses when acting in a professional capacity should at all times maintain standards of professional conduct which reflect credit upon the profession. 3. Nurse and the Profession  The nurse plays the major role in determining and implementing desirable standards of nursing practice and nursing education.  The nurse is active in developing a core of professional knowledge.  The nurse, acting through the professional organization, participates in establishing and maintaining equitable social and economic working conditions in nursing. Regulation of nursing practice  Every professional body in Nigeria has a governing body that oversees and regulates its practice in the country.  The Nursing and Midwifery practice is governed and regulated by the Nursing and Midwifery Council of Nigeria.  The Nursing and Midwifery Council of Nigeria is a parastatal of the Federal Government under the Federal Ministry of Health, charged with the primary responsibility of regulating and controlling Nursing Education and Practice in Nigeria in its entire ramification NURSING AND MIDWIFERY COUNCIL OF NIGERIA (N&MCN)  The Nursing Council of Nigeria was established by the Registration of Nurses Ordinance of August 1947 to regulate and control the Practice of Nursing in Nigeria.  The Midwives Board of Nigeria was established by the Midwives Ordinance of 1930 to regulate and control the Education and Practice of Midwifery in Nigeria.  The two bodies were merged into the Nursing and Midwifery Council of Nigeria by Decree No. 89 of 1979 now known as Nursing and Midwifery Registration Act, Cap. N143, Laws of the Federation of Nigeria 2004. NURSING AND MIDWIFERY COUNCIL OF NIGERIA (N&MCN) cont’d  The Council is a body corporate with perpetual succession and common seal charged with the general duty of:  Determining what standards of knowledge and skills are to be attained by persons seeking to become members of the profession of Nursing and Midwifery and reviewing these standards from time to time as circumstances may require..  Securing in accordance with the provisions of this Decree the establishment and maintenance of a register of persons entitled to practice the profession and the publication from time to time of the lists of those persons  Regulating and controlling the practice of the profession in all its ramifications  Maintaining in accordance with the Decree, discipline within the profession and  Performing the other functions conferred upon the Council by the Decree. General Functions Index all cadres of Nursing and Midwifery Students on commencement of their training 2. Develop and review periodically, the different curricula utilized for the education of all cadres of Nurses and Midwives 3. Co-operate with recognized bodies interested in conducting new schemes for Basic and Post Basic Education of Nurses and Midwives 4. Accredit all training institutions and clinical practice areas utilized for the education of all cadres of Nurses and Midwives 5. Conduct Final Qualifying Examinations for all cadres of Nurses and Midwives in Nigeria  Organize and Conduct Mandatory Continuing Professional and Educational Development Programmes for all cadres of Nurses and Midwives.  13. Conduct and Promote Researches in relevant areas of Nursing and Midwifery.  14. Maintain Discipline within the Nursing and Midwifery Profession in Nigeria  15. Prosecute Illegal Training Institutions.  16. Regulate and Control the practice of Nursing and Midwifery in all their ramifications