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. The Code can provide direction for multiple levels of direct and indirect care. 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 first formal Code for Professional Nurses was adopted in and was edited slightly before being revised in Fowler, 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 forms a central foundation for our profession to guide nurses in their decisions and conduct. 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. Since healthcare-related problems rapidly unfold in our society, the interpretive statements must be reviewed and revised every 10 to 12 years.
Review of the Code ANA, revealed several areas requiring updates in language and content. An overview of this process below illustrates the intentional considerations inherent to the revision, the opportunities for nurse participation at all levels, and the impact that nurses have toward the final product.
The use of technology made this recent revision process more effective and efficient than in previous times. For example, the pre-internet revision of the Code ANA, took seven years, had many onsite committee meetings, and handled over 15, written responses following a solicitation for feedback, editorial comments, and suggestions.
In the revision of the Code ANA, , greater use of technology resulted in a single onsite meeting. Much work was accomplished using conference calls, email, and other electronic platforms e. Table 1 provides a timeline of the most recent Code revision process.
Nurses participating in the revision process took advantage of technology for online committee meetings and discussions and online public comment periods to solicit feedback from nurses across the country. Table 1: Timeline of the Revision Process for the Code.
The process for the most recent revision began with an initial review by the ANA Ethics Advisory board of the current Code provisions and interpretive statements, the International Council of Nurses ICN code ICN, , and the codes of other health professions such as pharmacy, occupational therapy, social work, medicine, physical therapy, and public health.
This extensive review helped to determine the need for revision. The Code Review Working Group was appointed to collect public comment regarding the need for revision. The summary report of this analysis included recommendations to revise the Code ANA, for the following reasons:. After recommendations were accepted, the ANA website, NursingWorld, posted a call with an invitation to participate in the revision.
More than nurses volunteered; from these 15 were selected to serve on the Code Steering Committee SC. Between September and April , a draft revision was prepared. In May , the edited draft was posted for public comment. By early June, nearly 1, individuals had posted suggestions for changes, clarifications, additions, or deletions. Each suggestion was evaluated using the analysis processes described above, preserving the essential and eliminating the incidental. Further revisions were made based on this additional analysis.
The revision process led to several significant changes in the Code of Ethics. The preface was revised to strengthen the purpose of the Code, the ethical framework, and the context.
The Code Provisions have been reworded to be more concise and better articulate their intent, although the general structure remains the same as the Code ANA, For example, the first three provisions still describe the most fundamental values and commitments of the nurse; the next three address boundaries of duty and loyalty, and the last three address aspects of duties beyond individual patient encounters.
Finally, there were significant changes to the interpretive statements, where content has been updated to improve relevance to modern day practice, reorganized for consistency with the wording in the provisions, and revised to reduce redundancy. The Code is an important document that can provide effective guidance as the nurse negotiates the complexities inherent to many situations. This article has suggested several implications for nursing practice including consideration of the everyday nature of ethical concerns in nursing at multiple levels, the usefulness of the Code ANA, b as a guide, and the importance of an inclusive and thorough process for revising the Code.
Each day, situations arise for nurses that require both decision and action, and may include ethical dilemmas. Examples of those most common include errors and near misses, delegation, end-of-life care, use of technology and fatigue.
Managing these challenges well contributes to safe, compassionate, quality care. The Code ANA, b is an important document that can provide effective guidance as the nurse negotiates the complexities inherent to many situations. Nurses and other healthcare professionals are not expected to be able to resolve complex ethical problems alone, using only a code of ethics.
Often, other resources are needed to grasp the full complexity of an ethical dilemma. Selected potentially helpful online resources are listed in Table 2. The following recommendations can be helpful at any level of practice:.
ANA Nursespace. Presidential Commission for the Study of Bioethical Issues. The process for the Code revisions used technology to a great advantage. This provided an avenue for a highly participatory process to receive input from all nurses in every type of practice and allow working groups to collaborate efficiently and effectively with a minimum of travel.
Recognizing that nursing practice extends from horizon to horizon—from the bedside to the classroom, from the executive suite to the laboratory bench—the Code continues to provide all nurses with a firm foundation for ethical practice. Beth teaches ethics in the School of Nursing and lectures in the Center for Bioethics and Humanities. She was a flight nurse and achieved the rank of Colonel. Her responsibilities included representing the DoD as an ex-officio member of the Secretary's HHS Advisory Committee for Genetics, Health and Society, reviewing policies related to many aspects of healthcare and developing ethics programs and ethics expertise throughout the Air Force Medical Service.
Most recently she staffed the revision of the ANA Code of Ethics for Nurses with Interpretive Statements as content editor, revision coordinator and co-lead writer. American Association of Critical Care Nurses. Retrieved from www. American Medical Association.
Code of medical ethics. Retrived from www. Code of medical ethics, opinion 8. American Nurses Association. A suggested code. American Journal of Nursing 26 8 : A tentative code. American Journal of Nursing 40 9 : The code for professional nurses. American Journal of Nursing 60 9 : Code for nurses.
American Journal of Nursing 68 12 : Code for nurses with interpretive statements. Code of ethics with interpretive statements.
American Nurses Association position statements on ethics and human rights. Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks. Nightingale pledge. Retrieved from: www. Arnstein, P. Use of placebos in pain management. Pain Management Nursing, 12 4 : Austin, W. The ethics of everyday practice: Healthcare environments as moral communities.
Advances in Nursing Science, 30 1 : Beauchamp, T. Principles of biomedical ethics , 6 th ed. New York: Oxford University Press.
Chambliss, D. Beyond caring: Hospitals, nurses, and the social organization of ethics. Chicago: University of Chicago Press. Crawford, B, How and what to teach in nursing ethics. American Journal of Nursing, 26 3 , Engelhard, C. Healthcare ethics and a changing healthcare system. Filerman, A. Schyve eds. Managerial ethics in healthcare: A new perspective. Ethical problems. American Journal of Nursing, 26 8 , American Journal of Nursing, 33 3 , Fassler, M.
Frequency and circumstances of placebo use in clinical practice: A systematic review of empirical studies. BMC Medicine, 8 Fowler, M. The evolution of the code for nurses. The California Nurse, 81 5 : 5. Evolution of the code. According to the International Council for Nurses , the most important principle of the code is respect for human rights. Such respect encompasses the right to life, right to dignity, and right to proper treatment that factors in respect for the patient.
Over the years, this repeated application of these codes in the day to day conduct of nurses has impacted on the values of nurses. In line with these codes, nurses are expected to treat the patient with respect and dignity International Council for Nurses, This, therefore, requires nurses to abide by all the provisions of the code and other requirements that are directly aimed at enhancing the treatment of the patient.
In addition to that, nurses are required to factor in the input of the patient while caring and treating the patient. Specifically, a nurse may be required to obtain patient consent before performing any procedure that may require them to consent. In addition to that, nurses are expected to furnish the patient with all the relevant information regarding their condition and ensure that the patient clearly understands this information so that they may consider them in any decision that they take.
Finally, nurses are also expected to respect the patients and abide by their decisions provided that the patients have the mental and physical capacity to make such decisions. All in all, the ICN and ANA codes of ethics are an important set of provisions that have helped enhance the overall practice of nursing.
This benefits both the patients and nurses. The patients are in a position to receive much better care from the nurses as a result of these codes while on the other hand, the nurse is in a position to improve their practice through standardization of the quality of care to improve the care and treatment of patients across the board.
American Nurses Association. Nursing World. International Council For Nurses. Code of Ethics for nurses. Need a custom Essay sample written from scratch by professional specifically for you? We use cookies to give you the best experience possible. If you continue, we will assume that you agree to our Cookies Policy. Learn More.
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