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A code of ethics is a guide for an individual or group to follow in making decisions regarding
ethical issues.

In the broadest sense, ethics are the principles that guide an individual, group, or profession in
conduct. Although nurses do make independent decisions regarding patient care, they are still
responsible to the profession as a whole in how those decisions are made. From the earliest
concept of nursing, the proper behavior and conduct of a nurse was closely scrutinized. Florence
Nightingale wrote of specific issues of conduct and moral behavior. The Nightingale pledge that
was composed in 1893 by nursing instructor Lystra Gretter includes the vow "to abstain from
whatever is deleterious and mischievous and will not take or knowingly administer any harmful

Over the last 100 years, nursing has evolved into a very complex professional field. Nurses are
now faced with life and death decisions, sometimes on an hourly basis. Medical care has
advanced to the point that new technology with its potential benefit or harm to a patient changes
constantly. Although the private conduct of a nurse is no longer controlled by the employer, the
effects of that lifestyle on the nurse's ability to think and respond to patients while on duty falls
under the code of ethics.

The study of ethics is actually a branch of philosphy. The word ethics is derived from the Greek
term ethos which means customs, habitual usage, conduct, and character. The study of ethics
has led to the identification of basic concepts including rights, autonomy, beneficence,
nonmaleficence, justice, and fidelity. Understanding these concepts assists the nurse with making
decisions during difficult situations.

Webster defines a right as "something to which one has a just claim or the power or priviledge to
which one is justly entitled." Patient rights have evolved to the point that federal legislation has
been passed in the United States to protect a patient's individual rights. A Patient's Bill of Rights
was initially developed by the American Hospital Association in 1973 and revised in1992. All
hospitals are now required by law to inform patients of these rights upon admission to the

Autonomy comes from the latin auto meaning "self" and nomy which means "control." Individuals
must be given the rights to assist in their own decision making. This ethical concept has led to the
need for informed consent. Sometimes patients' religious or cultural beliefs lead them to make
decisions regarding their own care that may seem controversial or even dangerous. However, the
concept of autonomy gives them the right to make those decisions unless they are mentally
Beneficence and nonmaleficence

Beneficence means to do good, not harm, to other people. Nonmaleficence is the concept of
preventing intentional harm. Both of these ethical concepts relate directly to patient care. In the
American Nurses Association Code for Nurses, there is a specific charge to protect patients by
specifying that nurses should report unsafe, illegal, or unethical practices by any person. Nurses
are often faced with making decisions about extending life with technology, which might not be in
the best interest of the patient. Often the concept of weighing potential benefit to the patient
against potential harm is used in making these difficult decisions, along with the patient's own
stated wishes.
The word justice is closely tied with the legal system. However, the word refers to the obligation
to be fair to all people. In 2001, healthcare economics have hospitals and other providers
stretching their resources to their limits. Economic decisions about healthcare resources have to
be made based on the number of patients who would benefit. The potential of rationing care to
the frail elderly, poor, and disabled creates an ethical dilemma that is sure to become even more
complicated in the future.

Fidelity refers to the concept of keeping a commitment. Although the word is more closely used to
describe a marital relationship, fidelity is the concept of accountability. What is the nurse's
responsibility to his or her patient, employer, society, or government? Privacy and confidentiality
are concepts that could be challenged under the concept of fidelity. If a nurse is aware of another
healthcare giver who is impaired, but the circumstances are private or confidential, how is the
conflict resolved?
Professional implications

As a general rule, nurses are employed by a hospital, clinic, or private practice. Decisions that are
made about patient care are not totally independent. Every decision creates a ripple effect and
touches someone else in the health care field. One of the purposes of a code of ethics is to help
nurses keep perspective and a balanced view regarding decisions. One way to study a code of
ethics is to look at a case study.