Professional values and norms for nurses in Belgium

Because of their responsibilities for providing high-quality care, at times when they are continuously confronted with inherent professional and ethical challenges, nurses should meet high ethical standards of practice and conduct. Contrary to other countries, where codes of ethics for nurses are formulated to support those standards and to guide nurses' professional practice, Belgian nurses do not have a formal code of ethics. Nevertheless, professional ethics is recognized as an important aspect in legal and other professional documents. The aim of this article is to illustrate that codes of ethics are not the only professional documents reflecting nurses' values, norms and responsibilities. Other documents can also set out professional nursing ethics, and as such replace codes of ethics.     

Codes of ethics in physiotherapy: a retrospective view and look ahead

The concept of codes of ethics is examined, and their usefulness in the practice of physiotherapy is evaluated: with reference to the notion of professionalism and to the more practical need for guidance in everyday clinical practice. Two recently-revised physiotherapy codes, those of the British and American professional associations, are considered, and their strengths and weaknesses evaluated. A contrast is made between a code of ethics and a code of morality. In conclusion, the future role of ethical codes in the practice of physiotherapy is explored.     

Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice

ABSTRACT

Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients’ overall health.     

A professional code of ethics provides guidance for genetic nursing practice

While ethical quandaries and dilemmas are commonplace for nurses, recent advances in human genetics have and will continue to create new challenges and controversies. Throughout time, nursing has been an ethical endeavour, with nurses viewing the ethical mandates of their responsibilities on a par with other core dimensions of their professional life. The (American) profession's code of ethics, Code for nurses with interpretive statements, provides direction for practice and for the fulfillment of ethical obligations. The explication of these ethical norms and values that shape professional practice is necessary as nurses confront the integration of genetic services into health care. The goal of preserving professional integrity and ethical soundness in the context of genetic health care mandates that nurses rely on and act upon the profession's national and international codes of ethics.     

Moving from codes of ethics to ethical relationships for midwifery practice

This discussion examines the emergence of professional codes of ethics, influences that shape contemporary midwifery ethics, and the adequacy of codes to actualize values embedded in the midwifery ethics discourse. It considers the traditions of professional practice, the impact of institutionalization on health care, the application of a code of practice as a recent addition to those traditions, and the strengths and weaknesses of codes of ethics as models for ethical responses. That is, it sets out to articulate and deconstruct existing frames of ethical response. The ethics of strangers (normative theory and abstract principles) are rejected as inadequate, and the ethics of intimates (feminist-relational ethics) are proposed as a more adequate guide for well-woman centred midwifery practice.     

The value of nurses' codes: European nurses' views

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses' opinions of the content and function of codes and their use in nursing practice. A total of 49 focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be 'paper tigers' with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice.     

A proto-code of ethics and conduct for European nurse directors

The proto-code of ethics and conduct for European nurse directors was developed as a strategic and dynamic document for nurse managers in Europe. It invites critical dialogue, reflective thinking about different situations, and the development of specific codes of ethics and conduct by nursing associations in different countries. The term proto-code is used for this document so that specifically country-orientated or organization-based and practical codes can be developed from it to guide professionals in more particular or situation-explicit reflection and values. The proto-code of ethics and conduct for European nurse directors was designed and developed by the European Nurse Directors Association's (ENDA) advisory team. This article gives short explanations of the code' s preamble and two main parts: Nurse directors' ethical basis, and Principles of professional practice, which is divided into six specific points: competence, care, safety, staff, life-long learning and multi-sectorial working.     

Ethical reasoning as a clinical-reasoning strategy in physiotherapy

The ethics literature in physiotherapy has long recognised the need to better understand the relationship between ethical reasoning and clinical decision-making in clinical practice. This paper proposes a model of clinical reasoning which demonstrates how ethical reasoning can be considered in a wider clinical-reasoning framework without reducing the complex, moral dimensions of ethical reasoning to merely logical and rational processes of clinical decision-making.     

Reflective practice in nursing ethics education: international collaboration

BACKGROUND: The Internet provides the opportunity for international comparative study and collaboration when learning about ethics in clinical nursing practice. AIM: This paper aims to discuss Internet links developed between US and UK postregistration nursing students who were reflecting on clinical practice in order to explore how political and organizational structures of the health care system affect ethical decision-making. DISCUSSION: An analysis is presented of the stages in developing an exchange course for students from these countries, which involved various combinations of classroom-based teaching, on-line discussions and international visits by students and teachers during its evolution. The strengths and weaknesses of the different methods are considered, and future developments identified. CONCLUSION: The Internet collaboration resulted in postregistration nursing students using reflection on practice in the study of ethics in clinical practice and an understanding of how systems structures and procedures affect ethical decision making. Internet-assisted teaching offers opportunities for collaboration, and student participants demonstrate sophisticated critical thinking in ethical decision-making. Issues of access barriers and motivation remain challenges to wider use.     

How nurses and physicians face ethical dilemmas--the Croatian experience

The aim of this study was to assess nurses' and physicians' ethical dilemmas in clinical practice. Nurses and physicians of the Clinical Hospital Centre Rijeka were surveyed (N=364). A questionnaire was used to identify recent ethical dilemma, primary ethical issue in the situation, satisfaction with the resolution, perceived usefulness of help, and usage of clinical ethics consultations in practice. Recent ethical dilemmas include professional conduct for nurses (8%), and near-the-end-of-life decisions for physicians (27%). The main ethical issue is limiting life-sustaining therapy (nurses 15%, physicians 24%) and euthanasia and physician-assisted suicide (nurses 16%, physicians 9%). The types of help available are similar for nurses and physicians: obtaining complete information about the patient (37% vs. 50%) and clarifying ethical issues (31% vs. 39%). Nurses and physicians experience similar ethical dilemmas in clinical practice. The usage of clinical ethics consultations is low. It is recommended that the individual and team consultations should be introduced in Croatian clinical ethics consultations services.     

Canadian physiotherapy research and evidence-based practice initiative in the 1990s

Abstract

Evidence-based practice is critical to our professional survival in times of reduced and competing healthcare funding. The purpose of this review paper is to describe physiotherapy research activities in the universities and in clinical practice in Canada, and to elaborate upon the evidence-based practice initiatives facilitated by the Canadian Physiotherapy Association (CPA). First the undergraduate curriculum recommendations to encourage reflective practitioners are described, an overview of graduate education and academic research programmes is presented, and the status of clinical research is discussed. Finally, the role of CPA and its initiatives to facilitate and support evidence-based physiotherapy practice are summarized. Two of the significant challenges for continued development of physiotherapy research in Canada are to firmly establish evidence-based practice and to foster a highly regarded physiotherapy scientific commmuity.     

How nurses approach ethical problems in Turkey

Previously, nurse's adherence to ethical standards meant obedience to the physician and loyalty to the hospital; now, however, it means following ethical standards and rules set forth by professional codes of ethics. The International Council of Nurses' Code for Nurses (1973) has been the model for professional codes of ethics in countries throughout the world. ⁴ Using ICN's Code as a framework, a study was conducted in 1993 to find out how nurses in Turkey respond to ethical dilemmas. Below, a summary of the findings.     

Are nursing codes of practice ethical?

This article provides a theoretical critique from a particular 'ideal type' ethical perspective of professional codes in general and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) Code of professional conduct (reprinted on pp. 77-78) in particular. Having outlined a specific 'ideal type' of what ethically informed and aware practice may be, the article examines the extent to which professional codes may be likely to elicit and engender such practice. Because of their terminological inexactitudes and confusions, their arbitrary values and principles, their lack of helpful ethical guidance, and their exclusion of ordinary moral experience, a number of contemporary professional codes in health and social care can be arraigned as ethically inadequate. The UKCC Code of professional conduct embodies many of these flaws, and others besides. Some of its weaknesses in this respect are anatomized before some tentative suggestions are offered for the reform of codes and the engendering of greater ethical awareness among professionals in the light of greater public ethical concerns and values.     

New developments in international nursing ethics

This article has described numerous activities in nursing ethics at international levels. It acknowledges the larger context within which nurses practice by focusing on selected issues involved in resource allocation and death and dying, cross-culturally. The questions raised about universally shared moral principles reflects the larger questions of cultural and ethical relativism. The discussions of new developments in international nursing ethics focuses on international conferences, the teaching of nursing ethics, national nursing associations, and other professional groups that are actively involved in health care or nursing ethics. Finally, the development of international nursing ethics research studies is providing new knowledge about the scope of ethics within nursing and the nature of nursing care worldwide. Nurses are involved in some aspects of these new developments in nursing ethics in all countries. As they examine and reflect on ethical principles, virtues, and on an ethics of caring, they bring a new dimension to their work as nurses. This new dimension stands as one of the oldest and most central foundations in professional nursing.     

A proposal for a code of ethics for nurse practitioners

PURPOSE: To review established codes for health care professionals and standards of practice for the nurse practitioner (NP) and to utilize these codes and standards, general ethical themes, and a new ethical triangle to propose an ethical code for NPs. DATA SOURCES: Reviews of three generally accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). CONCLUSIONS: A proposal for a code of ethics for NPs is presented. This code was determined by basic ethical themes and established codes for nursing, formulated by the ANA, and for physicians, formulated by the AMA. The proposal was also developed in consideration of the AANP standards of practice for NPs. IMPLICATIONS FOR PRACTICE: The role of the NP is unique in its ethical demands. The authors believe that the expanded practice of NPs presents ethical concerns that are not addressed by the ANA code and yet are relevant to nursing and therefore different than the ethical concerns of physicians. This proposal attempts to broaden NPs' perspective of the role that ethics should hold in their professional lives.     

Navigating towards a moral horizon: a multisite qualitative study of ethical practice in nursing.

This paper reports the results of a qualitative study of nurses' ethical decision-making. Focus groups of nurses in diverse practice contexts were used as a means to explore the meaning of ethics and the enactment of ethical practice. The findings centre on the metaphor of a moral horizon--the horizon representing "the good" towards which the nurses were navigating. The findings suggest that currents within the moral climate of nurses' work significantly influence nurses' progress towards their moral horizon. All too often, the nurses found themselves navigating against a current characterized by the privileging of biomedicine and a corporate ethos. Conversely, a current of supportive colleagues as well as professional guidelines and standards and ethics education helped them to move towards their horizon. The implications for nursing practice and for our understanding of ethical decision-making are discussed.     

Confidence and knowledge regarding ethics among advanced practice nurses

As the scope of advanced practice nursing expands and the educational requirements increase, so do the ethical responsibilities. How prepared are advanced practice nurses (APNs) to manage the ethical challenges in advanced practice? The purpose of this study was to determine APNs' ethics knowledge and perceived level of confidence in their ability to manage ethical problems in advanced practice. Assuming ethics knowledge and abilities of APNs are similar to those of medical residents, a survey instrument for medical residents was modified for use with APNs. Responses to the modified survey indicated a fairly high level of confidence but a fairly low level of knowledge. Studies show that ethics education can be effective in improving knowledge, confidence, and ethical behavior. Given the expanding role of APNs as doctors of nursing practice, research is needed to determine the ethics knowledge needs and teaching strategies to better prepare nurses for the challenges of advanced practice.     

Core topics of health care ethics. The identification of core topics for interprofessional education

OBJECTIVES: The aim of this project was to identify core topics of health care ethics that could be taught through an inter-professional approach to undergraduate education. DESIGN: Five nominal group technique workshops. Setting and participants: Teaching staff from different professional disciplines in our university (nursing branches, occupational therapy and physiotherapy). RESULTS: Seven core topics of health care ethics that are common across all disciplines were identified. However participants in all workshops identified the need for case studies used in teaching and learning to be specific to the clinical setting encountered by the student. CONCLUSION: Despite the identification of core topics that apply to all disciplines, caution should be taken when seeking to integrate these into an inter-professional undergraduate programme. There is evidence from other studies that students have difficulty in transferring knowledge from one context to another. In view of this, an inter-professional approach to health care ethics teaching to a group, members of which do not encounter shared clinical ethical problems may be inappropriate. It is suggested that inter-professional learning in undergraduate health care ethics should focus on facilitating learning in the clinical area with students who share similar ethical encounters, in which case the learning will be truly inter-professional.     

Ethics in nursing: the way forward

This series of articles has been developed with the intention of increasing nurses' awareness of ethics and ethical decision-making and clarifying the relationship between ethical thinking and effective nursing practice. A number of issues have been examined to show how ethics affects the professional role, but many other clinical and non-clinical aspects of nursing demand ethical exploration. In the final article in the series, the relevance of ethics to effective nursing is emphasised and suggestions for enhancing the integration of ethical decision-making into practice are made.