TOPIC: ETHICS/ETIQUETTES IN NURSING

INTRODUCTION
Ethics is derived from the Greek word ethos, meaning custom or character. Ethics can be
defined as the branch of philosophy dealing with standards of conduct and moral judgment. It
refers to a method of inquiry that assists people to understand the morality of human behavior.
(i.e. it is the study of morality). When used in this sense, ethics is an activity; it is a way of
looking at or investigating certain issues about human behavior.
Ethics. -Are the qualities which make up the nursing character, in our moral obligations to the
sick and to each other, we have what is called the ethics of nursing. Ethics refers to the practices
or beliefs of a certain group (i.e. Nursing/Midwives ethics, Physicians' ethics). It also refers to
the expected standards as described in the group's code of professional conduct. Ethics is
concerned with what ought to be, what is right, or wrong, good or bad. It is a formal reasoning
process used to determine right conduct. It is professionally and publicly stated. It is process
of questioning, and perhaps changing, one's morals.
Moral: Are principles and rules of right conduct. It is private or personal. Commitment to
principles and values are usually defended in daily life.

TYPES OF ETHICS
1. Descriptive: It is the description of the values and beliefs of various cultural, religious or
social groups about health and illness.
2. Normative: a study of human activities in a broad sense in an attempt to identify human
actions that are right or wrong and good and bad qualities. In nursing normative ethics
addresses: scope of practice of different categories of nurses and, level of competence
expected.
3. Analytical: analyzes the meaning of moral terms. It seeks the reasons why these action or
attitudes are either wrong or right.

COMMON ETHICAL THEORIES

Ethical theories may be compared to lenses that help us to view an ethical problem. Different
theories can be useful because they allow us to bring different perspectives in to our ethical
discussions or deliberations. There are four ethical theories:
1. Deontology
2. Teleology
3. Intuitionism
4. The ethic of caring
Deontology (Duty or rule-Based theory): This theory proposes that the rightness or
wrongness of an action depends on the nature of the act rather than its consequences. This
theory holds that you are acting rightly when you act according to duties and rights.
Responsibility arises from these moral facts of life. The theory denotes that duties and rights
are the correct measuring rods for evaluating action. One place where such factors are presented
is in codes of professional ethics. E.g informed consent, respect of patient.
Teleology (utilitarian or end based theory): This theory looks to the consequences of an
action in judging whether that action is right or wrong. According to the utilitarian school of
thought right action is that which has greatest utility or usefulness. Utilitarian hold that no
action in itself is good or bad, the only factors that make actions good or bad are the outcomes,
or end results that are derived from them.
Types of Utilitarian Theories
Act utilitarianism: suggests that people choose actions that will in any given circumstances
increase the over all-good.
Rule utilitarianism: suggests that people choose rules that when followed consistently will
maximize the overall good
Intuitions: The notion that people inherently know what is right or wrong; determining what
is not a matter of rational thought or learning. For example, nurse inherently known it is wrong
to strike a client, this does not need to be taught or reasoned out.
The ethic of caring (case based theory): Unlike the preceding theories which are based on
the concept of fairness (justice) an ethical caring is based on relationships. It stresses courage,
generosity, commitment, and responsibility. Caring is a force for protecting and enhancing
client dignity.

ETHICAL PRINCIPLES
Principles are basic ideas that are starting points for understanding and working through a
problem. Ethical principles presuppose that nurses should respect the value and uniqueness of
persons and consider others to be worthy of high regard. These principles are tents that are
important to uphold in all situations. The major principles of nursing ethics are:
1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
5. Veracity
6. Fidelity
7. Confidentiality

1. Autonomy: is the promotion of independent choice, self-determination and freedom of

action. Autonomy means independence and ability to be self-directed in healthcare.
Autonomy is the basis for the client's right to self-determination. It means clients are
entitled to make decision about what will happen to their body. The term autonomy implies
for basic elements:
• The autonomous person is respected
• The autonomous person must be able to determine personal goals.
• The autonomous person has the capacity to decide on a plan of action.
• The autonomous person has the freedom to act upon the choices.
• Competent adult clients have the right to consent or refuse treatment even if health care
providers do not agree with clients' decisions; their wishes must be respected.

Informed consent: is a process by which patients are informed of the possible outcomes,
alternatives and risks of treatments and are required to give their consent freely. It assures the
legal protection of a patient’s right to personal autonomy in regard to specific treatments and
procedures.
Paternalism: Restricting others autonomy to protect from perceived or anticipated harm. The
intentional limitation of another’s autonomy justified by the needs of another. Thus, the
prevention of any evil or harm is greater than any potential evils caused by the interference of
the individual’s autonomy or liberty. Paternalism is appropriate when the patient is judged to
be incompetent or to have diminished decision-making capacity.
Non-compliance: Unwillingness of the patient to participate in health care activities. Lack of
participation in a regimen that has been planned by the health care professionals to be carried
out by the client. Noncompliance may result from two factors:
✓ When plans seem unreasonable to the patient
✓ Patients may be unable to comply with plans for a variety of reasons including resources,
lack of knowledge, psychological and cultural factors that are not consistent with the
proposed plan of care.
2. Beneficence: Beneficence is doing or promoting good. This principle is the basis for all
health care providers. Nurses/Midwives take beneficent actions when they administer pain
medication, perform a dressing to promote wound healing or providing emotional support to a
client who is anxious or depressed. This principle provides nursing’s context and justification.
It lays the groundwork for the trust that society places in the nursing profession and the trust
that individuals place in particular nurses or health care agencies.
The principle of beneficence has three components:
􀀎 Promote good
􀀎 Prevent harm
􀀎 Remove evil or harm
3. Non-maleficence: Non-maleficence is the converse of beneficence. It means to avoid doing
harm. When working with clients, health care workers must not cause injury or suffering to
clients. It is to avoid causing deliberate harm, risk of harm and harm that occurs during the
performance of beneficial acts. E.g Experimental research that have negative consequences on
the client. Non-maleficence also means avoiding harm as a Consequence of good. In those
cases the harm must be weighed against the expected benefit.
4. Justice: Justice is fair, equitable and appropriate treatment. It is the basis for the obligation
to treat all clients in an equal and fair way. Just decision is based on client need and fair
distribution resources. It would be unjust to make such decision based on how much he or she
likes each client.
5. Veracity: Veracity means telling the truth, which is essential to the integrity of the client-
provider relationship. Health care providers obliged to be honest with clients; the right to self-
determination becomes meaningless if the client does not receive accurate, unbiased, and
understandable information.
6. Fidelity: Fidelity means being faithful to one's commitments and promises. Fidelity means
not only keeping commitment but also keeping or maintaining our obligation.
▪ Nurses’ commitments to clients include providing safe care and maintaining competence
in nursing practice.
▪ In some instances, a promise is made to a client in an over way
▪ Nurse must use good judgment when making promises to client.
7. Confidentiality: Confidentiality comes from Latin fide: trust. Confidentiality is non-
disclosure of private or secret information with which one is entrusted. Confidentiality in the
health care context is the requirement of health professionals to keep information obtained in
the course of their work private and continues after the patient’s death. Nurses/ midwives hold
in confidence any information obtained in a professional capacity, and use professional
judgment in sharing such information.

ETIQUETTES
▪ Etiquettes is conventional requirements as to social behavior; proprieties of conduct as
established in any class or community or for any occasion.
▪ It is also a prescribed or accepted code of usage in matters of ceremony, as at a court or in
official or other formal observances. Or the code of ethical behavior regarding professional
practice or action among the members of a profession in their dealings with each other
▪ Etiquettes are rules of formal behavior among people, class of society in a profession.
Etiquettes of nursing should be developed during training and should mature in the course
of one’s practice.
Some of these personal qualities or etiquettes include:
1. Respect: nursing as profession respect the dignity of man therefore practitioners are
expected to respect whoever they render service to. Respect to superior colleagues and
other member of the health team is also important.
2. Kindliness: the task of assisting an individual requires a degree of friendliness and every
nurse is expected to possess that.
3. Empathy: for a nurse to assist her patient, it is not enough to sympathies with him but
place herself in the position of the patient and that will make her serve the patient more
appropriately.
4. Personal integrity: a nurse should be morally upright in order to maintain her personal
integrity. This is necessary if the patient and his family should have confidence in the
nurse. Habit such as gossiping, stealing, dubiousness, pilfering et.c should not be fund in
the nurse.
5. Humility: the nurse should be humble as she provides services to the people and as she
relates with colleagues.
6. Conscientiousness: nurse should have a high sense of duty toward whoever they are
serving or whatever they do. This enables them give the best nursing care possible.
7. Emotional maturity: the art of caring requires that the care provider assume the degree
of maturity before she will be able to appreciate the fellow human being and take care of
his problem
8. Honesty: nurses are expected to be honest in their dealing with patient, patient relatives
and co-workers at all time.
9. Punctuality: nurses are to be punctual to their duties