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Reviewer about bioethics, Study notes of Bioethics

Angeles University (AU)Bioethics

reviewer and study notes about bioethics

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2021/2022

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NCMA 218
Principles of Ethics and Research
1. Nuremberg code of 1947
Ethics principles for human experimentation
resulting from Nazi doctors’ trial
 Focus on human rights and welfare
10 principles of Nuremberg Code
1. Voluntary free informed consent
2. Good unprocurable by other means
3. Medically justified: prior animal trials,
4. Proper design
5. No unnecessary suffering or injury
6. No death or disability except if researcher is
subjected to risks never exceed humanitarian
purpose
7. Protection/safeguards in place
8. Qualified researcher
9. Participants can stop anytime
10. Researcher ready to stop anytime
Declaration of Helsinki
Statement of ethical principles for medical
research involving human participants, including
identifiable human material and data; doctors
doing medical research on patients
For all involved in medical research
Basis for Good Clinical Practice (GCP)
GENERAL PRINCIPLES
• Purpose: understand disease, improve
interventions
• Human participants necessary
• Primacy of patient’s best interest: health,
well-being, rights
• Duty and responsibility of researcher even if
with consent of participants
• Subject to ethical standards: International and
national guidelines cannot reduce Helsinki
• Respect and protect participants
• Minimize harm to environment
• Qualified researcher
• Fair access to research
CLINICAL REVIEW AND EDUCATION
• Access for under-represented
• Physician justify using patients by potential
value and ensure that research will not
adversely affect health
• Appropriate compensation and treatment for
harm
RISKS, BURDENS, AND BENEFITS
• Pre-assess then monitor
• Importance of objectives outweigh R/B for
participants
o Benefits outweigh risks for participants and
groups affected and managed
• Measures to minimize implemented
• Once risks outweigh the benefits or if there is
already a clear outcome: assess if research
should be continued
VULNERABLE GROUPS AND INDIVIDUALS
• Increased likelihood of wrong and harm
– Special protection
• Responsive to their health needs
• Cannot be done on non-vulnerable
• Stand to benefit from result
SCIENTIFIC REQUIREMENTS AND RESEARCH
PROTOCOLS
• Conform to accepted scientific principles
• Respect animals
• Complete protocol including addressed ethical
considerations
• Post-trial provisions indicated
RESEARCH ETHICS COMMITTEES
• Transparent, independent, and qualified
• Follow norms
• Approve protocol
• Monitor study, approve amendments, and
receive final report
PRIVACY AND CONFIDENTIALITY
• Protect
INFORMED CONSENT
1. For capable: voluntary, informed
• method of obtaining: caution of dependent
relationships
• if not written: documented and witnessed
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NCMA 218

Principles of Ethics and Research

  1. Nuremberg code of 1947  Ethics principles for human experimentation resulting from Nazi doctors’ trial  Focus on human rights and welfare 10 principles of Nuremberg Code
  2. Voluntary free informed consent
  3. Good unprocurable by other means
  4. Medically justified: prior animal trials,
  5. Proper design
  6. No unnecessary suffering or injury
  7. No death or disability except if researcher is subjected to risks never exceed humanitarian purpose
  8. Protection/safeguards in place
  9. Qualified researcher
  10. Participants can stop anytime
  11. Researcher ready to stop anytime Declaration of Helsinki  Statement of ethical principles for medical research involving human participants, including identifiable human material and data; doctors doing medical research on patients  For all involved in medical research  Basis for Good Clinical Practice (GCP) GENERAL PRINCIPLES
  • Purpose: understand disease, improve interventions
  • Human participants necessary
  • Primacy of patient’s best interest: health, well-being, rights
  • Duty and responsibility of researcher even if with consent of participants
  • Subject to ethical standards: International and national guidelines cannot reduce Helsinki
  • Respect and protect participants
  • Minimize harm to environment
  • Qualified researcher
  • Fair access to research CLINICAL REVIEW AND EDUCATION
  • Access for under-represented
  • Physician justify using patients by potential value and ensure that research will not adversely affect health
  • Appropriate compensation and treatment for harm RISKS, BURDENS, AND BENEFITS
  • Pre-assess then monitor
  • Importance of objectives outweigh R/B for participants o Benefits outweigh risks for participants and groups affected and managed
  • Measures to minimize implemented
  • Once risks outweigh the benefits or if there is already a clear outcome: assess if research should be continued VULNERABLE GROUPS AND INDIVIDUALS
  • Increased likelihood of wrong and harm
  • Special protection
  • Responsive to their health needs
  • Cannot be done on non-vulnerable
  • Stand to benefit from result SCIENTIFIC REQUIREMENTS AND RESEARCH PROTOCOLS
  • Conform to accepted scientific principles
  • Respect animals
  • Complete protocol including addressed ethical considerations
  • Post-trial provisions indicated RESEARCH ETHICS COMMITTEES
  • Transparent, independent, and qualified
  • Follow norms
  • Approve protocol
  • Monitor study, approve amendments, and receive final report PRIVACY AND CONFIDENTIALITY
  • Protect INFORMED CONSENT
  1. For capable: voluntary, informed
  • method of obtaining: caution of dependent relationships
  • if not written: documented and witnessed
  • option of being informed of general outcome and study results
  1. For not capable: legally authorized representative;
  • consider vulnerable group
  • assent if capable, dissent respected •condition vulnerable characteristic for research; if circumstances prevent Free and Informed Consent, REC approval, proxy; ASAP Belmont Report 1976 The Belmont Report is a report created by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Its full title is the Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research, Report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The report was issued on 30 September 1978[1] and published in the Federal Register on 18 April 1979. [2] The report took its name from the Belmont Conference Center where the document was drafted in part. The Belmont Conference Center, once a part of the Smithsonian Institution, is in Elkridge, Maryland, 10 miles south of Baltimore, and until the end of 2010 was operated by Howard Community College. [3] The Belmont Report [2] summarizes ethical principles and guidelines for research involving human subjects. Three core principles are identified: respect for persons, beneficence, and justice. Three primary areas of application are also stated. They are informed consent, assessment of risks and benefits, and selection of subjects. According to Vollmer and Howard, the Belmont Report allows for a positive solution, which at times may be difficult to find, to future subjects who are not capable to make independent decisions. The three fundamental ethical principles for using any human subjects for research are:
  1. Respect for persons: protecting the autonomy of all people and treating them with courtesy and respect and allowing for informed consent. Researchers must be truthful and conduct no deception;
  2. Beneficence: the philosophy of "Do no harm" while maximizing benefits for the research project and minimizing risks to the research subjects; and
    1. Justice: ensuring reasonable, non- exploitative, and well-considered procedures are administered fairly — the fair distribution of costs and benefits to potential research participants — and equally. Ethical Issues Related to Evidenced Based Practice Evidence- Based medicine or evidence based practice, is the judicious use of the best current evidence in making decisions about the care of the individual patient. Evidence-base practice is a systematic inter connecting scientifically generated evidence with the tacit knowledge of the expert practitioner to achieve a change in a particular practice for the benefit of a well-defined client/patient group. Evidence-based nursing it is a process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preference Ethical issues Moral principles such as truth, fairness, and respecting autonomy lie at the heart of these ethical concerns. Evidence based practice focuses on searching and appraising available evidence on the advantages and disadvantages of various interventions. Ethical issues include:  Status of evidence- available evidence in health care areas consists mostly of expert opinions where despite important advance in research, only few have amassed sufficient data to enable research-based confidence in treatment interventions.  Client Autonomy- patient and family participation in planning and intervention (autonomy) is an important dimension of rehabilitation. This participation should also include decision making under difficult circumstances by the client when competing interests are decided.  Conflict of interest- May be represented when clinical trials are subjected to questions about the validity of their contributions. ETHICO-MORAL OBLIGATIONS OF THE NURSE IN EVIDENCE-BASED PRACTICES
    2. Golden Rule
    3. The principle of Totality – The whole is greater than its parts
  1. The patient’s progress, including response to treatment, change in treatment, change in diagnosis, and patient non-compliance, should be documented.
  2. The written plan for care should include, when appropriate: • treatments and medications, specifying frequency and dosage;
  • any referrals and consultations; • patient/family education; and • specific instructions for follow-up.
  1. The documentation should support the intensity of the patient evaluation and/or the treatment, including through processes and the complexity of medical decision-making as it relates to the patient’s chief complaint for the encounter.
  2. All entries to the medical record should be dated and authenticated.
  3. The specific claim form should reflect the documentation in the medical record. GUIDELINES IN DOCUMENTATION
  4. Objective/Factual Documentation Direct observations and objective descriptions of interventions rendered to clients are recorded. Data are entered accurately, completely, and objectively including unintentional errors or any inaccuracy must be recorded properly.
  5. Timeliness Refers to completion of health care notes immediately within time specific care is rendered which reflects credibility and accuracy of health records.
  6. Use of Space Empty lines or spaces are avoided to prevent late-entry of data. Institutional policy on how to manage blank spaces such as writing “Not applicable” or “N/A” should be observed rather than leaving a space blank.
  7. Use of Abbreviations or acronyms that are internationally/institutionally accepted are the only ones used in the unit and that error-prone abbreviations must be eliminated.
  8. Follow-up All follow-up activities related to client care such as assessments, observations or interventions or other follow-up action taken, and the client’s response to interventions should be documented on the client’s health- care record.
  9. Correcting Errors in isolated cases when errors in documentation are committed it is advised that the SLIDE rule (Baker, 2000) be utilized. The steps of the SLIDE rule include: cross through the word(s) with a single line, and insert your initials, along with the date and time the correction is made; then enter the correct information/explanation. Some agencies require that the correction is highlighted by using an arrow or asterisk. Check the agency/facility policy for the accepted means of correcting errors, as some require that words such as “health-care recording or documentation error”, “error”, “mistaken entry” and “void” are included with your initials. 7.Recording Medication Administration of medications are immediately documented after administration in order to prevent medication errors and promote patient safety. Nurses are expected to document medications they personally administer. In the event another member of the health care are to administer drugs prepared by the nurse, there must be existing institutional policy that must be observed.
    1. Recording Assistance with Care There are numerous circumstances that one nurse is assisted by another nurse in performing a specific nursing intervention, in this event the nurse providing care must document the presence of the other nurse who assisted her in the report. It is not necessary to give the name of the nurse but in critical incidents like falls it is necessary to provide the names of those present.
    2. Designated Recorder in Emergency Situations During emergency situations there must be a designated recorder that identifies the people involved and the care they provided. This is to promote efficiency in delivering required care during emergency situation.
    3. Clarification of Orders Medical orders that are poorly written require nurses to call the writer for clarification. High risk for error and potential for an unsafe practice are evident. A written record of every telephone call should be maintained, whether it is with another care provider for clarification of orders, or with a client following discharge from your facility or unit.
    4. Recording a Telephone Conversation with a Client Telephone conversation with a client does not give the nurse the benefit of verifying objective findings. The hospital record must reflect the date, year and time of the call, the nature of the call, the response by the nurse and all significant health care advice provided to the client.
    5. Interactions with other Health-care Professionals It is the responsibility of the nurse when formulating nursing care plans to include outcomes of agreed upon plan of action and the

names of the people involved. All health-care professionals are responsible for documenting the care they provided or the actions taken. The system used should record all interactions with members of the health-care team, including clarification of orders, failed attempts to reach other team members, and the follow up action taken.

  1. Client Education Educational interventions and related health teachings that provide comprehensive information to clients must be documented. It promotes clear communications on a daily basis, of the scope and
  2. Documenting an Incident in the Health-care Record It is imperative that all incidents that occured with its corresponding pertinent data are documented in the client’s health record. Prescribed protocol on documenting these types of incidents are to be followed in order to provide clear resolutions. CONFIDENTIALITY Health care personnel are obligated to maintain confidentiality in dealing with all information pertaining to patient’s hospitalization an care provided to each one of them. Discretion in the access, retrieval, transmittal and storage of relevant documents and safe-keeping of all copies of valuable health records must be maintained at all times at all costs. Availability of various forms of technology must not change nor disregard this fundamental patient’s right to privacy of health information. ETHICAL AND LEGAL ASPECTS OF DOCUMENTATION Legal Implications of Documentation
  3. The patient’s health-care record is an important legal document.
  4. It must contain the following: • accountability and the provision of care/treatment • database used to resolve questions/concerns about care
  • chronological record of events involving patient care and hospital stay • nursing care rendered
  1. It is intended to: • refresh the nurse of situations that are required to give evidence in court • reconstruct events • establish times and dates • resolve conflict in testimony, and • show that standard of care and reasonable and prudent care was provided.
    1. Correcting errors in charting/documentation: Moral Decision-Making Principle of Moral Discernment Olson (2002) refers to the ability to discern what is morally right from morally wrong that requires moral reflectiveness on the meaning of good and bad. It refers to ability to draw conclusions from the discernment to develop convictions. Four Principles of Moral Discernment/Judgment  Principle of formal cooperation  Principle of Material cooperation  Principle of lesser evil  Principle of double effect Principle of well-formed conscience  Informed consent to medical treatment is fundamental in both ethics and law.  Patients have the right to receive information and ask questions about recommended treatments so that they can make well- considered decisions about care.  Successful communication in the patient- physician relationship fosters trust and supports shared decision making Strategies of Moral Decision-Making Process Ethical Dilemma  is a problem in the decision-making process between two possible options, neither of which is absolutely acceptable from an ethical perspective;  Approaches to solve an ethical dilemma were deduced:  Refute the paradox (dilemma): The situation must be carefully analyzed. In some cases, the existence of the dilemma can be logically refuted.  Value theory approach: Choose the alternative that offers the greater good or the lesser evil.  Find alternative solutions: In some cases, the problem can be reconsidered, and new alternative solutions may arise. PROCESS OF ETHICAL DECISION MAKING  Gather data and identify conflicting moral claims  Identify key participants  Determine moral perspective and phase of moral development of key participants  Determine desired outcomes

Is concerned with the distribution of benefits and costs to distinct individuals or groups. The maximization of benefits, which is associated with the general philosophical moral theory of utilitarianism or consequentialism, however, is routinely criticized for ignoring those considerations (Rawls 1971). Equity in health care distribution is complex and embodies several distinct moral concerns or issues that this chapter delineates. There is no generally accepted methodology comparable to CEA for determining how equitable a distribution is; nevertheless, allocations are unsatisfactory if equity considerations are ignored. Issues involving access to care  Access to Quality Care - Patients want to be able to access their healthcare when they want and need it.  Geographic and Manpower Shortage  Limited education  Poor infrastructures  Cost  Scientific evidence vs Cultural Practice BENEFITS AND CHALLENGES OF TECHNOLOGY  Reducing healthcare costs.  Predicting epidemics.  Avoiding preventable deaths.  Improving quality of life/quality care  Reducing healthcare waste.  Improving mobility/access  Developing new drugs and treatments.  Security e.g. data hacking/phishing  Volume of data in iCloud  Dangers with AI central data point  Impersonal patient-healthcare provider relationships  Connectivity  Cost  Fast and numerous changes Current technology: Issues and dilemma  Portability  Cost  Real-  Security  time events  Equity  Justice Lobbying/Advocating fort Ethical Issues Related to Health Care  Since the ethical foundation of lobbying is the vigorous public debate necessary for informed decision making, ethical dilemmas related to lobbying tend to arise when various behaviors by lobbyists and lawmakers undermine the fairness and transparency of that process and do not contribute to the common good  Ethical lobbyists embrace the rule of law and its underlying principles. Avoid conflicts of interest: If a potential conflict arises, ethical lobbyists disclose it immediately to both parties and recuse themselves until the matter is resolved. Code of Ethics for Nursing; Multiple Ethical Obligations; Nurse-Doctors Relations A. The History of Code of Ethics for Filipino Nurse’s 1922- The Code was formed 1982- PNA approved the COE October 1983- COE was published October 21, 1982- The final presentation of the documents. March 21, 1984- the PRC Board of Nursing adopted the ICN. BON Resolution no. 633 October 18, 1989- The amended Code of Ethics was approved by the BON in its resolution no. 1955 October 23, 2003- New COE was presented at the Assembly of Nursing Rep. during the 81st Foundation. Anniversary, 46th Nurses Week Celebration, and the Annual National Convention of Nurses in Iloilo City July 14, 2004- The new COE for Filipino Nurses was finally promulgated. PRC-BON Resolution no.220. B. CODE OF ETHICS FOR REGISTERED NURSES (BOARD OF NURSING) Board Resolution No. 220, Series of 2004 approved last 14th day of July, 2004 CODE OF ETHICS FOR NURSES WHEREAS, the Board of Nursing (BON) has the power to promulgate a Code of Ethics for Registered Nurses in coordination and consultation with the accredited professional organization (Sec. 9, (g), Art III of (Republic Act) No. 9173, known as the “Philippine Nursing Act of 2002); WHEREAS, in the formulation of the Code of Ethics for Registered Nurses, the Code of Good Governance for the Professions in the Philippines was utilized as the principal basis thereof: All the principles under the said Code were adopted and integrated into the Code of Ethics as they apply to the nursing profession;

WHEREAS, the promulgation of the said Code as a set of guidelines, regulations or measures shall be subject to approval by the Commission (Sec. 9, Art. II of R.A. No. 9173); and WHEREAS, the Board, after consultation on October 23, 2003 at Iloilo City with the accredited professional organization of registered nurses, the Philippine Nurses Association, Inc. (PNA), and other affiliate organizations of Registered Nurses, decided to adopt a new Code of Ethics under the afore-mentioned new law; NOW, THERFORE, the Board hereby resolved, as it now resolves, to promulgate the hereunder Code of Ethics for Registered Nurses: ARTICLE I PREAMBLE SECTION 1. Health is a fundamental right of every individual. The Filipino registered nurse, believing in the worth and dignity of each human being, recognizes the primary responsibility to preserve health at all cost. This responsibility encompasses promotion of health, prevention of illness, alleviation of suffering, and restoration of health. However, when the foregoing are not possible, assistance towards a peaceful death shall be his/her obligation. SECTION 2. To assume this responsibility, registered nurses have to gain knowledge and understanding of man’s cultural, social, spiritual, physiological, psychological, and ecological aspects of illness, utilizing the therapeutic process. Cultural diversity and political and socio-economic status are inherent factors to effective nursing care. SECTION 3. The desire for the respect and confidence of clientele, colleagues, co-workers, and the members of the community provides the incentive to attain and maintain the highest possible degree of ethical conduct. ARTICLE II REGISTERED NURSES AND PEOPLE SECTION 4. Ethical Principles

  1. Values, customs, and spiritual beliefs held by individuals shall be respected.
  2. Individual freedom to make rational and unconstrained decisions shall be respected.
    1. Personal information acquired in the process of giving nursing care shall be held in strict confidence. SECTION 5. Guidelines to be observed: REGISTERED Nurses must a. consider the individuality and totality of patients when they administer care. b. respect the spiritual beliefs and practices of patients regarding diet and treatment. c. uphold the rights of individuals. d. take into consideration the culture and values of patients in providing nursing care. However, in the event of conflicts, their welfare and safety must take precedence. ARTICLE III REGISTERED NURSES AND PRACTICE SECTION 6. Ethical Principles
    2. Human life is inviolable.
    3. Quality and excellence in the care of the patients are the goals of nursing practice.
    4. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability SECTION 7. Guidelines to be observed: REGISTERED Nurses must a. Know the definition and scope of nursing practice which are in the provisions o R. A. No. 9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of 2003, the “Rules and Regulations Implementing the Philippine Nursing Act. of 2002”, (the IRR). b. Be aware of their duties and responsibilities in the practice of their profession as defined in the “Philippine Nursing Act of 2002” and the IRR. c. Acquire and develop the necessary competence in knowledge, skills, and attitudes to effectively render appropriate nursing services through varied learning situations. d. If they are administrators, be responsible in providing favorable environment for the growth

do anything that will bring discredit to a colleague and to any member of other professions. g. respect the rights of their co-workers. ARTICLE V REGISTERED NURSES, SOCIETY, AND ENVIRONMENT SECTION 14. Ethical Principles

  1. The preservation of life, respect for human rights, and promotion of healthy environment shall be a commitment of a Registered Nurse.
  2. The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse. SECTION 15. Guidelines to be observed: REGISTERED Nurses must a. be conscious of their obligations as citizens and, as such, be involved in community concerns. b. be equipped with knowledge of health resources within the community, and take active roles in primary health care. c. actively participate in programs, projects, and activities that respond to the problems of society. D .lead their lives in conformity with the principles of right conduct and proper decorum. e. project an image that will uplift the nursing profession at all times. ARTICLE VI REGISTERED NURSES AND THE PROFESSION SECTION 16. Ethical Principles:
  3. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal.
  4. Compliance with the by-laws of the accredited professional organization (PNA), and other professional organizations of which the Registered Nurse is a member is a lofty duty.
    1. Commitment to continual learning and active participation in the development and growth of the profession are commendable obligations.
    2. Contribution to the improvement of the socio-economic conditions and general welfare of nurses through appropriate legislation is a practice and a visionary mission. SECTION 17. Guidelines to be observed: Registered Nurses must a. be members of the Accredited Professional Organization (PNA). b. strictly adhere to the nursing standards. c. participate actively in the growth and development of the nursing profession. d. strive to secure equitable socio-economic and work conditions in nursing through appropriate legislation and other means. e. assert for the implementation of labor and work standards. ARTICLE VII ADMINISTRATIVE PENALITIES, REPEALING CLAUSE, AND EFFECTIVITY SECTION 18. The Certificate of Registration of Registered Nurse shall either be revoked or suspended for violation of any provisions of this Code pursuant to Sec. 23 (f), Art. IV of R. A. No. 9173 and Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR. C.THE INTERNATIONAL COUNCIL OF NURSES (ICN) CODE OF ETHICS FOR NURSES An international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2012. Nurses have four fundamental responsibilities:
    3. To promote health
    4. To prevent illness
    5. To restore health
    6. To alleviate suffering What exists in nursing?

Is a respect for human rights These includes: Cultural rights The right to having a life and choice To have dignity To be treated with respect Nursing care is respectful of and unrestricted by considerations of: Gender and Age Color and Race Creed – set of beliefs Culture Disability or illness Social status Sexual orientation Nationality Politics The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct.

  1. Nurses and people -Nurse’s primary professional responsibility is to people requiring nursing care.
  2. Nurses and practice
  • Nurses carries personal responsibility and accountability for nursing practice
    • Maintaining competence by continual learning.
  1. Nurses and the profession The nurse assumes the major role in: determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in:
    1. Developing a core of research-based professional knowledge.
    2. Developing and sustaining a core of professional values.
  2. Nurses and co-workers The nurse sustains a collaborative and respectful relationship with c0-workers in nursing and other fields. The nurse takes appropriate action to safeguard individuals, families, and communities when their health is endangered by a co-worker or any other person. - The nurse takes appropriate action to support and guide co-workers to advance ethical conduct. SUGGESTIONS FOR USE of the ICN Code of Ethics for Nurses The ICN Code of ethics for Nurses is a guide for action based on social values and needs. It will have meaning only as a living document if applied to the realities of nursing and health care in a changing society. To achieve its purpose the Code must be understood, internalized and used by nurses in all aspects of their work. It must be available to students and nurses throughout their study and work lives. D. Professional Boundaries and Ethico-Moral Obligations for Nurses as Specified by the ANA Code of Ethics for Nurses with Interpretive Statements (2001) Clinical Practice Boundaries Respecting patients’ dignity Right to self-determination Delegating tasks appropriately Practicing good judgment Accepting accountability in practice Alleviating suffering Being attentive to patients’ interests Working within the nurse practice acts and nursing standards of practice Professional Practice Boundaries Maintaining authenticity in all relationships with others such as nurse-to-nurse relationships, nurse-physician relationships, nurse-to-patient relationships, and multidisciplinary collaboration. Addressing and evaluating issues of impaired practice; fraternizing inappropriately with patients or others; Accepting inappropriate gifts from patients and families; Confidentiality and privacy violations; and unhealthy, unsafe, illegal, or unethical environments. Self-Care and Self-Development Boundaries and Obligations
  1. Individual freedom to make rational and unconstrained decisions shall be respected.
  2. Personal information acquired in the process of giving nursing care shall be held in strict confidence. Nurses and the Profession Ethical Principles:
  3. Maintainance of loyalty to the nursing profession and preservation of its integrity are ideal.
  4. Compliance with the by-laws of the accredited professional organization (PNA), and other professional organizations of which the Registered Nurse is a member is a lofty duty.
  5. Commitment to continual learning and active participation in the development and growth of the profession are commendable obligations.
  6. Contribution to the improvement of the socio-economic conditions and general welfare of nurses through appropriate legislation is a practice and a visionary mission. Nurses and Practice Ethical Principles
  7. Human life is inviolable.
  8. Quality and excellence in the care of the patients are the goals of nursing practice.
  9. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability Nurses and Co-workers Ethical Principles
  10. The Registered Nurse is in solidarity with other members of the healthcare team in working for the patient’s best interest.
  11. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and other health care providers Nurses Society and Environment Ethical Principles
  12. The preservation of life, respect for human rights, and promotion of healthy environment shall be a commitment of a Registered Nurse.
  13. The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse.