HCE 2025 Material for Lesson 7

Nightingale Pledge

  • The Nightingale Pledge is a solemn vow recited by nursing students during graduation.
  • Initial version created in 1893 by a committee led by Lystra Gretter.
  • Notable updates:
    • In 1935, Gretter modified the final sentence of the pledge to emphasize public health:
    • "I will devote myself to the welfare of those committed to my care."
    • Original text of the pledge includes:
    • "I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug…"
  • Important references:
    • Marsha D. M. Fowler, "Ethics and nursing, 1893-1984: the ideal of service, the reality of history," Ph.D. thesis, USC, 1984.

Nursing Code of Ethics

History

  • According to the American Nurses Association (ANA), the nursing code of ethics serves as a guideline for nurses to uphold the quality of nursing care and ethical obligations.
  • Ethical values are critical for all healthcare workers, particularly nurses.
  • The code, suggested to have originated from the Nightingale Pledge in 1893, has undergone many revisions, culminating in its formal development by the ANA in the 1950s.
  • The most impactful revision occurred in 2015, with the addition of nine interpretative statements.
  • The nursing code of ethics also has legal implications and continues to see regular updates.

Four Main Principles of Nursing Ethics

  1. Autonomy

    • Definition: The recognition of each patient's right to self-determination and decision-making.
    • Nurses must provide all medical information, risks, benefits, and options to ensure patients can make well-informed decisions.
    • Patient advocacy is vital, as nurses may need to defend a patient's wishes against medical team consensus. Factors affecting treatment decisions include:
      • Culture
      • Age
      • Gender
      • Sexual orientation
      • General health
      • Social support system

  2. Beneficence

    • Definition: Actions guided by compassion, aiming for the good and welfare of others, including kindness and charity.
    • Defined by the ANA as actions motivated by compassion.

  3. Justice

    • Definition: Fairness in all medical and nursing decisions and care.
    • Nurses should provide equitable care regardless of an individual’s financial status, race, religion, gender, or sexual orientation.
    • Example: Providing free services in a flu clinic open to the entire community.

  4. Non-maleficence

    • Definition: The principle of "do no harm."
    • Focuses on interventions and care causing the least harm for the best beneficial outcome.
    • Ensures patient and community safety in care delivery.
    • Nurses must report unsafe treatment options that may harm patients, including scenarios with suicidal or homicidal ideations.

Nursing Code of Ethics Interpretive Statements

  • Revised in 2015, the ANA nursing code of ethics comprises the following nine provisions:
    1. The nurse practices with compassion and respect for every person’s dignity and uniqueness.
    2. The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
    3. The nurse promotes and protects the rights, health, and safety of the patient.
    4. The nurse holds authority and responsibility for nursing practice; decision-making must align with obligations to provide optimal care.
    5. The nurse owes double duties to self and others, including the responsibility to promote health safety, maintain competence, and pursue personal growth.
    6. The nurse, individually and collectively, enhances the ethical environment of settings to ensure safe and quality healthcare.
    7. The nurse advances the profession through research and the development of professional standards.
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