Alexandria University

Faculty of Nursing
Master Degree

Supervised by

Prof. Dr / ZAKIA TOMA

2009/2010
Team work
1- Asmaa Ahmed Ibrahim
2- Basms Ramdan Hamzawey
3- Hanan
4-Hayam Akl
5- Fawzeya Yossif Mohamed
6- Marwa Ali Abd-Elmaksoud
7-mnal Ali Mustafa
8-Nora Morsi Mahmoud
9- Zinab Moawad Elsaid
Out lines:
Introduction

Definitions

Historical background

Code of ethics

Basic ethical concepts & principles

Ethical consideration in nursing informatics

Negligence and malpractice

Nurses rights

Patient's bills of rights

Summary & conclusion

Introduction

A few years ago,Reference

sociologist Raymond Baumhart asked business
people," What does ethics mean to you?" among their replies were
the following:
"Ethics has to do with what my feeling tell me is right or wrong"
"Ethics has to do with my religious beliefs."
"Being ethical is doing what the law requires"
"Ethics consists of the standards of behavior our society accepts."
"I don't know what the word mean."
And at this research we will subject what is ethics mean "especially in
nursing"

Definitions:
Ethics : is a branch of philosophy that' concerned with the
study of principles that govern human behavior in our social world
John stone 1999
Ethics : the principles of conduct governing one's
relationship with others
Ethics : is concerned with the study and practice of what is
good and right for human beings (LAN E Thompson 2005)
Ethics : coming from Greek "refers to the science or study of
morals in academic context often called moral philosophy (Kath M Melia
2004).
Nursing ethics : it refers to all kinds of ethical and bioethical issues
from the perspective of nursing theory and practice (john stone 1999)
Rights : it is the claim that's owned to individual on legal or
ethical basis and it extends to including privileges concessions and
freedom (Joann Zerwakh 1994)
Freedom : is the right to act according to ones will without
being held up(Kenneth M boyd 2003 )
Morals : lateen word; refers to the standards of behavior
actually held or followed individuals and groups (Kenneth M boyd 2003 )
Or Morals : the domain of private standard of personal value,
rules, and lifestyle behavior may be goodness or badness.
Or morals : are the fundamental standards of right and wrong it
is based on religious concept and it is usually in the early stages of
childhood development. (Joann Zerwakh 1994)
Ethical dilemma : is a situation in which choice has to be made
between two alternatives that both are undesirable (Joann Zerwakh 1994)

Law : is a system of rules, usually enforced; through a set

of situations.
Laws : they are man made rules of social conduct that
protect society to all persons to protect the right of the public.
Values : is a property of objects, including physical object as
well as abstracted objects (action) representing their degree of importance
Or it is derived from cultural, ethical back grounds family, tradition, pear
group ideas and practice through influencing one's belief, behavior, and
attitude.

Types Of Rights

1- Negative rights require others to stop doing things that are causing
harm to you
2- Positive rights demand other to give you some benefits
3- Moral rights force as the accepted rules and concerns of the moral
community gives them
4- Legal rights enforce able through civil or crime.

Historical background:

As modern, civilized people, we might like to think that systematic

violations of moral principles within a research context occurred
centuries ago rather than the recent times, but this is not the case
The Nazi medical experiments of the 1930s and 1940s are the most
famous example of recent disregard for ethical conduct.

The Nazi program use the prisoners of war and racial" enemies" in
experiments designed to test the limits of human endurance and human
reaction to diseases and untested drugs .and more these people couldn't
refuse participation

For instance, between1932 and 1972 a study sponsored by U.S.

investigated the effect of syphilis on 400 men from a poor Black
community.

In 1993 U, S. federal agencies had sponsored radiation experiments since

the 1940s on hundreds of people, many of them prisoners or elderly
hospital patients.
Code of Ethics for Nurses

1. The nurse, in all professional relationships, practices with compassion

and respect for the inherent dignity, worth, and uniqueness of every
individual, unrestricted by considerations of social or economic status,
personal attributes, or the nature of health problems

2. The nurse’s primary commitment is to the patient, whether an

individual, family, group, or community
.
3. The nurse promotes, advocates for, and strives to protect the health,
safety, and rights of the patient.

4. The nurse is responsible and accountable for individual nursing

practice and determines the appropriate delegation of tasks consistent
with the nurse’s obligation to provide optimum patient care.

5. The nurse owns the same duties to self as to others, including the
responsibility to preserve integrity and safety, to maintain competence,
and to continue personal and professional growth.

6. The nurse participates in establishing, maintaining, and improving

health care environments and conditions of employment conducive to the
provision of quality health care and consistent with the values of the
profession through individual and collective action.

7. The nurse participates in the advancement of the profession through

contributions to practice, education, administration, and knowledge
development.

8. The nurse collaborates with other health professionals and the public in
promoting community, national, and international efforts to meet health
needs.
Basic ethical concepts & principles
Basic ethical concepts

1- Human rights: - Are justified claims that individuals and

groups can make upon other or society.

types of human rights it can be classified into 2 types :-

a- Liberty rights: - Consists of the responsible exercise of freedom

which requires only the non interference of others (first generation
rights) ex. bill of rights.
b- Claims rights: Are assertions that call for a fair share of the
resources, services and assistance of others in the realization of
human potential and in the protection from harm. ( second
generation rights ) EX: (the right to receive an education).

2- Autonomy: It is the right of self determination, independence

and freedom to make a decision.

The following are three points in health care decisions :-

a- Competency: - the patient able to take a decision related to his
health care.
b- Free from undue influence (voluntariness):- free from coercion
to take his decision.
c- Information ( disclosure ) :- the patient must informed about the
nature of proposed treatment ( the risks and benefits )

EX: - Breast cancer women must be informed about her disease.

 3- Justice: - It refers to the obligation to be fair to all people
regarding sex, age, race, religious. EX: - The patient on
university hospital must be deal with him as the patient on
private hospital.
4- Fidelity: - Morale obligation to be faithful to the agreement
and commitments and responsibilities that has made to one
self and others and also keeping promise and maintain
confidentiality & privacy.

5- Confidentiality :- Morale , legal , professional duty or

obligation to protect all information concerning client in the
course of professional practice and make disclosure only with
consent

6- Privacy: - The right to respect one's human being has personal

life . the patient right must be supplemented by his own health
information & under what circumstance to be able make his
health care decision and also consider privacy during ( case
discussion , consultation , examination , and treatment ) .
7- Veracity: - It is obligation to tell the truth accuracy not to lie
loss of truth – loose relation – create anxiety.

8- Responsibility risks: - Responsibility means the duty to

perform actions well and thought fully which praised or
blamed.
9-Beneficence & nonmal-efficience: - beneficence is the
obligation to do well, not harm to other people to act in the best interest
of others.
 It helps to guide difficult decisions where the benefities of a
treatment may be challenged by risks to the client's well being or
dignity.
 Although it may cause side effect it also help in the treatment

EX: - side effect of any drug may be explained to the patient to be able to
accept this side effect.
*The criteria for moral obligation in nursing responsibilities

1- The client is at significant risk of harm, loss or damage if the nurse

does not assist.
2- The nurse's intervention or care is directly relevant to preventing
harm.
3- The nurse's care will probably prevent harm, loss or damage to
client.

The benefits the client will gain out weighs any harm the nurse might in
car and doesn't present more than an acceptable risk to the nurse.

*Principles of ethics

A. Fundamental Ethical Principles

All social interactions are subject to fundamental ethical principles. Hips

function in a social setting. Consequently, their actions are also subject to
these principles. The most important of these principles are:

1. Principle of Autonomy

All persons have a fundamental right to self-determination.

2. Principle of Equality and Justice

All persons are equal as persons and have a right to be treated

accordingly.

3. Principle of Beneficence

All persons have a duty to advance the good of others where the nature of
this good is in keeping with the fundamental and ethically defensible
values of the affected party.
4. Principle of Non-Malfeasance

All persons have a duty to prevent harm to other persons insofar as it lies
within their power to do so without undue harm to them.

5. Principle of Impossibility

All rights and duties hold subject to the condition that it is possible to
meet them under the circumstances that obtain.

6. Principle of Integrity

Whoever has an obligation has a duty to fulfill that obligation to the best
of her or his ability.

B. General Principles of Ethics Informatics

These fundamental ethical principles, when applied to the types of

situations that characterize the informatics setting, give rise to general
ethical principles of informatics ethics.

1. Principle of Information-Privacy and Disposition

All persons have a fundamental right to privacy, and hence to control

over the collection, storage, access, use, communication, manipulation
and disposition of data about themselves.

2. Principle of Security

Data that have been legitimately collected about a person should be

protected by all read gradation, unauthorized destruction, access, use,
.manipulation, modification or communication

3. Principle of Access
The subject of an electronic record has the right of access to that record
and the right to correct the record with respect to its accurateness,
completeness and relevance.

4. Principle of Legitimate Infringement

The fundamental right of control over the collection, storage, access, use,
manipulation, communication and disposition of personal data is
conditioned only by the legitimate, appropriate and relevant data-needs of
a free, responsible and democratic society, and by the equal and
competing rights of other persons.

5. Principle of the Least Intrusive Alternative

Any infringement of the privacy rights of the individual person, and of

the individual’s right to control over person-relative data as mandated
under Principle 1, may only occur in the least intrusive fashion and with a
minimum of interference with the rights of the affected person

6. Principle of Accountability

Any infringement of the privacy rights of the individual person, and of

the right to control over person-relative data, must be justified to the
affected person in good time and in an appropriate fashion.
**-:Ethical consideration
*As health care institutions use computerized medical record in more
ways and as demands for personal data increase, public concern related
to informatics and abuse of information will addressed.

**In 1980 the organization for economic cooperation and development

(OECD) held that:-

Although national and policies differ countries have a common

interest in protecting privacy and the flow of information.

**This lead to the universal ethical guide lines:-

1- Collection limitation principles:-

It must done thorough lawful and fair means with the knowledge and
consent of the subject.

2-data quality principle:-

Should be accurate, complete and up to date.

3-purpose specification principle:-

The intended use should be mentioned at the tome of collection and

the usage shouldn't differ from the intended use.

4-use limitation principle:-

Data shouldn't be disclosed and should be authorized by law.

5-security safe guards principle:-

Personal data should be protected against risks as destruction

modification.

6-openness principle:-

A general policy of openness should exist about development,

practice and polices with respect of personal data.

7-individual participation principle:-

 the individual should have the rights of :-

*be able to obtain confirmation to data relating to him

*be able to have data relating to him self available within reasonable
time, manner and cost.

*be able to reason for refusal of a request.

*Examples of informatics ethical consideration In the whole

world:-

(1) The USA:-

The health Insurance Portability and Accountability ACT (HIPAA)

*Allow employees and their families to transfer insurance benefits from

one employer to another (1996)

*places restriction on the use of personal data including diskette CD-

ROM computer server, e.mail and voice recording.

(2)THE Canadian Organization for the Advancement of Computers

in Health (COACH):-

*Provide guide lines for the protection of health information related to

development and implementation of security (2004).

(3)The European Union:-

*Published guide lines related to personal data and its movement.(1995)

(4)The United Kingdom:-

*Guide lines elated to physical and mental data (1998)

**Nursing Responsibilities in informatics:-

(1) Should use secure pass word and change it frequently

(2) Should follow limitation on data collection and recording

(3) Should develop policy regarding privacy, confidentiality and

system security
 (4) Should inform public when implementing anew information
system

(5) Should obtain consent from the pt before input of

individuals data into a system

(6) Should obtain consent before using personal information for

research

(7) Should help the patient to obtain his record at ant time

*Non-male-efficiency ( efficiency ) :-
It is the obligation of avoidance of harm

*Florence night tingle stated that "the patient should be no harm to

nurse".

*Negligence and mal practice in nursing :-

The nurses are obligated by the law to care for clients in non
discriminatory manner, with respect for all human presence.

The nurses should be aware of illegal practice related to duties to avoid

involving in any legal problems.

*Forms of illegal practice :-

Negligence: - It's the failure to act as an ordinary prudent person would
act in the given circumstance.

Negligence in nursing practice: - a nurse who fails to meet the

required standard of care in a given situation or a nurse's care less ness in
carrying out her professional duties causing harm to patient .

The characteristics of negligence :-

1- The negligent person must be involved in a situation when she / he
is carrying out a duty toward harmed person.
2- Breach of duty must be present that is failure to fulfill the duty
according to the standards of the profession.
 3- The harm can be occurred to any individual.

Degree of negligence :-
1- Gross negligence: - occur when the nurse fails to exercise any care
to protect patient.
2- Criminal negligence :- occur when negligence result in death of the
patient
3- Contributory negligence: - occur when the patient has contributed
to his own in jury or harm by his own negligence.

2- Mal. practice:-
A professional misconduct, improper discharge of duties or failure to
meet the standard of care expected from a reasonably prudent which
cause harm to patient.

Mal practice is a specific type of negligence.

*The characteristics of malpractice:-

The same as mentioned before in the negligence.

*Prevention of Negligence and mal practice in nursing:-

The standard of care basically determines the nurse liability for negligent
act , so setting and maintain a high standard of a care leading to the
improvement of nursing practice that in turn contributes to prevention of
negligence and mal practice of the nurse that achieved by the following :

1-Self awareness:-
Through identifying own deficiencies in practice and improving it
through self development by education, experience, and discussion with
peers. Making has knowledge and skills up to date. Do not accepts
responsibilities for which you are not prepared

2-Adapting proposed assignment:

The nurse should assume duties that are within her competence, the
specialized nurse assume to the specialized duties
3-Following policies and procedures.
Polices are designed to provide legal diction and it is the responsibility of
the nurse to be aware of the polices and procedures of the organization
that employs her so she will be aware of what should be done and what
shouldn't be done.

4-Changing policies and procedures

Changing In policies and procedures are needed. To perform nursing
duties in high level of quality parts of the nurse responsibility , as a
professional is to work toward keeping all of policies and procedures up
to date .

5-documentation
For legal purpose, observations and actions that are not recorded consider
that it didn't occurred.

*The good documentation characteristics.

- Based on facts, legible and clearly understood and complete.
- Only international abbreviations should be used.
- Signed by full name and dated and time.
- Should be written in Ink
- Properly kept for protection.

*Bill of Rights for Registered Nurses

1. Nurses have the right to practice in a manner that fulfills their

obligations to society and to those who receive nursing care.
2. Nurses have the right to practice in environments that allow them to act
in accordance with professional standards and legally authorized scopes
of practice.
3. Nurses have the right to a work environment that supports and
facilitates ethical practice, in accordance with the Code of Ethics for
Nurses with Interpretive Standards.
4. Nurses have the right to freely and openly advocate for themselves and
their patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent
with their knowledge, experience, and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves
and for their patients.
7. Nurses have the right to negotiate the conditions of their employment,
either as individuals or collectively, in all practice settings.

The patient rights

Considering patient rights and caring for patient as human being

resulting in effective treatment
There are three basic rights:
1- The right to know
2- The right to privacy
3- The right to treatment

The 8 key areas of the Patient's Bill of Rights

 Information disclosure
 Choice of providers and plans
 Access to emergency services
 Participation in treatment decisions
 Respect and non-discrimination
 Confidentiality of health information
 Complaints and appeals
Other bills of rights

This bill of rights focuses on hospitals and insurance plans, but there
are many others with different focuses:

 A patient has the right to be treated with courtesy and respect, with
appreciation of his or her individual dignity, and with protection of
his or her need for privacy.
 A patient has the right to a prompt and reasonable response to
questions and requests.
 A patient has the right to know who is providing medical services
and who is responsible for his or her care.
 A patient has the right to know what patient support services are
available, including whether an interpreter is available if he or she
does not speak English.
 A patient has the right to know what rules and regulations apply to
his or her conduct.
 A patient has the right to be given by the health care provider
information concerning diagnosis, planned course of treatment,
alternatives, risks, and prognosis.
 A patient has the right to refuse any treatment, except as otherwise
provided by law.
 A patient has the right to be given, upon request, full information
and necessary counseling on the availability of known financial
resources for his or her care.
 A patient who is eligible for Medicare has the right to know, upon
request and in advance of treatment; whether the health care
provider or health care facility accepts the Medicare assignment
rate.
 A patient has the right to receive, upon request, prior to treatment,
a reasonable estimate of charges for medical care.
 A patient has the right to receive a copy of a reasonably clear and
understandable, itemized bill and, upon request, to have the charges
explained.
  A patient has the right to impartial access to medical treatment or
accommodations, regardless of race, national origin, religion,
handicap, or source of payment.
 A patient has the right to treatment for any emergency medical
condition that will deteriorate from failure to provide treatment.
 A patient has the right to know if medical treatment is for purposes
of experimental research and to give his or her consent or refusal to
participate in such experimental research.
 A patient has the right to express grievances regarding any
violation of his or her rights, as stated in Florida law, through the
grievance procedure of the health care provider or health care
facility which served him or her and to the appropriate state
licensing agency.
 A patient is responsible for providing to the health care provider, to
the best of his or her knowledge, accurate and complete
information about present complaints, past illnesses,
hospitalizations, medications, and other matters relating to his or
her health.
 A patient is responsible for reporting unexpected changes in his or
her condition to the health care provider.
 A patient is responsible for reporting to the health care provider
whether he or she comprehends a contemplated course of action
and what is expected of him or her.
 A patient is responsible for following the treatment plan
recommended by the health care provider.
 A patient is responsible for keeping appointments and, when he or
she is unable to do so for any reason, for notifying the health care
provider or health care facility.
 A patient is responsible for his or her actions if he or she refuses
treatment or does not follow the health care provider's instructions.

*Summary
Ethics is fundamental to all human interaction
Nursing students and graduate professional are required to be
knowledgeable about professional ethics and how to handle ethical
.dilemmas that inevitably arise in delivery of care

CONCLUSION
We subjected definitions of ethics, morals, values, law, rights, freedom,
ethical nursing and ethical dilemmas

We subjected human rights, Autonomy, justice, fidelity, confidentiality,

.privacy, veracity, responsibility and beneficence & non-mal efficiency

.We subjected professional standard of practice

.We subjected nursing rights and patient bills of rights

We learn how to work as a group

We gain presentation skills

References
From web sites *
www.wikipedia.org -

www.nursing-ethics.org

www.nursingcenter.com

www.scu.edu

www.nursingworld.org

www.ethics.sandiego.edu

www.socialscience.cybresscolledge.edu

www.ditex.com

http://www.imia.org/pubdocs/Ethics_Eng.pdf

From library *
Nursing ethics, LAN E Thompson & kith M melia, 2005*

*Essential of nursing research, Denise F .polit, 2006

*Nursing today transition and trends, JoAnn zerwekh, 2003

*Infrastructure Elements of the Informatics Environment, Kathryn

J.Hannah, 3rd, USA, 2006