COMPLIANCE TO LEGAL ETHICS AND MORAL STANDARDS OF NURSING PRACTICE AMONG LEVEL IV NURSING STUDENTS

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A Thesis Proposal Presented to The Faculty of College of Health Sciences University of Northern Philippines Vigan City, Ilocos Sur

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In Partial Fulfillment of the Requirements for the Degree Bachelor of Science in Nursing _________________________ by: JERMAINE MARIELLE TEMPLO PHILBERT PAUL TIMBREZA MAICA REOTUTAR MARICHELLE MANALO MAYCHEL GANDARA

2012

CERTIFICATION

This thesis entitled COMPLIANCE TO LEGAL ETHICS AND MORAL STANDARDS OF NURSING PRACTICE AMONG LEVEL IV NURSING STUDENTS prepared and submitted by Templo, Jermaine Marielle, et. al. In partial fulfilment of the requirements for the degree of Bachelor of Science in Nursing, has been examined and is hereby recommended for acceptance and approval for Proposal Defense.

ADELINA R. RAPANUT, Ed.D. Critic

Dr. ERWIN CADORNA Statistician

TERESITA AVILA, MAN Adviser

APPROVAL SHEET

Approved by the PANEL OF EXAMINEES on Proposal defense with a grade of _______________.

LARGUITA P. REOTUTAR, MAN, Ed.D. Chairman

MA. LINDA Q. DUMLAO, MAN Panel Member

GERALD DE PERALTA, MAN Panel Member

Accepted and approved in partial fulfilment of the requirements for the degree, Bachelor of Science in Nursing.

LARGUITA P. REOTUTAR, MAN, Ed.D. Dean, College of Health Sciences

Chapter I THE PROBLEM Introduction Every registered nurse studies medical ethics--nursing ethics in particular, a set of moral and practical guidelines that influences nursing decisions big and small. In essence, nursing ethics is a set of shared values or principles that govern the way nurses interact with patients, a patient's family, and even other doctors and nurses. In the United States, the American Nurses Association's (ANA) Code of Ethics outlines a nurse's ethical obligations and provides a non-negotiable ethical standard. It's kind of like an internal compass for navigating the clinical setting. Slight nuances set general medical ethics apart from ethics in nursing. Where doctors are concerned with treating the disease and finding a cure, nurses are dedicated to treating the person and easing suffering. That difference in perspective defines a nurse's ethical standpoint. Some of the broader nursing ethics issues today include questions about end-of-life care or the place of spirituality in nursing. Ethical issues on a day-to-day basis often involve patient communication and advocacy. Nurses are often the ones working closest with a patient while administering ongoing care. Patients may express desires, questions, and fears with their nurse, and those sentiments need to be shared with the rest of the health care team. From working with unbiased compassion to standing up for patients' rights, a nurse holds a wide range of responsibilities in addition to the actual physical work of caring for patients. The Code of Ethics guides nurses through these responsibilities, including: Practicing with

2 and respect for "the inherent dignity, worth and uniqueness of every individual; Always advocating for and striving to protect the health, safety, and rights of the patient; Helping to advance nursing by contributing to education and promoting public health initiatives; Nurses specializing in health care ethics may serve on hospital ethics committees or work in a legal setting. But a nurse in any setting must rely on and refer back to the nursing code of ethics throughout his or her career. In "Advanced Practice Nursing," Mariah Snyder and Michaelene Mirr state that professional nursing practice centers on four cornerstone ethical principles: autonomy, beneficence, nonmaleficence and justice. According to Joanne Hickey, Ruth Oimette, and Sandra Vengomi in "Advanced Practice Nursing," these ethical principles can include advocacy, loyalty, care/caring, compassion and human dignity. These ethical principles represent practical, professionally applicable expansions on the ANA "code."

In professional nursing practice, a consciously chosen ethical framework, appropriately applied, may facilitate the effectiveness of the nurse and other health-care staff, by providing an assistant "template" for data gathering that supports "reflective thinking," according to Snyder and Mirr. Ethical frameworks assist the nurse in decision making and facilitate the identification of multiple, often conflicting issues; or a well-defined ethical framework can assist the nurse in a relationship with the patient. Nurses must maintain a philosophy of care that includes ethical and moral principles as well as caring behaviours, according to Hickey, Oimette and Venegomi. Ethical frameworks help the nurse reconcile legal and ethical demands with care and compassion for the patient.

3 Having a code of ethics helps guide nurses through tricky situations and serves as a common reference point for everyone on the health care team. But the primary goal of nursing ethics is to protect patients. Veering from the code of ethics can lead to a breakdown in team communication and physical consequences for a patient. This study was primarily concerned to the compliance of level IV nursing students to the legal ethics-moral standards of nursing practice in order to evaluate their knowledge and skills regarding the legal ethics and moral standards as a graduating nurse. And as part of the study, the researcher was persuaded to have this research on compliance to legal ethics and moral standards since the researcher is focusing on medical practice and it has been in day to day life to have encounter situations where ethics and morals are applied. Thus, the researcher decided to know and assess how individual or the student nurses response to ethical-moral situations. As part of the Nursing Team, the researchers have chosen to have this type of research since,as student-nurse, in our day to day life would encounter situations where ethics and morals are applied. If a student-nurse would be lacking or would have an inadequate knowledge and skills about the legal ethics and moral standards, he would never be able to decide on what to do with the patient in such situations. Thus, in doing this research, the researchers will be able to know what ethical-moral is lacking in student-nurses so the results of this study can serve as a basis for what the nursing instructors and staffs should teach to the nursing students. Result of this study also serves as basis in the improvement of nursing care to patients.

4 Statement of the Problem This study aims to determine the level of compliance of legal ethics moral standards of nursing practice among level IV nursing students of University of Northern Philippines. Specifically, this study seeks to answer the following questions. 1. What is the profile of the level IV nursing students in terms of their Socio-demographic factors a. Age, b. Civil Status, c. Religion, d. Place of residence, e. Family income, f. Related seminar/training attended, and g. Involvement of related organizations 2. What is the level of knowledge on legal ethics-moral standards of nursing practice among level IV Nursing Students. 3. What is the level of compliance on legal ethics-moral standards of nursing practice among level IV Nursing Students. 4. Is there a significant relationship between compliance on legal ethics-moral standards among level IV Nursing Students and their socio-demographic factors.

5 Scope and Delimination The study aims to determine the level of compliance of the legal ethics and moral standards of nursing practice among Level IV nursing students of University of Northern Philippines last school year 2012-2013. There are one hundred (100) respondents which will purposively selected in this study distributed as follows: fifty (50) from College of Nursing and fifty (50) from College of Health Sciences respectively. The dependent variable of this study is the compliance of legal ethics-moral standards of nursing practice among level IV nursing students. The independent variable of the study is the profile of the level IV nursing students categorized as socio-demographic factors such as age, civil status, religion, place of residence and family income and student-related profile such as the related-seminar/training attended and involvement of related organizations.

Theoretical Framework Ethical theories provide a structured approach to moral reasoning in nursing practice. Ethical issues in nursing are better understood if the nurse explores the various methods of moral reasoning that are used to make judgments about the moral value of an action. There are three classes of theories used most often for moral reasoning in nursing practice. First, teleological or utilitarian theories - teleological is derived from the Greek

word "telos" meaning end and the word "logos" meaning science. Second, deontological or

6 principle based theories - deontological - is derived from the word "deon" which refers to duty. Third is the relational or caring theory. The names given to each of these classifications reflect the approach to the moral reasoning process that results in a judgment of moral wrong and right about a specific action. The utilitarian theories follow the line of moral reasoning that suggests that an act is morally good or bad based on its outcome or effect. Under this line of reasoning the action that brings the most good to the most numbers of people would be considered to be a "good" or morally correct act. This approach is sometimes referred to as a consequence base approach to moral reasoning and is often used to make decisions about funding and the delivery of health care. The deontological theories of moral reasoning emphasize the rightness of a particular action based on the ideas that certain principles must be upheld in human relationships. When trying to reason out what is the most moral action to take it is not the nature of the outcome that is judged. The action itself is judged to be morally right or wrong after consideration of individual rights, duties, and obligations that apply in the situation. In Canada there is a moral and legal obligation in nursing practice to act in the best interest of the patient even if that action is not in the best interest of the employer, the physician, or any other health care provider. The moral reasoning used in the following argument against capital punishment uses a deontological approach. "The purposeful killing of human beings is wrong and society uses that reasoning to make laws and punish people who commit such crimes. As humans we have an obligation to follow this principle and not then commit the same crime in the name of justice."

7 These theories bring an entirely new perspective to the process of moral reasoning forethical issues in nursing. Actions are not judged according to the outcome or the principles of duty and obligation. But rather a perspective of caring and responsibility is used to determine what might be a morally correct act. In others words the morally good act is the one that shows caring and concern for other people and what might be important to them. The three types of ethical theories use entirely different criteria for moral reasoning in order to come to a decision about right and wrong. Often when people disagree about "doing the right thing" it is because they are using different methods of moral reasoning to make a decision about the correct course of action. This becomes more obvious when these theories are examined in light of the questions that might be asked to make the moral determination of right and wrong. An understanding of the process of moral reasoning helps professional nurses to understand different viewpoints. This is especially helpful when the correct or morally "right" course of action is not immediately apparent when ethical issues in nursing practice are encountered; and when there is disagreement among family members or members of the health care team as to the most appropriate actions in a particular situation.

Conceptual Framework The researchers are guided by the paradigm which is shown below.

8 Independent Variable Dependent Variable

Socio-demographic factors a.Age, b.Civil Status,

Compliance of legal ethics-moral standards of nursing practice among level IV nursing students the

c.Religion, d.Place of residence, e.Family income, f.Seminars/Training attended, g.Involvement of related organizations,

University of Northern Philippines.

Figure 1. The research paradigm

The figure shows that the level of compliance of legal ethics-moral standards of nursing practice among level IV nursing students of University of Northern Philippines is significantly related to the Socio-Demographic Factors and Student-Related Profile among the Level IV Nursing Students.

9 HYPOTHESES The researcher posits that there is a significant relationship between the level of compliance of legal ethics-moral standards of nursing practice among level IV nursing students and their Socio-Demographic Profile.

Operational Definition of Terms For a clearer understanding of this study, the following terms are hereby defined along the context of their use. Level of Compliance of Legal Ethics-moral standards of nursing practice

Compliance- This refers to the act or process of complying to a desire, demand, proposal, or regimen or with coercion.

Legal ethics this refers to an ethical code governing the conduct of persons engaged in the practice of law and persons more generally in the legal sector.

Morality- this refers to the differentiation between intentions, decisions, and actions between those that are good (or right) and those that are bad (or wrong).

10 Standard- this refers to a degree or level of requirement, excellence or attainment. Nursing Practice- this refers to a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death. Code of Ethics- this refers to a law or code adopted by an organization in an attempt to assist those in the organization called upon to make a decision (usually most, if not all) understand the difference between 'right' and 'wrong' and to apply this understanding to their decision. The ethical code therefore generally implies documents at three levels: codes of business ethics, codes of conduct for employees and codes of professional practice.

SOCIO-DEMOGRAPHIC FACTORS- this refers to the personal attributes of the respondents used in this study in terms of age, civil status, educational attainment, occupation, monthly income, seminars/training attended, and involvement of related organizations. Age- This refers to the number of years that the respondents lived or existed at the time the study was conducted.

Civil Status-This refers to the marital status of the respondents as being single, married, widowed, or separated.

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Religion- This refers to the religious affiliation of the respondents.

Place of residence- This refers to the place where the respondents lived or resides the time this study was conducted.

Family income- This refers to the wages that received by the family which they use in the acquisition of their needs.

Related seminar/training attended- this refers to the seminars or trainings that the respondents had attended which is related to his course.

Involvement of related organizations- this refers to a related group or organizations that the respondents may be a part or a member of it.

Methodology This part of the study includes the research design, population, data gathering instrument, data gathering procedure as well as the statistical tools for data analysis.

12 Research Design This study will utilize the descriptive study because of the information that will be gathered are about present existing situations or conditions. Thus, the principal aim of this study is to employ this method to describe the nature of a situation as it exists at the time of study and to explore the effect of particular phenomena. And it also aims to know the compliance of legal ethics-moral standards of nursing practice among level IV nursing students.

Population and Sample The population of this study includes the Level IV nursing students of University of Northern Philippines from the College of Health Sciences and College of Nursing. In determining the samples of the study SLOVINs formula will be utilized while the respondents will be chosen through random sampling. Table 1 Distribution of the Respondents UNIVERSITY OF NORTHERN PHILLIPINES College of Health Sciences College of Nursing TOTAL: N n %

96 73 169

13 Data Gathering Instrument The questionnaire on the socio-demographic profile of the respondents and the questionnaire on the compliance to legal ethics and moral standards or nursing practice will be conducted by the researchers. Data Gathering Procedure The researcher will make a permission letter to the Office of the President at University of the Philippines, to the College Dean and with the level IV coordinators of the colleges involve in this research, to allow the researcher to float the questionnaires and ask some important information to the Level IV nursing student regarding to their compliance to legal ethics-moral standards. Statistical Treatment of Data The data that will be gathered will be analyzed, interpreted and presented as they will be documented based on the interview that the researchers will have conducted on this study. Thus, the following yare statistical tools in treating the data to be collected will be used: 1. Frequencies count and percentage were utilized to describe the socio-demographic profile of the level IV nursing students. 2. Mean will be used to describe the level of compliance to legal ethics-moral standards of nursing practice among the level IV nursing students. 3. Correlation Coefficient will be used to determine the relationship between compliance on legal ethics-moral standards among level IV Nursing Students and their socio-demographic factor.

14 QUESTIONAIRE ON COMPLIANCE TO LEGAL ETHICS-MORAL STANDARDS OF NURSING PRACTICE AMONG LEVEL IV NURSING STUDENTS Part 1. Socio-Demographic Profile DIRECTION: Please put ( X ) on your answer to each of the following questions. Some of your answer may be optional which you can write on the blank provided in each number. Please follow instructions carefully. NAME (Optional): _______________________________________________________________ COLLEGE: _____________________________________________________________________ A. Socio-demographic factors a. Age: _____ b. Civil Status ____Single ____Married ____Separated ____Widow c. Religion___________________ d. Place of residence: ________________________________________

15 e. Family income: ____ Below Php. 1,000.00 ____Php. 1,000.00 Php. 5,000.00 ____Php. 5,000.00- Php. 10,000.00 ____Php. 10,000.00 Php. 20,000.00 ____Php. 20,000.00 and Above f. Related seminar/training attended: ___________________________________ ___________________________________ ___________________________________ g. Involvement of related organizations: ___________________________________ ___________________________________ ___________________________________

Part II. Compliance to Legal ethics-moral standards of nursing practice.

CRITERIA

LEVEL OF COMPETENCY

SCORE

REMARKS

__________________COMPETENCIES 5 A. LEGAL RESPONSIBILITY 1. Compares ID Band with the name and number of the client in the chart. Checks the completeness of the admission consent and other documents contained in the chart. Documents in the chart accurately all matters related to the client. 4 3 2 1

2.

3.

16 CRITERIA LEVEL OF COMPETENCY SCORE REMARKS

__________________COMPETENCIES 5 B. ETHICO-MORAL RESPONSIBILITIES 1. 2. 3. 4. Respect the human rights and feelings of others. Demonstrate an understanding of the legal standards of care. Maintains privacy and confidentiality of the client. Respect Clients religious and cultural practices 4 3 2 1

TABLE OF CONTENTS

I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII.

Introduction.........................................................................................page 1 Statement of the problem....................................................................page 4 Scope and Delimination......................................................................page 5 Theoretical Framework.......................................................................page 5 Conceptual Framework.......................................................................page 7 Hypotheses..........................................................................................page 9 Operational Definition of Terms.........................................................page 10 Methodology.......................................................................................page 11 Research Design..................................................................................page 12 Population and sample.........................................................................page 12 Data Gathering Instrument..................................................................page 13 Data Gathering Procedure...................................................................page 13 Statistical Treatment of Data...............................................................page 13

XIV. Questionaire.........................................................................................page 15