THE ETHICAL PRINCIPLES

CODE OF ETHICS

Code : systematic collection of statutes, body of laws so arranged as to avoid inconsistency and
overlapping ; set of rules on any subject. 

Code of ethics is a set of ethical principles that are accepted by all members of a profession. (potter &
perry )

Code of ethics is a guideline for performance ,standards & personal responsibilities.

Purposes of Code of Ethics:

1. Set standards for the behaviors of nurse

2. Provide general guidelines for nursing action helps to distinguish between right & wrong
3. Enables a correct decision protect the rights of individual

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.

An International Code of Ethics( ICN )code of ethics for nurses has four principal elements that outline
the standards of ethical conduct.

Elements of the ICN Code of Ethics

1. NURSES AND PEOPLE

 The nurse’s primary professional responsibility is to people requiring nursing care.
 In providing care, the nurse promotes an environment in which the human rights, values,
customs and spiritual beliefs of the individual, family and community are respected.
 The nurse ensures that the individual receives accurate, sufficient and timely information in a
culturally appropriate manner on which to base consent for care and related treatment.
 Nurse holds in confidence personal information and uses judgement in sharing this
information. T
 The nurse shares with society the responsibility for initiating and supporting action to meet
the health and social needs of the public, in particular those of vulnerable populations.
 The nurse advocates for equity and social justice in resource allocation, access to health
care and other social and economic services. the nurse demonstrates professional values
such as respectfulness, responsiveness, compassion, trustworthiness and integrity

2. NURSES AND PRACTICE

 the nurse carries personal responsibility and accountability for nursing practice, and for
maintaining competence by continual learning.
 the nurse maintains a standard of personal health such that the ability to provide care is not
compromised.
 the nurse uses judgement regarding individual competence when accepting and delegating
responsibility.
  the nurse at all times maintains standards of personal conduct which reflect well on the
profession and enhance its image and public confidence
 the nurse, in providing care, ensures that use of technology and scientific advances are
compatible with the safety, dignity and rights of people. the nurse strives to foster and
maintain a practice culture promoting ethical behaviour and open dialogue.
3. .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 developing a core of research-based professional knowledge that
supports evidence-based practice.
 The nurse is active in developing and sustaining a core of professional values.
 The nurse, acting through the professional organisation, participates in creating a positive
practice environment and maintaining safe, equitable social and economic working
conditions in nursing.
 The nurse practices to sustain and protect the natural environment and is aware of its
consequences on health.
 The nurse contributes to an ethical organizational environment and challenges unethical
practices and settings
4. NURSES AND CO-WORKERS
 The nurse sustains a collaborative and respectful relationship with co-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

BOARD OF NURSING Board Resolution No. 220 Series of 2004

PROMULGATION OF THE CODE OF ETHICS FOR REGISTERED NURSES

WHEREAS, the Board of Nursing 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 R.A.
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 prinicipal basis therefor: 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,
THEREFORE, the Board hereby resolved, as it now resolves, to promulgate the hereunder Code of Ethics
for Registered Nurses:

ARTICLE I
 PREAMBLE SECTION

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.

3. Personal information acquired in the process of giving nursing care shall be held in strict confidence.

ARTICLE II

REGISTERED NURSES AND PEOPLE

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

1. Human life is inviolable.

2. Quality and excellence in the care of the patients are the goals of nursing practice.

3. 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 of 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. PRC-BN d. if they are
administrators, be responsible in providing favorable environment for the growth and developments of
Registered Nurses in their charge.

e. be cognizant that professional programs for specialty certification by the BON are accredited through
the Nursing Specialty Certification Council (NSCC).

g. see to it that quality nursing care and practice meet the optimum standard of safe nursing practice.

h. insure that modification of practice shall consider the principles of safe nursing practice.

i. if in position of authority in a work environment, be normally and legally responsible for devising a
system of minimizing occurrences of ineffective and unlawful nursing practice.

j. ensure that patients’ records shall be available only if they are to be issued to those who are
professionally and directly involved in their care and when they are required by law

SECTION 8.

Ethical Principle

4.Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard
their rights and privileges.

Guidelines to be observed: REGISTERED Nurses must

a. respect the “Patients’ Bill of Rights” in the delivery of nursing care.

b. provide the patients or their families with all pertinent information except those which may be
deemed harmful to their well-being.
c. uphold the patients’ rights when conflict arises regarding management of their care .

SECTION 10.

Ethical Principle

5. Registered Nurses are aware that their actions have professional, ethical, moral, and legal
dimensions. They strive to perform their work in the best interest of all concerned

SECTION 11.

Guidelines to be observed:

REGISTERED Nurses must:

a. perform their professional duties in conformity with existing laws, rules regulations. measures, and
generally accepted principles of moral conduct and proper decorum.

b. not allow themselves to be used in advertisement that should demean the image of the profession
(i.e. indecent exposure, violation of dress code, seductive behavior, etc.). c. decline any gift, favor or
hospitality which might be interpreted as capitalizing on patients.

d. not demand and receive any commission, fee or emolument for recommending or referring a patient
to a physician, a co-nurse or another. health care worker; not to pay any commission, fee or other
compensations to the one referring or recommending a patient to them for nursing care

e. avoid any abuse of the privilege relationship which exists with patients and of the privilege access
allowed to their property, residence or workplace.

ARTICLE IV

REGISTERED NURSES AND CO-WORKERS

SECTION 12. Ethical Principles

1. The Registered Nurse is in solidarity with other members of the healthcare team in working for the
patient’s best interest.

2. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and
other health care providers.

SECTION 13.

Guidelines to be observed:

REGISTERED Nurses must

a. maintain their professional role/identity while working with other members of the health team.

b. conform with group activities as those of a health team should be based on acceptable, ethico-legal
statndards.

c. contribute to the professional growth and development of other members of the health team.
d. actively participate in professional organizations.

e. not act in any manner prejudicial to other professions.

f. honor and safeguard the reputation and dignity of the members of nursing and other professions;
refrain from making unfair and unwarranted comments or criticisms on their competence, conduct, and
procedures; or not do anything that will bring discredit to a colleague and to any member of other
professions.

g. respect the rights of their co workers

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:
1. Maintainance of loyalty to the nursing profession and preservation of its integrity are
ideal.
2. 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.
3. Commitment to continual learning and active participation in the development and
growth of the profession are commendable obligations.
 4. 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. 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 VII

ADMINISTRATIVE PENALITIES, REPEALING CLAUSE, AND EFFECTIVITY

SECTION 18

8. 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.

SECTION 19. The Amended Code of Ethics promulgated pursuant to R. A. No. 877 and P.D. No. 223 is
accordingly repealed or superseded by the herein Code.

SECTION 20. PRC-BN This Code of Ethics for Nurses shall take effect after fifteen (15) days from its full
and complete publication in the Official Gazette or in any newspapers of general circulation. Done in
the City of Manila, this 14th day of July, 2004.

ETHICAL PRINCIPLES INVOLVED IN NURSING

In reality, ethical principles control professionalism in nursing practice

much more than the ethical theories. Principles encompass basic promises
from which rules are developed. Principles are the moral norms that
nursing, as a profession, both demands and strives to implement in
everyday clinical practice. The ethical principles that a nurse should
consider when making decisions are as follows:

1. Respect for persons

2. Respect for autonomy
3. Respect for freedom
4. Beneficence (doing good)
 5. Non-maleficence (avoiding harm to others)
6. Veracity (truth telling)
7. Justice (fair and equal treatment)
8. Respect for patients’ rights
9. Fidelity (fulfilling promises)
10. Confidentiality (protecting privileged information)

These principles are discussed in detail.

Respect for the Patient as a Person:  The basic responsibility of

nursing ethics is to respect the patient or the client as a person or a human
being. This is done by allowing the patients to take decisions based on the
choices available in treatment, addressing them by name and not by body
structure, providing respect for their privacy, respecting their beliefs and
wishes, and striving to obtain all their rights such as the right to be
informed, the right to get oriented, and the right to refuse or accept
treatment.

Respect for Freedom to Make Choices in the Patient Care:  Many

hospitals never allow the patient to choose the treatments and are very
authoritative. However, it is unethical. The patient has the freedom to make
choices about the treatment, continue the treatment, withhold or withdraw
the treatment, and get discharged at any time from the hospital.

Respect for Freedom to Make Choices in the Patient Care:  Many

hospitals never allow the patient to choose the treatments and are very
authoritative. However, it is unethical. The patient has the freedom to make
choices about the treatment, continue the treatment, withhold or withdraw
the treatment, and get discharged at any time from the hospital.

Beneficence:  Beneficence means doing good to benefit others. Being

beneficial or doing good is the ultimate goal of a nurse. When a patient gets
admitted to a hospital, it is the duty of the nurse to alleviate his/her
suffering and discomfort, whether it is physical, psychological, or social,
and to do only good to the patient throughout the period of his/her
hospitalization. Learning procedures while on duty should be avoided, for
example, learning to inject a patient. In procedures such as the insertion of
intravenous cannula in the patient’s vein, in which the nurse pierces the
patient’s skin, if he/she follows the correct standards of practice and inserts
the needle as per the procedure, he/she is doing good. Instead, if he/she is
learning to puncture the vein and tries repeated venupuncture in the same
vein, it will harm the patient and should not be done.

Non-maleficence:  

Nonmaleficence is the principle used to communicate the obligation to do no harm. Emphasizing

the importance of this principle is as old as organized medical practice. Healthcare professionals
have historically been encouraged to do good (beneficence), but if for some reason they cannot
do good, they are required to at least do no harm. Because of the two sides of the same coin
connotation between these two principles, some people consider them to be essentially one and
the same. However, many ethicists, including Beauchamp and Childress (2013), do make a
distinction.

A nurse should know about and anticipate the problems that may occur to
the patient during treatment. For example, the position of a bed-ridden and
paralysed patient should be changed frequently and all the necessary
comfort devices should be provided to him/her. Otherwise, it leads to
formation of bedsores in the patient, which is difficult to cure. If the nurse
never changes the position, it amounts to doing harm knowingly.
Therefore, all the nursing activity should be directed towards not doing
harm to the patient.

Veracity:  Veracity means telling the truth. A nurse should never lie in

any situation and should be honest and truthful not only to the institution
and patient but also to the profession. For example, a nurse should never lie
about the diagnosis details. Once the diagnosis is confirmed, he/she nurse
has to reveal the actual diagnosis made and should not lie for anybody’s
sake or favour.

Justice in Providing Nursing Care:  Justice means being fair to all the

patients, providing care to everyone, and trusting them equally, irrespective
of their caste, creed, religion, sex, age, education, race, socio-economical
status, and marital status. A nurse should not show any cultural or
language preference in patient care.

Respect for Patients’ Rights:  A nurse should always give respect to the
rights of a patient, such as the right to get respect, the right to be informed,
the right to be oriented, the right to take decisions, and the right to refuse
or accept any treatment. A nurse should be aware of all the rights of the
patient and treat him/her accordingly.
Fidelity:  Fidelity means maintaining promises and being more
trustworthy and fruitful towards the profession. A nurse should be
dedicated and work with full commitment, keep all the details of a patient
safe, and create a truthful and trustworthy relationship with patient.

Confidentiality:  It is the most important ethical principle in the nursing

profession. It is the duty of a nurse to keep all the details of a patient and
the relevant documents safe and not reveal anything to other patients,
nurses or anybody unknown.

Respect for Autonomy:  This is a very important ethical principle,

according to which a nurse should gives complete respect to the patient and
allow him/her to take decisions on his/her own. A nurse should never
interfere in any part of decision-making regarding the treatment unless the
patient asks for it. Moreover, he/she should never force the patient to
choose a treatment method. Even when the patient asks for help, a nurse
should suggest the best options available, explain the risks and benefits
associated with the treatment, and provide alternatives if available. While
obtaining informed consent, a nurse should explain the pros and cons of
the procedure and make sure that the patient has understood the details
clearly before getting the signature.

Patient Autonomy: Informed Consent

 Autonomy -One human person precisely as a human person does not have authority and
should not have power over another person. This means that an individual should not coerce
others or impose their will on others.

Principles of autonomy in health care states that an institution cannot treat a patient without
inform consent of the patient or her lawful surrogate except in narrowly defined emergencies .
This principle implies the meaning of respect for the person for his/her freedom in the context of
health care.

PATIENT’S RIGHTS

The term patient is derived from a Latin verb meaning “to suffer” and has
traditionally been used to describe those who are recipients of care,
whereas the term client is derived from a Latin verb meaning “to lean”
connoting alliance and independence.
A patient has two types of rights—the moral and ethical rights such as the
right to privacy and the legal rights such as the right to treatment.

 PURPOSE OF EXECUTING PATIENT’S BILL OF RIGHTS

The following are the purposes of executing the Patient’s Bill of Rights:

1. To make aware of the patient’s rights and to use them appropriately when needed.
2. To ensure patient’s dignity and respect and to improve the self-esteem.
3. To gain the patient’s cooperation and willingness to participate in the health care
system.
4. To legally protect the patient and the health care providers by adopting the patients’
bill of rights.
5. To improve the patient’s trust, faith, and confidence towards the health care providers.
6. To help the patient in decision-making regarding the treatment provided.
7. To keep the records of the patient’s confidential and exercise privacy while performing
any procedure for the clients.
8. To help coordinate with hospital rules and regulations.
9. To help ensure and continue the treatment as per the patient’s interests and beliefs.
10. To help the patient analyse about the available health resources and their utilization.

15.4 PATIENT’S BILL OF RIGHTS DURING HOSPITALIZATION

The Bill of Rights allows the patient to his/her rights including the
following:

Right to Admission:  A patient has the right to know about the

admission details in the out-patient department (OPD). If the patient wants
to know about the procedure of the OPD, the nurse should clearly explain
the details and make him/her feel comfortable. The patient should be free
from stress throughout his/her hospitalization.

In-patient Department:  When a patient is admitted in the ward,

he/she should be informed about the details of care to be given to him/her,
as a checklist for patient’s verification. The patient should be informed in
advance regarding the nursing procedures, who will be the nurse, etc.
Informed consent is an important legal documentation of the patient’s
rights, wherein the patient is informed clearly both orally and in writing
about the procedure to be performed and the signature obtained from the
patient or his/her spouse, parents, or family members.
Privacy:  A patient has the right to privacy, which is a right that extends to
all aspects of his/her care, including care for his/her personal needs,
screens should be provided during physical examination and the body
should not be exposed unnecessarily.

Moral Privacy:  This is the right to take decisions on his/her own without

the interference of others.

Legal Privacy:  This is the right to check on his/her own case sheet and
reports and the right to choose the treatment methods.

Violating Privacy:  The patient’s privacy rights should never be violated.

Details of patients should not be overheard or discussed in front of others.

Right for Attention:  A patient has the right to be attended immediately

when he/she calls and also the right to be provided information when
he/she requests it.

If a patient calls for help but is not attended or is ignored, the nurse is liable
to be sued under the law of negligence.

Right for Choosing the Treatment Methods:  A patient has full

rights to choose the treatment modalities for his/her illnesses. A nurse
should be able to clarify the patient’s doubts regarding the different kinds
of treatments available, their cost, and their advantages and disadvantages.
The patient has the right to choose or to refuse the treatment at anytime
and should not be forced or misdirected to choose any treatment method.

Right to Get Orientation of the Hospital:  When a patient gets

admitted to a hospital, the surroundings are new to him/her, and therefore,
a nurse should orient the patient to all the departments in the hospital. This
is considered to be an important right of the patient to ensure that he/she
does not feel neglected.

Right to Know About the Drugs Administered:  A patient should be

informed about the drugs being administered to him/her. It is the duty of a
nurse to ensure that the patient is given details such as the dosage of the
drug, the reason why it is administered, the action of the drug, its side
effects, and how it can be taken safely and also to administer the drug to the
patient on time.
Right to Access Documents:  A patient has the right to access
documents and reports when needed. Patient has the right to access the lab
values and to know the normal or the reference range and also any
deviation from the normal values.

Transcultural Care Rights:  A patient has the right to get complete

nursing care irrespective of his/her caste, religion, race, age, sex, ethnicity,
etc. There should be no racial discrimination or differentiation shown
towards the patients.

Right to Be Respected Throughout Care and Hospitalization:  A

patient should be respected and treated with dignity. He/she should be
addressed by his/her name, and not by the colour of the dress, physical
features such as height, or bed number.

Right to Get the Bills on Time:  A patient obviously pays for the care
provided to him/her during hospitalization. Hence, he/she has the right to
know about the related charges, but some health institutions delay the
settlement of bills. The amount should be informed prior, so that the
patient can be prepared to pay at the time of discharge.

Right to Complain:  A patient has the rights to express a complaint to

the concerned hospital authorities about problems faced regarding
treatment or care or regarding issues such as lack of respect. Every hospital
should have an opinion box, which is used to obtain the patient’s feedback
about the hospital procedures and the nursing care.

Right to Get Discharged at Any Time:  A patient has the right to get
discharged from the hospital at any time he/she wishes before the end of
the treatment. He/she cannot be compelled to stay in the hospital. The
expected length of stay for the illness should be explained clearly to the
patient, but the patient has the right to decide whether to continue
treatment or get discharged from the hospital.

Right to Access the Available Resources from the Hospital:  A

patient should be informed about the available resources and their
importance, for example, availability of the doctors, specialists, their arrival
time, treatment details, etc. The patient should be informed about these
details before he/she asks for it.
Right to Access the Emergency Services:  A patient has the right to
access the emergency services when needed.

15.5 ROLE OF NURSES IN IMPLEMENTING THE PATIENT’S BILL OF RIGHTS

The following are a nurse’s rights and responsibilities in implementing the

Patient’s Bill of Rights:

1. Help the patient to understand about the Patient’s Bill of Rights and its importance.
2. Provide care equally to all patients without any discrimination based on race, colour,
religion, sex, nationality, disability, socioeconomical status or age.
3. Provide respectful care in a safe and hygienic environment to all the patients.
4. Be always alert and prepared to attend to any kind of emergency. A patient in
emergency should be treated immediately without any delay.
5. Provide adequate needed information about the health care providers to the patient
and orient the patient as to the details regarding the physicians, the health care
professionals, and the hospital departments in advance, since the right of the patient
to be informed should be understood and respected by a nurse.
6. Inform the patient about the procedures, ward routines, names of health care
providers, and the rights of the patient to choose the physicians who provide care and
to refuse care.
7. Provide complete information about the patient’s assessment details, treatment and
progress.
8. Explain the details of informed consent and the benefits and risks before getting the
patient’s signature.
9. Explain to the patient about his/her right to choose treatment modalities and to
decide whether or not to continue treatment.
10. Explain to the patient about his/her right to refuse to get involved in research
activities.
11. Explain to the patient about his/her right to be present while taking decisions
regarding patient care.
12. Explain to the patient about his/her right to get a copy of medical summary regarding
all aspects of treatment from the hospital.
13. Explain to the patient about his/her right to get bill details in advance.
14. Inform the patient that he/she can lodge a complaint or give feedback if he/she is not
satisfied with the care provided by the hospital.
15. Explain to the patient about his/her right to provide authority to his/her family
members and spouse to visit him/her.
16. Explain to the patient about his/her right to donate the organs after death and record
his/her wish in the donor card that should be provided by the hospital to the patient.
 15.6 BILL OF RIGHTS

The following are the rights mentioned in the Patient’s Bill of Rights:

1. Right to get needed assistance from the hospital about using the patient’s rights
2. Right to get treatment irrespective of the patient’s sex, race, colour, nationality,
religion, disability, socioeconomic status and age
3. Right to get respectful care under a safe and hygienic environment
4. Right to get immediate care in emergency situations
5. Right to get informed about the details of health care providers of the hospital
6. Right to decide the treatment modalities planned for the patient
7. Right to know and be oriented to the ward routines and procedures of the hospital
8. Right to know about the patient’s diagnosis, observation, reports and treatment
9. Right to get the needed information before signing in the informed consent
10. Right to refuse any treatment provided to the patient
11. Right to participate or refuse in research and to withdraw at any stage of the
research
12. Right to get copies of medical reports and summary documents of the patient’s
details
13. Right to get bill details of the patient in advance before discharge
14. Right to keep the reports and details of the patient confidential
15. Right to get and provide privacy for the patient throughout hospitalization
16. Right to complain regarding patient care to the hospital management
17. Right to donate organs and get donor card from the hospital
18. Right to provide authority for the close family members/spouse to visit the patient
and they should be given priority in all aspects to visit the patient during visiting
hours

INFORM CONSENT

 Hipoccrates the ancient Greek physician did not believe that he needed the consent
of patients when being treated under his care.It was only in the second half of the
20th century the development of inform consent in the Unites States was formed into
law .
Inform consent was done most specially for any invasive procedures such as those involving
surgery or treatment with considerable risk involve .
To disregard inform consent means a law suits .
In 1960 the law has tended to say that the role of the health care professional requires
respect for the freedom of the client and it demand s inform consent . Informed consent in
regard to a patient’s treatment is a legal, and ethical, issue of autonomy. At the heart of
informed consent is respecting a person’s autonomy to make personal choices based on the
 appropriate appraisal of information about the actual or potential circumstances of a situation
(see Box 2-2). Though all conceptions of informed consent must contain the same basic
elements,
Elements of Informed Consent
1.Threshold elements (preconditions)
1. Competence (to understand and decide)
2. Voluntariness (in deciding)
II. Information elements
3. Disclosure (of material information)
4. Recommendation (of a plan)
5. Understanding (of 3 and 4)
III. Consent elements
6. Decision (in favor of a plan)
7. Authorization (of the chosen plan)
Dempski (2009) presented three basic elements that are necessary for informed consent to
occur:
1. Receipt of information: This includes receiving a description of the procedure, information
about the risks and benefits of having or not having the treatment, reasonable alternatives to
the treatment, probabilities about outcomes, and “the credentials of the person who will
perform the treatment” (Dempski, 2009, p. 78). Because it is too demanding to inform a patient
of every possible risk or benefit involved with every treatment or procedure, the obligation is to
inform the person about the information a reasonable person would want and need to know.
Information should be tailored specifically to a person’s personal circumstances, including
providing information in the person’s spoken language.
2. Consent for the treatment must be voluntary: A person should not be under any influence or
be coerced to provide consent. This means patients should not be asked to sign a consent form
when they are under the influence of mind-altering medications, such as narcotics. Depending
on the circumstances, consent may be verbalized, written, or implied by behavior. Silence does
not convey consent when a reasonable person would normally offer another sign of agreement.
3. Persons must be competent: Persons must be able to communicate consent and to
understand the information provided to them. If a person’s condition warrants transferring
decision-making authority to a surrogate, informed consent obligations must be met with the
surrogate

Key Concept of Inform Consent

1. The patient or appropriate surrogate must be competent or have decision making
capacity.
-be capable of understanding the consequences of the consent and be free from
coercion and undue influence that would substantially diminish freedom
2. The health care professional ,within the demands of his or her particular role must provide
the necessary information and make sure that it is understood.
Consent is the written document about any surgical procedure that is
explained by the nurse or surgeon to the patient, and patient’s family
members.

Types of Consent

1. General Consent

This is the kind of formal consent signed by the patient at the time of
admission, where if the patient is conscious signs, witness signed by the
parents or legal guardian, their consent legally authorizes that the patient
should get standardized care from the physician, the nurse and the entire
perioperative health care team. This consent is to perform general ward
routine activities, not for any specific invasive procedure.

2. Special Informed Consent

The entire health care team members are directly responsible in getting the
informed consent signed, since the duty is delegated to the perioperative
nurse practitioner and also the surgeon, any negligence to deliver the
details of informed consent is considered as branch of duty and
responsibilities, getting the document signed is not enough, but explaining
clearly in a understandable manner about the surgical procedure, the risks,
benefits, alternatives and any extension procedure that can be done along
with the stated one, especially about the anaesthetic agent given by
anaesthesia specialist should speak about the risk, benefits, care given,
alternatives if the circulatory nurse found that doctor does any extended
procedure without consent immediately she should inform it to the
supervisor or administrative authority about discrepancy.

References:
Aquinas, Thomas (13th c). Summa Theologica II-II, Q. 64, art. 7, “Of Killing”, in On Law, Morality,
and Politics, William P. Baumgarth and Richard J. Regan, S.J. (eds.), Indianapolis/Cambridge:
Hackett Publishing Co., 1988,
Other References :
https://plato.stanford.edu/entries/double-effect/
https://www.chausa.org/publications/health-progress/article/april-1995/the-principle-of-
cooperation
 https://www.consciencelaws.org/religion/religion002.aspx
http://inquisition.ca/en/polit/artic/solidarite.htm

CONCLUSION

The Patient’s Bill of Rights refers to the important rights of the patient in
the health care system. A nurse needs to know about these rights and
should ensure that they are implemented. These rights help in improving
the patient’s self-esteem and ensure that he/she is treated with respect and
dignity, which paves way for quality care.
ASSIGNMENT :

To be submitted next week in the MS team

“The Operation” by Anne Sexton.

Read the poem reflectively and do the following:

The Operation 
After the sweet promise,
the summer’s mild retreat
from mother’s cancer, the winter months of her death,
I come to this white office, its sterile sheet,
its hard tablet, its stirrups, to hold my breath
while I, who must, allow the glove its oily rape,
to hear the almost mighty doctor over me equate
my ills with hers and decide to operate.

It grew in her as simply as a child would grow,

as simply as she housed me once, fat and female.
Always my most gentle house before that embryo
of evil spread in her shelter and she grew frail.
Frail, we say, remembering fear, that face we wear
in the room of the special smells of dying, fear
where the snoring mouth gapes and is not dear.
There was snow everywhere.
Each day I grueled through
its sloppy peak, its blue-struck days, my boots
slapping into the hospital halls, past the retinue
of nurses at the desk, to murmur in cahoots
with hers outside her door, to enter with the outside
air stuck on my skin, to enter smelling her pride,
her upkeep, and to lie
as all who love have lied.

No reason to be afraid,
my almost mighty doctor reasons.
I nod, thinking that woman’s dying
must come in seasons,
thinking that living is worth buying.
I walk out, scuffing a raw leaf,
kicking the clumps of dead straw
that were this summer’s lawn.
Automatically I get in my car,
knowing the historic thief
is loose in my house
and must be set upon.
2.
Clean of the body’s hair,
I lie smooth from breast to leg.
All that was special, all that was rare
is common here. Fact: death too is in the egg.
Fact: the body is dumb, the body is meat.
And tomorrow the O.R. Only the summer was sweet.
The rooms down the hall are calling
all night long, while the night outside
sucks at the trees. I hear limbs falling
and see yellow eyes flick in the rain. Wide eyed
and still whole I turn in my bin like a shorn lamb.
A nurse’s flashlight blinds me to see who I am.
The walls color in a wash
of daylight until the room takes its objects
into itself again. I smoke furtively and squash
the butt and hide it with my watch and other effects.
The halls bustle with legs. I smile at the nurse
who smiles for the morning shift. Day is worse.

Scheduled late, I cannot drink

or eat, except for yellow pills
and a jigger of water. I wait and think
until she brings two mysterious needles: the skills
she knows she knows, promising, soon you’ll be out.
But nothing is sure. No one. I wait in doubt.

I wait like a kennel of dogs

jumping against their fence. At ten
she returns, laughs and catalogues
my resistance to drugs. On the stretcher, citizen
and boss of my own body still, I glide down the halls
and rise in the iron cage toward science and pitfalls.

The great green people stand

over me; I roll on the table
under a terrible sun, following their command
to curl, head touching knee if I am able.
Next, I am hung up like a saddle and they begin.
Pale as an angel I float out over my own skin.

I soar in hostile air

over the pure women in labor,
over the crowning heads of babies being born.
I plunge down the backstair
calling mother at the dying door,
to rush back to my own skin, tied where it was torn.
Its nerves pull like wires
snapping from the leg to the rib.
Strangers, their faces rolling lilke hoops, require
my arm. I am lifted into my aluminum crib.

Skull flat, here in my harness,

thick with shock, I call mother
to help myself, call toe to frog,
that woolly bat, that tongue of dog;
call God help and all the rest.
The soul that swam the furious water
sinks now in flies and the brain
flops like a docked fish and the eyes
are flat boat decks riding out the pain.

My nurses, those starchy ghosts,

hover over me for my lame hours
and my lame days. The mechanics
of the body pump for their tricks.
I rest on their needles, am dosed
and snoring amid the orange flowers
and the eyes of visitors. I wear,
like some senile woman, a scarlet
candy package ribbon in my hair.

Four days from home I lurk on my

mechanical parapet with two pillows
at my elbows, as soft as praying cushions.
My knees work with the bed that runs
on power. I grumble to forget the lie
I ought to hear, but don't. God knows
I thought I’d die—but here I am,
recalling mother, the sound of her
good morning, the odor of orange and jam.

All’s well, they say. They say I’m better.

I lounge in frills or, picturesque,
I wear bunny pink slippers in the hall.
I read a new book and shuffle past the desk
to mail the author my first fan letter.
Time now to pack this humpty-dumpty
back the frightened way she came
and run along, Anne, and run along now,
my stomach laced like a football
for the game.
Questions:
1. Analyze the story, symbolism, and feelings conveyed in the poem; discuss and provide
specific examples.

2. Discuss your perception of the quality of healthcare provider patient relationships

reflected in the poem; provide specific examples.