THE CODE OF ETHICS AND PROFESSIONAL CONDUCT FOR NURSES

The nursing profession is one of the most respected and honourable professions that require high ethical standards and professionalism. To ensure that nurses practice ethically and professionally, there is a code of ethics and professional conduct that guides their behaviour and actions.

The Code of Ethics and Professional Conduct for Nurses is a set of guidelines that outlines the ethical principles and values that nurses must uphold in their practice. It provides a framework for decision-making and guides nurses in their interactions with patients, families, colleagues, and the wider community.

The Code of Ethics and Professional Conduct for Nurses is a vital tool in promoting the nursing profession's values and principles, ensuring high-quality care for patients, and maintaining the public's trust in the nursing profession.

ICN CODE OF ETHICS

The International Council of Nurses (ICN) first adopted an international code of ethics for nurses in 1953. Since then, it has been revised and reaffirmed on several occasions, most recently in 2021.

The ICN Code of Ethics for Nurses serves as a statement of the ethical values, responsibilities, and professional accountabilities that guide nursing practice for both nurses and nursing students. It provides a framework for ethical decision-making that meets the professional standards set by regulatory bodies, although it is not a code of conduct.

The Code outlines ethical guidance for nurses regarding their roles, duties, responsibilities, behaviours, professional judgment, and relationships with patients, fellow healthcare professionals, and the wider community. It serves as a foundational document that can be built upon, in combination with local laws, regulations, and professional standards, to guide ethical nursing practice in all settings, roles, and domains.

PREAMBLE

From the origins of organised nursing in the mid-1800s and recognising nursing care is deeply rooted in the traditions and practices of equity and inclusion and in the appreciation of diversity, nurses have consistently recognised four fundamental nursing responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering and promote a dignified death. The need for nursing is universal. Inherent in nursing is a respect for human rights, including cultural rights, the right to life and choice, the right to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, colour, culture, ethnicity, disability or illness, gender, sexual orientation, nationality, politics, language, race, religious or spiritual beliefs, legal, economic, or social status.

Nurses are valued and respected for their contributions to improving the health of individuals, families, communities, and populations locally, nationally, and globally. They coordinate services with those of other health care professionals and related groups. Nurses demonstrate values of the profession such as respect, justice, empathy, responsiveness, caring, compassion, trustworthiness, and integrity.

THE ICN CODE

The ICN Code of Ethics for Nurses has four principal elements that provide a framework for ethical conduct: nurses and patients or other people requiring care or services, nurses and practice, nurses and the profession, and nurses and global health.

1.      NURSES AND PATIENTS OR OTHER PEOPLE REQUIRING CARE OR SERVICES

1.1.  Nurses’ primary professional responsibility is to people requiring nursing care and services now or in the future, whether individuals, families, communities, or populations (hereinafter referred to as either ‘patients’ or ‘people requiring care’).

1.2. Nurses promote an environment in which the human rights, values, customs, religious and spiritual beliefs of the individual, families and communities are acknowledged and respected by everyone. Nurses’ rights are included under human rights and should be upheld and protected.

1.3.   Nurses ensure that the individual and family receive understandable, accurate, sufficient, and timely information in a manner appropriate to the patient’s culture, linguistic, cognitive, and physical needs, and psychological state on which to base consent for care and related treatment.

1.4.   Nurses hold in confidence personal information and respect the privacy, confidentiality, and interests of patients in the lawful collection, use, access, transmission, storage, and disclosure of personal information.

1.5.  Nurses respect the privacy and confidentiality of colleagues and people requiring care and uphold the integrity of the nursing profession in person and in all media, including social media.

1.6.  Nurses share with society the responsibility for initiating and supporting action to meet the health and social needs of all people.

1.7.   Nurses advocate for equity and social justice in resource allocation, access to health care and other social and economic services.

1.8. Nurses demonstrate professional values such as respect, justice, responsiveness, caring, compassion, empathy, trustworthiness, and integrity. They support and respect the dignity and universal rights of all people, including patients, colleagues, and families.

1.9.   Nurses facilitate a culture of safety in health care environments, recognising and addressing threats to people and safe care in health practices, services, and settings.

1.10. Nurses provide evidence-informed, person-centred care, recognising and using the values and principles of primary health care and health promotion across the lifespan.

1.11.  Nurses ensure that the use of technology and scientific advances are compatible with the safety, dignity, and rights of people. In the case of artificial intelligence or devices, such as care robots or drones, nurses ensure that care remains person-centred and that such devices support and do not replace human relationships.

2.      NURSES AND PRACTICE

2.1.  Nurses carry personal responsibility and accountability for ethical nursing practice, and for maintaining competence by engaging in continuous professional development and lifelong learning.

2.2.   Nurses maintain fitness to practice so as not to compromise their ability to provide quality, safe care.

2.3.  Nurses practise within the limits of their individual competence and regulated or authorised scope of practice and use professional judgement when accepting and delegating responsibility.

2.4. Nurses value their own dignity, well-being, and health. To achieve this requires positive practice environments, characterised by professional recognition, education, reflection, support structures, adequate resourcing, sound management practices and occupational health and safety.

2.5.   Nurses maintain standards of personal conduct at all times. They reflect well on the profession and enhance its image and public confidence. In their professional role, nurses recognise and maintain personal relationship boundaries.

2.6.  Nurses share their knowledge and expertise and provide feedback, mentoring and supporting the professional development of student nurses, novice nurses, colleagues, and other health care providers.

2.7. Nurses are patient advocates, and they maintain a practice culture that promotes ethical behaviour and open dialogue.

2.8. Nurses may conscientiously object to participating in particular procedures or nursing or health-related research but must facilitate respectful and timely action to ensure that people receive care appropriate to their individual needs.

2.9.   Nurses maintain a person’s right to give and withdraw consent to access their personal, health and genetic information. They protect the use, privacy and confidentiality of genetic information and human genome technologies.

2.10.Nurses take appropriate actions to safeguard individuals, families, communities, and populations when their health is endangered by a co-worker, any other person, policy, practice or misuse of technology.

2.11. Nurses are active participants in the promotion of patient safety. They promote ethical conduct when errors or near misses occur, speak up when patient safety is threatened, advocate for transparency, and work with others to reduce the potential of errors.

2.12.  Nurses are accountable for data integrity to support and facilitate ethical standards of care.

3.      NURSES AND THE PROFESSION

3.1.   Nurses assume the major leadership role in determining and implementing evidence-informed, acceptable standards of clinical nursing practice, management, research, and education.

3.2. Nurses and nursing scholars are active in expanding research-based, current professional knowledge that supports evidence-informed practice.

3.3.   Nurses are active in developing and sustaining a core of professional values

3.4. Nurses, through their professional organisations, participate in creating a positive and constructive practice environment where practice encompasses clinical care, education, research, management, and leadership. This includes environments which facilitate a nurse’s ability to practice to their optimal scope of practice and to deliver safe, effective, and timely health care, in working conditions which are safe as well as socially and economically equitable for nurses.

3.5.  Nurses contribute to positive and ethical organisational environments and challenge unethical practices and settings. Nurses collaborate with nursing colleagues, other (health) disciplines and relevant communities to engage in the ethical creation, conduct and dissemination of peer reviewed and ethically responsible research and practice development as they relate to patient care, nursing, and health.

3.6. Nurses engage in the creation, dissemination and application of research that improves outcomes for individuals, families, and communities.

3.7. Nurses prepare for and respond to emergencies, disasters, conflicts, epidemics, pandemics, social crises, and conditions of scarce resources. The safety of those who receive care and services is a responsibility shared by individual nurses and the leaders of health systems and organisations. This involves assessing risks and developing, implementing, and resourcing plans to mitigate these.

4.      NURSES AND GLOBAL HEALTH

4.1.   Nurses value health care as a human right, affirming the right to universal access to health care for all.

4.2. Nurses uphold the dignity, freedom and worth of all human beings and oppose all forms of exploitation, such as human trafficking and child labour.

4.3.   Nurses lead or contribute to sound health policy development.

4.4.  Nurses contribute to population health and work towards the achievement of the United Nations Sustainable Development Goals (SDGs). (UN n.d.)

4.5.   Nurses recognise the significance of the social determinants of health. They contribute to, and advocate for, policies and programmes that address them.

4.6.   Nurses collaborate and practise to preserve, sustain and protect the natural environment and are aware of the health consequences of environmental degradation, e.g., climate change. They advocate for initiatives that reduce environmentally harmful practices to promote health and well-being.

4.7. Nurses collaborate with other health and social care professions and the public to uphold principles of justice by promoting responsibility in human rights, equity, and fairness and by promoting the public good and a healthy planet.

4.8. Nurses collaborate across countries to develop and maintain global health and to ensure policies and principles for this.

CODE OF ETHICS FOR NURSES IN INDIA

1.      The nurse respects the uniqueness of individual in provision of care – Nurse

1.1.   Provides care of individuals without consideration of caste, creed, religion, culture, ethnicity, gender, socio-economic and political status, personal attributes, or any other grounds

1.2.   Individualizes the care considering the beliefs, values, and cultural sensitivities

1.3.   Appreciates the place of individual in the family and community and facilitates participation of significant others in the care.

1.4.   Develops and promotes trustful relationship with individual(s)

1.5.   Recognizes uniqueness of response of individuals to interventions and adapts accordingly

2.      The nurse respects the rights of individuals as partner in care and help in making informed choices - Nurse

2.1.   Appreciates individual’s right to make decisions about their care and therefore gives adequate and accurate information for enabling them to make informed choices

2.2.   Respects the decisions made by individual(s) regarding their care

2.3.   Protects public from misinformation and misinterpretations

2.4.   Advocates special provision to protect vulnerable individuals/groups.

3.      The nurse respects individual’s right to privacy, maintains confidentiality, and shares information judiciously- Nurse

3.1.   Respects the individual’s right to privacy of their personal information

3.2.  Maintains confidentiality of privileged information except in life threatening situations and uses discretion in sharing information.

3.3. Takes informed consent and maintains anonymity when information is required for quality assurance/ academic/legal reasons

3.4.   Limits the access to all personal records written and computerized to authorized persons only.

4.      Nurse maintains competence in order to render Quality Nursing Care

4.1.   Nursing care must be provided only by registered nurse

4.2.   Nurse strives to maintain quality nursing care and upholds the standards of care

4.3.   Nurse values continuing education, initiates and utilizes all opportunities for self-development.

4.4.   Nurses values research as a means of development of nursing profession and participates in nursing research adhering to ethical principles.

5.      The nurse if obliged to practice within the framework of ethical, professional, and legal boundaries- Nurse

5.1.   Adheres to code of ethics and code of professional conduct for nurses in India developed by Indian Nursing Council

5.2.   Familiarizes with relevant laws and practices in accordance with the law of the state

6.      Nurse is obliged to work harmoniously with members of the health team - Nurse

6.1.   Appreciates the team efforts in rendering care

6.2.  Cooperates, coordinates, and collaborates with members of the health team to meet the needs of people

7.      Nurse commits to reciprocate the trust invested in nursing profession by society Nurse

7.1.   Demonstrates personal etiquettes in all dealings 7.2Demonstrates professional attributes in all dealings

CODE OF PROFESSIONAL CONDUCT FOR NURSES IN INDIA

1.      Professional Responsibility and accountability - Nurse

1.1.   Appreciates sense of self-worth and nurtures it

1.2.   Maintains standards of personal conduct reflecting credit upon the profession

1.3.   Carries out responsibilities within the framework of the professional boundaries

1.4.   Is accountable for maintaining practice standards set by Indian Nursing Council

1.5.   Is accountable for own decisions and actions

1.6.   Is compassionate

1.7.   Is responsible for continuous improvement of current practices

1.8.   Provides adequate information to individuals that allows them informed choices

1.9.   Practices healthful behaviour

2.      Nursing Practice - Nurse

2.1.   Provides care in accordance with set standards of practice

2.2.   Treats all individuals and families with human dignity in providing physical, psychological, emotional, social, and spiritual aspects of care

2.3.   Respects individuals and families in the context of traditional and cultural practices, promoting healthy practices and discouraging harmful practices

2.4.   Presents realistic picture truthfully in all situations for facilitating autonomous decision-making by individuals and families

2.5.   Promotes participation of individuals and significant others in the care

2.6.   Ensures safe practice

2.7.   Consults, coordinates, collaborates, and follows up appropriately when individuals’ care needs exceed the nurse’s competence

3.      Communication and Interpersonal Relationships -Nurse

3.1.   Establishes and maintains effective interpersonal relationships with individuals, families, and communities

3.2.   Upholds the dignity of team members and maintains effective interpersonal relationship with them

3.3.   Appreciates and nurture’s professional role of team members

3.4.   Cooperates with other health professional to meet the needs of the individuals, families, and communities

4.      Valuing Human Being - Nurse

4.1.   Takes appropriate action to protect individuals from harmful unethical practice

4.2.   Considers relevant facts while taking conscience decisions in the best interest of individuals

4.3.   Encourages and supports individuals in their right to speak for themselves on issues affecting their health and welfare

4.4.   Respects and supports choices made by individuals

5.      Management - Nurse

5.1.   Ensures appropriate allocation and utilization of available resources

5.2.   Participates in supervision and education of students and other formal care providers

5.3. Uses judgment in relation to individual competence while accepting and delegating responsibility

5.4.   Facilitates conductive work culture in order to achieve institutional objectives

5.5.   Communicates effectively following appropriate channels of communication

5.6.   Participates in performance appraisal

5.7.   Participates in evaluation of nursing services

5.8.   Participates in policy decisions, following the principle of equity and accessibility of services

5.9.   Works with individuals to identify their needs and sensitizes policy makers and funding agencies for resource allocation

6.      Professional Advancement -Nurse

6.1.   Ensures the protection of the human rights while pursuing the advancement of knowledge

6.2.   Contributes to the development of nursing practice

6.3.   Participates in determining and implementing quality care 6.4Takes responsibility for updating own knowledge and competencies

6.4.   Contributes to core of professional knowledge by conducting and participating in research

CONCLUSION

The Code of Ethics and Professional Conduct for Nurses is a vital document that outlines the ethical principles, values, and expected professional conduct for nurses worldwide. The code emphasizes the importance of patient-centred care, professional competence, collaboration, and social responsibility. By following the code, nurses can ensure that they are delivering ethical and competent care to their patients while upholding the highest standards of professionalism and accountability. The Code of Ethics and Professional Conduct for Nurses is a crucial tool for promoting ethical nursing practice and maintaining the trust and confidence of patients and the wider community in the nursing profession.