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Ethics includes personal behaviors and issues of character e.g. kindness, tolerance and
generosity. Ethic is derived from the word ETHOS ethos as defined by ernad Harding
compromises distinction attitudes, which characteri!e the cultural outlook of professional group.
Ethics are the distinction between right and wrong based on a body of knowledge, not
"ust based on opinions. Ethics in nursing is set of moral codes of professional behaviors towards
holistic care. The ethical code is a set of guidelines formulated by the members of profession
with the help of specialists in the field of nursing leaders, advocate#lawyers at times members
from the society.
Purposes of code of ethics in nursing
Standards for the behaviors of nurse and provide general guidelines for nursing action in
ethical dilemmas.
The code helps to distinguish between right and wrong at a given time especially when
alternatives appear "ust as satisfactory.
The code enables a correct decision and a uniform decision with in the groups.
Helps to protect rights of individuals, families and community and also the right of the
Uses of code of ethics
$cknowledge the rightful place of individual in health care delivery system.
%onstitutes towards empowerment of individual to become responsible for their health
and wellbeing.
%ontributes to &uality care.
'dentifies obligations in practice, research and relationships.
'nform the individual, families, community and other professionals about e(pectation of
Ethical principles
1. Ethical principles of respect and autonomy :
)espect for a person involves*+ level of understand of another person or empathy and
reducing e(ploitation.
$utonomy* + person,s independence, self determining action allow the patient to
make decision.
2. Principle of eneficence:!
$ctivity seeking benefits, promotion of good. The duty to do balance between
benefits and harms, Paternalism is an undesirable outcome of beneficence, in which the
health care provider decides what is best for the client and attempt to encourage the
clients to act against his or her own choices.
". Principle of #ustice and families:!
asic principle is that each person has e&ual right to the liberty available to
$. Principle of %eracity:! The obligation to tell the truth.
&. Principle of fidelity:! The duty to do what one has promised.
Ethical dilemma
$n ethical dilemma occurs when there is conflict between two or more ethical principles.
-o correct decision e(ists.
The nurse must make a choice between two alternatives that are e&ually unsatisfactory.
Such dilemmas may occur a result of differences in cultural or religious beliefs.
Ethical reasoning is the process of thinking through what one ought to do in an orderly and
systematic manner to provide "ustification for actions based on principles.
C'(E ') ETHICS )'* +U*SES I+ I+(I,
1. The nurse respects the uni-ueness of indi%idual in pro%ision of care.
.rovides care for individual without consideration of caste, creed, religion, culture,
ethnicity, gender, socio+economic and political status, personal attributes, or any other
'ndividuali!e the care considering the beliefs, values and cultural sensitivity.
$ppreciates the place of individuali!e in the family and community and facilities
participation of significant others in the care.
/evelop and promotes trustful relationship with individuals.
)ecogni!es uni&ueness to response of individuals to interventions and adapts
2. The nurse respects the rights of indi%iduals as partners in care and help in ma.ing
informed choices.
$ppreciates individuals, right to make decisions about their care and therefore gives
ade&uate and accurate information for enabling them to make informed choices.
)espects the decisions made by individuals regarding their care.
.rotects the public from misinformation and misinterpretations.
$dvocates special provisions to protect vulnerable individuals0groups.
". The nurse respects indi%iduals right to pri%acy maintains confidentiality and shares
information #udiciously.
)espects the individuals, right to privacy of their personal information.
1aintains confidentiality of privileged information e(cept in life threatening
situations an uses discretions in sharing information.
Takes informed consent and maintains anonymity when information is re&uired for
&uality assurance0academic0legal reasons.
2imits the access computeri!ed to authori!e persons only.
$. +ursing maintains competence in order to render -uality nursing care.
-ursing care must be provided only by registered nurse.
-urse strives to maintain &uality nursing care and upholds the standard of care.
-urse values containing education initiates and utili!e all opportunities for self
-urse values research adhering to ethical principles.
&. The nurse is oliged to practice /ithin frame/or. of ethical professional legal
$dheres to code of ethics an code of professional conduct for nurses in 'ndia developed
by 'ndian nursing council.
3amiliari!es with relevant laws and practices in accordance with the law of the state.
0. +urse oliged to /or. harmoniously /ith memers of the health team.
$ppreciates the team efforts in rendering care.
%ooperates, coordinates and collaborates with members of the health team to meet the
needs of people.
1. +urse comines to reciprocate the trust in%ested in nursing profession y society.
/emonstrate personal eti&uettes in all dealings.
/emonstrate professional attributed in all dealings.
C'(ES ') P*')ESSI'+,2 C'+(UCT )'* +U*SES
1. Professional responsiility and accountaility
$ppreciates sense of self worth and nurtures it.
1aintains standards of personal conduct reflecting credit upon the profession.
%arries out responsibilities within the framework of the professional boundaries.
's accountable for maintaining practice standards set by 'ndian -ursing %ouncil.
's accountable for own decisions and actions.
's compassionate
's responsible for continuous improvement of current practices.
.rovides ade&uate information to individuals that allow then informed choices.
.ractices healthful behaviors.
2. +ursing practice
.rovides care in accordance with set standards of practice.
)espect individuals and families in the conte(t of traditional and cultural practices
promoting healthy practices and discouraging harmful practices.
Treat all individuals and families with human dignity in providing physical,
psychological, emotional, social and spiritual aspects of care.
.romotes participation of individuals and significant others in the care
Ensures safe practice
%onsult, coordinates, collaborates and follows up appropriately when individuals care
needs e(ceed the nurse,s competence.
". Communication and interpersonal relationship
Establish and maintains effective interpersonal relationships with individuals, families
and communities.
4pholds the dignity of team members and maintains effective interpersonal relationship
with them.
$ppreciates and nurtures professional role of team members.
%ooperates with other health professionals to meet the needs of the individuals, families
and communities.
$. 3aluing human eing
Takes appropriate action to protect individuals, from harmful unethical practice.
%onsider relevant facts while taking conscience decisions in the best interest of
Encourages and supports individuals in their right to speak for themselves on issues
affecting their health and welfare.
)espects and supports choices made by individuals.
&. 4anagement
Ensures appropriate allocation and utili!ation of available resources.
.articipates in supervision and education of students and other formal care providers
4ses "udgment in relation to individual competence while accepting and delegating
3acilitates conductive work culture in order to achieve institutional ob"ective.
%ommunicates effectively following appropriate channels of communication.
.articipates in evaluation of nursing services.
.articipates in policy decisions, following the principle of e&uity and accessibility of
.articipates in performance appraisal.
5orks with individuals to identify their needs and sensiti!es policy makes and funding
agencies for resources allocation.
0. Professional ad%ancement. +urse:!
Ensures the protection of the human rights while pursuing the advancement of
%ontributes to the development of nursing practice.
.articipates in determining for upholding own knowledge an competencies
%ontributes to care professional knowledge by conducting and participating in research.
Autonomy means that individuals are able to act for themselves to the level of their
capacity. 't is the right of individuals, governing their actions according to their own purpose
and reason.
.rofessional nurse autonomy is defined as belief in the centrality of the client when
making responsible discretionary decisions, both independently and interdependently, that
reflect advocacy for the client. %ritical attributes include caring, affiliative relationships with
clients, responsible discretionary decision making, collegial interdependence, and proactive
advocacy for clients. $ntecedents include educational and personal &ualities that promote
professional nurse autonomy. $ccountability is the primary conse&uence of professional
nurse autonomy. $ssociated feelings of empowerment link work autonomy and professional
autonomy and lead to "ob satisfaction, commitment to the profession, and the
professionali!ation of nursing. $ student+centered, process+orientated curricular design
provides an environment for learning professional nurse autonomy. To support the
development of professional nurse autonomy, the curriculum must emphasi!e knowledge
development, understanding, and clinical decision making.
)espect for autonomy re&uires that a person honors another,s right to govern himself or
herself. The legal doctrine of informed consent for treatment and for participation in
research. The following are re&uired for a patient to give informed consent*+
/isclosure ade&uate presentation of relevant information about the proposed
treatment or study.
4nderstanding ade&uate comprehension of the disclosed information.
6oluntary agreement free assent, uninfluenced by e(ternal controlling factors.
%ompetence ade&uate decision+making capacity.
The principle of autonomy may be difficult to apply in patient care when there is strong
conviction on the part of the nurse or other members of health care team that respecting self+
determined choice is not really in the best interest of the patient.
'n this type of situation, the nurse may need to consider limits of individual patient autonomy
and the criteria for "ustified paternalism on the part of the nurse. Paternalism is defined as the
overriding of patient choices or intentional actions in order to benefits to the patient. $lthough
paternalism is seldom "ustified in the care of patients, there is reason to believe that some
situations warrant overriding patient autonomy. 5hen the benefits to be reali!ed are great and
the harms that will be avoided are significant 7childress, 89:;<.
Accountability is the process that mandates that individuals are answerable for their
actions and have an obligation to act.
$ccountability involves assuming only the responsibility that are within one,s scope of
practice and not assuming responsibility for activities in which competences has not been
$ccountability involves admitting mistakes rather than blaming others and evaluating
the outcomes of one,s own actions.
$ccountability includes a responsibility to the client to be competent to render nursing
services in accordance with standards of nursing practice and to adhere to the
professional ethics code.
The concepts of $ccountability have two ma"or attributes* + answerability and
responsibility. $ccountability can be defined in terms of either of these attributes but
answerability for how one has promoted, protected and met the health needs of the client. 't
means to "ustify or to give an account according to accepted moral standards or norms for
choices and actions that the nurse has made and carried out. 't involves a relationship between
the nurse and other parties and its contractual.
The terms of legal accountability are contained in licensing procedures and state
nurses, practice acts. The terms moral accountability are contained in the $-$ code for nurse
and other standards of nursing practice in the form of norms set by members of the profession. 't
is noted that accountability means =providing an e(planation or rationale for what has been done
in nursing role.>
,ccountaility of nursing personnel
-ursing personnel are accountable for* +
8. .roviding safe and therapeutic environment for the patients.
;. /elivering component and personali!ed care.
?. 1aintaining ade&uate supplies of material and e&uipment for smooth functioning
of the ward0unit.
@. 1aintaining accurate and upto date records and reports.
A. 1aintaining good interpersonal relationships.
B. .rotecting client,s legal rights and privacy.
C. 5orking within ethical and legal boundaries.
:. Deeping pace with changing health needs and developing technology.
9. /elivering care as per standards laid down by profession, statutory body and
8E. /elegating responsibility appropriately.
88. %ontributing to development of the profession.
$ssertiveness is a tool for e(pressing ourselves confidently and a way of saying yes and
no in an appropriate way. 't is considered as health behavior for all people against personal
powerlessness and results in personal empowerment. -ursing has determined that assertive
behavior among its practioners is an invaluable component for successful professional practice.
$ssertiveness is a style of behavior to interact with people while standing up for your
rights. $ssertive manner certainly means that we,ll feel more empowered and more in control of
circumstances. However, it is definitely not a strategy to get our own way more fre&uently.
$ssertiveness offers many benefits*+
5e create health, meaningful relationship.
There is less friction and conflicts.
There is increased self respect as well as respect from others.
Our self esteem is enhanced and we always feel in control.
Our productivity at work and the home increases.
There,s less stress at work and overall sense of well being.
'n e(pressing ourselves appropriately, we needn,t hold grudges, or store pent up
emotions. Our emotional and physical health improves.
$s nurse work in different situations they have to be assertive in order to meet the
challenges and to win the cooperation from others.
2E7,2 ,SPECTS I+ +U*SI+7
$ knowledge of legal aspects in nursing is absolutely essential for each nurse to
safeguard self and clients from legal complications. %onsumers are each becoming increasingly
aware of their legal rights in the health care. 't is essentialF therefore, a nurse should know her
legal rights and professional boundaries, and their conse&uences of nonconformity.
1embers of public may become victim of violence unintentionally even by the gentle
hands of nurse or by the tender touch of a surgeon or a physician. $s a nurse it has become an
important necessity to be aware of the legal aspects associated with caring and helping people in
the health industry today.
+ursing legislation
The first nursing law created was that of nursing registration in 89E? and they have only
evolved and e(panded over the years to create a thick book which must be studied today by
aspiring nurses.
2aws and regulations as they affect nurse in 'ndia are controlled by state legislation, as
state registration acts and a central act, the 'ndian nursing council act, which was enacted in
89@CF and amended in 89AC
The legal aspects of nursing are taught and e(pected to be kept up on throughout every
nurseGs career. Employment as a nurse does not only re&uire a nursing degree but knowledge of
the medical laws that will apply to you should there is a misunderstanding or challenge by a
patient or their family. $ nursing "ob is something many young people aspire to but without the
legal knowledge behind them, many hospitals will not hire them now that legal issues are
becoming more and more problematic.
2egal implications are as follo/s:!
3alse imprisonment
'nvasion of privacy
2egal documents
'nformed consent
Torts: torts are when others interfere in individuals, privacy, mobility, property or personal
,ssault: ,ssault occurs when a person puts another person in fear of a harmful or offensive
contact. The victim fears and believes that harm will result as a result of the threat.
6attery: it is an intentional touching of another,s body without the other,s consent.
+egligence: it is conduct that falls below the standard of care that a reasonable person
ordinarily would use in a similar circumstances or it is described as lack of proper care
and attention carelessness.
4alpractice: failure to meet the standards of acceptable care which results in harm to
another person,
)raud: it results from a deliberate deception intended to produce unlawful gains.
)alse imprisonment: it occurs when a client is not allowed to leave a health care facility
when there is no legal "ustification to detain the client or when restraining devices are
used without an appropriate clinical need.
In%asion of pri%acy: it includes violating confidentiality intruding on private client or family
matters, and sharing client information with unauthori!ed persons.
2egal documents: it comprised:
a< ,d%ance directi%e: written document recogni!ed by law that provides directions
concerning the provision of care when a person is unable to make his or her own
treatment choices.
b< (o not resuscitate orders: written order by a physician when a client has indicated a
desire to be allowed to die if the client stops breathing or the client,s heart stops beating.
Informed consent: it is clients, approval Hor that of the clients, legal representativeI to have
his or her body touched by a specific individual.
+U*SI+7 2I,6I2ITIES ,+( P*E3E+T 4E,SU*ES
'n order to protect you from malpractice suits, nurses must take as many precautions as
they can during their daily shifts. )ecording, documenting and reporting your daily routines and
decisions is one of the most common ways to make sure you are on track with your patience and
in the right.
$ll nursing observations should be noted carefully, describing accurately not only any
typical or erratic changes in the patient,s conditions, but also any lack of cooperation, or
any other behavioral problems.
.atients complains should be recorded as accurately and specifically as time and space on
the chart would permit some complaints often provide a clue to the cause of an accident
that might otherwise would have been difficult to e(plain.
-urse must report through proper channels, any activity or lack of it, by any subordinates
which indicates that they are not properly trained to carry out the assigned functions and
$uthorities must be informed regarding any kind of e&uipment, materials or supplies,
which for any reasons less than safe for use in the patient,s care. $n alert nurse will
always be aware of the fact that accidents can and will inevitably occur.
'nsurance protection* there is a moral and practical necessity for a nurse to purchase good
liability coverage.
2egal responsiility
2egal responsibility in nursing means to practice nursing within the guidelines laid down
by the law of centre0state, statutory bodies and institutional polices. The main responsibility of
nurses is to provide care based on nursing diagnosis, prioriti!ing the needsF planning,
implementation and evaluating the nursing care. -urse provides care to the patient based on
needs, respect, dignity, and right without considering race, nationality, caste, creed, color or
socio economic status.

There are certain determinants of legal framework for nursing practice in 'ndia* +

1. *egistration
2icensing is a mandatory procedure for practice of nursing. )egistration aims at protecting
patients by providing &ualified nurses. The nurse is responsible to obtain registration in the
respective State -ursing )egistration %ouncil.
Employers should recruit only as per the State -ursing Home $ct.
2. 2egal 2iaility8,ct 'f +egligence
2icense of a nurse can be suspended or cancelled for any act of negligence or mal practice,
following a specified procedure.
go%ernment acts
Standing orders
go%ernment acts
Standing orders
Institutional policies9
rules9 regulations9
standing orders
Institutional policies9
rules9 regulations9
standing orders
I+(I,+ +U*SI+7
Code of ethics and
professional conduct
I+(I,+ +U*SI+7
Code of ethics and
professional conduct
2egal frame/or.
for nursing practice
2egal frame/or.
for nursing practice
". 4edico : 2egal case ;4.2.C.<:
$ medical legal case is a patient who is admitted to the hospital with some unnatural
pathology and has to be taken care of in concurrence with the police and0or court.
Types of clients which are categori!ed as 12% in a hospital are*
)oad traffic accidents
'n"uries inflicted during brawls0fights, shooting, bomb blasts etc.
)ape victim
+urses role in a medico!legal case
8. obtain complete history from patient or significant other7s<
;. 'nform the police officer0constable on duty in the hospital and the %1O.
?. 5hen it is made a 12%. Then record it on the patient,s case sheet with red ink at
right hand top corner.
2egal liaility8 act of
%riminal 7'.%<
4nder section ?E@ of 'ndian penal code
E.g. wrong medication leading to death
of patient
Tort in civil court
7-egligence e.g. not giving railing bed
to conscious patient causing fall of
@. /o not give any statement about patient,s condition to police, magistrate or media.
Only a doctor has to give information.
A. 5hen a patient has to be discharged, inform the %1O. $fter clearance from them,
then only he0she can be discharged.
B. 'f a 12% patient absconds inform the %1O immediately and the treating doctor.
C. -o patient can leave against medical advice.
:. /ocumentation the care given to patients timely, accurately and duly sign the nurses
9. )ecords and all the documents pertaining to patient should be handled with care,
during the stay in the hospital. They must be kept safely and should be handed over to
the authori!ed person as designated by the hospital authority.
8E. 'ncase death of a 12%, the body is not to be handed over to the relatives. 't needs to
be accurately labeled and sent to the mortuary %1O and0 or police officer should be
informed simultaneously.
88. $ppropriately authority must be informed.
$. Correct identity
$ nurse0midwife is responsible to make sure that all babies born in hospital are
correctly labeled at birth and handed over to right parent.
4nknown0unconscious patients must be labeled as soon as their identity is known.
.atients who have to undergo surgery should be appropriately identified and labeled
Site of operation to be correctly marked particularly where symmetrical sides or
organs there.
Operation theatre 7O.T.<* scrub nurse has to see all the instruments0 swabs are
returned. She has to say JOD$K, before closure by the surgeon.

&. 2eft ,gainst 4edical ,d%ice ;2.,.4.,.<

'nform medical officer incharge. Signatures of both patients and witness to be taken as per
institutional policy.
0. Patient=s Property
'nform patient on admission that hospital does not take responsibility of his belonging. 'f patient
is unconscious0 or otherwise re&uired then a list of items must be made, counter checked by two
staff nurses and kept under safe custody.
1. (ying (eclaration:
/octor or nurse should not involve themselves in dying declaration, in case where police records
the dying declaration. /ying declaration is to be recorded by the magistrate.
ut if condition of patient becomes serious then medical officer can record it along with two
nurses as witness. /ying /eclaration can be recorded by the nursing staff with two nurses as
witness when medical officer is not present. Then the declaration to be sent immediately under
sealed cover to the magistrate.
>. ?ills:
3or this doctor has to be present for he can recode if re&uested.
@. EAamination of rape case:
3emale attendant0female nurse must be present during the e(amination.
1B. ,rtificial human insemination:
5ritten consent should be obtained from both donor and recipient.
/onor and recipient must have the same blood group.
/onor,s and recipient,s identity should be kept confidential.
$ll related documents should be kept confidential and safe.
11. Poison case:
/o not give either verbal or written opinion.
/o not allow to take photos unless special permission is granted by appropriate authority.
/o not give any information to public or press.
.reserve all evidence of poisoning.
%ollect and preserve all e(creta, vomitus and aspirates, seal them immediately and send to
forensic laboratory at the earliest.
12. Consumer Protection ,ct;1@>0<
%onsumer protection act was passed by parliament in 89:B to provide for better protection of the
interest of consumers and focuses on consumer "ustice through the establishment of consumers
councils and authorities for the settlement of consumers disputes and matters connected
therewith. The scope of the $ct is wide enough to include a vast variety of services.
)ights of a consumer0 patient are*
)ight to safety.
)ight be informed.
)ight to choose.
)ight to be heard.
)ight to seek redressal.
)ight of consumer education.
+urses role to pre%ent complications
8. )eview nursing practice periodically. 4pdate knowledge and improve skill by
attending short term courses, in+service education and continuing education programmes.
;. Should have complete knowledge of all rules and regulations of hospital and know
their descriptions 7duties and responsibilities<.
?. 3ollow nursing practice standards0protocols.
@. e a keen observer.
A. 5ritten instructions must have rules and code of practice laid down to ensure the
safety and well being of patients and nurses.
B. $ll hospitals must have rules an code of practice laid down ensure the safety and
well being of patients and nurses.
C. 1aintain records and reports of the unit properly.
:. 3ollow B ),s right patient, right drug, right time and right route with right
9. %heck the treatment order and use professional "udgment before implementing.
8E. /o not e(ceed the limits of nursing procedure laid down by statutory bodies.
Every nurse should act as per the legal guidelines for nursing practice while caring for
patients since negligence may cause a great distress to nurse, the patient and others, as well
as to reputation of the institution.
=Every individual is ordinarily liable for their own negligence.> Therefore nurse have a
responsibility of seeing that no harm comes to their patients and also to themselves.
8. T asvanthapa. -ursing administration. Ed.?
. Laypee .ublishersF -ew /elhi.
;EEEF @C@+A8E.
;. %hitty Day Dittrell. .rofessional -ursing %oncepts and challenges. Ed @
Elsevier Saunders. ;EEAF A;8+C;.
?. 'ndian nursing council. Teaching material for &uality assurance model* nursingF
. 'ndian nursing council. -ew /elhi. ;EEBF @@+AE, B;.
@. Loan 2. M .arker. %onceptual 3oundations of .rofessional -ursing .ractice.
1osbys. 8998F 8@9+8BE.
A. 1arry 2ucita. -ursing $dministration. Elsevier. ;EEAF ;A8+AC.
B. -ursing Times -ightingale. Lune ;EEC7?<F @9+A8.
C. .otter M .erry. 3undamentals of nursing. Ed. A
. 1osbys. ;EE878<F@E8+;?