Contents

Introduction
The role of the nurse in research
Some themes in nursing ethics
Code of ethics





















Introduction


Ethics is concerned with right and wrong, although agreeing what is right can be challenging.
An understanding of ethics is essential to the delivery of skilled professional care. It is vital that
nurses appreciate the value of ethics in their work. Ethics is relevant to clinical, practice-based
issues and affects all areas of the professional nursing role. To apply ethics effectively, nurses
must develop reasoning skills and understand the concepts and principles that assist ethical
analysis. This article, the first in a series of articles relating to ethics and nursing, offers an
introduction to ethics, primarily focusing on their application in clinical nursing practice.
Throughout the article, the terms ethical and moral are used interchangeably. The
contemporary Code of Ethics governing the conduct of professional nurses is an extension of the
Nightingale Pledge first composed in 1893 by a nursing instructor named Lystra Gretter,
which was itself an adaptation of the Hippocratic Oath originating in ancient Greece. As with the
Hippocratic Oath the nursing code of ethics sets forth a series of principles guiding the conduct
of nurses, with an emphasis on patient care and integrity, and a deep commitment to continuous
improvement, including remaining current on advances in the knowledge and practice of
medicine. The Code of Ethics maintained by the American Nurses Association includes as its
first provision a statement of commitment to the welfare of the community and to the treatment
of all patients with equal levels of care irrespective of socioeconomic status or the nature of
health problems. Provision Two of the code declares that the nurse's primary commitment is
to the patient, whether an individual, family, group, or community.










Role of a Research Nurse

Research nurses work in an extended and specialized role within a multidisciplinary team in a
variety of settings. There is enormous variability in employment practices. At present, the only
common requirement for undertaking the role is that the nurse must be maintained on the live
register of An Bord Altranais. Additional criteria are normally set by the hospital or practice
advertising the position which reflects the speciality and responsibility level of the position.
Currently research nurses are employed from Staff Nurse to CNM3 level.
Skills Required of a Research Nurse
The following skills are associated with the role of the research nurse and may be required prior
to appointment, or may be developed during the employment period:
IT skills
Project management skills
Protocol development
Resource management (staff, finances, study equipment and materials)
The ability to develop, assess and direct research protocols.
It is common for research nurses to have responsibility for co-ordinating a number of
different studies at one time.
The role of the research nurse is both diverse and complex and comprises of clinical, managerial,
and educational aspects:
Clinical
The research nurse acts as the primary advocate for the patient, both prior to and throughout their
participation in a research study. They also educate the patient and family about their disease
process, study related procedures and alternative choices. The research nurse is also involved in
the informed consent process. The research nurse schedules procedures and performs initial
patient interviews, nursing assessments and clinical duties such as venipuncture, drug
administration and adverse event management.
Managerial
The most significant and extensive aspect of the role of the research nurse is the management
and co-ordination of individual research studies. The research nurse is responsible for:
Preparation of study protocols
The preparation, submission and maintenance of ethics and regulatory documents
Developing study related documentation such as Patient Information Leaflets and
Consent forms, Case Report Forms and Tracking Forms
Screening and recruitment of patients into studies data collection, documentation and
reporting
Preparation of biological samples for shipment to reference laboratories
Financial account management
Establishment of Standard Operating Procedures
At all times it is the responsibility of the research nurse to have a comprehensive knowledge of
the principles of practice laid down by the governing bodies (Irish Medicines Board, ICHGCP).
Educational
Education is a vital role of the research nurse. Patients are educated about studies and procedures
and he/she educates the clinical team about the studies. It is the responsibility of research nurses
to continue their own education through literature review, meeting and workshop attendance
relevant to their clinical area or research speciality.

Research in
developing countries Increasing opportunities are arising for nurses to undertake research in
developing countries. Whilst some of these countries are developing research policies and
procedures, this is a relatively infrequent activity which tends to focus on the conduct of drug
trials. Prior to commencing any study it is essential that steps are taken to prevent any research
misconduct, poor performance or exploitation of subjects. This is particularly the case when
undertaking research with participants who may be considered vulnerable. Nurses wishing to
undertake studies in developing countries are advised to contact the host institution to locate the
existence of any guidelines. These can then be followed in conjunction with standard university
and NHS ethics and governance guidelines concerning recruitment, consent, data collection and
so on.







Some themes in nursing research

Nurses seek to defend the dignity of those in their care. Being able to respond to
the vulnerability of patients in a way that provides dignifying care is a key concept in the field.
In terms of standard ethical theory, respecting dignity can also be aligned with having a respect
for people and their autonomous choices. People are then enabled to make decisions about their
own treatment. Amongst other things this grounds the practice of informed consent that should
be respected by the nurse.
[7]
Although much of the debate lies in the discussion of cases where
people are unable to make choices about their own treatment due to being incapacitated or
having a mental illness that affects their judgment. A suggested way to maintain autonomy is for
the person to write an advance directive, outlining how they wish to be treated in the event of
them not being able to make an informed choice, thus avoiding unwarranted paternalism.
Another theme is confidentiality and this is an important principle in many nursing ethical codes.
This is where information about the person is only shared with others after permission of the
person, unless it is felt that the information must be shared to comply with a higher duty such as
preserving life.
[7]
Related to information giving is the debate relating to truth telling in
interactions with the person in care. There is a balance between people having the information
required to make an autonomous decision and, on the other hand, not being unnecessarily
distressed by the truth. Generally the balance is in favor of truth telling due to respect for
autonomy, but sometimes people will ask not to be told, or may lack the capacity to understand
the implications.
[11]
Finally, the role of empirical ethics has become prominent in recent years.
[10]

By giving consideration to the themes above, the nurse can endeavor to practice in an ethical
way. Unfortunately, this key outcome in nursing practice is sometimes challenged by resource,
policy or environmental constraints in the practice area,
[9]
which can lead to moral distress.
[2]









1. the code of ethics for registered nurses was promulgated by the Philippine Regulatory
Board of Nursing in consultation and coordination with the Philippine Nurses
Assosciation, with the code of good governance for the profession in the Philippines as
primary basis, as mandated by the articleIII, Section 9, of republic 9173 to serve as
ethico-legal basis in the practice of the nursing profession in the Philippines.
YEA Or NO





















CODE OF ETHICS FOR NURSES
WHEREAS, the Board of Nursing (BON) has the power to promulgate a Code of Ethics for
Registered Nurses in coordination and consultation with the accredited professional organization
(Sec. 9, (g), Art III of (Republic Act) No. 9173, known as the Philippine Nursing Act of 2002);
WHEREAS, in the formulation of the Code of Ethics for Registered Nurses, the Code of Good
Governance for the Professions in the Philippines was utilized as the principal basis thereof:
All the principles under the said Code were adopted and integrated into the Code of Ethics
as they apply to the nursing profession;
WHEREAS, the promulgation of the said Code as a set of guidelines, regulations or
measures
shall be subject to approval by the Commission (Sec. 9, Art. II of R.A. No. 9173); and
WHEREAS, the Board, after consultation on October 23, 2003 at Iloilo City with the
accredited
professional organization of registered nurses, the Philippine Nurses Association, Inc.
(PNA), and other affiliate organizations of Registered Nurses, decided to adopt a new
Code
of Ethics under the afore-mentioned new law;
NOW, THERFORE, the Board hereby resolved, as it now resolves, to promulgate the
hereunder
Code of Ethics for Registered Nurses:
ARTICLE I
PREAMBLE
SECTION 1.
Health is a fundamental right of every individual. The Filipino registered nurse, believing
in the worth and dignity of each human being, recognizes the primary responsibility to preserve
health at all cost. This responsibility encompasses promotion of health, prevention of illness,
alleviation of suffering, and restoration of health. However, when the foregoing is not possible,
assistance towards a peaceful death shall be his/her obligation.
SECTION 2.
To assume this responsibility, registered nurses have to gain knowledge and
understanding of mans cultural, social, spiritual, physiological, psychological, and ecological
aspects of illness, utilizing the therapeutic process. Cultural diversity and political and socio-
economic status are inherent factors to effective nursing care.
SECTION 3.
The desire for the respect and confidence of clientele, colleagues, co-workers, and the members
of the community provides the incentive to attain and maintain the highest possible degree of
ethical conduct.
ARTICLE II
REGISTERED NURSES AND PEOPLE
SECTION 4.
Ethical Principles
1. Values, customs, and spiritual beliefs held by individuals shall be respected.
2. Individual freedom to make rational and unconstrained decisions shall be respected.
3. Personal information acquired in the process of giving nursing care shall be held in
strict confidence.
SECTION 5.
Guidelines to be observed:
REGISTERED Nurses must
a. consider the individuality and totality of patients when they administer care.
b. respect the spiritual beliefs and practices of patients regarding diet and treatment.
c. uphold the rights of individuals.
d. take into consideration the culture and values of patients in providing nursing care.
However, in the event of conflicts, their welfare and safety must take precedence.
ARTICLE III
REGISTERED NURSES AND PRACTICE
SECTION 6.
Ethical Principles
1. Human life is inviolable.
2. Quality and excellence in the care of the patients are the goals of nursing practice.
3. Accurate documentation of actions and outcomes of delivered care is the hallmark of
nursing accountability.
SECTION 7.
Guidelines to be observed:
REGISTERED Nurses must
a. know the definition and scope of nursing practice which are in the provisions of R. A.
No. 9173, known as the Philippine Nursing Act of 2002 and Board Res. No. 425,
Series of 2003, the Rules and Regulations Implementing the Philippine Nursing Act. of
2002, (the IRR).
b. be aware of their duties and responsibilities in the practice of their profession as
defined in the Philippine Nursing Act of 2002 and the IRR.
c. acquire and develop the necessary competence in knowledge, skills, and attitudes to
effectively render appropriate nursing services through varied learning situations.
d. if they are administrators, be responsible in providing favorable environment for the
growth and developments of Registered Nurses in their charge.
e. be cognizant that professional programs for specialty certification by the BON are
accredited through the Nursing Specialty Certification Council (NSCC).
f. see to it that quality nursing care and practice meet the optimum standard of safe
nursing practice.
g. insure that modification of practice shall consider the principles of safe nursing
practice.
i. if in position of authority in a work environment, be normally and legally responsible
for
devising a system of minimizing occurrences of ineffective and unlawful nursing
practice.
h. if in position of authority in a work environment, be normally and legally responsible
for devising a system of minimizing occurrences of ineffective and unlawful nursing
practice.
i. ensure that patients records shall be available only if they are to be issued to those who
are professionally and directly involved in their care and when they are required by law.
SECTION 8.
Ethical Principle
4. Registered Nurses are the advocates of the patients: they shall take appropriate steps to
safeguard their rights and privileges.
Guidelines to be observed:
REGISTERED Nurses must
a. respect the Patients Bill of Rights in the delivery of nursing care.
b. provide the patients or their families with all pertinent information except those which
may be deemed harmful to their well-being.
c. uphold the patients rights when conflict arises regarding management of their care.
SECTION 9.
Ethical Principle
5. Registered Nurses are aware that their actions have professional, ethical, moral, and
legal dimensions. They strive to perform their work in the best interest of all concerned.
SECTION 10.
Guidelines to be observed:
REGISTERED Nurses must
a. perform their professional duties in conformity with existing laws, rules regulations.
measures, and generally accepted principles of moral conduct and proper decorum.
b. not allow themselves to be used in advertisement that should demean the image of
the
profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.).
c. decline any gift, favor or hospitality which might be interpreted as capitalizing on
patients.
d. not demand and receive any commission, fee or emolument for recommending or
referring a patient to a physician, a co-nurse or another health care worker; not to pay
any commission, fee or other compensations to the one referring or recommending a
patient to them for nursing care.
e. avoid any abuse of the privilege relationship which exists with patients and of the
privilege access allowed to their property, residence or workplace.
ARTICLE IV
REGISTERED NURSES AND CO-WORKERS
SECTION 11.
Ethical Principles
1. The Registered Nurse is in solidarity with other members of the healthcare team in working
for the patients best interest.
2. The Registered Nurse maintains collegial and collaborative working relationship with
colleagues and other health care providers.
SECTION 12.
Guidelines to be observed:
REGISTERED Nurses must
a. maintain their professional role/identity while working with other members of the health team.
b. conform with group activities as those of a health team should be based on acceptable, ethico-
legal statndards.
c. contribute to the professional growth and development of other members of the health team.
d. actively participate in professional organizations.
e. not act in any manner prejudicial to other professions.
f. honor and safeguard the reputation and dignity of the members of nursing and other
professions; refrain from making unfair and unwarranted comments or criticisms on their
competence, conduct, and procedures; or not do anything that will bring discredit to a
colleague and to any member of other professions. PRC-BN
g. respect the rights of their co-workers.
ARTICLE V
REGISTERED NURSES, SOCIETY, AND ENVIRONMENT
SECTION 13.
Ethical Principles
1. The preservation of life, respect for human rights, and promotion of healthy environment shall
be a commitment of a Registered Nurse.
2. The establishment of linkages with the public in promoting local, national, and international
efforts to meet health and social needs of the people as a contributing member of society is a
noble concern of a Registered Nurse.
SECTION 14.
Guidelines to be observed:
REGISTERED Nurses must
a. be conscious of their obligations as citizens and, as such, be involved in community concerns.
b. be equipped with knowledge of health resources within the community, and take roles in
primary health care.
c. actively participate in programs, projects, and activities that respond to the problems of
society.
d. lead their lives in conformity with the principles of right conduct and proper decorum.
e. project an image that will uplift the nursing profession at all times.
ARTICLE VI
REGISTERED NURSES AND THE PROFESSION
SECTION 15.
Ethical Principles:
1. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal.
2. Compliance with the by-laws of the accredited professional organization (PNA), and other
professional organizations of which the Registered Nurse is a member is a lofty duty.
3. Commitment to continual learning and active participation in the development and growth of
the profession are commendable obligations.
4. Contribution to the improvement of the socio-economic conditions and general welfare of
nurses through appropriate legislation is a practice and a visionary mission.