Is the professional code still the cornerstone of clinical nursing practice?*

Abstract

Although codes of practice for those concerned with the health care of others have always been inherent in the structure of societies, they have been institutionalized within the nursing discipline since the end of the last century. Up until the early 1970s they promulgated subservience to the medical discipline. As a result of the processes of emancipation and professionalization, the philosophy of the nurse has come to contain concepts of autonomy, accountability and patient-advocacy, based on a personal and individualized care system. Research in recent years has shown that nurses are making morally sound and ethically acceptable choices based on their own decision-making abilities, whilst having little or no active knowledge of the existing professional codes. Based on the literature, the author discusses ethical codes in relation to their perception by nurses in the clinical situation. The influence of the code in the areas of moral decision making, administration and management, and education are likewise discussed and the conclusion is reached that codes remain the cornerstone of nursing practice.

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

“…An opposite position is taken by Pattison (2001) and Thompson (2002), who both have argued that professional codes suffer from terminological inexactitudes and confusions as well as arbitrariness in values and principles. Empirical studies have also shown (Esterhuizen, 1996;Höglund, 2005) that nurses make ethically sound choices based on their own decision-making ability, while having little or no active knowledge of existing professional codes or ethical guidelines.…”

Influencers of ethical beliefs and the impact on moral distress and conscientious objection

“…However, research shows that many practicing nurses are not familiar with their professional codes and few nurses actually rely on these codes when making ethical decisions. 19 According to Ham 14 practicing nurses do not seek out continued education in the area of ethics and tend instead to focus on continuing education that focuses on their specialty areas of practice.…”

Professional Boundaries: Crossing a Line or Entering the Shadows?

“…Similarly transferable is the conclusion that if interpreted in a literal way, codes produce the opposite effect from that intended, forcing nurses to disguise their errors and not making accurate reports (Esterhuizen, 1996); the professional's commitment to act rightly according to moral standards is transferred to a focus on compliance with the code (Pattison, 2001). Yoder (1998) sees ethical expertise as interdisciplinary and, therefore, wider than clinical expertise, with codes unable to replace a professional's ethical sensitivity and individual decision making.…”