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Standards of Nursing Practice

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    The nursing practice, as it is constantly evolving, is dependent upon the regulations created by the standards of nursing practice. One of the highlights of the nursing standard illustrates the virtue that must be cultivated by a nurse in the conduct of one’s profession. In this research, three articles that define nursing ethics will be dissected and discussed, in the hope of shedding light to what this profession is all about. The succeeding paragraph will define what nursing ethics is all about, and how the practice of nursing is benefited by this standard.  Standards allow nurses to carry out professional roles. They serve as protection for both the nurse as well as the patient, even to the institution that provides healthcare. Each nurse is accountable for his or her own quality of practice and is responsible for the use of these standards to ensure knowledgeable, safe, and comprehensive nursing care.

    What is being stressed as far as the nursing practice is concerned, is for the nurse to possess the educational background in order to maintain competency in the field of practice, one that reflects the current and existing standard. It is also imperative that the nurse interacts with and contributes to the professional development of peers and colleagues – collegiality. In the aspect of collaboration, the nurse must be able to collaborate with the patient, family members, and others, in the conduct of nursing practice. He or she must integrate the ethical provisions in all areas of his or her profession. However, the most compelling part of the nursing role is the ability to integrate the knowledge with the attitude and behavior in order to function as an agent for the patient. This requires the nurses’ to abide by the ethics of the professional standard and apply this to the nature of the situation, fostering human integrity and morality regardless of race, religion and gender. This is the core issue of the three articles which this author has chosen.

    Austin, Wendy. (2007). The Terminal: a tale of Virtue. Nursing Ethics, 14, 54-61.

    In this article, nursing ethics is defined more as an ideal virtue that a nurse must possess in order to render an exceptional quality of patient care. In this article, such virtue is emphasized in relation to the character of a stranded airline passenger, Viktor Navorski, in the film entitled Terminal. This film illustrates the positive attitude that must be honed and harness amidst pressures and tribulation. The ideal characteristics of the main character in this film shows an obvious distinction from the two other roles, a flight attendant who tries so hard to establish a positive outlook in spite of the negativity of her situation, and the airport manager who just could not find anything positive about his external environment. These two roles which amplifies the distinction between the negative and positive attitude towards life, teaches us how honesty becomes a major factor in cultivating the ideals of virtue (Austin, 2007).

    Let us begin by looking back into the beginnings of nursing during the Crimean war, in the time of the famous Florence Nightingale – the lady with a lamp. Nightingale possessed the ideals of self dedication and self sacrifice, a virtue that exemplifies a positive attitude towards work. The nursing standards of ethics, identifies the proper attitude toward the practice – to be true to self, so as to render sincere service. Ethics, in this article, is more emphasized as an attitude and behavior, not as a law. Although the ethical standards of nursing stresses ethical virtue more on the context of regulatory standards rather than of a more personal one, this article highlights that an ideal nurse needs no established guidelines to provide quality care, but rather, a character similar to that of Viktor Navorski (Austin, 2007)

    Olthuis, G., Leget, C., & Dekkers, W. (2007). Why hospice nurses need high self-esteem. Nursing Ethics, 14, 62-71.

                This article talks about the correlation of self-esteem with competence in profession, where personal identity is dependent upon one’s personal circumstances, and a positive personal circumstances almost often generate efficiency and productivity. This article makes a particular reference with a nurse who was once assigned in an oncology unit and did not function efficiently there, but was otherwise, when assigned at the hospice. This article highlights the importance of personal identity in proficiency, and personal identity is corollary with self respect and integrity. An integral comparison is established by pointing out the difference in the kind of care rendered in the oncology unit to that of a hospice. While the former denotes a palliative routine type of care to a dying patient, the later renders a holistic approach that extracts and promotes nurse’s autonomy. The predictability of a negative outcome in the oncology unit is contrary to the promotive and restorative kind of care rendered in the hospice. This article advances the idea that giving the nurse autonomy in the choice of care often generates beneficial effects to the patient’s health, and likewise enhances her confidence and skills, whereas a monotonously mechanical/routine care rendered to a patient whom the nurse knows as dying, often triggers depression consequential to the nurse’s withdrawal to establish close relationship with such patient. It is pointed out that human behavior considers it a normal psychological defense mechanism to withdraw from the source pain, and while it is ideal to always separate the personal from the professional, the nursing practice finds it difficult to dissociate emotion from rendition of care, since the nurse-patient relationship establish the patient as an integral part of the profession, and is therefore impossible for the nurse not to get affected in the event where the patient dies. Since this is an inevitable occurrence in the nursing profession, it is understandable why nurses’ prefers to see their patient’s condition resolved.

    Johnson, Elizabeth. (2006). Case Studies in Nursing Ethics (3rd Ed.). Nursing Education

    Perspectives, 27,  332.

    In an article written by an associate professor of the University of Southern Indiana, she elaborated on what nursing ethics is all about – which essentially focuses on the “who should decide on the outcomes” (Johnson, 2006). A nurses’ role, is to advocate the patient’s preference when such patient is unable to speak for himself. The nurse is to abide by the wishes of the client only if this wishes and preferences are corollary with what the main objective is all about – health and wellness. He or she must also be able to consider and utilize factors related to safety, effectiveness, cost, and impact on the practice, in the planning and delivery of care. Since the nurse is expected to assist the needs of the patient, his or her responsibility in seeing to it that these needs are provided, extends until the procurement of imperative and relative resources that would render the patient and the family members, at ease in making a decision. This would be applicable in the instance where the elderly patient is advised to seek institutional care, where the nurse must be able to assist the family members in providing the necessary information that would help them make a better decision. This describes the standards of professional performance – Ethics – describing the nurses’ ethical obligations – the nurse’s decisions and action in behalf of the patient are determined in an ethical manner. For instance in the case of a DNR (do not resuscitate) case, the ethical sensibility dictates that the nurse notes the discrepancy between the patient’s documented wishes of DNR and the care that the patient received (Laduke, 2003).

    The nurse may sense a personal discomfort about this disregard. He or she may decide to ignore her discomfort and simply provide excellent technologic care or acknowledge her discomforts and respond. She then decides to speak with the physician about her knowledge concerning the patient’s preference and learns that the attending physician is unaware of the patient’s documented preference. She then contacts the previous assigned nurse who may have knowledge about this preference for verification, and learns that although the patient was quite clear about this, no one followed up and translated the conversation into orders on the patient’s chart. The current nurse then decides on calling an ethics consult when the attending says that there is nothing to be done now that the treatment has initiated. During the ethic consult, family members agree that the patient would not be happy to find himself on a ventilator and request that he be weaned – even if this result to his death. The ethicist explained that weaning the patient from an ineffective will not cure the cancer. In this care the nurse initiated the ethics consult because she believed that she could not be an advocate for this patient and merely provide good physical care. Once she knew or suspect that his preference had been ignored, she felt accountable for determining how the system had failed this patient and for remedying the problem. The nurse prides herself on being responsible and accountable and therefore could not risk any omission or commission – and thus pretend that this was not his/her problem. After the ethics consult, the nurse participates in plan to find an optimal time and condition to wean the patient from the ventilator and makes sure that his family is present. The patient does not survive the weaning, and although the family members are grieving, they are grateful to the nurse for her care.

    Goopy, Suzanne E. (2005). Taking account of local culture: limits to the development of a

    professional ethos. Nursing Inquiry, 12, 144-154

    Because the nurse had cultivated the virtues of responsibility and fidelity, a nurse’s course of action will become natural, and because she places a high value on being an effective patient advocate, there is a display of willingness to confront difficult situations that may hamper a nurse’s relationship towards colleague. While culture might dictate meekness, a nurse who values the well-being of his or her client, would be willing to go against the norms of his or her culture to insist what is right for the patient. This will however, take into account the benefits and condition of the patient, regardless of differences in culture. The management of the patient’s health is the primary goal that a nurse must uphold, instead of the distinction in the aspect of ethnicity and norms.

    While this may be of different case, it somehow relates to the second article, in the sense that the nurse upheld the preference of her patient despite of the obvious complications it will create in her relationship with her colleague. Moreover, while this preference might not be highly favored by the patient’s family or significant others, the nurse exemplified advocacy by insisting on what might alleviate the patient’s discomfort – which is the prolonging of patient’s agony. In cases like this, not every culture possess an affirmation to euthanasia, this in fact, have fueled several debates concerning the moral and ethics of such decision. In this particular situation, a nurses opinion and culture does not hold any place for consideration, it does not matter what view healthcare providers have on this issue. What matters most is what the patient wants, and if the patient can not speak for himself, the nurse is but the right person to stand in the patient stead to see to it that his or her wishes, however questionable they are, be granted.


                The above article thus concludes that the nursing standard of ethics is not something acquired or learned through theoretical and practical means. It is something innate and natural and is cultivated through dedication and willingness to be a part of a solution. The role of the nurse in the healthcare industry is what its name implies, which means to nurse the sick. Nursing the sick needs a holistic approach that requires the mind, body, and heart of a nurse to render sincere care. One cannot simply get involve in the process of promoting wellness, restoring health, preventing illness and alleviating pain, without getting affected should any of this goal fails. Nursing care establishes relationships, and relationship always requires emotion, emotion denotes love, all these then generates respect, for oneself and others – this is what nursing ethics is all about.


    American Nurses Association. American Journal of Nursing, 106, 15-16.

    Austin, Wendy. (2007). The Terminal: a tale of Virtue. Nursing Ethics, 14(1), 54-61.

    Goopy, Suzanne E. (2005).Taking account of local culture: limits to the development of a

    professional ethos. Nursing Inquiry, 12(2), 144-154.

    Johnson, Elizabeth. (2006). Case Studies in Nursing Ethics (3rd Ed.). Nursing Education

    Perspectives, 27(6), 332.

    Laduke, Sharon. (2003). Keeping up with standards, your key to safe practice. Nursing, 33(3)


    Olthuis, G., Leget, C., & Dekkers, W. (2007). Why hospice nurses need high self-esteem.

    Nursing Ethics, 14(1), 62-71.

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