NCM 108 – HEALTH CARE ETHICS (BIOETHICS)

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ETHICAL PRINCIPLES ON AUTONOMY
PBL GROUP A – BSN 3G
MRS. CATHERINE VERSOZA, RN

MAIN TOPIC TITLE American Nurses Association (ANA, 2010c)

Topic Outline explains the role of autonomy in nursing
• INTRODUCTION TO ETHICAL practice:
PRINCIPLE
• AUTONOMY All nursing practice, regardless of specialty,
• Examples role, or setting, is fundamentally independent
practice. Registered nurses are accountable for
Objectives nursing judgments made and actions taken in the
• Understand the definition of ethical course of their nursing practice, therefore, the
principles and ethical issues in nursing registered nurse is responsible for assessing
and healthcare. individual competence and is committed to the
• Learn about the principle of autonomy and process of lifelong learning. Registered nurses
provide examples in the healthcare develop and maintain current knowledge and skill
setting. through formal and continuing education and seek
certification when it is available in their areas of
ETHICAL PRINCIPLE practice

EXAMPLES OF AUTONOMY IN NURSING

• Part of a normative theory that justifies or
defends moral rules and/or moral
• Administering PRN medications
judgments;
• Openly communicating ideas and
• They are not dependent on one's
concerns with the patient care team
subjective viewpoints.
• Learning about new technologies to
• Basic justification for the many particular improve patient care
ethical prescriptions and evaluations of • Making decisions in emergency health
human actions. situations, i.e. providing CPR

Ethical Issues in Nursing and Healthcare WHEN CAN WE SAY THAT PRINCIPLE OF
AUTONOMY IS MORALLY OBJECTIBLE AND
• Autonomy WRONG?
• Non-Maleficence • Treating Patients without their consent
• Beneficence • Treating patients without giving them all the
• Justice relevant information
• Forcing nurses to act against their reasoned
moral judgments or conscience
AUTONOMY • Withholding information from patients
• Imposing information upon patients when
• The term “autonomy” comes from the they have expressed a considered choice not
Greek autos (meaning “self”) and nomos to receive it
(meaning “rule”, “governance” or “law").
• The right of competent adults to make Example Scenarios
informed decisions about their own SCENARIO 1:
medical care. A construction worker came to the clinic
complaining of low back pain. After a thorough
Insofar as an autonomous agent's actions do not investigation it was determined that he has a mild
infringe on the autonomous actions of others, that disk herniation between L5 and S1. The patient
person should be free to perform whatever action was advised to continue work since his injury is
he or she wishes (presumably even if it involves mild, but he refused and wanted a break from
considerable risk to himself or herself and even if work. After the doctor insisted, the worker agreed
others consider the action to be foolish). to continue working. There were no complications
in the 3 months follow up.

o What did the healthcare provider did

wrong/lack to do?
SCENARIO 2:
A woman enters the emergency room with
stomach pain. She undergoes a CT scan and is
diagnosed with an abdominal aortic aneurysm, a
weakening in the wall of the aorta which causes it
to stretch and bulge (this is very similar to what led
to John Ritter's death). The physicians inform her
that the only way to fix the problem is surgically,
and that the chances of survival are about 50/50.
They also inform her that time is of the essence,
and that should the aneurysm burst, she would be
dead in a few short minutes. The woman is an
erotic dancer; she worries that the surgery will
leave a scar that will negatively affect her work;
therefore, she refuses any surgical treatment.
Even after much pressuring from the physicians,
she adamantly refuses surgery. Feeling that the
woman is not in her correct state of mind and
knowing that time is of the essence, the surgeons
decide to perform the procedure without consent.
They anesthetize her and surgically repair the
aneurysm. She survives, and sues the hospital for
millions of dollars.

o Do you think that the healthcare provider

showed autonomy? If so, why?

CONCLUSION

One of the four guiding principles of medical

ethics is autonomy, along with beneficence, non-
maleficence, and justice. Patient autonomy is the
ability of the patient to make independent
decisions (Timms, 2016).

The health professional's job at that point is

to advise and educate patients, but not to take over
the portion of their treatment that involves making
decisions. The acknowledgement of patients'
vulnerability in healthcare settings serves as the
driving force behind patient autonomy.

Indeed, most people would find such a setting

odd. They are more susceptible to being
persuaded to accept procedures without carefully
weighing their options by medical paternalism
because of their negative feelings and lack of
medical knowledge. Autonomy has several
nuances as an ethical ideal, nevertheless, that
must be considered.
 NCM 108 – HEALTH CARE ETHICS (BIOETHICS)
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PRINCIPLES OF BIOETHICS
PBL GROUP C – BSN 3G
MRS. CATHERINE VERSOZA, RN

TOPICS
NURSE LEADERS AS STEWARDS
Topic Outline
• INTRODUCTION • Stewards, as well as practicing nurses
• WHO WE ARE who seek to preserve and promote values
• Principle Of Totality And It's at the point of service, may influence
Integrity managers in their decision about who
• Principle Of Stewardship And ought to receive what services and how
Role Of Nurses As Stewards and thus influence change in health care
• Principle Of Ordinary And organization.
Extraordinary Measures
• Principle Of Personalized
Sexuality ROLES OF NURSES AS STEWARDS

PERSONAL
— A nurse who exercise stewardship at the
THE CONCEPT OF PRINCIPLE point of service in accordance with
Maclntyre's theory of virtue ethics will
• The term "principle" refers to the facilitate nurse's justification of their shared
intellectual guide meant for ethical value priorities within professional settings
actions. such as the Canadian Nurse association
• Philosophically accepted basis or code of ethics.
foundation that can be used to establish
directions for ethically tenable actions. SOCIAL
• When erroneous principles are passed to — Nurses advocate for health promotion,
generations it becomes the norm. educate patients and the public on the
• Legality does not always morality. prevention of illness and injury, provide care
• The principles of bioethics are guiding and assist in cure, participate in rehabilitation,
instructions on moral or ethical conduct, and provide support. No other health care
as they express what individuals and professional has such a broad and far
society expect humans ought or ought not reaching role.
to do based on their personal and social
importance. ECOLOGICAL
• Principles of bioethics are derived from — The nursing profession is well positioned to
human behavior and is not a product of tackle the challenges of waste reduction with
mental speculations. hospital systems
— The healthcare sector generates a massive
amount of waste, contributing to
PRINCIPLE OF STEWARDSHIP AND ROLE OF environmental issues, such as air and water
NURSES AS STEWARDS pollution.

• STEWARDESS BIOMEDICAL
o Is a person appointed in the place of — BIOETHICS is a branch of applied ethics that
another. He/she takes charge of refers the discipline dealing with the ethical
representing and protecting another's implications of biological research and
interest, and sees to it that the service is applications especially in the medicine. It
carried out faithfully. involves issue relating to the beginning of end
of human life.
• IN HEALTH CARE PRACTICE
o Refers to the execution of responsibility PRINCIPLE OF TOTALITY AND IT'S
INTEGRITY
of the health care practitioners to look
after, provide necessary health care
services and promote the health and life • To promote human dignity in community,
of those entrusted to their care. every person must develop, use, care for,
and preserve all of his/her natural physical
and psychic functions in such as a way
that:
 - Immediate effect is to render
procreation impossible.
o lower functions are never
sacrificed except for the better TYPES OF DIRECT
functioning of the whole person o Eugenics
and even then, with an effort to - Seeking to avoid the transmission of
compensate for this sacrifice. hereditary defects.
o Hedonistic
o the basic capabilities that define - Evade the complications and
human personhood are never responsibilities of procreation without
sacrificed unless this is necessary giving up the sexual pleasure.
to preserve life. o Demographic
- To control the birth rate.
o Preventive
CONSIDERATIONS FOR PRINCIPLE OF - Render pregnancy impossible which
TOTALITY AND IT’S INTEGRITY might aggravate the sickness that
already exist.
1. That the organ by its deterioration in function
may cause damage to the whole organism INDIRECT (THERAPEUTIC)
or at least pose a serious threat to it. - Licit is an act of good stewardship of the
body; necessary for the survival of the
2. That there is no other way than taking the patient or to free him of proportional
indicated action against it or obtaining the sufferings/ infirmities.
desired good result.
- Inevitably required for the survival and
3. That the damage being avoided to the whole health of a person, sexual organs,
is proportional to that which is caused by the integrating parts which must yield to the
mutilation or incapacitation of the part. good of the whole. Licit if:

o This principle of totality does not apply to STERILIZATION

moral organization (family, society,and o A medical or surgical intervention, which
humanity), a person is still independent. causes a patient incapacity of generation.
He is not a subordinate to any group. He is
the subject, principle, and end of all social
institutions. ORGAN DONATION

o Authority cannot directly dispose the • A person may will to dispose of his body
physical and personal being of a and to destine it to ends that are useful,
person,removal of the undesirable or weak morally irreproachable, and even noble
parts of the society among them, the desire to aid the sick
and suffering.
ETHICAL ISSUES
Criteria for Organ Donation:
MUTILATION
o Destruction of member, organ/ part of the 1. There’s a serious need on the part of the
body (organic) or the suppression of a recipient that cannot be fulfilled in any
physical functional in such a way that the other way.
organism becomes no longer basically 2. The functional integrity of the donor with a
whole. - Is an action by which an organic human person will not be impaired even
function/ the use of a member of the body though anatomical integrity may suffer.
is intentionally destroyed either partially or 3. The risk taken by the donor as an act of
wholly. charity is proportionate to the good
resulting to the recipient.
TYPES 4. The donor’s consent is free and informed.
5. The recipients for the scarce organs are
DIRECT selected justly.
- Willed in itself, as end or as means,
intended and caused intrinsically
wrong. Offends human dignity.
 CADAVER DONATION
PRINCIPLE OF PERSONALIZED SEXUALITY
• When a body is being donated, a
responsible staff member must complete WHAT IS SEXUALITY?
a death certificate. o It is a complex aspect of our personality and
self.
• Acute and critical care nurses have a o Our sexuality is defined by sexual thoughts,
central role in the organ donation process, desires and longings, erotic fantasies, turn-
from identifying and assessing potential ons and experiences.
donors and supporting their families to o It is based on the understanding of sexuality
involvement in logistics. as one of the basic traits of the human
person and must be developed in ways
CONDITIONS ON DONATION consistent enhancing human dignity.
Element of human character that often
1. Donor must be verbally and legitimately leads to a loss of human dignity and an
dead. inability to pursue the trully fulfilling goals of
2. Informed consent human life.
3. Remains must be treated with respect.
EXAMPLES:

o Healthcare workers are supposed to give

PRINCIPLE OF ORDINARY AND information to patients about reproductive
EXTRAORDINARY CARE health. Healthcare workers, although practice
ethics about everyone’s right to practice
ORDINARY CARE sexual freedom, must also provide
— Morally obligatory as they are likely to help information about safe sexual practice and
the patent Offers hope of benefit is high and family planning. This gives people knowledge
cost is low. about the things that should be considered
when they practice sexual intimacy.
Example:
An infant is born with Down syndrome, o This principle also lets healthcare workers to
indicating probable mental retardation. He needs give options about contraceptives as stated
very low-risk surgery for an easily correctable that the principle of personalized sexuality’s
intestinal defect. If untreated the baby will not be able purpose is not just only for reproduction but
to retain food and will die the parents refuse surgery, also for pleasure and fulfillment. Making sure
stating that the mental that a patient has the freedom to feel pleasure
and fulfillment without taking risks on STDs
and failed family planning is also the job of a
EXTRAORDINARY CARE healthcare worker.
— Painful, frightening hazardous disruptive
Financially too burdensome Does not offer
hope of benefit Cost is very high, the benefit
is getting low.

Example:
An 87-year-old incompetent woman with
congestive heart and kidney failure has primary
cancer of the intestine. Surgery is the usual treatment
for such cancer, but the family and doctor decide
against it.
 NCM 108 – HEALTH CARE ETHICS (BIOETHICS)
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CODE OF ETHICS - NURSING
PBL GROUP D – BSN 3G
MRS. CATHERINE VERSOZA, RN

MAIN TOPIC TITLE

Topic Outline B. CODE OF ETHICS FOR REGISTERED
• History of Code of Ethics for Filipino NURSES (BOARD OF NURSING)
Nurse’s Board resolution no. 220, series of 2004
• Code of Ethics for Nurses of the approved last 14th day of July, 2004
Philippines
• Code of Ethics for International Council of • CODE OF ETHICS FOR NURSES
Nurses (ICN) WHEREAS, the Board of Nursing (BON)
• Nurse-Physician Relationship has the power to promulgate a Code of
Ethics for Registered Nurses in
coordination and consultation with the
TERMINOLOGIES accredited professional organization (Sec.
9, (g), Art III of (Republic Act) No. 9173,
o CODE OF ETHICS FOR NURSING known as the “Philippine Nursing Act of
- is a succinct statement of the ethical 2002);
obligations and duties of every
individual who enters the nursing WHEREAS, in the formulation of the Code
profession. It is the profession's of Ethics for Registered Nurses, the Code
nonnegotiable ethical standard. It is an of Good Governance for the Professions
expression of nursing's own in the Philippines was utilized as the
understanding of its commitment to principal basis thereof: All the principles
society. under the said Code were adopted and
integrated into the Code of Ethics as they
o ETHICAL OBLIGATION apply to the nursing profession;
- Ethical obligations are a set of “ought
to” standards that define a moral WHEREAS, the promulgation of the said
course of action and draw a line Code as a set of guidelines, regulations or
between right and wrong. measures shall be subject to approval by
the Commission (Sec. 9, Art. II of R.A. No.
9173); and
A. THE HISTORY OF CODE OF ETHICS FOR
WHEREAS, the Board, after consultation
FILIPINO NURSE’S on October 23, 2003 at Iloilo City with the
accredited professional organization of
• 1922- The Code was formed registered nurses, the Philippine Nurses
• 1982 - PNA approved the COE Association, Inc. (PNA), and other affiliate
• October 1983 - COE was published organizations of Registered Nurses,
• October 21, 1982 - The final presentation decided to adopt a new Code of Ethics
of the documents. under the afore-mentioned new law;
• March 21, 1984 - the PRC Board of
Nursing adopted the ICN. BON Resolution NOW, THERFORE, the Board hereby
no. 633 resolved, as it now resolves, to
• October 18, 1989 - The amended Code of promulgate the hereunder Code of Ethics
Ethics was approved by the BON in its for Registered Nurses:
resolution no. 1955
• October 23, 2003 - New COE was
presented at the Assembly of Nursing Rep. Article I
during the 81st Foundation. Anniversary, PREAMBLE
46th Nurses Week Celebration, and the SECTION 1.
Annual National Convention of Nurses in • Health is a fundamental right of every
Iloilo City individual. The Filipino registered nurse,
• July 14, 2004 - The new COE for Filipino believing in the worth and dignity of each
Nurses was finally promulgated. human being, recognizes the primary
PRC-BON Resolution no.220. 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 3. Accurate documentation of actions and
possible, assistance towards a peaceful outcomes of delivered care is the
death shall be his/her obligation. hallmark of nursing accountability

SECTION 2. SECTION 7.
• To assume this responsibility, registered Guidelines to be observed:
nurses have to gain knowledge and • REGISTERED Nurses must
understanding of man’s cultural, social, A. Know the definition and scope of nursing
spiritual, physiological, psychological, and practice which are in the provisions of R.
ecological aspects of illness, utilizing the A. No. 9173, known as the “Philippine
therapeutic process. Cultural diversity and Nursing Act of 2002” and Board Res. No.
political and socio-economic status are 425, Series of 2003, the “Rules and
inherent factors to effective nursing care. Regulations Implementing the Philippine
Nursing Act. of 2002”, (the IRR).
SECTION 3. B. Be aware of their duties and
• The desire for the respect and confidence of responsibilities in the practice of their
clientele, colleagues, co-workers, and the profession as defined in the “Philippine
members of the community provides the Nursing Act of 2002” and the IRR.
incentive to attain and maintain the highest C. Acquire and develop the necessary
possible degree of ethical conduct. competence in knowledge, skills, and
attitudes to effectively render appropriate
nursing services through varied learning
situations.
Article II D. If they are administrators, be responsible
REGISTERED NURSES AND PEOPLE in providing favorable environment for
the growth and developments of
SECTION 4. Registered Nurses in their charge.
• Ethical Principles E. Be cognizant that professional programs
1. Values, customs, and spiritual beliefs held for specialty certification by the BON are
by individuals shall be respected. accredited through the Nursing Specialty
2. Individual freedom to make rational and Certification Council (NSCC).
unconstrained decisions shall be respected. F. Sees to it that quality nursing care and
3. Personal information acquired in the practice meet the optimum standard of
process of giving nursing care shall be held safe nursing practice.
in strict confidence. G. Ensure that modification of practice shall
consider the principles of safe nursing
SECTION 5. practice.
Guidelines to be observed: H. If in position of authority in a work
• REGISTERED NURSES MUST environment, be normally and legally
A. consider the individuality and totality of responsible for devising a system of
patients when they administer care. minimizing occurrences of ineffective
B. respect the spiritual beliefs and practices and unlawful nursing practice.
of patients regarding diet and treatment. I. Ensure that patients’ records shall be
C. uphold the rights of individuals. available only if they are to be issued to
D. take into consideration the culture and those who are professionally and directly
values of patients in providing nursing care. involved in their care and when they are
However, in the event of conflicts, their required by law.
welfare and safety must take precedence.
SECTION 8.
ETHICAL PRINCIPLES
1. Registered Nurses are the advocates of the
Article III patients: they shall take appropriate steps to
REGISTERED NURSES AND PRACTICE safeguard their rights and privileges.

SECTION 6. SECTION 9.
ETHICAL PRINCIPLES Guidelines to be observed:
1. Human life is inviolable. • REGISTERED NURSES MUST:
2. Quality and excellence in the care of the A. respect the “Patients’ Bill of Rights” in
patients are the goals of nursing the delivery of nursing care.
practice.
 B. provides the patients or their families SECTION 13.
with all pertinent information except Guidelines to be observed:
those which may be deemed harmful to REGISTERED Nurses must
their well-being. A. Maintains their professional role/identity
C. upholds the patients’ rights when conflict while working with other members of the
arises regarding management of their health team.
care. B. Conform with group activities as those of a
health team should be based on acceptable,
SECTION 10. ethico-legal standards.
1. Registered Nurses are aware that their C. Contribute to the professional growth and
actions have professional, ethical, moral, development of other members of the health
and legal dimensions. They strive to team.
perform their work in the best interest of D. Actively participate in professional
all concerned. organizations.
E. Not act in any manner prejudicial to other
SECTION 11. professions.
Guidelines to be observed: F. Honor and safeguard the reputation and
• REGISTERED NURSES MUST: dignity of the members of nursing and other
A. performs their professional duties in professions; refrain from making unfair and
conformity with existing laws, rules unwarranted comments or criticisms on their
regulations. measures, and generally competence, conduct, and procedures; or
accepted principles of moral conduct and not do anything that will bring discredit to a
proper decorum. colleague and to any member of other
B. not allow themselves to be used in professions.
advertisement that should demean the G. Respect the rights of their co-workers.
image of the profession (i.e. indecent
exposure, violation of dress code,
seductive behavior, etc.).
C. declines any gift, favor or hospitality ARTICLE V
which might be interpreted as REGISTERED NURSES, SOCIETY, AND
capitalizing on patients. ENVIRONMENT
D. not demand and receive any
commission, fee or emolument for SECTION 14.
recommending or referring a patient to a Ethical Principles
physician, a co-nurse or another health 1. The preservation of life, respect for human
care worker; not to pay any commission, rights, and promotion of healthy environment
fee or other compensations to the one shall be a commitment of a Registered
referring or recommending a patient to Nurse.
them for nursing care. 2. The establishment of linkages with the public
E. avoids any abuse of the privilege in promoting local, national, and international
relationship which exists with patients efforts to meet health and social needs of
and of the privilege access allowed to the people as a contributing member of
their property, residence or workplace. society is a noble concern of a Registered
Nurse.

SECTION 15.
ARTICLE IV Guidelines to be observed:
REGISTERED NURSES AND CO-WORKERS REGISTERED Nurses must
A. Be conscious of their obligations as citizens
SECTION 12. and, as such, be involved in community
Ethical Principles concerns.
1. The Registered Nurse is in solidarity with B. Be equipped with knowledge of health
other members of the healthcare team in resources within the community, and take
working for the patient’s best interest. active roles in primary health care.
2. The Registered Nurse maintains collegial C. Actively participate in programs, projects,
and collaborative working relationship with and activities that respond to the problems
colleagues and other health care providers. 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 C.THE INTERNATIONAL COUNCIL OF
profession at all times. NURSES (ICN) CODE OF ETHICS FOR
NURSES

• An international code of ethics for nurses

ARTICLE VI was first adopted by the International
REGISTERED NURSES AND THE PROFESSION Council of Nurses (ICN) in 1953.
• It has been revised and reaffirmed at
SECTION 16. various times since, most recently with
Ethical Principles: this review and revision completed in
1. Maintenance of loyalty to the nursing 2012.
profession and preservation of its integrity
are ideal.
2. Compliance with the by-laws of the 4 FUNDAMENTAL RESPONSIBILITIES OF
accredited professional organization (PNA), NURSES:
and other professional organizations of • To promote health
which the Registered Nurse is a member is • To prevent illness
a lofty duty. • To restore health
3. Commitment to continual learning and active • To alleviate suffering
participation in the development and growth
of the profession are commendable WHAT EXISTS IN NURSING?
obligations. Is a respect for human rights.
4. Contribution to the improvement of the
socio-economic conditions and general These includes:
welfare of nurses through appropriate
• Cultural rights
legislation is a practice and a visionary
• The right to having a life and choice
mission.
• To have dignity
SECTION 17. • To be treated with respect
Guidelines to be observed:
Registered Nurses must Nursing care is respectful of and unrestricted by
A. Be members of the Accredited Professional considerations of:
Organization (PNA). • Gender and Age
B. Strictly adhere to the nursing standards. • Color and Race
C. Participate actively in the growth and • Creed – set of beliefs Culture
development of the nursing profession. • Disability or illness
D. Strive to secure equitable socio-economic • Social status
and work conditions in nursing through • Sexual orientation
appropriate legislation and other means. • Nationality
E. Assert for the implementation of labor and
work standards. The ICN Code of Ethics for Nurses has four
principal elements that outline the standards
of ethical conduct.

ARTICLE VII • NURSES AND PEOPLE

ADMINISTRATIVE PENALITIES, REPEALING - Nurse’s primary professional
CLAUSE, AND EFFECTIVITY responsibility is to people requiring
nursing care.
SECTION 18.
• The Certificate of Registration of Registered Example:
Nurse shall either be revoked or suspended Nurse Diane ensures fair treatment and
for violation of any provisions of this Code respect to each and every patient,
pursuant to Sec. 23 (f), Art. IV of R. A. No. regardless of their gender, race, status,
9173 and Sec. 23 (f), Rule III of Board Res. religion, or ethnicity. She ensures quality
No. 425, Series of 2003, the IRR. care and that no discrimination is tolerated
out of sight in the hospital. She ensures
that every individual and family receive
understandable, accurate, sufficient, and
timely information in appropriate manner
while assuring confidentiality and privacy.
 • NURSES AND PRACTICE Example.
- Nurses carries personal responsibility • Nurse Matthew has been having a hard
and accountability for nursing practice time opening up to his co- worker, nurse
- Maintaining competence by continual Andrei when they had a disagreement
learning. which led to an argument during
implementation of patient care. However,
Example: this did not limit nurse Matthew to express
Nurse Niko has been on the field for 15 himself and his queries regarding their
years. He maintains fitness to practice so disagreement. Because he believes that it
as to not compromise his ability to provide is only natural to disagree with co-workers
quality, safe care. He carries personal from time to time.
responsibility and accountability for ethical
nursing practice, and for maintaining
competence by engaging in continuous D. NURSE- PHYSICIAN RELATIONSHIP
professional development and lifelong
learning. He takes appropriate actions to WHAT IS A HEALTH CARE PROFESSIONAL
safeguard individuals, families, RELATIONSHIP?
communities and populations when their o As a social being, the human person trends
health is endangered by a co-worker, any to relate with others. In establishing
other person, policy, practice or misuse of relationship, he uses language which may
technology. take variety of forms such as spoken or
written words, gestures, signs, and other.
o Communication or interaction is essential to
any human relationship.
• NURSES AND THE PROFESSION o The relationship among people in health care
- The nurse assumes the major role in: milieu is professional. Meaning, it is
determining and implementing established in connection with the
acceptable standards of clinical performance of work as an occupation that is
nursing practice, management, meant to cater the health care needs of the
research and education. client. The interaction between health care
practitioners themselves and their clients
Example. ought to enhance their professional
Nurse Alexia, has been working for 10 relationship.
years in St. Paul Hospital as a nurse
practitioner. However, nurse Alexia’s
contract has been terminated when she 10 STEPS TO IMPROVING PHYSICIAN-NURSE
crossed her professional boundaries. This RELATIONSHIPS
was when she was caught taking bribes
and showing favoritism to a certain patient Tips for Nurses:
by spending more time with him than
necessary. The report showed how she 1. Always have the chart in hand when calling a
had solicited large amount of money from physician.
the patient’s family. 2. Adopt the SBAR tool as a standard of
communication especially telephone
conversations.
3. Don’t begin telephone conversations with “I’m
• NURSES AND CO-WORKERS sorry to bother you....”
- The nurse sustains a collaborative and 4. Be prepared for rounds. Anticipate late night
respectful relationship with co-workers problems ahead of time.
in nursing and other fields. 5. Use the progress notes to briefly
- The nurse takes appropriate action to communicate your key
safeguard individuals, families, and concerns/interventions.
communities when their health is 6. Confront physicians whose behaviors are
endangered by a co-worker or any degrading by speaking to them in private.
other person. State the behavior and its effect. Ask
- The nurse takes appropriate action to manager for support if needed.
support and guide co-workers to 7. Take the time to thank and acknowledge
advance ethical conduct. those physicians with whom you have a good
working relationship.
 8. Don’t complain about a doctor to other staff.
If you have a problem, speak to the physician Scenario 4:
in private. One of your patients is a consultant who
9. Raise your awareness. Identify those works at the local hospital. He comes to
physician behaviors which belittle or diminish see you and admits that he is having a lot
you (one- word answers, no eye contact, of trouble at home. Because of this, he
interrupting, raised voice, etc.) has started drinking alcohol very heavily
10. Further your education by pursuing a BSN or and feels dependent on it. He insists that
MSN degree this is not impacting on his work, but you
believe that it may be, due to the heavy
level of drinking and the withdrawal
symptoms he describes when has not had
a drink. You contemplate informing the
PRACTICE QUESTIONS:
hospital about the consultant’s alcohol
dependence.
IDENTIFY if the scenario is related to which of the
following Ethical Principles: Scenario 5:
o Autonomy Patients suspected of having cancer are
o Non-maleficence prioritized within the NHS, with the
o Justice maximum waiting time for referral being
o Beneficence two weeks (as opposed to 18 weeks for
o Confidentiality non-urgent referrals). Patients diagnosed
with cancer are entitled to a range of
Scenario 1: treatments including radio- and
A 26-year-old male has been involved in a chemotherapy. These treatments are
high-speed collision, in which he expensive and treat a small, but
sustained blunt force trauma to his head significant proportion of patients.
as his head hit the front windscreen of his
car. He did not lose consciousness, he is
fully responsive and has no indications of
neurological damage. He does, however,
have a significant head wound that is
bleeding continuously. This patient has
refused treatment on the grounds that he
feels “fine” and is refusing to have sutures
to close his head wound. He would like to
leave the Department.

Scenario 2:
An eight-year-old child has been admitted
to hospital with a significant open fracture
to their left leg. The limb is deformed with
significant bleeding and the patient is
extremely distressed. The parents are
demanding immediate action be taken.

Scenario 3:
A 52-year-old man collapses in the street
complaining of severe acute pain in his
right abdomen. A surgeon happens to be
passing and examines the man,
suspecting that he is on the brink of
rupturing his appendix. The surgeon
decides the best course of action is to
remove the appendix in situ, using his
rusty pen-knife.