Research methods design and analysis 12th edition
To practice competently and with integrity, today's nurses must have in place several key elements that guide the profession, such as an accreditation process for education, a rigorous system for licensure and certification, and a relevant code of ethics. The American Nurses Association has guided and supported nursing practice through creation and implementation of a nationally accepted Code of Ethics for Nurses with Interpretive Statements. This article will discuss ethics in society, professions, and nursing and illustrate how a professional code of ethics can guide nursing practice in a variety of settings.
We also offer a brief history of the Code of Ethics , discuss the modern Code of Ethics , and describe the importance of periodic revision, including the inclusive and thorough process used to develop the Code and a summary of recent changes. Finally, the article provides implications for practicing nurses to assure that this document is a dynamic, useful resource in a variety of healthcare settings. Citation: Epstein, B. To practice competently and with integrity, today's nurses must have in place several key elements that guide the profession To practice competently and with integrity, today's nurses must have in place several key elements that guide the profession, such as an accreditation process for education, a rigorous system for certification and licensure, and a relevant code of ethics.
The American Nurses Association ANA has guided and supported nursing practice through policy development and action; establishment of the scope and standards of nursing practice; and implementation of a nationally accepted Code of Ethics for Nurses with Interpretive Statements hereafter referred to as the Code; ANA, b.
This article will discuss ethics in the context of society, professions, and nursing and illustrate how a professional code of ethics, specifically the Code, can guide nursing practice in a variety of settings. We also offer a brief history of the Code of Ethics, discuss the modern Code of Ethics and describe the importance of periodic revision, including the inclusive and thorough process used to develop the Code and a summary of recent changes.
Finally, the article provides implications for practicing nurses to assure that the Code is a dynamic, useful resource in a variety of healthcare settings.
The agreement to live by rules may be externally imposed by laws and leaders or internally imposed by the common morality. The field of ethics addresses how we ought to treat each other, how we ought to act, what we ought to do, and why. We manage ethical issues every day as members of society, as members of families, and as members of a profession. To live in society, for example, we are obligated to not kill or hurt one another or to take from others what is not ours.
These rules are not just in our own best interest not to be killed, for instance , but they promote the flourishing of our society.
We would likely have great difficulty living productive lives if we constantly worried about our homes being ransacked or our lives being in danger. These are not necessarily imposed upon us, as through strong leadership, but are internally driven moral rules.
Regardless, our abilities to live peacefully and productively and to identify our obligations to one another in our own society and across cultures are informed by ethics.
To consider ethical issues, some level of guidance about how to do so should be in place. You are. Citizens are not morally required to keep in confidence information they hear about another.
As professionals, we agree to identify those ethical issues that tend to arise within our chosen profession. For many professions, this is done with a code of ethics. These documents guide practice decisions and set a standard of practice behavior expected of every member of a given profession. Nurse involvement in biomedical ethics.
Nurses typically encounter ethical issues in three realm of biomedical ethics including the broad, overarching, health-related problems that impact policy or society as a whole; dilemmas that arise within organizations; and those that affect patient populations or individual patients. On a policy or societal level, broad questions are asked. Examples of such queries may include discussion about whether access to healthcare is a right or a privilege; how to protect research participants from harm; the most fair method for resource distribution during an Ebola crisis; or the inappropriateness of punitive measures against pregnant women who use drugs and alcohol.
Nurses are involved in these questions as clinicians, researchers, policy makers, ethicists, and educators. At the organizational level, many ethically challenging questions arise for nurses. In the s, Chambliss conducted a sociological study of hospital nurses to better understand the kinds of ethical issues that arose Chambliss, In their analysis of the moral habitability of the nursing work environment, Peter et al.
They also found, however, that nurses tended to identify paths of resistance and influence, such as finding strength in numbers and being assertive in order to achieve their goals. Thus, it is clear that the organizational ethics aspects of healthcare are important factors for nurses. An effective ethical code for nursing practice must provide guidance on managing ethical problems that arise at the societal level, the organizational level, and the clinical level.
On a clinical level, ethical questions arise every day. In a study of the ethical issues encountered by nurses, Ulrich et al. Other common issues included advanced care planning, surrogate decision making, end-of-life decision making, and breeches of confidentiality Ulrich et al. Nurses acted in several ways to address these problems, such as communicating and speaking up, advocating and collaborating, being present and empathetic, and being informed Pavlish et al.
The utility of the Code. This scenario demonstrates the benefit of the Code as a useful tool for evaluation and action. Logan participate in his own pain management plan? In Mr. The action to question this physician order suggests that nurse believes that deceiving the patient is wrong. Provision 1 of the Code states that the nurse is obligated to act with compassion and to respect the dignity and autonomy of each patient ANA, b.
Lying to the patient, watching him suffer, and not involving him in his plan of care achieve neither goal. However, in this case, there is an inkling of doubt because of the possibility of a placebo effect. That is, the saline injection may induce some analgesic effect even though it is not a pain medication. Also, there is some concern that while an opioid may provide short-term benefit, it could cause harm in the longer term by causing re-addiction.
After review of the Code and a search of the literature, Mr. Investigating the risks and benefits of placebo use and pain management in patients with histories of substance abuse will be helpful to answer this question.
However, placebo use continues even after years of advocacy against this practice. Thus it is not surprising that there are healthcare providers still willing to use placebos, including the physician in Mr. A recent position statement by the American Society for Pain Management Nursing supports a pain management regimen including careful monitoring and agreement with a fully-informed patient Oliver et al. Using a placebo to treat Mr. The question now becomes, how should the nurse best advocate for this patient?
Whether or not to advocate is not in doubt Provision 3 , but just how to do that is a bit more difficult. This dilemma is also an organizational issue as the nurse does not have authority to single-handedly change the prescription.
Clearly, advocating will involve collaboration with a hesitant physician. The Code can provide some guidance, but some weighing and balancing of the different provisions is necessary.
In response to Mr. This would alleviate the concern about deception and withholding information Provision 5. Conversely, this may undermine Mr. In addition, it may threaten the collegial relationship between the nurse and physician Provision 2.
Logan has been discharged. Provision 6 also addresses maintaining an ethical work environment in order to support quality of care. Another alternative for the nurse is to collaborate with the physician first, bringing to light the concerns about patient deception and the evidence of inappropriate placebo use. This alternative action will hopefully have several benefits, such as increasing the likelihood of a more effective treatment plan, maintaining patient trust in the healthcare team, and supporting a professional and collegial doctor-nurse relationship.
The potential benefits of approaching the physician first suggest that this is the more sound, justifiable solution to the dilemma. Ethical issues in clinical nursing often involve not only dilemmas at the bedside, but also dilemmas at the organizational level, such as navigating a complex system to protect a patient or provide quality care or identifying ways to collaborate with colleagues to maintain strong working relationships and trust.
The Code ANA, b can provide direction for multiple levels of direct and indirect care. The Code applies to other areas of nursing practice as well, such as nursing education, research, and policy making. Advancing the profession through research and policy by attending to informed consent, advocacy, and accountability of practice are examples of other professional areas of practice with potential ethical dilemmas that make the provisions of the Code a relevant nursing resource.
The first formal code of ethics for nurses was adopted in Fowler, However, a need for ethical guidance was recognized soon after modern nursing began to formalize in the mids. Although in , one of the initial goals of the newly established American Nurses Association was to write a code of ethics, urgent issues such as nurse registration, the welfare of nurses, and accreditation processes for nursing schools took precedence Fowler, The provisions were framed in terms of the various relationships between the nurse and patient; the nurse and medicine; and nurses and their profession.
The first formal Code for Professional Nurses was adopted in and was edited slightly before being revised in At the same time as the suggested code, ethics was on the minds of nurse faculty and administrators in terms of training and educating nursing students and practicing nurses Crawford, ; Ethical Problems, ; Ethical Problems, ; Fowler, Their work highlights the thinking of the time, that is, that character was a significant factor in determining right action.
The revision of the Code included several significant changes ANA, First, prior to this revision, the provisions were simply listed with little, if any, interpretation. The new code provided brief interpretations which helped the nurse see how the provision might be applied. Second, the provisions were reduced from 17 to a more manageable Finally, there was a fundamental shift in language in the revision.
With changes in the level of practice independence; advances in technology; societal changes; and expansion of nursing practice into advanced practice roles, research, education, health policy, and administration, the Code has been revised over time to introduce obligations to advance the profession and build and maintain a healthy work environment ANA, ; ANA, ; ANA, ; ANA, b.
As in the past, the current Code of Ethics with Interpretive Statements ANA, b forms a central foundation for our profession to guide nurses in their decisions and conduct. It establishes an ethical standard that is non-negotiable in all roles and in all settings.
The Code is written by nurses to express their understanding of their professional commitment to society. The provisions and interpretive statements reflect broad expectations without articulating exact activities or behaviors. Nurse practice acts in many states incorporate the Code of Ethics. Even though the Code is primarily ethics-related, it also has legal implications. Given the importance of the Code to the profession on so many levels, revisions continue on a regular basis.
As society changes, so must the Code ANA, b. It is a living document that informs and is informed by advances in healthcare such as genomics, technology, new roles for nurses and changes in healthcare delivery. The nine provisions address the general, enduring obligations of nurses and rarely require major revision.
However, the interpretive statements are more specific and address current topics and issues.