- Nurses take appropriate action to protect individuals, families and communities when their health is at risk from colleagues or any other person.
- The nurse uses appropriate actions to support and guide colleagues to improve their ethical conduct.
1.2.2.2. Nursing ethics standards in some developed countries
* European nursing ethics standards [106]
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The European Code of Ethics for Nursing is published by the European Council of Nursing Regulator. This organization was founded in 2004.
* Australian Nursing Ethics Standards [96]
The Australian Nursing Code of Ethics sets out the principles for the nursing profession in Australia. It covers all levels of nursing practice and areas of practice including: clinical, management, education and research.
The Australian Nursing Code of Ethics includes the following key principles: Nurses value equitable nursing care for all; respect for human diversity; equitable access to health care and nursing care for all;….
* Japanese Nursing Ethics Code (JNA) [124]
The Japanese view is that professional healthcare requires a set of rules to train both the ethics and practice of nursing. Therefore, the JNA adopted the “Nursing Ethics Code” in 1988. However, since that year, nursing activities have undergone major changes and nurses are often faced with complexities, difficulties, and ethical challenges as patient care techniques have advanced and people have great concerns about their rights. Therefore, the JNA revised and supplemented the “Nursing Ethics Code” in 2003 with 15 ethical rules.
* Canadian Nursing Ethics Standards [103]
The Code of Ethics includes the Canadian Nurses Association (CNA) standards of nursing ethics as revised by the College of Nurses and the Association of Registered Nurses of Alberta (CARNA). The code was first drafted and adopted in 1954, and was revised in 1980, 1997, and 2002; the most recent revision was in 2008.
The Canadian Nurses Code of Ethics, entitled “Responsiveness to Nursing Values and Ethics,” describes the basic responses in ethical nursing practice. Nursing ethics includes 7 main values and accompanying responses, the foundation of which is the professional relationship of nurses with each individual, family, population, community (such as students, associations) and other health care professionals.
1.2.3. Ethical standards of nursing in Vietnam
1.2.3.1. Legal regulations on ethical standards for nurses General professional ethics have been stipulated in the Law
Anti-corruption [66], Article 42, as follows: “Professional ethics are standards of conduct appropriate to the characteristics of each profession, ensuring integrity, honesty and responsibility in practicing the profession”; “Social-professional organizations shall coordinate with competent state agencies to promulgate professional ethics rules for their members in accordance with the provisions of law”.
The principles in medical examination and treatment practice are stipulated in Article 3, Law on Medical Examination and Treatment [67] as follows: “Equality, fairness and no discrimination towards patients” ; “Priority for medical examination and treatment for emergency cases, children under 6 years old, people with severe disabilities, people aged 80 years or older, people with revolutionary contributions, pregnant women”; “Ensuring professional ethics of practitioners”; …
The rights and obligations of patients are clearly stated in Articles 7; 10; 11; and 12 in Chapter II of the Law on Medical Examination and Treatment [67].
1.2.3.2. Regulations on nursing ethics standards of the Ministry of Health [7]
The basic competency standards for Vietnamese nurses were issued by the Ministry of Health in Decision No. 1352/QD-BYT dated April 21, 2012. The basic competency standards for Vietnamese nurses are structured according to the common model of nursing in the Asia-Pacific and ASEAN regions to meet the requirements of the region, for easy comparison and integration with nursing competency standards of other countries.
The Vietnamese nursing basic competency standards are structured into 3 areas, 25 standards and 110 criteria. Each area represents a basic function of a nurse. This competency standard is divided into 3 areas: Practical competency; Care management and professional development; Nursing law and ethics. Each standard represents a part of a field and covers a task of a nurse. Each criterion is a component of a standard. A criterion can be applied to all standards and areas.
1.2.3.3. Nursing ethics code of the Vietnam Nursing Association [32]
The professional ethics standards of Vietnamese nurses are built on the following bases: (1) Legal: based on Article 42, Law on Anti-Corruption; (2) Professional obligations of nurses are regulated by: relationships with patients, colleagues and society; (3) Challenges of medical ethics in the market mechanism give rise to conflicts in the implementation of professional obligations of nurses; (4) On the basis of international integration: refer to the professional ethics standards of nurses of ICN 2000 and the medical ethics code of the World Medical Association (Medical Ethics Manual of the World Medical Association; 2005).
The Nurse Ethical Standards are the rules, professional values, and models that guide nurses in making ethical decisions during their practice. The Nurse Ethical Standards are also the basis for patients, citizens, and managers to monitor and evaluate the performance of Nurses nationwide. All nurses must commit to applying them at all times, in all places of practice, and at all medical facilities.
The professional ethics standards of nurses are applied to Vietnamese nurses, nursing instructors and head nurses at all levels. This standard is built with the following purposes: Educating nurses to self-train according to ethical standards appropriate to the nursing profession recognized by society; Helping nurses make decisions in practice situations in accordance with professional ethics standards; Publicizing the professional ethics standards of nurses; Being the basis for people, patients and health managers to monitor and evaluate the implementation of nurses; Announcing the professional ethics standards of Vietnamese nurses to ASEAN countries and other countries.
Professional ethics standards of nurses, including the following standards:
* Ensure patient safety
- Maintain the highest possible standards of practice in the workplace.
- Take personal responsibility for all decisions and professional actions in patient care.
- Intervene promptly and report to the person in charge when detecting medical staff's practices that do not ensure patient safety.
* Respect patients and their families
- Respect the age, gender, ethnicity and religion of the patient.
- Respect the patient's right to self-determination while practicing care.
- Respect honor, dignity and ensure the best possible confidentiality for patients during care and procedures.
- Provide full information related to solutions and care activities for patients/patients' families.
- Keep secrets related to illness and private life of the patient/patient's family.
- Treat patients/patients' families fairly.
* Friendly to patients and their families
- Introduce name, greet patient and patient's family in a friendly manner.
- Listen to the patient and the patient's family, respond with kind words and polite gestures.
- Provide care with a friendly smile.
- Helps patients reduce pain caused by illness and surgery and procedures.
* Honesty in practice
- Honesty in managing and using drugs and consumables for patients.
- Be honest in performing professional patient care activities and implementing treatment instructions.
- Be honest in recording information in the patient's medical record.
* Maintain and improve professional capacity
- Fully perform the professional functions of the nurse.
- Continuous learning to update knowledge and professional skills
- Participate in evidence-based research and practice
* Professional pride
- Maintain and protect professional reputation when others damage the values and honor of the profession.
- Dedicated to customer service, voluntarily comply with workplace regulations.
- Refusing to receive money or other benefits from patients or their relatives for the purpose of receiving priority in medical examination and treatment.
- Respect the regulations and voluntarily participate in the activities of the Nursing Association.
* Honest and united with colleagues
- Cooperate and help colleagues complete tasks.
- Respect and protect the honor and reputation of colleagues.
- Impart and share professional experience with colleagues.
* Commitment to community and society
- Speak and act according to the law
- Be a role model in the community and place of residence.
1.2.4. Some factors affecting the ethical practice of nurses
1.2.4.1. Nurses' awareness of ethical practice
* The Canadian Nurses Association sets out standards of ethical nursing practice with requirements that nurses need to have [103]:
Conceive and perceive nursing goals clearly.
Clear concept and perception of the patient.
Clear concept or awareness of their role in meeting the health needs of society.
Clear concept and awareness of the patient's difficulties.
Awareness of the importance and methods of nursing intervention.
Be aware of the consequences of nursing actions.
* Nursing practice requires application of the nursing process:
Collect data that is relevant to the patient's perception.
Analyze collected data according to care goals and patient challenges.
Plan care and develop nursing actions based on current and potential patient problems and provide timely nursing interventions.
Nursing interventions must be consistent with the plan of care.
Must be able to evaluate the steps of the nursing process.
* Nursing practice requires a supportive relationship, which is the nature and relationship between the nurse and the patient/patient's family:
Nurses begin the relationship by increasing the right mindset that the patient will have about health services such as: understanding, ease of access to health services.
Nurses must agree with each other and make patients understand more correctly and correctly about medical services.
Nurses must ensure that the supportive relationship between the nurse and the patient is fully successful.
* Nursing practice requires nurses to fully perform professional responsibilities:
Nurses must respect the regulations related to the profession and at practice facilities.
Nurses must comply with the ethical rules of their profession.
The nurse must work with members of the health care team.
1.2.4.2. Professional qualifications of nurses
Shimaoka Nobuki once conducted a study on the perception and expectation of nursing professionals. The results showed that from 67.2% to 70.25% of respondents expected nursing professionals to participate and play an active role in the department [quoted from 4].
The results of a study by Saravolats et al. in Detroit, Michigan, showed that nurses who were trained had a correct understanding of the need for urinary catheterization. After training, there was a significant reduction in the number of days patients needed catheterization compared to before training (the rate of 203 days/100 days of patient hospitalization decreased to 162 days/100 days of patient hospitalization with p<0.05).
Knowledge of pathology is essential for nurses to effectively provide comprehensive care (CSTD) and disease counseling to patients. The results of Shmidt et al.'s study showed that when assessing the knowledge of nurses performing CSBD with melanoma, nurses should have sufficient knowledge and understanding of this disease. The results showed that the ability to counsel patients is very limited, especially the ability to recognize melanoma lesions of nurses needs to be improved [quoted from 4].
The hospital practice environment of nurses is very important, it can greatly affect the effectiveness of CSBN. According to Silber's research at the Dana Faber Cancer Institute in Boston, nurses who are well trained and well equipped with knowledge can have a better near-term and long-term prognosis for cancer patients in surgical hospitals [quoted from 4].
According to a study by Donna Munroe and colleagues in the US on the knowledge, skills and attitudes of nurses, head nurses have an impact on evidence-based practice in clinical departments of provincial hospitals. The results showed that: in terms of knowledge, there was a difference in awareness of evidence-based practice between before and after training (3% and 28%). In terms of skills: before training, the percentage of nurses with confidence related to clinical practice was 46%, after training it increased to 60% (p = 0.018) [133].
The working attitude of head nurses was also higher when compared with that of nurses, especially there was a difference between before and after training for both nurses and head nurses with p=0.046 [quoted from 4],[133].
1.2.4.3. Working conditions and environment of nurses
Evidence-based research in clinical departments in hospitals is essential for nurses when doing CSNB work to find out the remaining problems that need to be supplemented and modified to help improve the quality of CSNB. According to Tran and colleagues at the University of Greenwich in London, the