Module-II
Nursing Ethics
Nursing Ethics 1
Outline
• Session 1: Introduction to Nursing Ethics
• Session 2: Ethical Principles
• Session 3: Nursing Values
• Session 4: Ethical Dilemmas and Ethical distress in
Nursing
• Session 5: Ethical Decision Making in the Nursing
Practice
• Session 6: Legal Aspects of the Nursing Practice
• Session 7: Nursing Code of Ethics
Nursing Ethics 2
Session 1
Introduction to
Nursing Ethics
Nursing Ethics
Session Objectives
Define Nursing Ethics
Nursing Ethics 4
Brain Storming:
What is Ethics?
Nursing Ethics 5
Nursing Ethics
Derived from the Greek word “ethos”,
means custom or guiding beliefs.
Rules of conduct
Determines the characteristics of a
profession and is also called as a
“code of conduct”.
Nursing Ethics 6
Nursing Ethics
Provides the professional standards for nursing
activities, which
protect the nurses and the patients from legal and ethical
issues.
Concerned with fundamental principles of right and
wrong and what people ought to do
Inform our judgments and values and help individuals
decide on how to act
Nursing Ethics 7
Nursing Ethics
According to ANA code of ethics for nurses serve
Ethical obligations and duties of every person
who chooses to enter the profession of nursing.
To act as the nonnegotiable standard of ethics
To serve as an expression of the understanding
on nursing’s commitment to society.
Nursing Ethics 8
Session 2
Ethical
Principles
Nursing Ethics
Session Objectives
Identify Principles of Nursing Ethics
Analyze Principles of Nursing Ethics
Nursing Ethics 10
Activity: 5 Minutes
State Principles of
Ethics You Know
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Ethical Principles
Provide criteria on which to base
judgments in relation to ethical theories.
Ethical principles include:
i. Beneficence v. Veracity
ii. Non-maleficence vi. Fidelity
iii. Respect for vii. Privacy and
Autonomy
Confidentiality
iv. Justice
viii.Paternalism
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Ethical Principles
Beneficence - to do good
This is done by:
Providing health benefits to the clients.
Balancing the benefits and risks of harm.
Considering how a client can be best
helped.
Example: Page 50
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Ethical Principles
Non Maleficence: To do no harm
Avoidance of harm or hurt;
Avoiding deliberate harm, risk of harm that
occurs during the performance of nursing
actions.
Determining whether the use of technological
advances provides benefits that outweigh risks.
Example: Page 51
Nursing Ethics 14
Ethical Principles
Autonomy:
individuals right to self-determination
individuals right to make decisions about their
lives without interference from others.
Respecting a client’s rights, values and choices
Informed consent is a method that promotes
and respects a person’s autonomy.
Example: Page 51
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Ethical Principles
Justice
Equal and fair distribution of resources,
based on analysis of benefits and
burdens of decision.
Example: Page 52
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Ethical Principles
Veracity: Duty to tell the truth
Not intentionally deceive or mislead
clients.
The nurse should be truthful to the
patient
After decision is made, the nurse should
be truthful to the patient.
Tell him the decision and why they chose
it.
Nursing Ethics 17
Ethical Principles
Fidelity: Duty to Keep Promises
Requires loyalty, fairness, truthfulness,
advocacy, and dedication to our
patients.
It involves an agreement to keep our
promises.
Keeping a commitment
Example: Page 53
Nursing Ethics 18
Ethical Principles
Privacy and Confidentiality
Privacy belongs to each person and, as such, it
cannot be taken away from that person unless
he/she wishes to share it.
Confidentiality, on the other hand, means that the
information shared with other persons will not be
spread abroad and will be used only for the
purposes intended.
Nursing Ethics 19
Ethical Principles
Paternalism
Healthcare professionals make decisions about diagnosis,
therapy, and prognosis for the patient.
is characterized by the professional acting on behalf of and
in the best interest of the patient.
Paternalism is commonly agreed to be the overriding of an
individual's autonomy, for the purpose of acting in his best
interests.
is closely associated with the principles beneficence and
non-maleficence
Its is always the desire to safeguard an individual's best
interest
Example: Page 53
Nursing Ethics 20
Group Activity
• Discuss on the issue for 5
Minutes
• Come back to the larger
class and discuss ( 30
minutes)
• Discussion Questions:
• What is the ethical issue?
• What should you do?
Nursing Ethics 24
Session 3
Nursing values and
moral values
Nursing Ethics
Learning Objectives:
At the end of this session, participants
will be able to:
Explain nursing values
Explain ideal nurse ethical
competencies
Nursing Ethics 26
Activity: 5 Minutes
Why do you think being a nurse is
important, worthwhile and worth
striving for?
What do you think the nurse should
value most and why?
Have you ever felt you are maintaining
these values?
If not why and what should be done to
maintain these values?
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Definition Nursing Value
Values
“What is important, worthwhile
and worth striving for and made
who we are as individuals.”
• Values are also beliefs that are
considered to be socially and
personally desirable
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Values
• Are unwritten standards, ideals, or concepts
• Give meaning to a person’s life and
• Serve as a guide for making decisions and
setting priorities in daily life.
• Are impacted by the society, culture, morals
and beliefs
• Are related and overlapping.
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Professional nursing values
• The term refers to the attitudes, beliefs,
and priorities of nurses
• Ultimately functions as a guide and
motivation in nurses interactions
• They are the guiding beliefs and principles
that influence nurses work behaviour.
• Individually held and shared among nurses
Nursing Ethics 30
Ideal Nursing Ethical
Competencies
Activity 3 Minutes
1. What are the characteristics
of an ideal nurse?
2. To what extent nurses are
applying these
characteristics?
Nursing Ethics 31
10 Ideal Nurse
Competencies
2. Communication:
1. Moral integrity:
i. Honesty vi. Mindfulness and
ii. Truthfulness and vii. Effective listening; and
3. Concern:
truth telling,
viii.Advocacy
iii. Benevolence
ix. Power and
iv. Wisdom and
v. Moral courage; x. Culturally sensitive care
Nursing Ethics 32
1. Moral Integrity
“State of being, acting like, and
becoming a certain kind of person. This
person is honest, trustworthy, consistently
doing the right thing and standing up for
what is right despite the consequences”
(Laabs’s, 2011).
Nursing Ethics 33
1. Moral Integrity
People with moral integrity:
Pursue a moral purpose in life,
Understand their moral obligations in the
community
Committed to execute good and right actions
using rational application
Nursing Ethics 34
i. Honesty
It is being real, genuine, authentic, and
bona fide
Nurses must
Stay true to their word.
Stay committed to their promises to
patients and
Follow through with appropriate behaviours,
Such as returning to patients’ hospital rooms
as promised to help them with certain tasks.
Nursing Ethics 35
ii. Truthfulness and truth
telling
It is the intermediate state between imposture
(excessiveness) and self-depreciation
(deficiency).
Being genuine in all words and deeds and is
never false or phony.
• Nurses
Are usually ethically obligated to tell the truth and
Are not intentionally to deceive or mislead
patients
Case study ( Page 62)
Nursing Ethics 36
iii. Benevolence
“morally valuable character trait, or
virtue, of being disposed to act to
benefit others”
Characterizations of a benevolent
person
Altruistic, kind-hearted, caring, courteous, and warm-
hearted
Common descriptors
compassionate care, kindness
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iii. Benevolence
Benevolence is a central motivating factor
Nurses has to seek out ways to perform
acts of kindness rather than only
recognizing ways to do good
Nursing Ethics 38
iv. Wisdom
• Requires calculated intellectual ability,
contemplation, deliberation, and efforts to
achieve a worthy goal.
• Develops with intellectual accomplishment,
and practical expertise
• Nurses must have the feature of intellectual
accomplishment and the proclivity to seek the
right and the good
Nursing Ethics 39
v. Moral Courage
Nurses with moral courage
• Stand up for or act upon ethical principles to do what is
right
• Make a personal sacrifice for what they believe is the
right
• Choose ethically right decision, even when under intense
pressure
• Act according to their core values, beliefs, or moral
conscience.
• Examples: Page 63-63
Nursing Ethics 40
2. Communication
• Effective communication nurtures
relationships and is fundamental to
nursing
• To be effective, nurses must reside in
a state of mindfulness and be an
effective listener.
Nursing Ethics 41
vi. Mindfulness
• Mindful nurses
– Are engaged and attentive in their activities
or roles by continuously analysing,
categorizing, and distinguishing data
– Pay close attention to their attitudes and
find ethical ways to interact and behave.
• Mindlessness
– State of unawareness and not focusing,
similar to functioning in autopilot mode
Nursing Ethics 42
vi. Mindfulness
• Examples of the benefits of mindfulness
– Reduces stress, negative emotions, and
depression
– Enhances attention skills and focusing
– Enhances communication skills
– Promotes more positive relationships
– Increases memory and learning capacity
– Increases the ability for a deeper type of
empathy, compassion, serenity, and altruism
Nursing Ethics 43
vii. Effective Listening
Without effective listening nurses
– Cannot respond appropriately no matter how
well-meaning a person’s intention of listening
is.
– Will not give competent care and
– Misinterpret facts, physician’s orders, or
patient interactions.
Nursing Ethics 44
3. Concern
• Sense of responsibility about scope of care
important for patients
• Often it prompts nurses to action.
• composes
i. Being an advocate,
ii. Using power, and
iii. Giving culturally sensitive care
Nursing Ethics 45
viii. Advocacy
• Is pleading in favour of or supporting a
case, person, group, or cause,
• Three central characteristics :
– Safeguarding patients’ autonomy
– Acting on behalf of patients
– Championing social justice in the provision of
health care (Jezewski, 2006)
Nursing Ethics 46
vii. Advocacy
Barriers to nursing advocacy (Hanks, 2007)
• Conflicts of interest between the nurse’s moral
obligation to the patient and the nurse’s sense of
duty to the institution
• Institutional constraints
• Lack of education and time
• Threats of punishment
• Barrier related to nurses’ expectations of a
subservient duty to medical doctors
Nursing Ethics 47
ix. Power
• Nurses with power have the ability to
influence persons, groups, or
communities.
• Nurses are in powerful positions to
– improve quality of inpatient care and
– oversee professional nursing practice
standards.
• Properties of a powerful professional
nursing practice : Page 65
Nursing Ethics 48
x. Culturally Sensitive
Care
• Cultural competence is the
adaptation of care in a manner that
is consistent with the culture of the
client
• Nurses must first have a basic
knowledge of culturally diverse
customs and act accordingly
Nursing Ethics 49
The Most Important Qualities of a
Professional Nurse
They will be the nurse that patients
want
• To be on shift to look after them:
• To take care of them, speak up for
them, soothe them, monitor them
and
• Make sure they are getting the best
possible care in the circumstances.
10 Ideal Nurse
Competencies
2. Communication:
1. Moral integrity:
i. Honesty vi. Mindfulness and
ii. Truthfulness and vii. Effective listening; and
3. Concern:
truth telling,
viii.Advocacy
iii. Benevolence
ix. Power and
iv. Wisdom and
v. Moral courage; x. Culturally sensitive care
Nursing Ethics 51
Session 4
Ethical dilemma and distress
in nursing practice
Nursing Ethics
Session objectives
Describe elements of ethical dilemma and
distress
Apply Ethical decision-making models to
solve ethical dilemmas and distress
Nursing Ethics 53
Ethical dilemmas
Activity (5 Minutes)
• Have you ever felt difficulty to
choose between two or more options
that will affect the outcome of the
patient you care for?
• Have you ever felt frustration
because all possible options have
both positive and negative
consequences?
Nursing Ethics 54
Ethical dilemmas
• Is situations when
– Equally compelling ethical reasons both
for and against a particular course of
action are recognized,
– Appropriate choice in the situation is
unclear
– And a decision must be made
• Although each option can be justified
as “good,” both have pros and cons
Nursing Ethics 55
Ethical dilemmas
• It creates uncertainty in the outcome
• May or may not be the same decision
that others believe is the right
decision.
• The DECIDE model to achieve morally
and ethically sound decisions (page
69)
Nursing Ethics 56
Ethical dilemmas
• Activity (page 70)
Nursing Ethics 57
Ethical/Moral distress
• Activity (page 70)
Nursing Ethics 58
Ethical/Moral distress
Moral/ethical distress is an emotion
that occurs when nurses have identified and
know what right response is called for, but
institutional or other constraints make it
almost impossible to pursue the right course
of action (Jameton, 1984).
Nursing Ethics 59
Ethical/Moral distress
• Has situational, cognitive, action, and feeling
dimensions,
• Has short- and long-term effects
• Result in significant physical and emotional
stress,
• Contributes to nurses’ feelings of loss of integrity
and dissatisfaction
• Affects relationships with patients and others
Nursing Ethics 60
• Affect the quality, quantity, and cost of nursing
Ethical/Moral distress
• Groups of people who work together in situations
that cause distress may experience
– Poor communication,
– Lack of trust,
– High turnover rates,
– Defensiveness, and
– Lack of collaboration across disciplines.
Nursing Ethics 61
Ethical/Moral distress
Moral distress is
• Ineffective policy,
linked to
• Incompetent or poor
• Futile care,
care, • Unsuccessful
• Unsafe or inadequate advocacy,
staffing, • The current
• Overwork, definition of brain
• Cost constraints, death,
• Low job satisfaction • Objectification of
• Nurses turnover patients, and
• Unrealistic hope
Nursing Ethics 62
Ethical/Moral distress
Four A’s to Rise Above Moral Distress (2004)
1. Ask appropriate questions to become aware that moral
distress is present.
2. Affirm your distress and commitment to take care of yourself
and address moral distress.
3. Assess sources of your moral distress to prepare for an action
plan.
4. Act to implement strategies for changes to preserve your
integrity and authenticity
Activity (page72)
Nursing Ethics 63
Ethical/Moral distress
• Activity (page 70)
Nursing Ethics 64
Ethical dilemma and
distress
Case studies (page 71 to
73)
Nursing Ethics 65
Session 5
Ethical Decision Making
in the Nursing Practice
Nursing Ethics
Session Objectives
• Identify appropriate ethical decision
making procedures
• Demonstrate sound ethical decision
making ability
Nursing Ethics 67
Brain Storming
What is ethically
sound decision?
Nursing Ethics 68
Introduction
• Ethical questions are a challenge to navigate
• Consider the following issues:
• multiple clinical facts
• Patient values & preferences
• Concerns and values of family
• Contextual features including law
• In some cases quick decision may be required
Nursing Ethics 69
The Four Quadrant
Approach
• Provides a framework for sorting
through and focusing on specific
aspects of clinical ethics cases
• Connects the circumstances of a case
to their underlying ethical principles
Nursing Ethics 70
The Four Quadrant
Approach
The quadrants:
1. Medical indications
2. Patient preferences
3. Quality of life
4. Contextual features
• Page 75
Nursing Ethics 71
The Four Quadrant
Approach
• Case study
participants manual
page 76
Nursing Ethics 72
Session Summary
• What are the things you need to
consider in order to reach into sound
ethical decision?
Nursing Ethics 73
Session 6
Legal Aspects of the
Nursing Practice
Nursing Ethics
Session Objectives
• describe general legal concepts of
nursing
• discuss legal issues in relation to the
nursing practice
Nursing Ethics 75
Activity
• Case scenario:
participant’s
manual page 77
Nursing Ethics 76
Functions of law in nursing
• Establishes legal ground for patient care
• Differentiates the nurses’ responsibilities
• Shows the boundaries of independent
nursing action
• Maintains standard of care (accountability)
Nursing Ethics 77
Activity
Cases scenario:
participant’s
manual page 79
Nursing Ethics 78
Negligence and malpractice
Malpractice
– wrongful conduct
– improper discharge of
professional duties
– failure to meet the standards of
acceptable care
Nursing Ethics 79
Negligence and malpractice
…
Negligence (breach of duty)
• is the failure of an individual to provide
care that a reasonable person would
ordinarily use in a similar circumstance.
Nursing Ethics 80
Assault and Battery
• Assault: is the intentional & unlawful offer
to touch a person in an offensive, insulting
or physically intimidating manner.
• Battery: is the touching of another person
without the person’s consent
Nursing Ethics 81
Selected Legal Aspects of
Nursing Practice
• Informed consent
• Delegation
• Violence, Abuse, and Neglect
Nursing Ethics 82
Informed Consent
Major elements:
– The consent must be voluntary
– The consent must be given by a client
who is capable and competent to
understand
– The client must be given enough
information to be the ultimate decision
maker
– It is the responsibility of the person who
performs the procedure
Nursing Ethics 83
Informed Consent …
Information to be given:
– Diagnosis or condition that requires
treatment
– Purpose of treatment
– What the client can expect to feel or
experience
– The intended benefits of the procedure
– Possible risks
– Advantages and disadvantages of
alternatives to treatment (including no
treatment)
Nursing Ethics 84
Delegation
• Does the Nurse Practice Act (if any)
permit delegation?
• Is there a list of procedure a nurse
can delegate?
• Are there guidelines explaining the
nurse’s responsibilities when
delegating?
Nursing Ethics 85
Violence, Abuse, and
Neglect
• the nurse must report the situation to
the appropriate authority.
Nursing Ethics 86
Legal Responsibilities in
Nursing
• Common-sense precautions
Follow accepted procedures
• Be competent in practice
• Ask for assistance
• Document well
• Do not give legal advice to clients
• Do not accept gifts
Nursing Ethics 87
Federal Ministry of
Health
Session-7
Nursing Code of Ethics
Nursing Ethics CH-
III-3
Session objectives
At the end of this session, participants
will be able to:
•Explain the nursing code of ethics
Nursing Ethics 89
Brain Storming:
What is nursing
code of ethics?
Nursing Ethics 90
Nurses’ professional code of Ethics
• Modular
Nursing Ethics 91
Nursing Ethics 92
Nursing Ethics 93
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