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    Nine Tenets Essay

    Reviewing Appendix B in Butts, choose
    two of the Nine Tenets of the Code of Ethics for Nurses and describe how you will personally apply each tenet in the practice setting with your patients. Describe in detail the purpose of the tenet and provide examples of the tenet applied in practice. Explain why it is important to uphold the tenet in maximizing the quality of patient care and identify how it enhances your own practice as a nurse.
    Your paper should be 1 page.
    Include a title page and a reference page to cite your text. Adhere to APA formatting throughout and cite any outside sources you may use.
    Review the rubric for further information on how your assignment will be graded.
    The nine provisions of the 2001 Code have been retained with some minor revisions that amplify their inclusivity of nursing’s roles, settings, and concerns. Together, the nine provisions contain an intrinsic relational motif: nurse-to-patient, nurse-to-nurse, nurse-to-self, nurse-to-others, nurse-to-profession, nurse-to-society, and nursing-to-society, relations that are both national and global. The first three provisions describe the most fundamental values and commitments of the nurse; the next three address boundaries of duty and loyalty; the final three address aspects of duties beyond individual patient encounters. This revision also retains, for each provision, interpretive statements that provide more specific guidance for practice, are responsive to the contemporary context of nursing, and recognize the larger scope of nursing’s concern in relation to health. It was the intent of the Steering Committee to revise the Code in response to the complexities of modern nursing, to simplify and more clearly articulate the content, to anticipate advances in health care, and to incorporate aids that would make it richer, more accessible, and easier to use.
    Provision 1.
    The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 1.1 Respect for Human Dignity A fundamental principle that underlies all nursing practice is respect for the inherent dignity, worth, unique attributes, and human rights of all individuals. The need for and right to health care is universal, transcending all individual differences. Nurses consider the needs and respect the values of each person in every professional relationship and setting; they provide leadership in the development and implementation of changes in public and health policies that support this duty. 1.2 Relationships with Patients Nurses establish relationships of trust and provide nursing services according to need, setting aside any bias or prejudice. Factors such as culture, value systems, religious or spiritual beliefs, lifestyle, social support system, sexual orientation or gender expression, and primary language are to be considered when planning individual, family and population-centered care. Such considerations must promote health and wellness, address problems, and respect patients’ or clients’ decisions. Respect for patient decisions does not require that the nurse agree with or support all patient choices. When patient choices are risky or self-destructive, nurses have an obligation to address the behavior and to offer opportunities and resources to modify the behavior or to eradicate the risk. 1.3 The Nature of Health Nurses respect the dignity and rights of all human beings regardless of the factors contributing to the person’s health status. The worth of a person is not affected by illness, ability, socioeconomic status, functional status, or proximity to death. The nursing process is shaped by unique patient preferences, needs, values, and choices. Respect is extended to all who require and receive nursing care in the promotion of health, prevention of illness and injury, restoration of health, alleviation of pain and suffering, or provision of supportive care. Optimal nursing care enables the patient to live with as much physical, emotional, social, and religious or spiritual well-being as possible and reflects the patient’s own values. Supportive care is particularly important at the end of life in order to prevent and alleviate the cascade of symptoms and suffering that are commonly associated with dying. Support is extended to the family and to significant others and is directed toward meeting needs comprehensively across the continuum of care. Nurses are leaders who actively participate in assuring the responsible and appropriate use of interventions in order to optimize the health and well-being of those in their care. This includes acting to minimize unwarranted, unwanted, or unnecessary medical treatment and patient suffering. Such treatment must be avoided, and conversations about advance care plans throughout multiple clinical encounters helps to make this possible. Nurses are leaders who collaborate in altering systemic structures that have a negative influence on individual and community health. 1.4 The Right to Self-Determination Respect for human dignity requires the recognition of specific patient rights, in particular, the right to self-determination. Patients have the moral and legal right to determine what will be done with and to their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed decision; and to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment. They also have the right to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or prejudice, and to be given necessary support throughout the decision-making and treatment process. Such support includes the opportunity to make decisions with family and significant others and to obtain advice from expert, knowledgeable nurses, and other health professionals. Nurses have an obligation to be familiar with and to understand the moral and legal rights of patients. Nurses preserve, protect, and support those rights by assessing the patient’s understanding of the information presented and explaining the implications of all potential decisions. When the patient lacks capacity to make a decision, a formally designated surrogate should be consulted. The role of the surrogate is to make decisions as the patient would, based upon the patient’s previously expressed wishes and known values. In the absence of an appropriate surrogate decision-maker, decisions should be made in the best interests of the patient, considering the patient’s personal values to the extent that they are known. Nurses include patients or surrogate decision-makers in discussions, provide referrals to other resources as indicated, identify options, and address problems in the decision-making process. Support of patient autonomy also includes respect for the patient’s method of decision-making and recognition that different cultures have different beliefs and understandings of health, autonomy, privacy and confidentiality, and relationships, as well as varied practices of decision-making. Nurses should, for example, affirm and respect patient values and decision-making processes that are culturally hierarchical or communal. The importance of carefully considered decisions regarding resuscitation status, withholding and withdrawing life-sustaining therapies, foregoing nutrition and hydration, palliative care, and advance directives is widely recognized. Nurses assist patients as necessary with these decisions. Nurses should promote advance care planning conversations and must be knowledgeable about the benefits and limitations of various advance directive documents. The nurse should provide interventions to relieve pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the sole intent to end life. Nurses have invaluable experience, knowledge, and insight into effective and compassionate care at the end of life and should actively engage in related research, scholarship, education, practice, and policy development. Individuals are interdependent members of their communities. Nurses recognize situations in which the right to self-determination may be outweighed or limited by the rights, health, and welfare of others, particularly in public health. The limitation of individual rights must always be considered a serious departure from the standard of care, justified only when there are no less-restrictive means available to preserve the rights of others, meet the demands of law, and protect the public’s health. 1.5 Relationships with Colleagues and Others Respect for persons extends to all individuals with whom the nurse interacts. Nurses maintain professional, respectful, and caring relationships with colleagues and are committed to fair treatment, transparency, integrity-preserving compromise, and the best resolution of conflicts. Nurses function in many roles and settings, including direct care provider, care coordinator, administrator, educator, policy maker, researcher, and consultant. The nurse creates an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect. This standard of conduct includes an affirmative duty to act to prevent harm. Disregard for the effects of one’s actions on others, bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable behaviors. Nurses value the distinctive contribution of individuals or groups as they seek to achieve safe, quality patient outcomes in all settings. Additionally, they collaborate to meet the shared goals of providing compassionate, transparent, and effective health services.
    Provision 2
    The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. 2.1 Primacy of the Patient’s Interests The nurse’s primary commitment is to the recipients of nursing and healthcare services—patient or client—whether individuals, families, groups, communities, or populations. Each plan of care must reflect the fundamental commitment of nursing to the uniqueness, worth, and dignity of the patient. Nurses provide patients with opportunities to participate in planning and implementing care and support that are acceptable to the patient. Honest discussions about available resources, treatment options, and capacity for self-care are essential. Addressing patient interests requires recognition of the patient’s place within the family and other relationships. When the patient’s wishes are in conflict with those of others, nurses help to resolve the conflict Where conflict persists, the nurse’s commitment remains to the identified patient. 2.2 Conflict of Interest for Nurses Nurses may experience conflict arising from competing loyalties in the workplace, including conflicting expectations from patients, families, physicians, colleagues, healthcare organizations, and health plans. Nurses must examine the conflicts arising between their own personal and professional values, the values and interests of others who are also responsible for patient care and healthcare decisions, and perhaps even the values and interests of the patients themselves. Nurses address such conflicts in ways that ensure patient safety and that promote the patient’s best interests while preserving the professional integrity of the nurse and supporting interprofessional collaboration. Conflicts of interest may arise in any domain of nursing activity, including direct care, administration, education, consultation, policy development, and research. Nurses in all roles must identify and, whenever possible, avoid conflicts of interest. Nurses who bill for services and nurse executives with budgetary responsibilities must be especially aware of the potential for conflicts of interest. Healthcare financing and delivery systems may create conflict between economic self-interest and professional integrity. Bonuses, sanctions, and incentives tied to financial targets may present such conflict. Any perceived or actual conflict of interest should be disclosed to all relevant parties and, if indicated, nurses should withdraw, without prejudice, from further participation. 2.3 Collaboration The complexity of health care requires collaborative effort that has the strong support and active participation of all health professions. Nurses should foster collaborative planning to provide safe, high-quality, patient-centered health care. Nurses are responsible for articulating, representing, and preserving the scope of nursing practice, and the unique contributions of nursing to patient care. The relationship between nursing and other health professions also needs to be clearly articulated, represented, and preserved. Collaboration intrinsically requires mutual trust, recognition, respect, transparency, shared decision-making, and open communication among all who share concern and responsibility for health outcomes. Nurses ensure that all relevant persons, as moral agents, participate in patient care decisions. Patients do not always know what questions to ask or may be limited by a number of factors, including language or health literacy. Nurses facilitate informed decision-making by assisting patients to secure the information that they need to make choices consistent with their own values. Collaboration within nursing is essential to address the health of patients and the public effectively. Although nurses who are engaged in nonclinical roles (e.g., educators, administrators, policy-makers, consultants, or researchers) are not primarily involved in direct patient care, they collaborate to provide high-quality care through the influence and direction of direct care providers. In this sense, nurses in all roles are interdependent and share a responsibility for outcomes in nursing care and for maintaining nursing’s primary commitment to the patient. 2.4 Professional Boundaries The work of nursing is inherently personal. Within their professional role, nurses recognize and maintain appropriate personal relationship boundaries. Nurse–patient and nurse–colleague relationships have as their foundation the promotion, protection, and restoration of health and the alleviation of pain and suffering. Nurse–patient relationships are therapeutic in nature but can also test the boundaries of professionalism. Accepting gifts from patients is generally not appropriate; factors to consider include the intent, the value, the nature, and the timing of the gift, as well as the patient’s own cultural norms. When a gift is offered, facility policy should be followed. The intimate nature of nursing care and the involvement of nurses in important and sometimes highly stressful life events may contribute to the risk of boundary violations. Dating and sexually intimate relationships with patients are always prohibited. Boundary violations can also occur in professional colleague relationships. In all communications and actions, nurses are responsible for maintaining professional boundaries. They should seek the assistance of peers or supervisors in managing or removing themselves from difficult situations.


Subject Nursing Pages 7 Style APA


                                        Tenets of the Code of Ethics for Nurses

This paper discusses two of the tenets of the Code of Ethics for Nurses: respect for human dignity and relationship with patients.

Respect for Human Dignity

I will uphold this tenet in practice by observing the inherent dignity, worth, unique attributes, and human rights of all individuals. The purpose of this tenet is to ensure respect for patients so that they feel important in their own right, even to the extent of exerting control over their own behaviors, surroundings, and the manner in which they are treated (by others). An integral aspect of ensuring respect for human dignity in nursing is to recognize that every patient has a right to receive effective and appropriate healthcare with respect irrespective of his or her religion, culture, race, ethnicity, socioeconomic status, and level of education among others (Parandeh et al., 2016). Thus, upholding human dignity remains a moral obligation for nurses and a fundamental human right for all people (including patients). Examples where this tenet is applied in practice include caring for the terminally ill (particularly those whose conditions dictate that they receive support with basic life functions) and respecting patients’ decisions touching on their treatment. Upholding this practice helps maximize the quality of patient care because doing so ensures patients’ decisions are respected and they receive culturally appropriate care. Indeed, this tenet enhances my own practice as a nurse because it facilitates and emphasizes the personal responsibility to ensure safety and integrity during care while promoting competence and as such professional and personal growth.



Relationships with Patients

This tenet emphasizes the therapeutic relationship (between nurse and patient) as the foundation of the contextual care for the entire spectrum of contact (Balzer-Riley, 2012). . No matter how long the nurse-patient relationship lasts it should be characterized by empathy, genuineness, respect, active listening, confidentiality, and trust (Smith et al., 2013). I will apply this tenet in practice by respecting, supporting, and actively listening the patients to promote their healing and enhance or support normal functioning even in difficult situations of illnesses.  I will maintain professionalism by observing boundaries as relationships with patients are different from social relationships. Examples where this tenet could be applied in practice include referring to patients by their names, informing patients on planned treatment or procedures, and ensuring that no romantic or sexual relationships develop with patients. Largely, this tenet helps enhance my own practice as a nurse by instilling a sense of professionalism and making a call to such even in cases where the vulnerability of patients could lead to inappropriate social relationships.



Balzer-Riley, J. W. (2012). Communication in nursing. St. Louis, Missouri: Elsevier.

Parandeh, A., Khaghanizade, M., Mohammadi, E., & Mokhtari-Nouri, J. (2016) Nurses’ human dignity in education and practice: An integrated literature review. Iranian Journal of Nursing and Midwifery Research, 21(1): 1-8.

Smith, M. C., Turkel, M. C., & Wolf, Z. R. (2013). Caring in nursing classics: An essential resource. New York, NY: Springer Pub.















Appendix A:

Communication Plan for an Inpatient Unit to Evaluate the Impact of Transformational Leadership Style Compared to Other Leader Styles such as Bureaucratic and Laissez-Faire Leadership in Nurse Engagement, Retention, and Team Member Satisfaction Over the Course of One Year

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