Essentials of Nursing Leadership and Management, 5th Edition

chapter 4 | Questions of Values and Ethics 47

her father. However, it is available only through a

research study being conducted at a nearby univer-

sity. To participate in the research, the patient must

be informed of the purpose of the study, the medica-

tion to be given and its side effects, and follow-up

procedures. Ms. Allen continues to refuse to allow

her father to be told his diagnosis because she is

certain he will commit suicide.

The nurse practitioner faces a dilemma: does he
abide by Ms. Allen’s wishes based on the principle
of beneficence, or does he abide by the principle of
veracity and inform his patient of the diagnosis.
What would you do?

Accountability

Accountability is linked to fidelity and means
accepting responsibility for one’s actions. Nurses
are accountable to their patients and to their col-
leagues. When providing care to patients, nurses
are responsible for their actions, good and poor. If
something was not done, do not chart or tell a col-
league that it was. An example of violating
accountability is the story of Anna:

Anna was a registered nurse who worked nights on

an acute care unit. She was an excellent nurse, but as

the acuity of the patients’ conditions increased, she

was unable to keep up with both patients’ needs and

the technology, particularly intravenous (IV ) lines.

She began to chart that all the IVs were infusing as

they should, even when they were not. Each morning,

the day shift would f ind that the actual infused

amount did not agree with what the paperwork

showed. One night, Anna allowed an entire liter to be

infused in 2 hours into a patient with congestive heart

failure. When the day staff came on duty, they found

the patient expired, the bag empty, and the tubing

f illed with blood. Anna’s IV sheet showed 800 mL

left in the bag. It was not until a lawsuit was f iled

that Anna took responsibility for her behavior.

The idea of a standard of care evolves from the
principle of accountability. Standards of care pro-
vide a rule for measuring nursing actions.

Ethical Codes

A code of ethics is a formal statement of the rules
of ethical behavior for a particular group of individ-
uals. A code of ethics is one of the hallmarks of a
profession. This code makes clear the behavior
expected of its members.

The Code of Ethics for Nurses with Interpretive

Statements provides values, standards, and princi-

ples to help nursing function as a profession. The

original code was developed in 1985. In 1995 the

American Nurses Association Board of Directors

and the Congress on Nursing Practice initiated the

Code of Ethics Project (ANA, 2002). The code may

be viewed online at nursingworld.org

Ethical codes are subject to change. They reflect

the values of the profession and the society for which

they were developed. Changes occur as society and

technology evolve. For example, years ago no

thought was given to do not resuscitate (DNR)

orders or withholding food and fluids. Technological

advances have since made it possible to keep people

in a kind of twilight life, comatose and unable to

participate in living in any way, but nevertheless

making DNR and withholding very important

issues in health care. Technology has increased

knowledge and skills, but the ability to make deci-

sions regarding care is still guided by the principles

of autonomy, nonmaleficence, beneficence, justice,

confidentiality, fidelity, veracity, and accountability.

Virtue Ethics

Virtue ethics focuses on virtues, or moral character,

rather than on duties or rules that emphasize the

consequences of actions. Take the following example:

Norman is driving along the road and f inds a cry-

ing child sitting by a fallen bicycle. It is obvious that

the child needs assistance. From one ethical stand-

point (utilitarianism), helping the child will

increase Norman’s personal feelings of “doing good.”

The deontological stance states that by helping,

Norman is behaving in accordance with a moral

rule such as “Do unto others....” Virtue ethics looks at

the fact that helping the person would be charitable

or benevolent.

Plato and Aristotle are considered the founders

of virtue ethics. Its roots can be found in Chinese

philosophy. During the 1800s virtue ethics disap-

peared, but in the late 1950s it reemerged as an

Anglo-American philosophy. Neither deontology

nor utilitarianism considered the virtues of moral

character and education and the question: “What

type of person should I be, and how should I live”

(Hooker, 2000; Driver, 2001). Virtues include such

qualities as honesty, generosity, altruism, and relia-

bility. They are concerned with many other ele-

ments as well, such as emotions and emotional