Introduction to Ethics..................................................

Introduction to Ethics..................................................

1. Introduction to Nursing
Ethics
DR. LOAI ZABIN

3. Practice of Nursing-Definitions
What it means:
•The work nurses do to help people stay healthy, prevent illness, and care for patients.
What it includes:
•Giving care and treatment
•Teaching patients and families about health
•Helping people manage changes in health, illness, or disability
Key values in nursing:
•Scientific Knowledge –Using evidence and skills
•Compassionate Care –Showing kindness & empathy
•Advocacy –Speaking up for patients’ needs

4. The International Council of Nurses (ICN) defines the scope قﺎطﻧof nursing
practice as:
◦Autonomous and collaborative care for individuals of all ages, families, groups, and
communities, whether sick or well, in various settings.
According to the American Nurses Association (ANA), the scope of practice in
nursing describes the services that qualified health professionals (such as nurses
and advanced practice registered nurses) are competent to perform based on
their professional license.

5. Introduction to Nursing Ethics
•The beginning of professional nursing can be traced to 19th- century England,
to the school founded by Florence Nightingale , where profession- shaping
ethical precepts ئدﺎﺑﻣﻟا and values were communicated.
•For the first 30 to 40 years in Nightingale’s school, male physicians trained
prospective nurses because there were not enough educated nurses to teach
nursing.
•Early nursing educators focused on technical training rather than on the art
and science of nursing, as Nightingale would have preferred.

6. Nursing: An Art and a Science
•Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and
injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human
response, and advocacy in the care of individuals, families, groups, communities, and populations (ANA,
2015)
•In the mid-nineteenth century, the art of nursing was characterized as mothering and homemaking.
•Nursing was referred to as “nursing arts”, characterized as bathing, bedmaking, positioning patients,
comforting techniques, and hospital housekeeping
•The art of nursing relies on nurses using common sense, reflection on client experiences, and personal
observation (Peplau, 1988).
•Nursing has been referred to as an art and a science since the early 20th century.
•Today, the art of nursing is the act of caring and respect for human dignity (ANA, 2015).

7. •By the end of the 19th century, modern nursing had been established, and ethics
in nursing were seriously being discussed.
•The presence of the Nightingale Pledge , first developed in 1893 and written
under the chairmanship of Detroit nursing school principal Lystra Gretter, helped
establish nursing as an art and a science.
•The International Council of Nurses (ICN), established in 1899, has been a pioneer in developing a code of nursing ethics.
•By 1900, the first book on nursing ethics, Nursing Ethics: For Hospital and Private Use, had been written by the American nursing leader Isabel Hampton Robb.

8. Florence Nightingale Pledge
•I solemnly pledge myself before God and, in the presence of this assembly, to pass
my life in purity and to practice my profession faithfully.
•I will abstain from whatever is deleterious and mischievous and will not take or
knowingly administer any harmful drug.
•I will do all in my power to maintain and elevate the standard of my profession and
will hold in confidence all personalmatters committed to my keeping and all family
affairs coming to my knowledge in the practiceof my calling.
•With loyalty will I endeavor to aid the physician in his work and devote myself to the
welfare of those committed to my care.

9. What are ethics?
•Ethics is a branch of philosophy exploring ideal human behavior
forms.
•In healthcare, ethics aims to understand, analyze, and distinguish
behaviors and attitudes that are right or wrong (good
or bad).
•It is important to distinguish ethics from morals.
•Ethics in nursing are based on formalized principles and professional
codes, while morals are more individual and subjective. Nurses
navigate both ethical dilemmas and personal morals as they provide
patient-centered care.

10. •Ethical systems of care rely on a general agreement regarding
whether specific activities are beneficial or detrimentalةرﺎﺿto
patient well-being.
•Ethical theories provide a framework for interactions with clients
or service users.
•From these theories, ethical principles have developed to guide
judgments on how to care for patients.

11. Ethics VS Morals
Ethics:What it means:
•Ethics = rules and values that guide what is right or wrong in a profession or community.
•Helps people make fair and safe decisions.
In Nursing:
•Nurses follow a code of ethics that tells them how to act with patients, families, and coworkers.
•Ethics guide nurses in giving safe, respectful, and honest care.
•Sometimes nurses face ethical dilemmas (hard choices between two important values).
Example:
•Pro-Life vs. Pro-Choice: Imagine a pregnant patient named Samantha who has a history of cardiac
disease. Her doctor recommends terminating the pregnancy due to potential risks to her health.
However, Samantha believes abortion is wrong based on her upbringing ﺔ���ﺗ.As a nurse, you face
an ethical dilemma: respecting Samantha’s autonomy while considering her health and safety.

12. Ethics VS Morals (cont.)
Morals: What it means:
•Morals = a person’s own sense of right or wrong.
•Shaped by culture, religion, and family.
•They are personal and may differ between people.
In Nursing:
•Nurses carry their own morals into practice.
•But personal morals may not always match professional ethics.
•Morals can affect how nurses care for patients and make decisions.
Example:
•
A nurse holds a strong, personal religious belief that abortion is morally wrong and the taking of
a life.
•But the hospital's policy, based on professional ethics (respecting patient autonomy and legal
rights), dictates that the nurse must provide nonjudgmental care to all patients, including those
undergoing elective procedures like an abortion.

13. Moral Development
•Ethical decisions require individuals to think and reason.
•Moral development is the process of learning to tell the difference
between right and wrong and learning what ought and ought not
to be done. It is a complex process that begins in childhood and
continues throughout life.
ﮫﺑ مﺎﯾﻘﻟا بﺟﯾ ﻻ ﺎﻣو بﺟﯾ ﺎﻣ مﻠﻌﺗو ﺄطﺧﻟاو باوﺻﻟا نﯾﺑ زﯾﯾﻣﺗﻟا مﻠﻌﺗ ﺔﯾﻠﻣﻋ وھ ﻲﻗﻼﺧﻷا روطﺗﻟا .ﻲﻓ أدﺑﺗ ةدﻘﻌﻣ ﺔﯾﻠﻣﻋ ﺎﮭﻧإ
ةﺎﯾﺣﻟا لاوط رﻣﺗﺳﺗو ﺔﻟوﻔطﻟا.

14. Morality and Law
Nurses should distinguish between morality and law:
Morality vs. Law
•Law = rules made by society/government.
•Morality = what people feel is right or wrong.
•Laws often reflect moral values, but they are not the same.
Examples:
•Something can be legal but not moral → Doing CPR on a dying patient may be
legal, but some may question if it is the right thing.
•Something can be moral but not legal → Driving over the speed limit to save a
patient’s life may feel right, but it breaks the law.

15. Ethics and Religious
•Religion = beliefs and practices based on faith.
•Ethics = professional values and principles that guide care.
•Sometimes religion and ethics agree, but sometimes they conflict.
Examples:
Some religions support practices like
female circumcision, but ethics see this as harming
human rights.
Other examples where religion and ethics may differ:
◦Blood transfusions/ Abortion/ Sterilization/ Contraception and safe sex counseling.

16. What are nursing ethics?
•Johnstone (2008) defined nursing ethics as “the examination of all kinds of
ethical and bioethical issues from the perspective of nursing theory and practice,
which, in turn, rest on the agreed core concepts of nursing, namely: person,
culture, care, health, healing, environment, and nursing itself ” .
•Nursing ethics permeates all of the nursing roles.
• It is a branch of applied ethics that specifically concerns itself with activities in
the nursing field. It shares many principles with medical ethics, such as
beneficence, non-maleficence, and respect for autonomy. However, nursing
ethics strongly emphasizes relationships, human dignity, and collaborative care.
In essence, nursing ethics guides nurses in making decisions that align with
ethical standards while providing compassionate, patient-centered care.

17. The application of ethics can be objective ﻲﻋوﺿوﻣor relative ﻲﺑﺳﻧ, depending.
•Objective ethical reasoning implies that a situation has a clear right or
wrong course, such as the decision to administer emergency care to a
patient in need.
•Relativism in ethical judgments is common in nursing practice, where
there may be pros and cons associated with an action.
•Balancing the risks and benefits of a treatment course and
implementing suitable precautionary measures are vital to ensure the
ethical treatment of patients.

18. Ethical Codes
•For everyday ethical decision-making in work roles, nurses should
refer to the Code of Ethics for Nurses as a nonnegotiable guide for
ethics and then branch out, as needed, to other literature and
experts on the topic for more support.
•Ethical codes
are systematic guidelines for shaping ethical
behavior that answer the normative questions of what beliefs and values should be morally accepted.
•It must be noted that no code can provide absolute or complete rules free of conflict and ambiguity.

19. American Nurses Association Code of Ethics for Nurses
•The formal code of ethics was developed in the 1950s by the American
Nurses Association (ANA) and has undergone numerous modifications since.
•The most significant recent change was in 2015 when 9 interpretative
statements or provisions were added to the code of ethics to help guide
nursing practice in a more definitive way.
•Even though the code of ethics is primarily ethics-related, it also has legal
implications. Given the importance of the code to the nursing profession,
revisions continue on a regular basis.

20. ANA Code of Ethics for Nurses 2015
The nurse practices with compassion and respect for the inherent
dignity, worth, and unique attributes of every person.
Provision 1
The nurse’s primary commitment is to the patient, whether an
individual, family, group, community, or population.
Provision 2
The nurse promotes, advocates for, and protects the rights, health,
and safety of the patient.
Provision 3
The nurse has authority, accountability, and responsibility for nursing
practice, makes decisions, and takes action consistent with the
obligation to provide optimal patient care.
Provision 4
The nurse owes the same duties to self as to others, including the
responsibility to promote health and safety, preserve wholeness of
character and integrity, maintain competence, and continue personal
and professional growth.
Provision 5

21. 1.Provision 1: Example: A nurse provides emotional support to a terminally ill patient, respecting their
wishes and ensuring comfort during their final days.
2.Provision 2: Example: A nurse advocates for a pediatric patient’s pain management, ensuring their
needs are met despite resource constraints.
3.Provision 3: Example: A nurse reports a medication error promptly to prevent harm to the patient.
4.Provision 4: Example: A charge nurse ensures adequate staffing levels during a busy shift, prioritizing
patient safety.
5.Provision 5: Example: A nurse attends regular continuing education sessions to stay updated on
evidence- based practices.

22. The nurse, through individual and collective effort, establishes,
maintains, and improves the ethical environment of the work setting
and conditions of employment that are conducive to safe, quality
health care.
Provision 6
The nurse, in all roles and settings, advances the profession through
research and scholarly inquiry, professional standards development,
and the generation of both nursing and health policy.
Provision 7
The nurse collaborates with other health professionals and the public
to protect human rights, promote health diplomacy, and reduce
health disparities.
Provision 8
The profession of nursing, collectively through its professional
organizations, must articulate nursing values, maintain the integrity
of the profession, and integrate principles of social justice into
nursing and health policy.
Provision 9

23. 6.Provision 6: Example: A nurse participates in hospital committees to address ethical
issues and improve patient care policies.
7.Provision 7: Example: A nurse contributes to research studies on effective wound care
techniques, benefiting both patients and fellow nurses.
8.Provision 8: Example: A nurse works with social workers and community organizations
to address health disparities in underserved populations.
9.Provision 9: Example: A nurse actively participates in professional nursing associations,
advocating for policies that benefit patients and nurses alike.

24. ICN Code of Ethics for Nurses
• The International Council of Nurses (ICN) first adopted an international code
of ethics for nurses in 1953. It has been revised and reaffirmed at various
times since then, most recently with this review and revision completed in
2021.
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. (ICN code of ethics 2021)

25. Common Threads Between the ANA and ICN
Codes
•Common threads exist between the nine provisions of the ANA code (2015)
and the four elements of the ICN code (2021).
•The codes apply to all nurses in all settings and roles and are nonnegotiable
ethical nursing standards focusing on social values, people, relationships, and
professional ideals.
•Both codes share respect, privacy, equality, and advocacy values.

26. What are the core ethical principles of nursing
practice?
Nurses use these principles to guide decisions and patient care:
1.Non-maleficence – Do no harm.
2.Beneficence – Do good and help patients.
3.Autonomy – Respect patients’ right to make their own choices.
4.Justice – Be fair and treat everyone equally.