ETHICAL CONSIDERATIONS IN

COMMUNITY
HEALTH NURSING PRACTICE

Prepared by: Maria Seniz C. Calma, RN MAN

Learning Outcomes
● Able to identify specific measures in the practice of
community health nursing with emphasis on ethical
responsibilities.
● You will be able to develop strong sense of commitment to
practice community health nursing morally and legally.
● You will be able to familiarize and know by heart the different
public laws.
● To be able to demonstrate nursing core values and filipino
cultures and practices in the community health setting.
Ethical consideration
➢ Means considering the morals or the principles of goodness

➢ The right and wrong of an action prior to doing the action

➢ It considers whether or not it is within the rules or standards of right

conduct or practice, especially the standards of a profession, so in our
case we are talking about the nursing profession
1. The rightness or wrongness of the human behavior
2. With the motivation behind the behavior, there are a lot of legal and ethical issues in
community health nursing practice.
● Selling of drugs, toxins, and highly abused medications
● Packages like family planning supplies
● Asking payment for services rendered in barangay health centers
According to George Washington Carver:
“Once motives are wrong then nothing can be right”
OR
“There's no right way to do the wrong thing.”
3. Application of all nursing principles to life and death is used in all clinical setting
● The main duties and obligations of healthcare practitioners are: (1) preservation
of life and health, (2) protection of bodily integrity from harm, and (3) respect for
human dignity.
Ethical Issues

Occurs when a given decision in a scenario or activity creates the conflict within the society’s moral
principles. This conflicts are sometimes legally dangerous since some of the alternatives to solve
these issues might break a particular law.
1. MORAL DILEMMA
➢ One example of a common ethical dilemma nurses deal with in the community health
nursing practice is establishing boundaries with clients. There are instances in the community
where an assistant can be a very manipulative and tend to establish extract closeness to the
community health nurse.

2. MORAL CERTAINTY OR MORAL CONFLICT

➢ This happens when the nurse is unsure which moral principle to apply. Nurses particularly
during the time of pandemic had a hard time making decisions on how to be fair to all patients
in triaging or prioritizing the presenting s/sx.
3. MORAL DISTRESS
➢ This happens when the nurse knows the right thing to do but organizational constraints
keep them from doing it. Conflict with other healthcare providers, excessive workload, and
working with colleagues believed to be incompetent are examples of clinical situations that
cause moral distress to nurses.

4. MORAL OUTRAGE
➢ A nurse witnesses an immoral act by another but feels powerless to stop it. It is also a
behavioural response to a certain situation. For example, in the context of covid 19, moral
outrage is manifested as frustration particularly in the context of treatment and the level of
risk to help professionals like frontliners.
ETHICAL VS LEGAL

The need to practice within the moral standards of the nursing profession and within the
context as governed by our legal laws.

The need to be knowledgeable enough, judicious & considerate in discharging your

duties and responsibilities.

ETHICAL: “ought to”

PRUDENT: “knowledge”

LEGAL: “must”
ETHICAL PRINCIPLES

1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
5. Veracity
6. Fidelity
Autonomy
The nurse must be reminded of the rights of the community people to self-determination.

The nurse has a responsibility to treat individuals as autonomous human beings and has the
right to make decisions.

There are instances that “Paternalism” is being utilized and restricts autonomy. The nurse is
duty bound to decide on behalf of the client in instances where developmental
considerations and health related challenges restrict the autonomy of the client to decide for
himself.

The nurse makes decisions on behalf of the client. It is considered acceptable when a
client does not have decision making capacity
Beneficence
This refers to actions that benefit others based on the
hypothetical to apply measures that will benefit the sick.
An ethical principle that addresses the idea that the nurse's
actions should promote good or doing good is taught of doing
what is best for the clients.
“Centerpiece of caring”
Non-maleficence

The nurse is trying to prevent harm or totally remove harm.

It is more binding than beneficence because the nurse is going beyond his or
her responsibilities, to do good or prevent harm to the patient.
Example:
“The nurse is carefully dressing a wound of an injured child.”
Fidelity

The nurse is duty bound to be faithful and loyal to commitments. Fidelity in

nursing means that nurses must be faithful to the promises they made as
professionals to provide competent and quality care to their patients.

2 Types of Promises:

a. Implicit promises - is when someone doesn't say they will do something, but it's expected that they will.
Implicit promises are those that are implied and may be contained in other things.
b. Explicit promises - are those where the promise is clearly stated in its own right. Explicit promises are easy.
They are seen and recognized.
3 ASPECTS AS THE MODEL FOR FIDELITY
● Keeping one’s word of honor
● Loyalty to commitment and oaths
● Reliability
By fidelity, we mean the obligation to act in good faith and to keep vows and promises,
fulfill agreement, maintain relationships and fiduciary responsibilities.
Fiduciary responsibilities - refers to the contract of relationship the nurse enters into
with the patient. Fiduciary relationship backs on trust and confidence which means that
once the physician or nurse enter into a relationship with the patient, these
professionals become the trustees of the patient’s health and welfare.
Veracity
The community nurse is bound to be truthful and honest in all dealings with the community
people. This is an obligation to tell the truth and not to lie or deceive others.

Principles of Veracity

1. Confidentiality - the nurse is duty bound to keep privilege information private meaning
anything stated to the nurse or health care providers by the patient must remain
confidential. In instances wherein patients indicate harm to themselves or other, it can
be violated. It also applies in instances where patients need permission for the
information to be shared.

2. Principle of double effect - means that some actions can be morally justified even if
those consequences may be a mixture of good and evil.
4 Criteria of the Principle of Double Effect
1. The action itself is morally good or neutral.

2. The agent intends the good effect and not the evil (the evil may not be
foreseen and not intended).

3. The good is not achieved by the evil.

4. There is favor of good over evil.

3. Duty based (Deontology)

➢ Duty to do or to refrain from doing something.

➢ Decisions are made because there is duty.

➢ Deontology is patient centered. It defends as an ethical theory that the

morality of action should be based on either that the action itself is right or wrong
under a series of roles rather than it is based on the consequence of action.
4. Virtue Ethics

➢ Actions are consistent with certain ideal virtues. Decisions are directed at maintaining
virtues.
Example: (honesty, courage, compassion, and service)

5. Principlism
➢ Use of ethical principles instead of theories to evaluate actions.
(Most likely to be used by nurses in practice)
➢ Requirements knowledge of principles, rather than knowledge of theories
Ethics in Professional Practice (Global)

Nursing practice is governed by National Council of Nurses or

the NCN.

NCN code of Ethics for Nurses is a guide for action based on

social values and needs.

The code correlates the 4 Fundamental Nursing

Responsibilities
4 FUNDAMENTAL RESPONSIBILITIES OF NURSES

1. Promote health
2. Prevent illness
3. Restore health
4. Alleviate suffering
American Nurses Association (Code of Ethics)
Applies to all nurses in all healthcare setting Ethical principle agreed upon by
member of the profession.

It sets standards of conduct and behaviors for nurses.

The ANA code of ethics for nurses is concise statement of the ethical
classifications and duties of every individual who enters the nursing profession. It
is a profession's negotiable ethical standards and it is an expression of nursing on
understanding of its commitments to the community or to the people.
Key Points:
1. Primary commitment is to the patient (individual, family or community)
2. Demonstrate compassion and respect for all patients regardless of
patients’ status
3. Promotes the health welfare of patients
4. Accountable for individual practice
5. Maintains and increase own knowledge base
6. Works to improve healthcare environment for providers and patients
In every professional practice, there should also be Professional Boundaries.

What is Professional Boundary?

➢ It means that a nurse abstains from obtaining personal gain at the patient’s expense
and refrains from jeopardizing the therapeutic nurse-patient relationship

How do we describe boundary violations?

➢ Refers to unethical acts that are used in therapeutic relationship or acts that are
harmful to the clients

➢ Examples are exploitation or personal gain.

TERMS:
Boundaries
➢ Spaces between nurse’s power and client’s vulnerability.
Crossings
➢ Brief excursions among boundaries that may be inadvertent, thoughtless, or even purposeful if done
to meet a specific therapeutic need.
Violations
➢Results when there is a confusion between the needs of the nurse and those of the client.

Sexual Misconduct
➢Extreme form of violation that is seductive, sexually demeaning, harassing, or interpreted as sexual
by the client.
Boundary Crossing Examples
1. Excessive Self-Disclosure
➢ The nurse discusses her personal feelings or aspects of personal life in front of the
patient
2. Secretive Behaviours
➢ The nurse keeps secrets with the client or becomes guarded when someone
questions their interaction
3. Selective Communication
➢ The nurse fails to explain actions or actions of care
4. “Super nurse”
➢ The nurse believes that only he/she can meet the needs of the client
Boundary Crossing Examples

5. Singled out client treatment/client attention to the nurse

➢ Nurse spends inappropriate amounts of time with the client, client may give gifts to
the nurse
6. Failure to protect the client
➢ Nurse doesn’t recognize sexual feelings towards the client
➢ In psychiatric nursing, this is called countertransference, so the nurse falls in love
with the client
7. You and me against the world behavior
➢ Nurse views client in a very protective manner
8. Flirtations
➢ Inappropriate behavior of a nurse towards a client.
How to set Professional Boundaries?
❖ Not discussing a client’s private health information with others. Meaning, we
need to emphasize the principle of confidentiality.
❖ Keeping work contact numbers separate from personal contact number.
❖ Not performing additional favors for clients outside the score of your role.
Nurses challenges in setting Professional Boundaries:

❖ Be aware of her own and her own feelings and beliefs

❖ Be cognizant of her own and patient’s culturally
negotiated behaviors
❖ Be observant of the behavior of other professionals
❖ Always act in the best interest of the client
As a nurse:
➢ Know yourself and your values

➢ Protect your patient by intervening if you identify an ethical question

➢ Know your facility policy for access to the ethics committee

➢ Know your responsibilities with regard to informed consent

➢ Respect the patient’s advance directives

Reference
https://www.studocu.com/ph/document/notre-dame-university/bsnursing/ncm-104-l
esson-1-ethical-considerations-in-community-health-nursing-practice/23766726