The Evolution of Ethics in Nursing A Brief History and Application

18Ethics in Actionby Marg Olfert, RN, Nursing Advisor, Policy, SRNAThe Evolution of Ethics in NursingA Brief History and ApplicationWelcome to a new Ethics inAction – I am excited tobegin my role here at theSRNA, and write, this, my first ethicsarticle! I will explore the history ofnursing ethics and then discuss myown evolving understanding aboutethical nursing practice.Ethics is about doing the rightthing, the right way. As such, in ethicsthe means are as important as theends. In nursing, this relates to howRNs ought and ought not to act, so isintrinsically linked to nursing practice(Oberle & Bouchal, 2009).Historically, nursing ethics inCanada has evolved over time. Thevalues of the nursing profession inCanada were influenced by FrenchRoman Catholic nuns, who providedcare for the sick in Canada’s earlydays. Thus etiquette and generalcomportment were highly valued. Thedesired characteristics for a nurse werethat of being courteous, quiet, loyal,obedient and respectful (Oberle &Bouchal, 2009). Florence Nightingalealso considered character to be the keycomponent of ethical conduct, andshe sought such attributes as honesty,kindness, ad truthfulness in potentialnurses (Lamb, as cited in Storch,2007).As nursing ethics were so closelyrelated to the characteristics of loyaltyand obedience, unfortunately it wasalso seen as embodying a primaryloyalty to the physician and theSRNANewsBulletinEthics is about doingthe right thing, theright way.organization, with the patient assecondary (Storch, 2007). By the latenineteenth century, nursing leadersin North America were interested inestablishing a code of ethics for nurses.However, that attempt to create acode of ethics for nursing at a nationalconvention was thwarted when aphysician urged that a code wouldbe more trouble than it was worth,adding that being “good women” wasall that was really needed (Dock, ascited in Storch, 2007).As nursing was becomingprofessionalized by the mid-1920s,the ideal of unquestioning respectfor authority was consideredinappropriate. Ethics began to focuson the nature of the nurse-patientwinter 2 0 1 3relationship and human rights(Oberle & Bouchal, 2009). In 1926,a nursing code of ethics was finallypresented at the national conventionof American nurses, and its purposewas that of creating a sensitivity toethical situations and formulatinggeneral principles to guide action inspecific situations (Mooney, as cited inStorch, 2007). Financial difficulties ofthe 1930s and then the Second WorldWar contributed to the postponementof the adoption of the code.The code of ethics for nurseswasn’t finally a reality until theInternational Council of Nursesadopted it in 1953. Between the1930s and 1960s, it became clearerthat nurses were responsible for theirown choices, and able to exerciseindependent professional judgement(Storch, 2007). Nursing was nolonger considered to be under theabsolute control of medicine, and itwas becoming clear that nurses hadresponsibility for decision-makingabout their own practice (Oberle& Boucahl, 2009). Since that time,The code of ethicsfor nurses wasn’tfinally a reality untilthe InternationalCouncil of Nursesadopted it in 1953.I believe that theapplication of the codeto individual nursingpractice continues toevolve as well.nursing ethics has been viewed asunique and distinct from medicalethics, and has continued to evolve.I believe that the application of thecode to individual nursing practicecontinues to evolve as well. Considerconfidentiality and privacy. In ourinitial basic nursing education, wewere all instructed on the importanceof maintaining confidentiality in ournursing practice. As I reflect on myearly nursing career, I recall learninghow to put this theory into practice.In my first full-time, permanentposition as an RN in a regionalhospital almost thirty yearsago, I learned how to maintainconfidentiality in a small community.Everyone knew everyone, and tendedto stop you in the grocery store to askabout someone they knew that hadbeen hospitalized. I recall discussingsuch situations with my nursingcolleagues and coming to somedecisions about what to do. Overtime, I learned how to respond to thequestions, while not appearing to berude.In this same setting, all patientswere given the option of signingconsents when they were admittedto hospital, allowing their nameand condition to be announced ona local radio program each day. AsRNs on the night shift, we thenprovided an update for the localradio reports each day as to theircondition. This included a briefdescription – the patient status wasdescribed as “progressing favourably”,or “satisfactory”, or “fair”. As anew RN, I wondered about thispractice, and usually determined eachpatient was “progressing favourably”even if I knew their condition wasdeteriorating. Thus I wondered aboutthe usefulness and, yes, the ethics ofthe radio report, but the communityseemed to value the information.Years later, in my teaching career,maintaining confidentiality andprivacy about patient informationtook on a different application.The impact of social media wasprevalent as students learned aboutconfidentiality and maintainingprivacy. What should be shared andwith whom? Communication byWhile the code of ethicswill continue to evolveover time, I know thathow I apply it to mynursing practice willalso evolve.SRNAelectronic means was becoming somuch more social and communal –experiences between students wereshared instantly and frequently, andstudents did not always know how toconsider the values of privacy in theirday to day practice. Students, like meyears earlier, accepted the principlesof ethical practice but the applicationof those values and principles wasmore challenging, and often requiredguidance and discussion.While the code of ethics willcontinue to evolve over time, I knowthat how I apply it to my nursingpractice will also evolve. It is thisafter all that helps to define ourprofession and informs others of theresponsibilities that RNs accept intheir practice (CNA, 2008).ReferencesCanadian Nurses Association. (2008). Codeof ethics for registered nurses. Ottawa,ON: Author.Oberle, K., & Bouchal, S. R. (2009). Ethics inCanadian nursing practice: Navigatingthe journey. Toronto: Pearson PrenticeHall.Hardingham, L. (2003). Ethical and legalissues in nursing. In M. McIntyre &E. Thomlinson (Eds.), Realities ofCanadian nursing: Professional,practice, and power issues (pp. 339356). Philadelphia: Lippincott, Williams,& Wilkins.Storch, J. (2007). Enduring values inchanging times: The CNA code of ethics.Canadian Nurse 103(4), 29-33, 37.NewsBulletinwinter 2 0 1 319Copyright of SRNA Newsbulletin is the property of Saskatchewan Registered NursesAssociation and its content may not be copied or emailed to multiple sites or posted to alistserv without the copyright holder’s express written permission. However, users may print,download, or email articles for individual use.

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