The code of ethics for nurses.

Nurses are ever-increasingly confronted with complex concerns in their practice. Codes of ethics are fundamental guidance for nursing as many other professions. Although there are authentic international codes of ethics for nurses, the national code would be the additional assistance provided for clinical nurses in their complex roles in care of patients, education, research and management of some parts of health care system in the country. A national code can provide nurses with culturally-adapted guidance and help them to make ethical decisions more closely to the Iranian-Islamic background. Given the general acknowledgement of the need, the National Code of Ethics for Nurses was compiled as a joint project (2009-2011). The Code was approved by the Health Policy Council of the Ministry of Health and Medical Education and communicated to all universities, healthcare centers, hospitals and research centers early in 2011. The focus of this article is on the course of action through which the Code was compiled, amended and approved. The main concepts of the code will be also presented here. No doubt, development of the codes should be considered as an ongoing process. This is an overall responsibility to keep the codes current, updated with the new progresses of science and emerging challenges, and pertinent to the nursing practice.

Introduction

Nurses are responsible to provide their clients/patients with the high-quality care. They are undoubtedly confronted with various ethical challenges in their professional practice, so they should be familiar with ethical codes of conduct and the essentials of ethical decision making.

The codes of ethics have been adopted for many professions in recent decades. In nursing, as one the most-trusted professions, the ethical codes have been also published by nearly every recognized professional group worldwide. The first international code of ethics for nurses was adopted by the International Council of Nurses (ICN) in 1953 (1). The two codes prepared by American Nurses Association (ANA) (2) and Canadian Nurse Association (CAN) (3) are the examples of national codes of ethics for nurses. The codes outline how the nurses should behave ethically as a profession, and how they should decide when encounter barriers preventing them from fulfilling their professional obligations. The codes can also support nurses in their practice and reduce their moral distress.

In Iran, studies have shown nurses’ weaknesses in the knowledge of ethics and its application in practice (4, 5). In a qualitative study carried out by Negarandeh et al, the nurses identified “lack of code of ethics” as a barrier to patient advocacy in Iran (6). Sanjari et al, also, reviewed nursing codes of ethics and emphasized the necessity of compiling a national code of ethics for nurses in healthcare setting in 2008 (7). They suggested an adapted code considering cultural context and Islamic background of the country.

Considering the growing activities in the field of medical and healthcare ethics in Iran (8,9), and in order to address the needs and help to fulfill goals of health care system in the country, the National Code of Ethics for Nurses was prepared under supervision of the Ministry of Health and Medical Education (MOHME). It is expected that the Code will serve the interests and needs of the profession more efficiently, since it illustrate moral and professional obligations of nurses for prevention of diseases, promoting health in the society, communicating with colleagues, management of health care systems, and research activities.

The goal of this paper is to provide the nurses with the information about the National Code and help them to apply the provisions in their profession. The manuscript will introduce the main concepts of the recently published codes.

Methods

The project of “Compiling the National Code of Ethics for Nurses” was initiated by the Ethics Group of the Endocrinology and Metabolism Research Center (EMRC) of Tehran University of Medical Sciences (TUMS) in 2009.A working group composed of 3 nurses and one general practitioner prepared the first draft of the code through a study including the wide search of international and national codes of ethics for nurses in other countries. After compiling the draft, the project was continued as a joint project with Medical Ethics and History of Medicine Research Center (MEHRC) of TUMS and the Secretariat of High Council for Medical Ethics of Health Policy Council of MOHME.

At first, the preliminary draft was presented at special discussion secession at MEHRC and was challenged by professors, researchers and PhD and MPH students of TUMS. According to the discussions held, the draft was revised. Then, a Task Force that was appointed by the Secretariat of High Council for Medical Ethics of Health Policy Council of MOHME actively engaged in the process of reviewing and modification of the second draft of the code. The Task Force was composed of invited supervisors or head-nurses from main hospitals of TUMS, professors of Faculty of Nursing and Midwifery of TUMS, specialists in different fields of ethics, law, religion, and the representatives of Iranian Nursing Organization (INO), Medical Council of Islamic Republic of Iran, Office of Nursing Advisor to MOHME, Academy of Medical Sciences and Nursing Board of MOHME.

Owing to the sincere cooperation of all members of the Task Force, the final code was prepared after some discussion sessions. Then, it was proposed to the Health Policy Council of MOHME for evaluation and approval. The code as the National Code of Ethics for Nurses was delivered in the country in early 2011.

National Code of Ethics for Nurses

The Code is an entirely new document produced for nursing ethics in the country, which was published in Farsi (10). It is also available through the website of MOHME (11). The English version is enclosed here as annex1. The target audience includes all nurses in the fields of nursing education, research, administrative, and clinical care, in the whole.

The National Code defines the values which are comprehensive and culturally-adapted. Then, it classify the ethical responsibilities as five main parts of “Nurses and People”, “Nurses and the Profession”, “Nurses and Practice”, “Nurses and Co-workers”, and “Nursing, Education and Research”, including 71 provisions in total.

The code sets out the required elements for ethical conduct and empowers nurses to make ethical decisions more perfectly as they perform as clinical nurses, researchers, administrators and policy-makers. It also reminds the nurses of the valuable state of their profession and what they should attempt to uphold as a nurse in providing direct care to clients/patients, teaching nursing students, performing research, and the supervision and management.

As a main general conceptual background of the National code, the patients are not considered as only people who receive the nursing care, and others including the patients’ family and healthy people in the society are considered in the plans and services. Another essence of the Code is that the individual dignity should be respected, regardless of who is receiving the care, or from which nationality, ethnicity, religion, culture, socio-economic class, gender, etc the patient/client is. Meanwhile, under the provisions of the National Code, nurses must recognize and respect cultural sensitivity in everyday practice, even in this era of globalization.

According the Code, the nurses should be sensitive to the ethical challenges and do their best to fulfill their moral duties. It also emphasizes the importance of informed consent, and addresses main ethical issues in everyday practice such as respect to privacy and confidentiality of patients/clients, relationship with colleagues, efficient performance of the professional duties, conflicts of interests, ethics in educational activities and protection of participants in research.

The Code also deals with the administrative duties of nurses. Moreover, it elucidates the concern of how the nurses should communicate with the hospital ethics committee for decision-making when are confronted with ethical cases.

Conclusion

Considering the experiences in compiling national ethical codes and guidelines (12–18), the National Code of Ethics for Nurses is developed as a guide for performing nursing responsibilities and the ethical obligations of the profession. Although there are authentic international codes of ethics for nurses, the national code would be the additional assistance provided for clinical nurses in their complex roles in care of patients, education, research and management of some parts of health care system in the country. Most nurses may be either too busy or exhausted to think about their behavior in practice. However, accountability through meeting the obligations is essential in nursing which is one the most-trusted professions in all societies.

Development of the codes should be considered as an ongoing process, so it is expected that nurses reflect their ideas when they deal with the shortcomings of the codes in their practice. The inputs will enable authorities to improve the code and pave the way for its effective implementation. The codes should be revised and updated in regular intervals considering reflections from nurses across the country. This is an overall responsibility to keep the codes current, updated with the new progresses of science and emerging challenges, and pertinent to the nursing practice.

Ethical considerations

Ethical issues (Including plagiarism, Informed Consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc) have been completely observed by the authors.