S4: Ethics and Professional Code of...

 Key Unit competence
 Demonstrate characteristics of nursing profession while providing care to patient 

1.0 Introductory activity
 This article illustrates how some aspects of professionalism can have impact 
on the patient’s care. An example is the importance of handover among health 
professionals. After reading the following text and respond to the questions 
accordingly: 

A study was conducted using about clinical handover practices. Health 
professionals employed in public hospitals and community health centres were 
involved. The sample comprised doctors, nurses and allied health professionals, 
including physiotherapists, social workers, pharmacists, dieticians and midwives 
employed in Australia. 

The survey collected information about health professionals’ experiences about 
clinical handover. Clinical handover is a way health professionals communicate 
patient information for continuity, quality and safety of care for that patient. 

Despite widespread measures available to improve clinical handover processes, 
participants experienced adverse events relating to clinical handover in seven 
areas: delayed prolonged treatment, lack of monitoring information, patient 
deterioration, medications errors, patient falls, injuries, and putting infants at risk 
of infection. 

Innovations are needed in training and education to address the complex barriers 
to effective handover existing in health care organisations.
 1) What is the importance of handover?
 2) What are the consequences of lack of handover?
 3) Which health professionals involved in this activity?
4) Which other health professional that you know?

 5) Which qualities do you expect for a good health professional?

1.1. Concept of professionalism and profession

Learning activity 1.1

Mr. G. is admitted in the emergency ward after sustaining a serious road traffic 
accident. The healthcare team receive him with empathy and determination. 
The nurse performed a rapid assessment and immediately called the doctor 
for intervention she uses her time effectively to avoid any complication. She 
puts on an IV fluid to prevent shock due to much bleeding and collect blood 
sample for lab investigation and send them to laboratory and the lab technician 
examined them. The radiologist comes immediately and performed an X-ray of 
the fractured bone of the lower limb, the surgeon decided that the patient will be 
operated. The anaesthesiologist comes in to evaluate the patient condition to 
prepare him for an operation. The surgeon performed operation, the 2nd day after 
the operation the patient’s relative received instructions from dietician about the 
meal which is accepted after operation. On the 3rd day, the physiotherapist came 
to evaluate the level of mobility of the leg for any intervention to facilitate the 
patient to move without any complication. 
1) Which professionals are involved in treating MR.G?
 2) Which activities they performed to save the life of Mr. G?

 3) What qualities do you expect those professionals to display for Mr. G?

 Definition of concepts
 A Profession is a group (vocational or occupational) that requires specialized 
education and intellectual knowledge.  

Professionalism is an awareness of the conduct, aims, and qualities defining a 
given profession, familiarity with professional code of ethics, and understanding 
of ethical schools of thought, patient-professional interaction models and patient 
rights. 

Values are qualities or standards desirable or worthy of esteem in themselves, they 
are expressed in behaviours, language and standards of conduct. 

Professional values are general attributes sized by a professional group. Nurses 
may learn about their profession’s values, standards and motivations trough code 
of ethics, formal instruction, and role modelling. 

Personal values are the beliefs and attitudes held by an individual that provide a 
foundation for behaviour and the way the individual experiences life. 

Cultural values that are specific to a people or culture are known as cultural values.

Critical thinking is a purposeful, self-regulatory judgment, resulting in interpretation, 
analysis, evaluation and inference.  

Quality of practice is an evidence-based professional standards balanced against 

service user needs, satisfaction and organisational efficiency

Self-assessment 1.1

1. Define those concepts:
– Professionalism, 
– Quality of practice

 2. Differentiate professional values from personal values

1.2. Common professions

Learning activity 1.2

Observe the following images and match each number of the image to the 

appropriate profession inside the table below:

Match each number to the suitable profession

1.2.1. Different functions of health care professionals
 Nurses are the largest healthcare occupation, the specific duties of individual nurses 
are dependent on the role, practice setting, population served, and specialty area 
of the healthcare practice in which they are employed. All nurses assess patient’s 
health, provide clinical treatment, and educate patients and families.

 Medical doctor (MD) is licensed health care professional who has the role or 
function of assessing the patient, make the diagnosis and can provide medical 
treatment and services in any medical specialty, ranging from psychiatry to surgery. 
They work in a variety of settings, which include hospitals; outpatient clinics; 
academic institutions.
 
Pharmacists are the medication-use experts in the healthcare system. They 
provide medication therapy management, coordinate systems of medication 
distribution and dispensing, interface with patients and prescribers, and engage in 
the provision of clinical and community-based preventive services.
 
Dentists perform    
the evaluation, diagnosis, prevention and/or treatment 
(nonsurgical, surgical or related procedures) of diseases, disorders and/or 
conditions of the oral cavity, maxillofacial area and/or the adjacent and associated 
structures and their impact on the human body; provided by a dentist within the 
scope of his/her education, training and experience, and in accordance with the 
ethics of the profession and applicable law.

 Physiotherapist can be involved in providing valuable guidance in the inpatient 
setting and that adherence to recommendations may lower the risk of readmission. 
This observation highlights the role that structured assessments and sharing of 
patient information in the inpatient setting have in promoting favourable patient 
outcomes after discharge. 

They also provide expertise related to exercise prescriptions and training, physical 
activity recommendations, patient education, and exercise equipment. Those 
working in the inpatient setting are likely to have regular contact with inpatients 
either through formal educational sessions or by meeting one-on one with inpatients.
 
Midwife takes care to the mothers and their babies by providing perinatal care 
during pregnancy and delivery with promoting healthy practices like family planning.
 
Anaesthesiologist works within the operating team by giving anaesthetic drugs 
and cardiopulmonary intervention for operated patients. 

Lab technician is responsible for testing, analysing, blood test and other body 
fluids of patients to confirm the diagnosis.
 
Radiologist is responsible for performing medical diagnosis for patients using 

imaging devices like X-rays, ultrasound, CT scan, MRI etc.

A dietician as a person with legally recognized qualifications in nutrition and 
dietetics who applies the science of nutrition to the feeding and education of groups 
and individuals in health and diseases. 

Public health officer is in charge of policy making and decision making for the 
health of populations.
 
Ophthalmologists diagnose and give treatment to patients with eye diseases or 
unhealthy condition. Assess symptoms, diagnose conditions, prescribe medication, 
provide follow-up care of patients.

 

Notice: all health professionals, stay current on medical technology and research

Self-assessment 1.2 

Explain the functions of the following health professionals:
 Nurse 
Doctor
 Dentist
 Ophthalmologist, 
Physiotherapist
 Dietician

 Lab technician, Radiologist

1.3. Characteristics of a model associate nurse

Learning activity 1.3

 Mr. N., 70 years of age, is a male patient who is admitted to the medical-surgical 
unit with pneumonia. The patient complains of fatigue, shortness of breath and 
cannot finish a short sentence before the respiratory rate increases above the 
normal, and presents blue colour on his body extremities. The patient is using 
accessory muscles, weak cough reflex.

 Vital signs: blood pressure 90/50 mm Hg, heart rate 101 bpm, respiratory rate 28 
breaths/min, and temperature 39.5°C. 

The nurse Mr.G. performs an assessment to establish a nursing care plan for 
Mr. N. : monitoring of vital signs, filling the patient file, entering patient data 
in computer system, bed bath and bed making, administration of analgesics, 
antimicrobial drugs, and, drug for respiratory system using  a proper device; 
observation of the patient and record any change, put the patient in suitable 
position, administer oxygen, provide health education to the patient’s relative, 
evaluate the results and discuss with the doctor about modalities of treatment, 
communicate with other health workers about the patient’s condition.
 1) Which nursing procedures that will be performed by an associate nurse 
to help this patient?
 2) Which nursing procedures that will not be done by an associate nurse to 

help this patient?

1.3.1. Definition of terms
 A nurse is a person educated and trained to care for sick or disabled. She/he has 
completed a program of basic, general nursing education and is authorized by the 
appropriate regulatory body to practice nursing in his/her country.   

A nurse is a licensed person who is registered with the Rwandan Nursing and 
midwifery council based on completion of a recognized education and training 
program to take care of, assist and treat the client, who can be an individual, family 
or group, sick or well.

 Nursing is the protection, promotion, and optimization of health and abilities, 
prevention of illness and injury, facilitation of healing, alleviation of suffering through 
the diagnosis and treatment of human response, and advocacy in the care of 
individuals, families, groups, communities, and populations’’ (ANA, 2017).
 
Nursing: a profession focusing on assisting individuals, families, and communities 
who are healthy or sick to attain, recover, and maintain optimum health and function 
from birth to old age (Taylor et al 2011). The use of conducive environment (fresh 
air, pure water, cleanness, light) for the patient to assist him/her recovery (Florence 
Nightingale 1860). Nursing consists in assisting the individual sick or well, in the 
performance of those activities contributing to health or its recovery or a peaceful 
death (Virginia Henderson, 1966).                                           

An associate nurse is a member of the nursing team that helps bridge the gap 
between health and care assistants and registered nurses. Associate nurses work 
with people of all ages, in a variety of settings in health and social care. Their role 
contributes to the core work of nursing, freeing up registered nurses to focus on more 
complex clinical care. It’s a stand-alone role that also provides a progression route into 
graduate level nursing. Some personal qualities that make a good associate nurse are : 

1.3.2. Qualities of a good associate nurse
 a. Observantion: It’s extremely important for nursing assistants to have 
the ability to pay attention to small details. The smallest changes 
could be a major health problem for their patient, especially with the 
elderly. Minor changes like new bruises and a loss of appetite must 
be reported to the patient’s physician. Sometimes, paying attention to 
small details like this could be the difference between life and death. 

b. Emotional Stability: It takes a strong-willed, compassionate and caring 
person for this type of career. Caring for patients can be stressful, especially 
those who are struggling with their health or nearing the end of their life. 

Being supportive and strong for them and their families is crucial. 

c. Patience: You will need to have an encouraging and calm manner 
while caring for someone who may have just had a stroke and is 
learning how to dress again or helping patients walk after surgery. 

d. Communication Skills: Nursing assistants or CNAs have to communicate 
with doctors, nurses, caseworkers, families, patients and other healthcare 
team members daily. It’s important to be clear and detailed as much 
as possible with what you’ve observed while caring for your patient. 
You will need to listen well, offer support and give clear instructions. 

e. Compassion and Empathy: These are qualities that can’t be taught as a 
nursing assistant. To have the ability to show compassion and put yourself in 
someone else’s shoes and understand how they’re feeling is a much-needed 
trait to have while in this career.

 1.3.3. The functions of an associate nurse 
According to the ministerial order, the associate nurses usually take care of patients 
basing on their physical and psychological needs.
 1. Provide basic patient care by maintaining patient hygiene, nutrition and 
comfort.
 E.g.: bed making, bed-bath, position changing, feeding …

 2. Monitor the patient’s condition and reports as necessary.
 E.g.: taking vital signs, carrying samples taken by the nurse, to the laboratory 
for exam
 
3. Perform sterile and clean procedures with specific focus on prevention and 
control of infection in the health facility environment according to established 
standards and protocols.
 E.g.: simple wound dressing 

4.  Administer diligently medication within his/her scope of practice according 
to prescription and monitor the patient response.
 E.g.: provide oral drugs under supervision of registered nurse
 
5. 5° Carry out pre and post-operative nursing care within his/her scope of 
practice. 
E.g.: wound dressing

 6. Educate and advise the client and other people on continued care and 
prevention of recurrence of the health problem.

 E.g.: provide educational session on hygiene

 7. Facilitate patient discharge and where necessary refers him/her to other 
health care providers. 
E.g.: register discharged patients
 
8. Transmit verbal and written report and shares information with colleagues 
and the direct supervisor on the patient and care provided.
 E.g.: fill the vital signs chart

 9. Contribute to physical and nutritional rehabilitation in preparation for patient 
discharge.
 E.g.: Facilitate in patient feeding
 
10. Provide comprehensive care according to his/her scope of practice to 
chronically and terminally ill patients who are referred back.
 E.g.: provide support to patient living with HIV or NCDs (hypertension, 
diabetes…) reminding or encouraging them to take oral drugs
 
1.3.4. Comparison of roles between associate nurse and 
registered nurses
 The respective roles of both associate nurses and registered nurses are to deliver 
quality healthcare services to their clients. Although clients benefit from the care 
given by associate nurses in a range of settings, associate nurses will contribute 
to most aspects of care, including health care delivery and monitoring. Registered 
Nurses will take the lead to assessment, planning and evaluation. Registered 
Nurses will also lead to managing and coordinating health care with full contribution 
from the associate nurses within the integrated care team. 

Table3: Comparison between roles of associate nurse vs registered nurse

Self-assessment 1.3 

Mr N., a 70  years male patient,  is admitted to the medical-surgical unit with 
pneumonia. The patient complains of fatigue and shortness of breath and cannot 
finish a short sentence before the respiratory rate increases above the normal, 
and presents blue colour on his body extremities. The patient is using accessory 
muscles, coughs weakly, without any sputum. 

The vital signs are: blood pressure 90/50 mm Hg, heart rate 101 bpm, respiratory 

rate 28 breaths/ minute, and temperature 39.5°F. 

The nurse do an assessment to establish a care plan with the following nursing 
care to give for Mr. G. : monitoring of vital signs, filling the patient file, entering 
patient data in computer system, bed bath and bed making, administration 
of analgesics, antimicrobial drugs, and, drug for respiratory system using  a 
proper device, observation of the patient and record any change occurring to 
the patient, put the patient in suitable  position, provide  oxygen, provide health 
education to the patient relative, evaluate  the results and discuss with the doctor 
about modalities of treatment, communicate with other health workers about the 

patient condition.

 1. Describe the activities that will be performed by an associate nurse to 

respond to the patient’s need?

 2. Give three activities that will be performed by a registered nurse to provide 

nursing care to  this patient?

 1.4. Professionalism
 Learning activity 1.4
 Mrs D. is working in the surgical ward, she comes to her duty on time,  she 
organizes her ward , always assess the patient’s needs and make sure the ward 
is clean and ventilated she talk to patients’ family and give health education she 
communicates timely every abnormal finding to the doctor and always document 
the care provided she does follow up of patient lab results and call in the lab if the 
results are not available in due time. She encourages her colleagues and always 
reminds them that they should take responsibility of their tasks.
 
On the other side, Mrs Z. is coming late to her duties and ask for permissions 
several times and she always find reasons not to come to her duties, she even 

falsifies the medical leave to be able to go and do her business. 

When she is in ward, there is a lot of mess, patient’s bed is not clean, the lab 
results are not documented on patient’s file and the charts are not well filled. She 
talks badly to the patients and their relatives she despises the colleagues and 
does not listen to the advises. The unit manager write her the explanation letter 
and does not give explanation of her conduct instead she goes to the medical 
director and says that every people hates her and despises her and she claims 
for not being sent to the training for HIV management because she saw the nurse 
in charge of HIV in maternity was trained and when she called meeting to share 
the knowledge, Mrs Z refuses to attend and claimed that all nurses should go to 
the training while the manager suggested that three nurses will be trained each 
trimester so that the patients are not abandoned. she always calls her friends on 
the phone in working hours and complain that nobody ever cares for her while 
she is always caring for patients alone and go home late due to many patients. 
She claims that the hospital is poor and does not provide enough materials for 
patient care however, never give report to the unit manager on the drugs and 
consumables that is reported every week. She even calls to her cousin who is a 
manager of a big company to asks that he would give her another job because 
she is not happy to be a nurse.

Compare the behaviour of Mrs. D. and  Mrs. Z regarding their nursing profession.
 
Professionalism is an idea relating to the word “profession” which is almost 
synonymous with “occupation” (Downie, 990, pp. 148–157), the same author 
indicated the following six characteristics of professionals:
 1. The professional has skills or expertise proceeding from a broad knowledge 
base. 
2. The professional provides a service based on a special relationship with 
those whom he or she serves. This relationship involves a special attitude of 
beneficence tempered with integrity. To the extent that the public recognises 
the authority of the professional, he or she has the social function of speaking 
out on broad matters of public policy and justice, going beyond duties to 
specific clients. 
3. Professionals must be independent of the influence of the state or commerce. 
4. The professional should be educated rather than trained and should continue 
to develop her or his knowledge and skills within a framework of values. 
5. A professional should have legitimised authority and credibility in the eyes 
of the general public. 
6. A good understanding of bioethics and the ability to apply ethics principles 
and skills in the healthcare context is vitally important for all healthcare 

practitioners. 

i. Responsibility: is an obligation or duty. Condition, quality, fact, or instance of 
being responsible; obligation, accountability, dependability, …
 ii. Self-determination is defined as the personal decision to do something or 
think a certain way, without outside influence. 
iii. Accountability is the quality or state of being accountable, especially : 
an obligation or willingness to accept responsibility or to account for one’s 
actions, it is taking or being assigned responsibility for something that you 
have done or something you are supposed to do. 
iv. Integrity should be regarded as the primary virtue in the healthcare context. 
Healthcare practitioners often support their actions to act or not, on the base 
that it would undermine or violate their integrity and/or core beliefs if acting 
otherwise.
 v. Trust involves an assurance that another will act with the right intentions and 
in agreement with fitting moral norms.
 vi. Confidentiality the ethical principle or legal right that a physician or other 
health professional will hold secret all information relating to a patient, unless 
the patient gives consent permitting disclosure.
 vii. Adherence to high standards of quality providing evidence-based 
healthcare services to those who need them;
 viii.  Collaboration with others and communicative a working practice whereby 
individuals work together for a defined and common purpose, and enables 
individuals to achieve that purpose.

Such understanding and application should be fostered during the formal training 
of healthcare practitioners and it should continue as part of each practitioner’s 
continuous professional development for as long as they practise their profession. 

Self-assessment 1.4 
1. Explain the authority of a professional in public 

2. Describe the importance of communication in nursing profession

1.5. Characteristics of nursing profession

Learning activity 1.5

 Mr. G. a 60 years old male patient is admitted in the emergency is on  the 3rd 
day after  surgical intervention. The patient complains of dizziness, his body 
extremities are cold and pale, vital signs are as follows: blood pressure 80/45 
mm Hg, heart rate 131 bpm, respiratory rate 28 breaths/min, and temperature 
36.1 °C. The saturation on room air is decreasing to 82% and Hb 10 g/dL.
 
Mrs. T. a Registered Nurse who is on duty that night, she is a committed nurse 
who works with empathy, diligence, and discernment. She is able to manage time 
and communicate effectively to her colleague nurses and other health a care 
professionals in the  surgical unit. She is a hard working with close observation 
and use critical thinking to resolve patient’s problems.
 
When she enters in the room of Mr. G. she remarks that the patient’s operative 
wound is bleeding. She takes vital signs, blood sample for lab test and the result 
of haemoglobin was 6.5 g/dl. She calls the doctor immediately, and explained 
the patient situation the doctor responded that Mr. G. should be transfused, then 
the nurse filled a request for the blood transfusion to bring the blood for Mr. G 
with the blood Group of A+. However, the lab technician responds that the blood 
available is group O+. Mrs.T. never forgets to crosscheck the blood with the 
colleague to make sure the patient will not be harmed.
 1) What are the qualities that Mrs.T.  is using to save the life of Mr.G?
 2) If the nurse doesn’t intervene what consequences could result from her 

inaction?

The following qualities should also characterise a professional nurse.
 a. Responsibility: is an obligation or duty. Condition, quality, fact, or instance 
of being responsible; obligation, accountability, dependability, …For example, 
a nurse should take responsibility to give drug appropriate dose if the doctor 
commits an error in prescription.
 
b. Self-determination is defined as the personal decision to do something 
or think a certain way, without outside influence. e.g.: a nurse working with 
determination should not wait the unit manager to remind her the care to be 
given to the patient
 
c. Accountability is the quality or state of being accountable, especially: an 
obligation or willingness to accept responsibility or to account for one’s actions, 
it is taking or being assigned responsibility for something that you have done 
or something you are supposed to do.  e.g.: if a nurse does not provide care 
to the patient according to the quality required, she is accountable.
 
d. Integrity should be regarded as the primary virtue in the healthcare context. 
Healthcare practitioners often support their actions to act or not, on the 
base that it would undermine or violate their integrity and/or core beliefs if 
acting otherwise. e.g.: the nurse who does not respect patient’s  privacy and 
confidentiality 

e. Effective Communication
 In the workplace, nurses must be able to communicate clearly with their 
co-workers and with patients and their families. They must be able to take 
instructions from co-workers and supervisors, especially in high-pressure 
situations. 

They must also communicate effectively with patients and their families to 
meet their needs and provide quality care. The ability to receive information 
effectively and efficiently is essential for nurses. They must be able to read 
charts and understand a treatment plan without in-depth instruction. After they 
collect data about a patient’s vital signs, they must record that information 
immediately and accurately for other nurses, doctors and medical staff to 
interpret. Proactive communication with patients and families can set nurses 
apart from their peers. 

e.g.: the nurse must document on patient file and provide information 
necessary like change of vital signs or lab results. If he/she does not report 
timely, the patient can get in severe condition and miss necessary intervention 

at the right time.

f. Optimism While this career may be emotionally challenging at times, 
outstanding nurses know how to remain positive and focus on serving others. 
Further, nurses who have a positive attitude can act as leaders in their 
practice, inspiring optimism in others as well. e.g. :if the patient is in critical 
condition, she will not give up to him, she continues to provide care even for 
the chronic disease there is a way to improve life condition.

 g. Compassion In their career, nurses will see patients suffer. Beyond simply 
offering a solution, they must be able to express compassion for patients and 
their families. E.g.: a nurse should always consider the pain of the patient and 
listen to his/her concerns
 
h. Even-Temperedness: nurses must be able to manage their responses to 
difficult situations in order to solve problems and concentrate on their patients’ 
health and safety. Not getting visibly angry or upset with patients is important 
no matter how difficult the day has been.e.g.: if a nurse is angry to the patient 
that one would lose trust 

i. Flexibility: Remaining calm under pressure also helps nurses stay flexible 
in their work since shifts are typically long. Nurses may have to work nights, 
weekends and holidays. On the job, flexibility is a must for nurses. They 
cannot predict what the day will bring and what illnesses or injuries they will 
have to treat. e.g.: like if the nurse is called during his/ her day off or obliged 

to go home late due to patient’s condition

Self-assessment 1.5
 Mr. G. is admitted in the emergency is on  the 3rd day after  surgical intervention, 
The patient complains of dizziness, and his body extremities are cold and pale. 
The vital signs are as follows: blood pressure 80/45 mm Hg, heart rate 131 bpm, 
respiratory rate 28 breaths/min, and temperature 36.1 °C. The pulse oximeter on 
room air is decreasing to 82%. and Hgb 10 g/dL.
 Mrs. T. a registered  nurse remarks that the patient’s operative wound is bleeding. 
She  took blood sample for lab test and the result of haemoglobin was 6.5 g/dl. 
She calls the doctor immediately, and explained the patient situation the doctor 
responded that Mr. G. should be transfused, then the nurse filled a request for 
the  transfusion unit to bring the blood for Mr. G with the blood Group of  A+ 
. However, the lab technician responds that  the blood available is group O+; 
although Mrs.T. knows that the blood with group O+  can help the patient, she 
never forgets to  check patient identification to make sure the patient will not be 
harmed.
 1) Explain at least five characteristics of a professional nurse

 2) What are the qualities of nurses in patient care?

1.6. End unit assessment

End unit assessment

1) Define those concepts: Profession, value
 2) Explain the functions of the following health professionals:
 Nurse 
Radiologist 
Lab technician

Dentist 

3) What is the role of an associate nurse in healthcare team?
 4) Compare and contrast the roles of nurse and associate nurse
 5) Explain why the  health professionals should have the virtue of discernment
 6) Using  practical  examples in patient care, explain the five qualities of 
health professionals
 7) Explain at least five characteristics of a professional nurse
 8) Enumerate the five qualities of health professionals
 9) Describe how  a nurse can apply the qualities of health professionals  in 
health care
 10) Mr J. is a RN in surgical  unit, he has patients with different needs:
 The patient A., who was operated for abdominal disease and have to be  given a 
timely and appropriate food intake according to his condition. Another patient B 
was operated for fracture of the left lower limb, and need to be mobilized on the 
day provided by the surgeon 
The following activities will be required for the  nursing management of patients 
A and B: monitor the patient vital signs, pain, rehydration/feeding, elimination, 
ensure the hygiene, comfort and proper position for the  patient, take the samples 
for lab examination, document abnormal changes and complete the charts in the 
patient’s file, administering drugs according to the prescription, provide health 
education, call the dietician for prescription of diet, call the physiotherapist for the 
exercise, take the patient to the radiologist for the x-ray
 1. What is the task he will do himself as a registered nurse?
 2. What are the tasks that will delegate to the associate nurse working in the 
same service?
 3. Who are the other health professionals who will work with him to assure 

the treatment of those patients?