UNIT 3

INTRODUCTION
Ethics is the science, which deals with the moral actions and one's value system. It is a branch
of psychology which is concerned with human character and conduct. Ethics are defined as
science of moral in human conduct. When a person becomes the member of a profession, he
accepts the responsibility of living upon the code of 'ethics' of that profession.

Definition of Ethics
Ethics are the rules or principles that govern the right conduct. Nursing ethics is a branch of
applied ethics that concerns itself with activities in the field of nursing.
"A science of human duty in its widest extent".
-Oxford dictionary
"The morals concerned with or relating to what is right and wrong in matters of human
behavior".
-Webster
"Ethics in nursing is a particular code of behaviours, characters, conducts and relationship
unique only to the nursing personnel".
Nursing ethics is "a system of principles governing the conduct of a nurse, her relationship to
the patient and his family, her associates and society at large".

Importance of Ethics in Nursing

In any professional setting, there are certain ways which are accepted by the professional
body. It is important to study ethics in nursing because:
1. Goal of nursing is to provide care with respect and dignity.
2. Ethical knowledge is necessary for professional acceptance.
3. Help the nurses in decision making in a better way.
4. Nurses work in various settings and assume various roles that require interaction with
client, family and team members.
5. Ethics help the nurses to understand his/her account care.

BIOETHICS
DEFINITIONS

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It is a branch of science that deals with the ethical and moral implications of new biological
discoveries and biomedical advances.
Or
It is a branch of ethics, philosophy, and social commentary that discusses the life sciences
and their potential impact on society.
Or
It deals with the study of value judgements pertaining to human actions in the fields of
biology and biotechnology.
Or
It is a study of the moral and ethical choices that scientists and doctors face in medical
research and in the treatment of patients.
Or
It is a branch of science that explores the moral and ethical questions surrounding life,
health, science, medicine and environment.
PURPOSE AND SCOPE
The purpose and scope of bioethics are as follows:
1. To reveal the hidden bioethical issues, for example, abortion, surrogate mother.
2. To measure the safety limits of any bioethical issue.
3. To create a new ethical law based on the bioethical issues.
4. To solve the bioethical issues and dilemmas that arise in health
5. To evaluate the range of bioethical ethical issues involved while performing any patient
care as mild, moderate or severe, because it is important to analyse whether the depth of the
issue is simple or complex. It is better to safeguard the nurse and the patient at the earliest,
that is, at the simple or mild stage of the issue care.
6. To do any research on humans, it is important to analyse whether at any timing the
research process, any injury or harm might be caused to the individual or society.

BIO-ETHICAL PRINCIPLES
The Universal Declaration on Bioethics and Human Rights adopted by the United Nations.
Educational, Cultural and Scientific Organization (UNESCO) identifies the following fifteen
bioethical principles:
1. Human dignity and human rights
2. Benefit and harm
3. Autonomy and individual responsibility

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4. Consent
5. Persons without the capacity to consent

6. Respect for human vulnerability and personal integrity

7. Privacy and confidentiality
8. Equality, justice and equity
9. Non-discrimination and non-stigmatization
10. Respect for cultural diversity and pluralism
11. Solidarity and cooperation
12. Social responsibility and health
13. Sharing of benefits
14. Protecting future generations
15. Protection of the environment, the biosphere and biodiversity.
Human Dignity and Human Rights: Human dignity and human rights need to be respected.
This can be done by allowing the patient to participate in all discussions regarding the
treatment and listening to his/her wishes. This will help in gaining the patient's confidence
and co-operation, which, in turn, will help in providing efficient care.
Benefit and Harm: This principle indicates that the care given to a patient must benefit
him/her and no harm must be done knowingly while giving care. For example, while giving
bath to an unconscious patient, the mackintosh should be removed slowly and meticulously.
Since the patient is unconscious. the nurse may think that he/she will not be able to complain
and so may rashly pull out the mackintosh. which will create friction and skin breakdown,
leading to decubitus ulcers or pressure sores.
Autonomy: This bioethical principle is for the staff nurses who care for the patient. Nurses
are not the physician's handmaid and need greater autonomy. They should be allowed to take
standard independent decisions while giving care, which has been in practise in some foreign
countries. These nurses are called nurse practitioners. However, this practice is lacking in
countries such as India, where nurses are not allowed to treat patients without doctor's
permission. example of consciously doing harm to the patient.
Persons Without the Capacity to Consent: This principle applies to the patients who are
terminally ill. posted for euthanasia (mercy killing) where there is no consent or consultant
done to improve the care. An unconscious patient who is brought to the emergency
department will also fall under this category. In such situations, the consent of the family
members or the spouse is obtained before starting treatment, but sometimes even after the
patient gains consciousness, it is not informed to the concerned patient.
Respect for Human Vulnerability and Personal Integrity: This principle refers to
providing respect for a patient who is approaching death and also after death. In many places,

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a patient approaching death is treated like an animal and after death is treated like a
vegetable. For example, a patient's sense of hearing might still be working and gossiping in
front of such a patient about his/her condition will affect his/her personal integrity. A patient
who is terminally ill is not given proper respect.

Privacy and Confidentiality:

Privacy: This refers to the respect given to a patient while providing care. It includes keeping
the rooms closed or providing screens when private areas are exposed during care and
following the principle of exposing the parts when only when essential. This is an important
principle to be followed especially when providing bed bath for patients.
Confidentiality: A patient trusts that his health condition and other personal details will not
be disclosed to anyone else by the nurse. It is the duty of the nurse to keep the records of a
patient safe and confidential. Details about the patient should not be discussed in public.
Equality, Justice and Equity: This principle implies that all patients should be treated fairly
and as equals. There should be impartial provision of care in spite of differences in race,
caste, creed and culture.
Justice and equity means provision of care that benefits the patient and never harms him/her
and providing justice equally to all patients irrespective of their social and economic status,
age, gender, etc.
Non-discrimination and Non-stigmatization: Non-discrimination means showing no
difference in providing care and not separating patients into upper class and lower class based
on their socioeconomic status. Not providing any care to poor patients and giving more care
for rich patients is described as showing discrimination in nursing care.
Non-stigmatization means not having stigma towards certain patients' disease condition. For
example, a nurse may fear to touch or provide care to HIV patients, thinking that they should
be neglected and not cared for. This is a kind of strong stigma towards the patient. Non-
stigmatization means having a humanitarian approach towards such patients and caring for
them just like others.
Respect for Cultural Diversity and Pluralism: This principle refers to the respect to be
given for all kinds of patients who might be belonging to different cultures. Transcultural
nursing aims at learning about cultural differences, nursing in other countries, international
health issues, and international health organizations, which will help nurses give due respect
to the patients' cultural beliefs.
Solidarity and Cooperation: It is a kind of firmness in provision of care and of being strict
with implementation of care by following scientific steps without any compromise and
without altering the normal structure of care. Solidarity is a kind of firmness not only in
implementing the care.
Social Responsibility and Health, Sharing of Benefits, Protecting Future Generation
Protection of Environment, Biosphere and Biodiversity: These principles imply the
benefit society. Every nurse should have a responsibility towards the society and should care
for benefits of health schemes should be shared. Nurses should help in creating public
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awarenes protecting the earth and its environment for future generations and ensuring
evergreen biosph biodiversity.

ETHICAL DILEMMAS

1. INFORMED CONSENT: Informed consent is a formal permission obtained

from the patient, and it can be used as a legal evidence. However, in many hospitals,
the informed consent is not even shown to the patient completely. The authorities get
them signed quickly and fail to explain its importance and requirement to the patient.
In certain situations, the informed consent becomes an issue, for example, when the
consent needs to be obtained for the following situations:
(a) Do not resuscitate order
(b) Withholding/withdrawing nutrition and fluids
(c) Starting or discontinuing a life support system
The following are the characteristics of consent:
1. Consent is a written acceptance from the patient.
2. Every adult of sound mind has a right to determine what shall be done with his body.
3. For a consent to be valid, it must be a free and informed consent: (a) The patient must
be able to understand the choices he/she is required to make. (b) Consent must be free and
voluntary.(c) The procedure for which consent is sought must have been explained to the
patient. It is wrong to withhold important information. (d) Consent must not be procured
by deceit.
4. Patients less than 12 years of age cannot give consent for general physical examination.
It must come from their parent/guardian.
5. Patients in between ages 12 and 18 years can give consent for general physical
examination.
6. If the patient is more than 18 years of age, the consent must come from the patient
himself/ herself except in the following circumstances:
Consent-should come from parent/guardian/significant others in the case of patients who
are in a capacity to decide for themselves such as patients with dementia, delirious
patients. Mentally challenged patients, deaf and mute patients, patients with mental
disorders, unconscious patients, patients who are gravely ill.
2. ABORTION: Terms of Abortion as per the MTP Act, 1975 (Revised)
According to the MTP Act, the following points need to be adhered to when an induced
abortion is being performed:
1. The MTP should be performed by a registered nursing practitioner who is qualified,
has assisted in at least 25 termination of pregnancies in an authorized centre, has
certificates with required details, and has licence from the Medical Council.

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2. The MTP can also be performed by a qualified registered medical practitioner who has
undergone at least six months of training in obstetrics and gynaecology as a house
surgeon. 3. A qualified registered medical practitioner who has got a diploma or degree in
obstetrics and gynaecology is also allowed to perform the MTP.
4. The MTP can be done only when consent is given by the pregnant woman on whom
the abortion is to be performed.
5. MTP can be done only if the informed consent is given by the pregnant woman; the
husband's consent is not required.
6. Pregnancy in case of minor girls by rape or sexual abuse or women with psychiatric
illness can be terminated by obtaining informed consent from the parents or legal
guardian.
7. The MTP is permitted only up to 20 weeks of pregnancy. If the gestational age is
beyond 12 weeks, the medical opinion of another qualified and experienced medical
practitioner is required.
8. The details of abortion are kept confidential by the medical practitioners and the
reports are submitted to the directors of health services of the particular state in the
prescribed abortion form.

3. EUTHNASIA:
The act or practice of killing or permitting the death of hopelessly sick or injured individuals
in a relatively painless way for reasons of mercy.
MEANING OF EUTHANASIA
The word 'euthanasia' comes from the Greek word 'eu' meaning good or well and thanatos'
meaning death; hence, euthanasia means good death. The term explains that it is an
intentional termination of life by another at the explicit request of the person who wishes to
die.
ROLE OF A NURSE IN EUTHANASIA
Euthanasia is a very important ethical issue and a nurse should be clear about his/her role.
The areas where the nurse will face the ethical issues of euthanasia are as follows:
Do Not Resuscitate Order: This means not to take any active measures such as
cardiopulmonary resuscitation to sustain the breath and the pulse rate.
Withdrawing and Withholding the Drugs and Food: A nurse is never told to withhold or
withdraw drugs and food when it is required to sustain or prolong the life. A nurse is taught
that passive euthanasia is against the code of ethics. However, in case of patients in negative
state where further no treatment is possible, the patient needs a dignified death. Therefore, the
nurse has to obey the decision taken by the patient, his/her relatives, or the doctor and provide
care accordingly.
Pain Control and Management of Patient for Euthanasia: Pain is the most discomforting
sign that the patient cannot tolerate his/her illness. A patient suffering terminally from
chronic pain needs pain relief and comfort. A nurse has to provide the analgesics, for

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example, administering morphine sulphate for a cancer patient reduces pain initially and
gives comfort but later on it has its own side effects that are enough to take away the patient's
life; he/she does not even need euthanasia. Therefore, the nurse needs to be accountable and
responsible for each and every action and needs to be careful in administration of medication
for the patient who has asked for euthanasia and act as per the code of ethics and ethical
principles. The nurse has to provide care, relieve the patient's discomfort, and, at the same
time, safeguard the patient from all kinds of side effects of the drug.
Nurse Cannot Decide for Patient Regarding Euthanasia: A nurse cannot force a a patient
for euthanasia or even suggest it; it is against ethical and moral law.
Right to Die Issues: A nurse has to be neutral and should neither support nor go against the
patient's wish for euthanasia. The patient has the right to take his/her own decision to die or
to live, and a nurse cannot and should not intervene in the decision of the patient.
4. ETHICAL ISSUES IN PREGNANT WOMEN CONSUMING ALCOHOL AND
DRUGS
Many states have tried to punish the pregnant drug and alcohol users for illicit drug use
abuse. According to The Centre for Reproductive Rights (2000):
1. Prosecuting the pregnant alcohol or drug users does not particularly protect the well the
foetus.
2. Threatening pregnant drug users with punishment may well only deter them from natal
care and especially drug treatment, which thereby further harms their children.
3. Poor and minority pregnant women are disproportionately tested for drugs and threat
punishment
Pregnant women addicted to drugs are called 'crack moms' and their children 'crack babies'.
Consumption of alcohol, smoking cigarettes and cocaine abuse pregnant the foetus to harmful
substances and have teratogenic effects, which results in the
(a) Mentally retarded child or foetal alcohol syndrome (FAS)
(b) Child with foetal tobacco syndrome (FTS)

5. Ethical and Legal Issues Affecting Patients with Psychiatric Illness:

The following are some of the ethical and legal issues affecting patients with psychiatric
illness:
1. Forced drugging and involuntary treatment is equivalent to undertaking medical treatment
without patient's consent.
2. Mentally ill live in a unhealthy environment, where it is difficult to survive. They are
mostly homeless and resort to beggary and substance abuse. The society does not seem to
care for or help the psychiatric patients and they are forced to live in the streets, without
proper food, water, and shelter, even from stray animals.

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4. Many families leave their mentally ill member in hospitals as orphans. Their right to
proper medical care is denied. Most of the times, the families do not even bother to enquire
whether the patient gets proper treatment or not.
5. The psychiatric patients have the right to get informed consent and information. Though
they may be unable to understand the meaning of informed consent or incompetent to provide
informed content, they too are human beings. However, if the patient refuses the treatment,
the decision should be accepted. The patient's family members can try to make him/her
understand the necessity of the treatment, but forcing the patient or abusing verbally to accept
ECT is unethical.
6.The condition of mentally ill patients, especially in community houses, is very pathetic and
painful in many circumstances. Such patients, especially female, are vulnerable to sexual
abuse by the hospital care providers including male attendants and sweepers.
7. Mentally ill patients are vulnerable or prone to be used as a prey or sample for
experimental research. The reasons are as follows:
(a) They are incapable of giving informed consent or refusing participation.
(b) They lack the ability to understand people or situations.
(c) There is nobody to take accountability or responsibility for the patients or to question if
any harm or injury happens to them.
(d) They are unable to fight for their rights.
(c) They are easily available.
8. There is no privacy, respect, or protection for mentally ill patients and their self-care needs
are not met. They are not cared for properly in many mental hospitals, especially government
hospital.
6. Whistle-Blowing' Issues: Whistle-blowers are those who alert or disclose internal or
external danger, malpractice, corruption, bribery, theft, fraud, negligence, resource wastage,
misinterpretation, and safety volition done by an employee or the authorities of management
to the public and the concerned authorities. Anyone can make mistakes, but we have to
follow certain ethical principles to regulate the behaviour of the workers. The nursing
activities of the nurses, especially the newly appointed ones, are evaluated, controlled and
supervised to check their eligibility for being made permanent and for promotions. The
employee will not know that he/she is being observed. The attitude, behaviour, approach, and
working ability towards patient care will be evaluated by the nursing administrator who will
then lecide whether to continue with the staff or not. In whistle-blowing process, there will be
an officer or administrator to evaluate the concerned staff every day.
ETHICAL ISSUES IN PRACTICE:
The following are the ethical issues in nursing practice that result in conflict:
Libel: This refers to the false and harmful written reports given by the nurse with an intention
of hurting the colleague's reputation in nursing practice.

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Slander: This is the false and harmful oral report about one nurse given by another nurse
with an intention to hurt his/her reputation in nursing practice.
Malpractice: This refers to the failure in performing professional duties or the lack of skill or
practice that causes injury or harm to the client or patient.
Negligence: This means failure of the nurse to administer or provide nursing care in the right
time to the right patient at the right place; it is also called as carelessness.
Bribery and Corruption: This refers to the act of violating the legal and medical laws
towards the patient care, such as performing illegal abortion against the Medical Termination
of Pregnancy (MTP) Act by an untrained nurse and getting some gift or money as bribe from
the affected patient.

Forgery and Fraud: Getting the signature from the patient in the informed consent form is
an important procedure. If the nurse signs instead of the patient or if he/she signs in the
register for another nurse, it is called forgery or fraud.
Wasting Hospital Resources: The resources of the hospital should not be wasted. For
example, solutions such as Dettol, savlon, betadine, and spirit should be used limitedly and
should not be intentionally wasted. Moreover, cotton, gauge, gloves, plaster, and disposable
needles should not be used without proper planning.
Theft or Stealing: It is quite common is hospitals to find that cotton, gauze, solution, unused
sanitary pads, etc. disappear from patients' side lockers; it can be taken by the sweepers,
attenders, and even nurses.
Misinterpretation: Healthcare providers such as nurses or co-workers should not confirm
the diagnosis before the physician confirms and informs the patient, because
misinterpretation of report result and diagnosis leads to conflicts in the health care system.
Violating the Safety Needs: The main aim of a nurse should be to protect the patient from
all hazards Among these are slippery floors and faulty and non-repaired apparatus such
defibrillator. For example if the faulty water heater in the bath room is touched unknowingly,
it might lead to the patient's death

PROCESS OF ETHICAL DECISION MAKING

Nurse's decisions are increasingly constrained by ethical issues. Ethical decision making
involves reflection on the following:
 Who should make the choice?
 Possible options or courses of action,
 Available options,
 Consequences, both good and bad, of all possible options, Rules, obligations and
values that should direct choices, and
 Desired outcomes.
When making decisions, nurses need to combine all of these elements using an orderly,
systematic, and objective method. There are various models for ethical decision making.

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Perhaps the easiest ethical decision making model to remember and to implement in practice
is the "moral model" developed by Thirona and Halloraw as follows:
M-Massage the dilemma. Identify and define the issues in the dilemma. Consider the
opinions of all major players in the dilemma as well as their value system. This includes
patient's family members, nurses, doctors, priest and any other interdisciplinary healthcare
team member.
O-Outline the options. Examine all options including those less realistic and conflicting; this
stage is designed only for considering options and not for making final decision.
R-Resolve the dilemma. Review the issues and options, applying the basic principles of
ethics to each option. Decide the best option based upon the views of all those concerned in
the dilemma.
A-Act by applying chosen action. This step is usually the most difficult as it requires actual
implementation. While the previous steps had only allowed for dialogue or discussion.
L-Look back and evaluate the entire process including the implementation. No process is
complete without a thorough evaluation. Ensure that those involved are able to follow
through on the final option. If not, a second decision may be required and process must start
again at the initial step.
Another exchange of traditional model of ethical decision making are as follows:
 Identify the problem.
 Gather data to analyse the causes and consequence of the problem.
 Explore the optional solutions to the problem.
 Evaluate the optional solution.
 Select the appropriate solution from all the options.
 Implement the selected solution.
 Evaluate the result

ETHICAL DECISION-MAKING MODELS

 Murphy and Murphy model
 Curtin model
 Levin, Ariff, Groh model.
 Rest's model

Curtin Model
Steps
1) Presume goodwill: It is essential that nurses and all other important persons, entering
ethical discussion should presume goodwill.
2) Identify the key person: Consider all the people who are involved in moral decision-
making process like physician, nurses, patients, relatives or other health care team
members, etc.

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3) Gather relevant information: It is an extremely important step in ethical decision-
making process. Information to be gathered includes family status, client preference,
medical diagnosis, prognosis, social consideration, etc.
4) Identify and consider all the ethical principles: Considering the ethical principles
help the nurses to explore fully the values inherent in dilemmas.
5) Consider alternative courses of actions: It involves considering alternative courses
of action which would help to identity the best appropriate solution.
6) Action: It involves implementation of appropriate actions which help to serve the
ethical dilemma.

ROLE AND RESPONSIBILITIES OF ETHICAL COMMITTEE

IN RESEARCH :
Research ethics committees have an important role to play in ensuring the ethical standards
and scientific merit of research involving human subjects.

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A Research Ethics Committee (REC) is defined as a multidisciplinary, independent, body
charged with reviewing research involving human participants to ensure that their dignity,
rights and welfare are protected.
There are three important obligations placed on the ethics committee.
 Firstly, and most importantly, the ethics committee must ensure that the rights of
research participants are protected. This is achieved by ensuring that individuals
receive sufficient information, which can be easily understood, and ensuring that
appropriate strategies are in place to protect participants from potential adverse
consequences of the research.
 Secondly, the research ethics committee has an obligation to society which provides
the resources for research and will ultimately be affected by the results.
 Thirdly, the research ethics committee has an obligation to the researcher. The
research proposal should be treated with respect and consideration.
The research ethics committee should strive to meet each of these obligations.
RESPONSIBILITIES OF RESEARCH ETHICAL COMMITTEE:

 Identifying and weighing up the risks and benefits of a study (considering human
subjects, animals, the community, and the environment).
 Recognizing any financial or personal interests that may affect the research.
 Evaluating the recruitment process and any incentives that will be given to the
participants.
 Assessing the procedures and methods used to ask for participants’ informed consent.
 Ensuring that all the research activities are recorded properly and reported in a
responsible, honest, and objective way.
 Guaranteeing fairness, confidentiality, and privacy for all the subjects involved in the
study—or at least full transparency about data-sharing in cases where absolute
confidentiality is not possible.

If the research also includes medical interventions, scientists and ethics committees must
make sure that adequate care and treatment will be provided.

IN CLINICAL DECISION MAKING:

Roles
The CEC can act as an analyst, advisor, moderator, disseminator, facilitator, Observer, and
guardian of values and laws. Discussion In order to fulfil their responsibilities in handling
priority setting cases, CECs need knowledge of both the ethics and the institutionalized
systems of priority setting.

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CODE OF ETHICS
The code of ethics will state what kind of conduct is expected from the members of a
profession, what are the responsibilities of its members towards those whom they serve, their
co-workers, the profession and the society as a whole. The nurse will adjust better if she
understands what a wrong/right behavior in different situations is. The first such code of
ethics, called the international code of nursing ethics, was adopted by the grand council of the
International council of nurses at Sao Paulo, Brazil in 1953. It was later revised in Frankfurt,
Germany in 1965 and then became known as ICN code of ethics.
“Code of ethics defines professional standard and is an integral part of foundation of
nursing. It makes explicit the primary goals, values and obligations in nursing.”
Purposes of Code of Ethics
• Code of ethics provide standards for professional behavior and includes values and
principles that govern decisions in nursing.
• Inform the public about the profession minimum standards.
• Demonstrate nurses commitment to the public they serve.
• Outline major ethical consideration of nursing.
• Provide general guidelines for professional behavior and professional development.
Protects the right of individual, family, and community. Remind us of the special
responsibility we assume in caring for the sick.
• Basis for self-regulation and relationship with others.

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• Provide well-defined policy and procedures for dissolving

INTERNATIONAL COUNCIL OF NURSES

The nurse will adjust better if she understands what a wrong/right behavior in different
situations is. The first such code of ethics, called the international code of nursing ethics, was
adopted by the grand council of the International council of nurses at Sao Paulo, Brazil in
1953. It was later revised in Frankfurt, Germany in 1965 and then became known as ICN
code of ethics.

Nurses and People

 The nurse's primary professional responsibility is to provide care to people requiring
nursing care.
 In providing care, the nurse promotes an environment in which the human rights,
values, customs and spiritual beliefs of the individual, family and community are
respected.
 The nurse ensures that the individual receives accurate, sufficient and timely
information in a culturally appropriate manner on which to base consent for care and
related treatment.
 The nurse holds in confidence personal information and uses judgment in sharing this
information.
 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 advocates for equity and social justice in resource allocation, access to
healthcare and other social and economic services.
 The nurse demonstrates professional values such as respectfulness, responsiveness,
compassion, trustworthiness, and integrity.

Nurses and Practice

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 The nurse carries personal responsibility and accountability for nursing practice, 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 responsibility.
 The nurse at all times maintains standards of personal conduct, which reflect well on
the profession and enhance its image and public confidence.
 The nurse, in providing care, ensures that use of technology and scientific advances
are compatible with the safety, dignity, and rights of people.
 The nurse strives to foster and maintain a practice culture promoting ethical behavior
and open dialogue.

Nurses and the Profession

 The nurse assumes the major role in determining and implementing acceptable
standards of clinical nursing practice, management, research and education.
 The nurse is active in developing a core of research based professional knowledge
that supports evidence-based practice.
 The nurse is active in developing and sustaining a core of professional values. The
nurse, acting through the professional organization, participates in creating a
positive practice environment and maintaining safe, equitable social and economic
working conditions in nursing.
 The nurse practices to sustain and protect the natural environment and is aware of
its consequences on health.
 The nurse contributes to an ethical organizational environment and challenges
unethical practices and settings.

Nurses and Co-workers

 The nurse sustains a collaborative and respectful relationship with co-workers in
nursing and other fields.
 The nurse takes appropriate action to safeguard individuals, families and
communities when their health is endangered by a co-worker or any other person.
 The nurse takes appropriate action to support and guide co-workers to advance
ethical conduct.

INDIAN NURSING COUNCIL CODE OF ETHICS

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Code of ethics and professional conduct for nurses are very essential in building
professionalism. Nurses must have professional competence, moral responsibilities and
obligations and are responsible for providing services to people even though it is in
conflict with his/ her personal beliefs and values. Indian nursing council has set code of
ethics for nursing practice in India to ensure quality care and to identify obligations in
nursing research and practice in India (Fig. 12).

CODE OF ETHICS BY INC

The nurse respects the uniqueness of an individual in provision of care.
 Provides care of individuals without consideration of caste, creed, religion, culture,
ethnicity, gender, socio-economic and political status, personal attributes, or any other
grounds.
 Individualizes the care considering the beliefs, values and cultural sensitivities.
 Appreciates the place of an individual in the family and community and facilitates
participation of significant others in the care.
 Develops and promotes trustful relationship with individual(s).
 Recognize uniqueness of response of individuals to intervention and adapts
accordingly.
The nurse respects the rights of individuals as partner in care and help in making
informed choices

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 Appreciates individual's right to make decisions about their care and therefore gives
adequate and accurate information for enabling them to make informed choices.
 Respects the decisions made by individual(s) regarding their care.
 Protects public from misinformation and misinterpretations.
 Advocates special provision to protect vulnerable individuals/groups.
The nurse respects individual's right to privacy, maintains confidentiality, and shares
information judiciously.
 Respects the individual's right to privacy of their personal information.
 Maintains confidentiality of privileged information except in life-threatening
situations and uses discretion in sharing information.
 Takes informed consent and maintains anonymity when information is required for
quality assurance/academic/legal reasons.
 Limits the access to all personal records written and computerized to authorized
persons only.
Nurse maintains competence in order to render quality nursing care.
 Nursing care must be provided only by the registered nurse.
 Nurse strives to maintain quality nursing care and upholds the standards of care.
 Nurse values continuing education, initiates and utilizes all opportunities for self-
development.
The nurse if obliged to practice within the framework of ethical, professional and legal
boundaries.

 Adheres to code of ethics and code of professional care conduct for nurses in India
developed by INC.
 Familiarizes with relevant laws and practices in accordance with the law of the state.
Nurse is obliged to work harmoniously with members of the health team.

 Appreciates the team efforts in rendering care.

 Cooperates, coordinates and collaborates with members of the health team to meet the
needs of people.
Nurse commits to reciprocate the trust invested in nursing profession by society.
 Demonstrates personal etiquette in all dealings.
 Demonstrates professional attributes in all dealings.

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UNIT 3

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