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ADVANCE DIRECTIVES

• are instructions that indicate health - the designation must be in writing and
care intervention to initiate or must be signed and dated by the person
withhold, or that designate someone making the designation and two
who will act as a surrogate in making witnesses other than the designated
such decisions in the event that we lose surrogate
decision making capacity
- The designating person may revoke the
• Can be considered as a kind of designation any time by changing the
informed consent for future person named as surrogate or by
interventions destroying the document

• It supports people in making decisions - The authority of the surrogate does not
on their own behalf and help to ensure become effective until it has been
that patients have the kind of end-of- determined that the person has lost
life care they want decision-making capacity – authority is
effective only for the duration of the
• Types of Advance Directives loss of decision making capacity
• 1. Living wills – are legal documents Nursing Role and Responsibilities in
giving directions to health care
Advance Directive
providers related to withholding or
withdrawing life support if certain - Ensuring that patients have an
conditions exist. opportunity to complete advance
directives and in interpreting and
• - they guide decisions by indicating a following through with patient’s wishes
person’s desire regarding life sustaining
as expressed through these directives
interventions; however they also raise
issues of concern as the directives may - The need to know state’s statutes that
be vague and address only guide and given advance directives
interventions a person does not want (
in some states only the terminally ill or - The need to know policies and
those whose death is imminent is procedures regarding advance
allowed to make living wills) directives of the workplace

• 2.Durable Power of Attorney – allows a - Be familiar with our patient’s directives


for care and ensure that care is
competent person to designate another
as a surrogate or proxy to act on her or consistent with the patient’s wishes as
his behalf in making health care expressed in the advance directives
decisions in the event of the loss of - Nursing’s advocacy role in this regard
decision-making capacity includes informing other health team
members of the presence and content
-
of advance directives, alerting
appropriate team member to changes rate of CPR near the end of life is
in patient wishes or to evidence of extremely low.
changes in the patient’s decision-
making capacity A DNR order does not mean "do not
treat."
- Intervening on behalf of the patient
when wishes expressed in advance • Rather, it means only that CPR
directives are not being followed will not be attempted. Other
treatments (for example,
- Increase public awareness about antibiotic therapy, transfusions,
advance directives through patient and dialysis, or use of a ventilator)
community education that may prolong life can still be
provided. Depending on the
1. DO NOT RESUSCITATE (DNR) person's condition, these other
ORDERS treatments are usually more
- The legal definition of DNR is NOT to likely to be successful than CPR.
initiate CPR in the event of a cardiac or Treatment that keeps the
pulmonary arrest. Principles utilized to person free of pain and
justify decisions regarding resuscitation comfortable (called palliative
include autonomy, self determination, care) should always be given.
nonmaleficence and respect for persons. • Today, every patient is a “full
- General practice regarding CPR – it code” unless a DNR order is
must be initiated UNLESS documented clearly in the
medical record
- it would clearly be futile to do so -- the
practitioner has specific instructions not NURSING ROLES AND RESPONSIBILITIES
to do so 1. Ensure patients have an opportunity to
- A do-not-resuscitate (DNR) order placed complete advance directives and in
in a person’s medical record by a doctor interpreting and following through with
informs the medical staff patient’s wishes as expressed through
that cardiopulmonary these directives
resuscitation (CPR) should not be 2. Be familiar with patient’s directive for
attempted. Because CPR is not care and ensure that care is consistent
attempted, other resuscitative with the patient’s wishes
measures that follow it (such as electric
shocks to the heart and artificial 3. Nursing advocacy role in this regard
respirations by insertion of a breathing includes informing other health team
tube) will also be avoided. This order members of the presence of advance
has been useful in preventing directives, alerting appropriate team
unnecessary and unwanted invasive members to changes in patient decision
treatment at the end of life. The success making capacity and intervening in
behalf of the patient when wishes in • What makes this situation an ethical
advance directives are not followed. problem? Are there conflicting
obligations, duties, principles, rights,
4. Increase public awareness about loyalties, values or beliefs?
advance directives through patient and
community education, through • What are the issues
research and through education of
nurses and other health care providers • What facts seem most important?

ETHICAL DECISION MAKING PROCESS • What emotions have an impact?

Everyone makes decisions as part of • What are the gaps in information at this
everyday living. Some decisions seem time?
routine, other decisions like which job 2. Identify Key Participants
to accept or whether to marry call for
more deliberation. - Identify the key persons involved in
the decision making process and
- The process of decision making in ethics delineate each person’s role.
follows a procedure that is similar to Determining rights, duties, authority,
the scientific process. “ A comparison context and capabilities of decision
between the giving of good reasons in makers is a critical component of the
science, which is called explanation and process. The focal question is, “Whose
the giving of good reasons in ethics, decision is this to make?”. Identification
which is called moral justification of the principal decision maker is
PROCESS OF ETHICAL DECISION sometimes all that is needed to
MAKING facilitate the process

1. Gather Data and Identify conflicting Guide Questions


Moral Claims • Who is legitimately empowered to
When an ethical problem occurs, gather make this decision
information or facts in order to clarify • Who is affected and how?
issues. Identification of the conflicting
moral claims that constitute the ethical • What is the level of competence of the
dilemma is the first part of the process. person most affected in relation to the
You should examine the situation for decision to be made
evidence of conflicting obligations,
• What are the rights, duties, authority,
principles, duties, rights, loyalties,
context and capabilities f the
values or beliefs. Pay attention to
participants?
societal, religious and cultural values
and beliefs. 3. Determine Moral Perspective and
Phase of Moral Development of Key
Guide Questions:
Participants
- Knowledge of moral development and • What emotions are evident
ethical theory may provide a helpful within the interaction and with
framework for understanding each person involved?
participants and their perspectives and
• What is the level of moral
responses in the process. Assess how
those involved fit into paradigms of development of the
moral development. It is valuable to participants?
recognize, for instance, whether the • 4. Determine Desired Outcomes
principal decision maker is at a
developmental level in which choices • Identifying the desired outcomes and
neglect a desire to please others, this their potential consequences is a
susceptible to choosing an alternative substantial step in the decision-making
solely on the basis of seeking approval. process. At this point, participant will
exclude those outcomes that are totally
It is also crucial to identify the unacceptable. As with the nursing
participant’s ethical perspectives. For process , implementation of a plan of
example, if one of the major action cannot logically occur without
participants involved in discussions explicit knowledge of the desired
relative to discontinuing life support outcome. Clarifying the outcomes and
believes that it is always wrong to take their anticipated consequences
a life, the process of negotiation with enhances the understanding of options
those who believe differently is likely to and alternatives.
be frustrating. It would be more
beneficial under those circumstances to •
begin the discussion by defining the
• Guide Questions:
point at which death actually occurs,
thus finding a common ground. • How does each party describe the
circumstance of the outcome?
Guide Questions
• What are the consequences of the
• do participants think in terms of
desired outcomes
duties or rights
• What outcomes are unacceptable to
• Do the parties involved exhibit
one or all involved?
similar or different moral
perspectives? • 5. Identify Options
• Where is the common ground? • Various options begin to emerge
The differences? through the assessment process.
Participants must consider legal and
• What principles are important
other consequences. They must also
to each person involved?
determine which alternative best meet
the identified outcomes and fit their
basic beliefs, lifestyles and values.. This • How has the process affected those
process helps to narrow the list of involved?
acceptable alternatives, It is critical to
eliminate all unacceptable alternatives • Are further actions required
and begin the process of listing, Applying the Decision –Making Process
weighing, ranking and prioritizing those in the following case
that found to be acceptable.
Participants must make a choice among A couple is pregnant with their
options with both head and heat; taking second child after numerous
time to dwell with remaining unsuccessful attempts with artificial
alternatives, recognizing that there is insemination. During a routine
rarely a good solution ultrasound at 28 weeks gestation, the
physician discovers that the fetus is
• Guide Questions anencephalic. The life expectancy of an
anecephalic baby is only a few days to
• What options emerge through the
assessment process weeks after birth. The couple struggles
with the choice to terminate the
• How do the alternatives fit the lifestyle pregnancy at this time to carry the child
and values of the person(s) affected? to term.

• What are legal considerations of the 1. Gathering data and identifying


various options? conflicting moral claims

• What alternatives are unacceptable to 2. Identify key participants


one or all involved?
3. Determine Moral Perspective
• How are alternatives weighed, ranked and Phase of Moral
and prioritized Development of Key
Participants
• 6. Act on the Choice
4. Determining Desired outcomes
• Taking action is major goal of the
process, but can be one of the most 5. Identifying options
difficult parts. It can stir numerous
emotions laced with both certainty and 6. Acting on choice
doubt about the rightness of the 7. Evaluating outcome of Action
decision
ETHICAL CONSIDERATION IN
• Guide Questions: LEADERSHIP AND MANAGEMENT
• Has the ethical dilemma been resolved? 1. Moral decision making
• Have other dilemmas merged related to
the action? Leaders are seen as moral persons
when they demonstrate certain
traits, behaviors, and decision- 4. We must prayerfully reflect to
making patterns. Critical traits discern the will of God (Forming
include integrity, trustworthiness, Consciences for Faithful
and honesty. The corresponding Citizenship, no. 18).
behaviors generally reveal a
concern for other people, • Good Clinical Practice (GCP) is an
openness, and a personal morality international ethical and scientific
quality standard for the design,
(Treviño et al. 2000
conduct, performance, monitoring,
Thus, leaders who are moral persons auditing, recording, analyses and
will naturally consider relevant ethical reporting of clinical trials. It also serves
issues when making a decision or at a to protect the rights, integrity and
minimum recognize where a moral confidentiality of trial subjects.
dimension might need further
consideration.

PRINCIPLE OF WELL INFORMED


CONSCIENCE

• “Conscience is a judgment of practical


reason that helps us to recognize and
seek what is good and to reject what is
evil” (Catechism of the Catholic Church,
no. 1778, 1796).

• A well-formed conscience is an ongoing


exercise (Catechism of the Catholic
Church, no. 1784). The Church offers
the following process in forming one’s
conscience:

1. When examining any issue or


situation, we must begin by
being open to the truth and
what is right.

2. We must study Sacred Scripture


and the teachings of the
Church.

3. We must examine the facts and


background information about
various choices.
GUIDELINES FOR MEDICAL RECORD AND providers to use current,
CLINICAL DOCUMENTATION consistent data, and care goals
to facilitate continuity of care.
Professional documentation includes Clear, complete, accurate and
Any and all forms of documentation by
factual documentation provides
a clinician recorded in a professional a reliable, permanent record of
capacity in relation to the provision of patient care and is an accurate
patient care. record of the history of the
• This documentation may include patient’s health care

1. written and electronic health 2. Accountability


records, audio and video tapes, • Documentation demonstrates
emails, facsimiles, images the clinician’s accountability
(photographs and diagrams), and records their professional
observation charts, check lists,
practice.
communication books,
shift/management reports, • It may be used to determine
responsibility of care providers
2. incident reports and clinical and to resolve questions or
anecdotal notes or personal concerns in relation to care
reflections (held by the
required.
clinicians personally or any
other type or form of • The clinician’s documentation
documentation pertaining to may be used in relation to
the care provided. performance management,
internal organizational inquiries
PURPOSE OF PROFESSIONAL and/or legal proceedings (such
DOCUMENTATION as civil lawsuits or coronial
1. Communication . inquests).

• Documentation in medical 3. Legislative requirements


records is the basis for • Nurses and midwives are
communication between health required to make and keep
professionals. records of their professional
• It informs of the care provided, practice in accordance with
the treatment and care planned standards of practice of their
and the outcome of that care as profession and organizational
a continuous and policy and procedure.
contemporaneous record. • Legislation in different
• Documentation enables health countries may further identify
professionals and other care and require specific information
and content to be recorded and outcomes, patient care and is a
maintained. concise record, essential for
accurate research data and
• Failure to keep and maintain evidence based practice.
certain documentation records
as required, falsifying CODES OF ETHICS
documentation, incomplete or
inaccurate documentation, A Code of Ethics is a systematic
signing or issuing a document statement of principles or rules of
that the person knows or appropriate professional conduct,
suspects to be false or usually established by professional
misleading, may be found to societies.
constitute unprofessional What makes a code of ethics an
conduct by a regulatory important document for nurses?
authority.
A code of ethics functions as a tool
4. Quality improvement and necessary mark of a profession
• Documentation may be used to and professional self-definition
evaluate professional practice (Davis, 2008). Professionals also
as a part of quality assurance engage in self-regulation. Nursing is
mechanisms such as no different. A code of ethics is one
performance reviews, audits such structure that displays
nursing’s scope and responsibilities
and accreditation processes,
legislated inspections and as a profession (ANA, 2003).
critical incident reviews. The Code articulates nursing’s
• Clinical staff can also use this commitment to provide high quality
information to reflect on their care to patients and communities,
practice and implement supporting each other in the
changes based on evidence. process, so that all nurses can fulfill
their ethical and professional
Documentation is evidence of
the quality provision of care obligations, as well as meet their
and services to the public. own professional career goals.

5. Research The ANA Code of Ethics

• Medical Record documentation Provisions I-III Fundamental Values


is a valuable source of data for of the Professional Nurse
health researchers. I. The nurse, in all professional
• It provides information in relationships, practices with
relation to clinical compassion and respect for the
interventions, evaluates patient inherent dignity, worth, and
uniqueness of every individual, to all who require the services
unrestricted by considerations of of the nurse
social or economic status, personal
attributes, or the nature of health • The Right to self determination
(autonomy)– respect for human
problems.
dignity requires the recognition
• Respect for Human Dignity) The of specific patient rights.
concept of human dignity is based on AUTONOMY is the philosophical
the principle of respect for persons. basis for informed consent in
This is a fundamental principle that health care. It gives the patient
underlies all nursing practice. the moral and legal right to
Respecting all persons means the nurse determine what will be done
respects other and honors their dignity with their own person to
in every encounter . This includes include refusal of treatment.
patients as well as interactions with
colleagues, other professionals, and in "Each nurse has an obligation to be
knowledgeable about the moral and
fact, in encounters with everyone.
legal rights of all patients to self-
For the bedside nurse, this can be determination" (ANA, 2001, p. 8).
expressed in small gestures such as
closing curtains for privacy, and in The nurse does this by
large gestures, such as assuring assessing the patient's
patient autonomy through the comprehension of the
establishment of conditions treatment options presented
necessary to provide truly informed and the implications of each. If
consent. the nurse feels that the patient's
comprehension is questionable,
Cont. of Code 1 the

• Relationships to patients- nurse enlists the use of a


delivery of health care is surrogate.
universal transcending all
individual differences. This is In the absence of a surrogate,
nursing care without prejudice the nurse does his or her
best to ensure that decisions are
respecting lifestyles, value
system and religious beliefs made in the best interest of
the patient, considering
• Nature of health problem -The "the patient's personal values to
worth of the person is not
affected by disease, disability, the extent that they are
functional status and proximity known" (ANA, 2001, p. 9).
to death. The respect extends • Relationship with
colleagues and others –
The nurse maintains Therefore the need for a
compassionate and multidisciplinary approach to deliver
caring relationships health services requiring the
with colleagues and participation of all health professionals
others with a is necessary.
commitment to the fair
treatment , integrity • Professional boundaries – While the
preserving compromise nature of nursing work has an
and to resolving inherently personal component, the
conflict. nurse-patient relationships and nurse
colleague relationships has its purpose
II. Primacy of the Patient’s interest of preventing illness, alleviating
- emphasizes the patient (whether suffering and protecting, promoting and
person, family, group, or restoring the health of patients. Hence
community) as the primary it differs from those that are purely
recipient of the nurse’s personal and unstructured such as
commitment of caring. friendship.

When the patient’s wishes are in III. The nurse promotes, advocates
conflict with others, the nurse seeks for and strives to protect the
to help resolve the conflict- where health, safety and rights of the
conflict persists, the nurse’s patient.
commitment remains to the
identified patient. • No one should be the subject of
medical or genetic
• Conflict of Interest for Nurses experimentation, even if it is
therapeutic, unless the person
Nurses must examine the conflicts or surrogate first has given free
arising between their own personal and informed consent.
and professional values, the values
and interest of others who are • The nurse "must be alert to and
responsible for care and health care take appropriate action
decisions, as well as those of regarding any instances of
patients. Nurses strive to resolve incompetent, unethical, illegal
such conflicts in ways that ensure or impaired practice by any
patient safety, guard the patient’s member of the health care
best interest and preserve the team or the health care system
professional integrity of the nurse. or any action on the part of
others that places the rights or
• Collaboration – is not just cooperation, best interests of the patient in
but it is the concerted effort of jeopardy"
individuals and groups to attain a
shared goal (addressing health needs).
• The Code of Ethics makes an personal risk to advocate for the
interesting distinction between patient.
questionable practice and
impaired practice, • Responsibility "refers to the
specific accountability or
acknowledging the difference
between such things as a self- liability associated with the
medicating nurse under a great performance of duties of a
deal of stress, a colleague who particular role"
is overtly incompetent due to • What exactly are nurses
drug abuse, or a clinically responsible for, other than
incompetent practitioner. providing good patient care?
• Provisions 4-6: Duty and Loyalty • They are responsible for
• IV. The nurse is responsible and assessing their own
competence, and seeking
accountable for individual nursing
practice and determines the remedies when certain
appropriate delegation of tasks responsibilities fall outside their
consistent with the nurse's obligation to competency.
provide optimum patient care • Nurses do this by seeking
• Each nurse is individually accountable educational resources, and
and responsible for his or her own collaborating with others,
practice. What is the difference including nurse educators.
between accountability and • All nurses are required to
responsibility? Accountability "means to continually assess and improve
be answerable to oneself and others for their own competence through
one's own actions continuing education, self-
• "for judgments made and actions taken study, networking, and formal
in the course of nursing practice, programs.
irrespective of health care organizations • 5. The nurse owes the same duties to
policies or providers' directives," self as to others, including the
• Nurses act under a code of ethical responsibility to preserve integrity and
conduct that is grounded in moral safety, to maintain competence, and to
principles of fidelity, and respect for continue personal and professional
dignity, worth and self-determination of growth.
patients” • Addresses duties to self in a very new
• When policies of the hospital or actions and compelling way. In addition to
by physicians are not in the patient’s physical health, continuing education
best interest, nurses may have to take a and financial security, the code also
includes wholeness of character, maintaining an ethical
identity and integrity environment.

• Nurses must be aware that becoming a • Virtues are an important


professional is a process of integration feature of the
of professional and personal values and professionalization of the nurse,
is key to wholeness of character. but they can be thwarted by the
“Professional growth moves the nurse work environment.
beyond mere competence, as a
minimum standard of practice, toward • When varying values are
excellence and is thus directed toward expressed regarding a patient's
an ideal of practice” (Fowler, 2009, p. care, the nurse has a moral
responsibility to express his or
59).
her viewpoint, even if this
• Peer review and self evaluation are viewpoint is not the prevailing
tools that can be used by nurses for one.
achieving insight into their job
performance. .

6. The nurse participates in Provisions 7-9: Expanded Duties


establishing, maintaining, and Beyond Direct Patient Care
improving health care VII. The nurse participates in the
environments and conditions of advancement of the profession
employment conducive to the through contributions to practice,
provision of quality health care and education administration and
consistent with the values of the knowledge development.
profession through individual and
collective action. The provision creates a moral “link
between the nurse as a person, the
• Creating, promoting and individual practice of the nurse, and
maintaining an environment for the nursing professional as a whole”
ethical practice is the
responsibility of every nurse • To become a nurse, then, is not
to practice nursing as merely a
• Provision six provides guidance job, but to see oneself through
through explanation of the a professional's eyes, which
influence that the environment means collaborating with other
has on moral virtues, values and nurses to advance the
ethical obligations. It also profession
describes methods and
strategies for nurse’s individual • Because a professional has
and collective participation in obligations to society as a
whole, the nurse has an
obligation to engage in civic responsibilities and for
"ongoing scholarly activities“, advocating for appropriate
they must be aware of ongoing health-related legislation.
challenges and anticipate future
Copyright: American Nurses
challenges that nursing must
prepare itself to meet. Association, Code of Ethics for
Nurses with Interpretive
8. The nurse collaborates with Statements, Silver Spring, MD:
other health professionals and the American Nurses Publishing, 2001
public in promoting community,
national, and international efforts
to meet health needs. GOD - COMMON GOOD -
Relying on ethical theories of SOLIDARITY, HUMAN DIGNITY,
justice, Nurses are to be committed SUBSIDIARITY
to the resolution of social ills that ETHICAL ISSUES
hinder the well-being of all people.
DATA PRIVACY ACT OF 2012
• Individually and collectively,
have a responsibility to know • SECTION 1. Short Title. – This Act shall
the health needs of their be known as the “Data Privacy Act of
communities as well as the 2012”.
large communities in which they
• RA 10173, or the Data Privacy Act of
live.
2012, protects individuals from
• individually and collectively, unauthorized processing of personal
have an obligation to educate information that is (1) private, not
the public through different publicly available; and (2) identifiable,
means about the health of where the identity of the individual is
individual communities. apparent either through direct
attribution or when put together with
9. The profession of nursing, as other available information.
represented by associations and
their members, is responsible for • The act states that the collection of
articulating nursing values, for personal data “must be a declared,
maintaining the integrity of the specified, and legitimate purpose” and
profession and its practice, and for further provides that consent is
shaping social policy. required prior to the collection
of all personal data.
• As individual nurses have these
obligations, so do their BENEFITS AND CHALLENGES OF
professional associations. This TECHNOLOGY
provision addresses nurses’
obligations to participate in
The many benefits brought to the • In some circumstances, this is
health care arena by technology are accepted as part of the
often accompanied by serious treatment process, such as pain
dilemmas for both practitioners associated with surgery or the
and patients. side effects of chemotherapy –
we are willing to deal with the
• Current technology makes it possible to discomfort because there is an
restart arrested hearts, use machines to expectation of recovery, that
breathe for people, correct deformities, we will ultimately feel more
etc. healthy.
• The ability to prolong life or at least • In circumstances in which there
extend the functioning of the physical
is little or no expectation of
being has prompted the necessity of recovery or improved
dealing with some very important functioning, the essential
issues such as; question is whether the harm
1. Quality of life- the ability to imposed by technology
keep people alive and physically outweighs the good intended
functioning through the use of by it use.
technology has led to much • Making decisions regarding use
reflection and discussion about of technology may cause pain,
what constitutes life and living, and there is suffering in living
whether physical existence is with unknown results of these
synonymous to living ongoing decisions. RELIEF OF
2. Principles of Beneficence and SUFERRING, A GOAL OF
Nonmalficence may be in HEALING NEEDS TO BE
conflict ADDRESSED IN ALL PATIENT
ENCOUNTERS
A. Dealing with Issues of
Technology • B. Current Technology Issues and
Dilemmas
The principles of beneficence and
nonmaleficence may be in conflict • Current technology related to organ
in this regard. and tissue transplantation, genetic
engineering, reproduction and
A particular technology which may sustaining life have profound potential
be implemented with the intention for affecting our lives and health in
of doing good (beneficence), may positive ways
result in much suffering for the
patient. Inducing such suffering is • Nurses generally do not make the
counter to the maxim of do no decisions regarding implementing or
harm (nonmaleficence) withdrawing particular technologies –
except in situations like initiating CPR • Self awareness related to values, beliefs
following specific protocols and reactions is especially significant
when dealing with issues related to
• 1. Issue of withdrawing or withholding technology – this will enable the nurse
treatment to differentiate personal values from
• Decisions are generally made by those of patient and others involved in
physicians in consultation with patients the situation
and family members • Self determination and autonomy
2. Issues of Life, Death and Dying counsels the nurse to understand that
individuals by judge benefits of an
• Technology has stretched the intervention from varying perspectives
boundaries and clouded the waters
surrounding life’s beginning and ending • Recognizing where personal values may
be different enables nurses to be more
• Determining when life ends has become attentive to fostering good
a critical issue related to use of communication , encouraging others to
technology prompting the involvement make their own decisions, avoiding
of courts in decision making judgment about the rightness or
wrongness of the decision based on
• Perspectives vary from the belief that
personal values, and accepting those
life’s begins at conception to the view
decisions even if they are different from
that it begins when an infant can
what the nurse would do.
survive outside the womb.
CODE ETHICS FOR FILIPINO NURSES
• Dying is more than a medical
occurrence; it is a spiritual process The professional code of ethics for
Filipino nurses strongly emphasizes
• Current technologies can prolong
the fourfold responsibility of the
suffering by prolonging the dying
nurse, the universality of nursing
process, and separate people from their
practice, the scope of their
families by actual physical barriers and
responsibilities to the people they
institutionalization
serve, to their co-workers, to
NURSING PRACTICE IN MIDST OF society and environment, and to
TECHNOLOGY their profession. The Code of Ethics
used by Filipino nurses prior to
1984, was the code promulgated by
the International Council for
• The essence of nursing remains the
Nurses. In 1982, the PNA Special
focus of caring for patients and families
Committee developed a Code of
and being attentive to the needs of
Ethics for Filipino Nurses, but was
persons whose lives are affected by the
not implemented.
technology.
The Code of Ethics for Filipino 2. Personal information acquired in the
Nurses embodies ethical principles process of giving nursing care shall be
and guidelines to be observed, held in strict confidence.
stipulated under seven (7) articles.
Article III – Registered Nurses and
The ethical principles are stated
below. Practice

Article I – Preamble 1. Human life is inviolable.

1. Health is a fundamental right. 2. Quality and excellence in the care of


The Filipino RN, believing in the patients are the goals of nursing
worth and dignity of each human practice.
being, recognizes the primary 3. Accurate documentation of actions and
responsibility to preserve health at outcomes of delivered care is the
all cost. hallmark of nursing accountability.
2. To assume this responsibility, 4. Registered nurses are the advocates of
RNs have to gain knowledge and the patients: they shall take appropriate
understanding of man’s cultural, steps to safeguard their rights and
social, spiritual, psychological, and privileges.
ecological aspects of illness,
utilizing the therapeutic process. 5. Registered Nurses are aware that their
Cultural diversity and political and actions have professional ethical, moral
socio-economic status are inherent and legal dimensions. They strive to
factors to effective nursing care. perform their work in the best interest
of all concerned.
3. The desire for the respect and
confidence of clientele, colleagues, Article IV – Registered Nurses and
coworkers, and the members of the Co-workers
community provides the incentive
1. The RN is in solidarity with other
to attain and maintain the highest
members of the health care team in
possible degree of ethical conduct.
working for the patient’s best interest.
Article II – Registered Nurses and
2. The RN maintains collegial and
People
collaborative working relationship with
1. Values, customs, and spiritual beliefs colleagues and other health care
held by individual shall be represented. providers.
Individual freedom to make rational
Article V – Registered Nurses,
and unconstrained decisions shall be
Society, and Environment
respected.
1. The preservation of life, respect for
human rights, and promotion of healthy
environment shall be a commitment of crimes committed during human
a RN. experiments on concentration camp
prisoners. ...
2. The establishment of linkages with the
public in promoting local, national, and 7. The Nuremberg trial described and
international efforts to meet health and documented some of the most
social needs of the people as a gruesome and painful medical
contributing member of society is a experiments carried out by Nazi
noble concern of a RN. Doctors. On trial were 22 men and one
woman for their participation in these
Article VI – Registered Nurses and experiments. Most were doctors,
the Profession though three were not. The defendants
1. Maintenance of loyalty to the nursing in this case are charged with murders,
profession and preservation of its tortures, and other atrocities
integrity are ideal. committed in the name of medical
science. The victims of these crimes are
2. Compliance with the by-laws of the numbered in the hundreds of
accredited professional organization thousands. most of these miserable
(PNA) and other professional victims were slaughtered outright or
organizations of which the RN is a died in the course of the tortures to
member is a lofty duty. which they were subjected. The
judgment by the war crimes tribunal at
3. Commitment to continual learning and
Nuremberg laid down 10 standards to
active participation in the development
which physicians must confirm when
and growth of the profession are
carrying out experiments on human
commendable obligations.
subjects in a new code that is now
4. Contribution to the improvement of accepted worldwide.
the socio-economic conditions and
10 Standards
general welfare of nurses through
appropriate legislation is a practice and 1. Voluntary consent
visionary mission
2. Scientific Studies
5. Nuremberg Code = is a set of research
ethics principles for human 3. Prior knowledge
experimentation created as a result of 4. Injury and suffering
the Nuremberg trials at the end of the
Second World War. 5. No experiment should be conducted
where there is any prior reason to
6. The Nuremberg Code was introduced in believe that death or disabling injury
August 1947, after
will occur
the Nuremberg trials. In these trials,
Nazi doctors were convicted of the 6. Protection against Risks
7. Proper preparations should be made 6. To be forthcoming about sponsors of
and adequate facilities provided causes and interests and never engage in
misleading practices such as “astroturfing”
8. Qualified Investigators
9. Freedom to withdraw 7. To be aware of the power of social
media, and use it responsibly;
10. Termination of Studies
8. To never engage in the creation of or
knowingly circulate fake news;
1. The Declaration of Helsinki is a set of 9. To adhere to their Association’s Code of
ethical principles regarding human Conduct, be mindful of the Codes of Conduct of
experimentation developed for the other countries, and show professional respect
medical community by the World
at all times
Medical Association. It is widely
regarded as the cornerstone document 10. To take care that their professional
on human research ethics duties are conducted without causing offence
on the grounds of gender, ethnicity, origin,
2. The Declaration developed the religion, disability or any other form of
ten principles first stated in the
discrimination.
Nuremberg Code, and tied them to
the Declaration of Geneva (1948), a
statement of physicians' ethical duties

The 10 principles in the Helsinki


Declaration

1. To work ethically and in accordance


with applicable laws;
2. To observe the highest professional
standards in the practice of public
relations and communications.
3. To respect the truth, dealing honestly
and transparently with employees,
colleagues, clients, the media,
government and the public;
4. To protect the privacy rights of clients,
organizations, and individuals by
safeguarding confidential information;
5. To be mindful of their duty to uphold
the reputation of the industry;

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