Professional Documents
Culture Documents
Lachman
Elizabeth O’Connor Swanson
and Policy Jill Winland-Brown
tain particular attributes of moral character might not developing practice standards consistent with the Code
be expected of everyone, but are expected of nurses” (p. and other foundational documents. The third focus
23). Nurses in all roles are responsible for instituting, underscores the nurse’s responsibility to lead or serve on
sustaining, and cultivating an ethical work environ- institution, local, state, regional, or global civic or orga-
ment. Nurse managers/executives must involve nurses nizational policymaking committees.
in decisions related to workplace conditions and profes- The first interpretative statement focuses on “contri-
sional practice. Nurse executives also need to advocate butions through research and scholarly inquiry.”
for appropriate organizational change to create a moral- Knowledge development, whether through research or
ly good environment. scholarly inquiry, is necessary to advance the theory
Interpretive statement 1 focuses on expanding the and practice of nursing. Clinical nurses have the ethical
definitions of the virtues of nursing and states nurses are obligation to know and disseminate the most recent
expected to have specific attributes of moral character. research findings to support best practices. They also
Keisha has violated the Code by making derogatory have the obligation to protect patient rights in research.
comments about patients, thereby failing to demon- Kiesha had demonstrated an initial interest in research
strate respect and compassion for those in her care. and joined the unit research council. Now she is disen-
Keisha also is not caring for herself, placing her physical gaged and is not meeting scholarly publication obliga-
well-being at risk. The interpersonal communication tions. While this level of involvement is not a require-
between Lindsey and Keisha is hostile, leading both ment, all nurses must remember clinical questions
nurses to be in violation of the Code. Neither is practic- developed at the bedside often generate research ques-
ing the expected nurse virtues of compassion, patience, tions. “All nurses must participate in the advancement
or respect. of the profession…” (p. 27).
Interpretative statement 2 focuses on “the environ- The second interpretative statement addresses “con-
ment and ethical obligation.” This statement asserts, tributions through developing, maintaining, and imple-
“Nurses in all roles must create a culture of excellence menting professional practice standards.” Professional
and maintain practice environments that support nurs- nurses have an obligation to develop practice standards
es and others in the fulfillment of their ethical obliga- that support ethical practice and nursing’s body of
tions” (p. 24). This means each nurse has a responsibil- knowledge. Because of her compassion fatigue or
ity to address Lindsey’s bullying to help ensure Keisha burnout, Keisha appears to be doing little and is not
does not continue to be a target. Peer pressure may meeting the obligations of professional nurses. Nurse
influence the team’s response, but if members continue managers and executives must support the autonomy of
to allow the bullying through their silence, they are in nurses in executing these standards to maintain quality
violation of the Code. Understanding the Code and other patient care.
ethical position statements will provide nurses the The third interpretative statement centers on “contri-
knowledge necessary to construct an environment butions through nursing and health policy develop-
needed for professional nursing practice. ment.” Nurses can meet their ethical obligations by par-
Interpretative statement 3 addresses the “responsibil- ticipating in a variety of local, state, national, or global
ity for the healthcare environment.” This statement initiatives. Keisha could use her addiction recovery
emphasizes, “nurses are responsible for contributing to experience to help change nursing regulations in her
a moral environment that demands respectful interac- state and present at state and national conferences on
tions among colleagues, mutual peer support, and open needed policy changes.
identification of difficult issues…” (p. 24). Nurses on the
team have a collective responsibility to confront Keisha
regarding her unprofessional remarks about patients, Provision 8
her lack of involvement in team professional activities, The nurse collaborates with other health profession-
and the hostile relationship between Keisha and als and the public to protect human rights, promote
Lindsey. “The workplace must be a morally good envi- health diplomacy, and reduce health disparities.
ronment to ensure safe, quality patient care and profes-
sional satisfaction for nurses and to minimize and First, in comparison to the previous Code (ANA,
address moral distress, strain, and dissonance” (p. 24). 2001), this provision adds health as a universal right
and significantly increases the focus of the nurse on
human rights and health disparities. Second, it increases
Provision 7 the nurse’s obligation to take action on social injustice.
The nurse, in all roles and settings, advances the For the first time, it also addresses nurse’s moral obliga-
profession through research and scholarly inquiry, pro- tions in extreme and extraordinary practice settings
fessional standards development, and the generation (e.g., Ebola, Hurricane Sandy).
of both nursing and health policy. The first interpretative statement, “health is a univer-
sal right,” is new in this Code revision. This assertion is
This provision first focuses on the nurse’s role in held in common with many human rights treaties; it
knowledge development through research and scholarly includes many public health measures (e.g., sanitation,
inquiry. The second emphasis is on the importance of potable water, immunizations), basic access to preven-
tion, and treatment of illness and injury. The Code lists The first interpretative statement about “articulation
16 different entitlements included in this right (e.g., and assertion of values” identifies the need for profes-
access to care, emergency care, prevention education). sional nursing organizations to provide a unified voice
Keisha could take an active role in educating nurses and for the profession. The various professional organiza-
public in the prevention and treatment of drug abuse. tions of nursing “communicate to the public the values
The second interpretative statement is “collaboration that nursing considers central to the promotion or
for health, human rights, and health diplomacy.” restoration of health, the prevention of illness or injury,
Though nurses have a personal obligation to address and the alleviation of suffering” (p. 35). By acting in
human rights and health disparities, only through col- unity, nurses can have a noteworthy impact on social
laboration with other health care professionals can they justice and global health policies.
make significant needed impact on these social justice The “integrity of the profession” is the second inter-
issues. Practicing nurses see on a daily basis how a social pretative statement and is based on the knowledge and
problem becomes a health problem, as they view the observance of essential documents, such as the Code
effects of poverty, drug-infested neighborhoods, and (ANA, 2015a) and Nursing: Scope and Standards of Practice
food deserts (“urban neighborhoods and rural towns (ANA, 2015b). These documents support the covenant
without ready access to fresh, healthy, and affordable between the nursing profession and society. This prom-
food”) (U.S. Department of Agriculture, 2015, para. 1). ise also is supported by defined educational require-
Keisha has seen health disparities among homeless per- ments for entry into practice, augmented utilization of
sons through previous work via her cycling. advanced practice nurses, increased focus on certifica-
Interpretative statement 3 addresses the “obligation tion, and nursing’s commitment to evidence-based
to advance health and human rights and reduce dispar- practice. Keisha is not doing the needed work for recer-
ities.” Individually or through community organiza- tification, which could be seen as a violation of this pro-
tions, nurses can educate the public and join in legisla- vision.
tive efforts to promote health. Again, nurses know first- The focus of the third interpretative statement is
hand the barriers to health; homelessness, abuse and “integrating social justice,” with examples of the multi-
violence, and lack of cultural sensitivity are a few of the ple ways this can be accomplished. This interpretative
obstacles to quality health care. Keisha has experienced statement recognizes the responsibility of nursing
personally how drug addiction stops the outward focus organizations to advocate for changes in health policies
on others, and she could be a good addition to any team on local, national, and international stages. Because
that addresses addiction leading to homelessness. social determinants of health continuously foster social
Interpretative statement 4 focuses on “collaboration injustice, nurses must take action with governmental
for human rights in complex, extreme, or extraordinary and nongovernmental bodies related to health affairs.
practice settings.” Nurses can face competing moral The statement also identifies the nurse’s responsibility
claims, for example, in caring for victims of natural dis- to “firmly anchor students in nursing’s professional
aster while needing to care for family. Nurses have a responsibility to address unjust systems and struc-
moral obligation to both groups, and only the individ- tures...” (p. 36). Keisha could address the issue of social
ual nurse can determine which moral option to address justice for recovering individuals by volunteering to
(ANA, 2006). “Only in extreme emergencies and under speak to nursing classes. Through content education,
exceptional conditions, whether due to forces of nature staff development, or clinical experience, nurses can
or human action, may nurses subordinate human rights help students and practicing professional nurses model
concerns to other considerations” (p. 33). In such cir- a commitment to eradication of social injustice.
cumstance, the Code suggests a utilitarian framework “Social justice in nursing and health policy” is the
could guide actions (greatest good for the greatest num- final interpretative statement in the new Code (ANA,
ber) (ANA, 2011). 2015a). This final statement fittingly focuses on global
health and the need for voices of U.S. nurses to be heard
around the world. In this reiteration of the Code, the
Provision 9 health of the natural world is first addressed. Though
The profession of nursing, collectively through its Florence Nightingale demonstrated concern for the
professional organizations, must articulate nursing effects of environment on health, the profession today
values, maintain integrity of the profession, and inte- must extend its advocacy as the “environmental assaults
grate principles of social justice into nursing and disproportionately affect the health of the poor” (p. 37).
health policy. The “Laudato Si” statement by Pope Francis (2015)
In comparison to the previous Code (ANA, 2001), this starkly ties the effects of climate change to devastating
Code (ANA, 2015a) addresses more in depth nurses’ effects on the poor.
responsibilities to engage in rectifying social injustices
and health disparities in the community and beyond. continued on page 368
The interpretative statements address issues impacting
nursing practice now (e.g., climate change, human traf-
ficking).
Lachman, V.D., Swanson, E.O., & Windland-Brown, J. (2015). The new ‘code of ethics for nurses with interpretive
statements’ (2015): Practical clinical application, part II. MEDSURG Nursing, 24(5), 363-366, 368.