Give an account of one clause from the Nursing and Midwifery Council (2002) Code of Professional Conduct and discuss the importance of this for your present / future practice.
Clause 2 of the Nursing and Midwifery Council’s (NMC) Code of Conduct states that: “As a registered nurse, midwife or health visitor, you must respect the patient or client as an individual (NMC, 2002).” This is the most fundamental aspect of nursing care and is based on the ethics of autonomy. This essay will examine the importance of the clause and elaborate on each of the sub-clauses by providing examples of how these duties can be fulfilled.
The duties set out in the NMC Code of Professional Conduct are based on the ethics of autonomy, beneficence, nonmaleficence and justice (Edwards, 1996). They provide rules of conduct and define the nurse’s responsibility to patients and to other healthcare professionals. The Code’s aim is to protect the public rights whilst in the care of all Nurses, Midwives, and Health Visitor and applies to all areas of care such as in the community or in a hospital setting.
Sub-clause 2.1 states that a Nurse must recognise and respect the role of patients as partners in their care. This clause is based on everyone’s right of autonomy. Beauchamp and Childress (1994) defines personal autonomy as: “….personal rule of the self that is free from both controlling interferences by others and from personal limitations that prevent meaningful choice”. Allowing patients to have a say in their care allows them to gain some control and has shown to have a positive impact on patients’ mood, well-being and can provide a meaning to life (Valimakil and Leino-Kilpi, 1998). Ideally, both the Nurse and the patient should create nursing care plans together. The Nurse should find out what the patient’s goals and desired outcomes are and provide the patient with all the necessary information to make decisions on treatment where alternatives are available.
Clause 2.2 states that Nurses’ should safeguard a patient’s dignity (NMC, 2002). Protecting a patient’s dignity requires treating that patient as a whole person, taking into account their physical, psychological and social needs. For example, privacy is a social need among many people therefore a Nurse should ensure privacy whenever patients are being examined or treated, changing clothes, etc. The Code also highlights that the requirements to promote the dignity of patients are not always the same. A Nurse will need to take into account a person’s race, gender, age, customs, values and spiritual beliefs in order to tailor their care. Using the need for privacy example, Bauer (1994) discovered that elderly patients perceived more lack of privacy than younger patients (cited in Back, 1998), therefore more care is need to establish adequate levels of privacy for this group.
Clause 2.3 states that the Nurse should maintain a professional relationship with the patient at all times and the relationship should entirely focus on the needs of the patient (NMC, 2002). Maintaining a good Nurse / patient relationship is an important aspect of nursing care. As rapport and trust builds between both parties, the patient will be able to feel more comfortable in discussing his/her anxieties and will feel less self-conscious when the nurse is providing intimate care. However, Morse (1991) states that clinical judgement is negatively effected if a Nurse becomes emotionally involved with a patient (cited in Williams A, 2001).
Clause 2.4 highlights the duty to promote the interests of patients. This suggests that Nurses should assume a patient advocacy role. Dubler (1992) defines this as: “acting to the limit of professional ability to provide for the clients interests and needs, as the patient defines them.” (cited in Hewitt, 2002). However, this advocacy should not be used to undermine a patient’s autonomy and a Nurse should only act when the patient is unable or unwilling to do so themselves. For example, a Nurse can raise objections or highlight concerns to a Doctor about an operation a patient is about to have, if that patient feels unable, to do this him/herself.
The final sub-clause (2.5) deals with a Nurse’s right to conscientious objection (NMC, 2002). In the UK, conscientious objection is a fundamental right of any person to be excused or excluded from any activity that conflicts with their values and beliefs (Burnard and Chapmen, 1993). For example, a Nurse may hold strong anti-abortion values and therefore would not want to take part on such a procedure. However, a Nurse’s right to object is excluded from emergency situations, where the Nurse is expected to participate in care until another Nurse can take over.
In conclusion we can see how the code of conduct protects the rights of the patient. This particular clause of the code highlights the need for patient autonomy and their need for care based on their physical, psychological and social needs. These needs are individual to every patient and it is the Nurse’s duty to discover those needs and plan patient care accordingly.