DEVELOPMENT OF CODE OF ETHICS

 A need for ethical guidance was organized soon after modern nursing began to formalize in
the mid-1800s. Although in 1896, one of the initial goals of the newly established American Nurses Association was to write a code of ethics, urgent issues such as nurse registration, the welfare of nurses, and accreditation processes for nursing schools took precedence. Thus, for many years, nurses had no formalized code of ethics and used Gretter's Nightingale Pledge, akin to medicine's Hippocratic Oath, to guide their practice. In the early 1900s, Isabel Hampton Robb's text, Nursing's Ethics for Hospital and Private Use described the obligation of the nurse to the patient, physician, institution, self and profession and the creativity needed to find solutions to problems and provide good nursing care. In 1926, the ANA published a "suggested" code which provided the first outline of ethical behavior for nurses.

A "Tentative Code" in 1940 described nursing as a profession and outlined many provisions similar to those in the 1926 suggested code, including framing the provisions in terms of relationships to patient, colleagues, and profession. The first formal Code for Professional Nurses was adopted in 1950 and was edited slightly before being revised in 1960. The 1960 Code for Professional Nurses outlined 17 provisions beginning with the "fundamental responsibility to conserve life, to alleviate suffering, and to promote health" and extending to accountability for practice and conduct, participation in research and "action on matters of legislation affecting nurses".

The 1968 revision of the code included several significant changes. First, prior to this revision. the provisions were simply listed with little, if any, interpretation. The code provided brief interpretations which helped the nurse see how the provision might be applied. Second, the provisions were reduced from 17 to a more manageable 10. Finally, there was a fundamental shift in language in the 1968 revision. The obligations of the nurse changed from generalized responsibilities to "conserve life, alleviate suffering and promote health " to a deeper, more duty-based obligation to "respect the dignity of man, unrestricted by considerations of nationality, race, creed, color or status" and to "safeguard the individual's right to privacy". With changes in the level of practice independence; advances in technology; societal changes ' and expansion of nursing practice into advanced practice roles, research, education, health policy, and administration, the Code has been revised over time to introduce obligations to advance the profession and build and maintain a healthy work environment.

As in the past, the current Code of Ethics with Interpretive Statements forms a central foundation for our profession to guide nurses in their decisions and conduct. It establishes an ethical standard that is non-negotiable in all roles and in all settings. The Code is written by nurses to express their understanding of their professional commitment to society. It describes the profession's values, obligations, duties and professional ideals. The provisions and interpretive statements reflect broad expectations without articulating exact activities or behaviors. The 2015 Code "addresses individual as well as collective nursing intentions and actions; it requires each nurse to demonstrate ethical competence in professional life". Nurse practice acts in many states incorporate the Code of Ethics. Even though the Code is primarily ethics-related, it also legal implication. Given the importance of the Code to the profession on so many levels, revisions continue on a regular basis.

Code of Ethics in Nursing Development 

1897 - The need for code of ethics for nursing was experienced by American Nurses Association 

In the early 1900s - Isabel Hampton Robb's text, Nursing's Ethics for Hospital and private Use described the obligations of the nurse to patient, physician, institution, self and profession and the creativity needed to find solutions to problems and provide good nursing care.

1926 - ANA published a "suggested" code which provided the first outline of ethical behavior for nurses.

1950 - The first formal Code for Professional Nurses was adopted.

1960 - The 1960 Code for Professional Nurses outlined 17 provisions.

1976 - Code was the emphasis on nurses relationship to the "client" and not the "patient"

1985 - Code was again updated. In this revision elevent statements of the code remain unchanged.

1968 - Revision of the Code and provisions changed from 17 to 10


2015 -
The 2015 Code "addresses individual as well as collective nursing intentions and actions; it requires each nurse to demonstrate ethical competence in professional life".

The Nightingale pledge, prepared by Greater, included the basic principles of governing ethical practice.  


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