Provision 3 – of ANA Code of Ethics book in the Medical Library
Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. The six interpretive statements within this provision combine two from the previous Code (ANA, 2001) (privacy and confidentiality) and add a new one: “professional responsibility in promoting a culture of safety.” This provision focuses on the nurse’s obligation to protect patients from harm. The first interpretive statement for this provision addresses “protection of the rights of privacy and confidentiality.” This statement was most violated in the case situation. Keisha and Kyle should have known the importance of maintaining confidentiality and should not be discussing this case on the elevator. While they did not give any specifics related to the case, how many other patients on their unit are likely to have an intestinal problem and four children at home? This violates the fundamental trust between patient and nurse. “Patients rights are the primary factors in any decisions concerning personal information, whether from or about the patient” (p. 10). The second interpretive statement centers on “protection of human participants in research” and is similar to the third statement in the previous edition. This addresses the importance of informed consent and the fact participants may decline to participate or withdraw from any research. Nurses have the obligation to raise questions about the individual’s capacity to consent and honor the patient’s right to withdraw from research. If Mrs. Williams chooses to engage in a Phase 1 clinical trial, nurses may have to support her withdrawal. The third interpretive statement, which focuses on “performance standards and review mechanisms,” is clearer and more concise than the previous edition. The statement addresses the need for nurses to continue their professional development to maintain their competence because nurses “are responsible and accountable for nursing practice and professional behaviors” (p. 11). Maintenance of confidentiality is considered a basic performance standard in nursing. Interpretive statement four is entirely new: “professional responsibility in promoting a culture of safety.” This statement addresses the importance of the nurse’s role in patient safety. The nurse is responsible for reporting any errors or near misses to the appropriate authority, ensuring disclosure of the errors to patients, and establishing processes to investigate these errors to prevent recurrence. The nurse also must not remain silent in the event of an error. If a colleague would overhear
Ethics, Law, and Policy
Keisha’s and Kyle’s conversation, he or she would be required to address this violation with them. Not addressing their error could be seen as condoning their conversation. The fifth statement in Provision 3 centers on the “protection of patient health and safety by acting on questionable practice.” This is similar to the previous edition, addressing the need to support nurses who become whistleblowers. As mentioned previously, the nurse overhearing Keisha and Kyle’s conversation has an obligation to confront them and organizational leaders have an obligation to protect the confronting nurse from any retaliation. “Reporting questionable practice, even when done appropriately, may present substantial risk to the nurse; however, such risk does not eliminate the obligation to address threats to patient safety” (p. 13). The sixth and final interpretative statement focuses on “patient protection and impaired practice” and is similar to the previous version. The definition of impaired practice is broadened in this revision to include “mental or physical illness, fatigue, substance abuse, or personal circumstances” (p. 13). This statement not only addresses reporting the impaired nurse but also ensures the nurse receives assistance. This advocacy includes supporting the return of the individual to practice after recovery, as Kyle did for Keisha.