Patient Safety and the ANA Code of Ethics

Abstract

The American Nurses Association (ANA) Code of Ethics is a necessary and invaluable instrument that provides guidance through ethically charged situations. Conceivably the component that is most important to nursing practice is sub-provision 3.4, which discusses safety culture. By establishing and supporting a culture that emphasizes patient safety, nurses are upholding the principle of nonmaleficence (Grace, 2018). Although the Code is a thorough and comprehensive tool, it must continue to evolve alongside a continually changing nursing practice. An aspect that may require change in the future is the method of expressing concern to a potentially impaired healthcare individual. If done incorrectly, this expression may harbor feelings of anger, contempt, and anger.

Patient Safety and the ANA Code of Ethics

The American Nurses Association (ANA) Code of Ethics establishes a set of ethics and standards that signify the duties of the American nurse. As patient advocates, nurses must be aware of the complex ethics that surround the profession as well as the obligation they have to the safety and well-being of the patients they care for. The Code is to be utilized in all aspects of patient care, particularly when making decisions regarding patient care and analyzing the ethics of a situation (American Nurses Association [ANA], 2015). The purpose of this paper is to offer a personal view of the most important aspect of the ANA Code of Ethics, discuss its necessity, and provide recommendations for change.

Prioritizing Safety: Creating a Safety Culture

Sub-provision 3.4 establishes the responsibility of those in the nursing profession to promote a culture of patient safety (ANA, 2015). This is arguably the most important aspect of the Code for nursing practice as it reflects the duty to protect patients from additional, preventable harm (Grace, 2018). The Code states that encompassed within the scope of nursing is the protection of patients and prevention of injury or illness (ANA, 2015).  A culture of patient safety has been offered as a means to reduce the number of casualties that result from preventable medical errors (DiCuccio, 2015). Medical errors remain the third leading cause of death in the United States, contributing to as many as 251,000 deaths annually (Anderson & Abrahamson, 2017). While patient safety is the duty of each nurse individually, a greater number of patients would benefit if more healthcare individuals took on this duty as well. Therefore, it is the responsibility of professional nurses to develop and maintain a culture of patient safety.

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A culture of patient safety promotes and encourages all healthcare staff to raise concerns regarding medical errors and unsafe practices so that they may be resolved through appropriate channels to minimize harm (DiCuccio, 2015). If a healthcare employee were to observe an error that has the potential to cause patient harm and fail to address the issue through a chain of command, they would be in violation of the principle of nonmaleficence (Grace, 2018). Although the individual did not directly jeopardize patient safety, they failed to protect the patient from preventable harm. The intent of reporting errors is not to reprimand those involved in the incident, but to create a learning opportunity as well as correct the systems errors that contributed to the error (DiCuccio, 2015). To Err is Human recognizes that many errors committed by healthcare professionals are not always attributable to due negligence, but to faulty systems that play on the fact that all humans make errors (Institute of Medicine, 2000). By establishing a culture a patient safety, systems errors can be recognized and corrected to prevent similar errors from occurring in the future. Furthermore, a patient safety culture establishes a set of shared procedures, values, and norms that are held by all members of the healthcare team (Weaver et al., 2013).

Necessity of the Code

Not every clinical situation requiring decision and action is ethically clear-cut. The professional nursing code provides a guideline for ways to approach situations while holding the values and duties of the nursing profession (ANA, 2015). The Code offers guidance through the ethical issues that arise at patient and organization levels as well as the tools nurses need to contribute to the development of a healthy society (Kangasniemi, Pakkanen, & Korhonen, 2015). While the general intent of the code is to ensure the patients needs and rights are respected, navigating policies and other healthcare members’ decisions may complicate this and raise questions regarding ethics. It has been noted that nursing is a morally distressing profession and that having a guide to assist in decision making may assist in alleviating some distress (Kangasniemi et al., 2015). Nursing is an ever-evolving profession, giving rise to new and unique situations that require decisions to be made that follow nursing standards of conduct (Kangasniemi et al., 2015). As the profession evolves, the code that guides these decisions must evolve as well to remain ethically relevant to the advances in healthcare and the nursing role (Epstein & Turner, 2015).

Changes to the Code

Although the ANA Code of Ethics is a comprehensive and invaluable tool for the nursing profession, I feel as though a minor change could be made to sub-provision 3.5. The Code states that when it is suspected that an individual may be involved in impaired or incompetent practice, the suspecting nurse must express the concern to said individual (ANA, 2015). My concern with this duty is that some nurses may not know or may not utilize the best strategies for approaching this situation. Expressing concern to an individual about their practices may cause the individual to become defensive, especially if it is not a colleague that the nurse is close with. Another instance where discussing concerns with the individual may not be effective is when the person is in a state of denial. A person in denial about their impairment may become defensive when approached with information that contradicts their views (Williams, Olfson, & Galanter, 2015).  Although the Code also does state that concerns should be shared through the chain of command, approaching the person individually and without training may not be effective if the nurse is not trained to do so.

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Considering this, the change I would make would be to have the nurse to first bring the concerns to the attention of an immediate supervisor and then the nurse along with the supervisor could approach the individual. By doing so, the supervisor could mediate the conversation and ensure that the individual in question understands that this is being done out of concern for the patients as well as the individual’s well-being. Supervisors would undergo training for these types of interactions that include empathy and de-escalation. I believe that this would keep the individual in question calm and more willing to listen.

Conclusion

The guidance provided by the ANA Code of Ethics is a cornerstone of nursing practice. The Code provides a framework for nurses to utilize in practice when approaching situations of ethical concern. Perhaps the most valuable aspect of the Code is sub-provision 3.4, which concerns the establishment and support of a culture of patient safety (ANA, 2015). By establishing a climate in which the central focus is the safety of the patient, all healthcare providers feel comfortable addressing instances of unsafe practice (DiCuccio, 2015). While sub-provision 3.5 effectively deals with the support of the impaired healthcare worker, I believe changes can be made to make the approach more effective. By appointing supervisors trained in approaching individuals that may be in denial about their level of impairment, there is a reduced chance of anger and an unwillingness to change. As the ever-evolving ANA Code of Ethic is a tool formulated by nurses for nurses, it reveals the level of dedication those in the nursing profession hold to protecting patient safety and rights.

References

• American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursebooks.org. Retrieved from https://www.nursingworld.org/coe-view-only
• Anderson, J. G. & Abrahamson, K. (2017). Your health care may kill you: Medical errors. Studies in Health Technology and Informatics, 234, 13-17.
• DiCuccio, M. H. (2015). The relationship between patient safety culture and patient outcomes: A systematic review. Journal of Patient Safety, 11(3), 135-142.
• Epstein, B. & Turner, M. (2015). The nursing code of ethics: Its value, its history. The Online Journal of Issues in Nursing, 20(2). http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/The-Nursing-Code-of-Ethics-Its-Value-Its-History.html
• Grace, P. J. (2018). Nursing ethics and professional responsibility in advanced practice. Sudbury, MA: Jones & Bartlett Learning.
• Institute of Medicine. (2000). To err is human: Building a safer health system. Washington, DC: The National Academies Press.
• Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: An integrative review. Journal of Advanced Nursing, 71(8), 1744-1757.
• Weaver, S. J., Lubomski, L. H., Wilson, R. F., Pfoh, E. R., Martinez, K. A., Dy, S. M. (2013). Promoting a culture of safety as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158, 369-374.
• Williams, A. R., Olfson, M., & Galanter, M. (2015). Assessing and improving clinical insight among patients “in denial”. JAMA Psychiatry, 72(4), 303-304.