Ethics is knowledge of what is right conduct and wrong conduct. Morals are involved. It also deals with choices or judgments about what should or should not be done. An ethical person behaves and acts in the right way. He or she does not cause a person harm.

Ethical behavior also involves not being prejudiced or biased. To be prejudiced or biased means to make judgments and have views before knowing the facts. Judgments and views usually are based on one’s values and standards. They are based in the person’s culture, religion, education, and experiences. The person’s situation may be very different from your own. For example:

• Children want their mother to have nursing home care. In your culture, children care for older parents at home.

• A person has many tattoos and body piercings. You do not like tattoos or body piercings.

• An 83-year-old man does not want life-saving measures. You believe that everything must be done to save a life.

Do not judge the person by your values and standards. Do not avoid persons whose standards and values differ from your own.

Ethical problems involve making choices. You must decide what is the right thing to do. For example:

• You find a co-worker in an empty room drinking from a cup. You smell alcohol on her breath. She asks you not to tell anyone.

• A resident has bruises all over her body. She told the nurse that she fell. She tells you that her son is very mean to her. She asks you not to tell the nurse.

Professional groups have codes of ethics. The code has rules, or standards of conduct, for group members to follow. The American Nurses Association (ANA) has a code of ethics for registered nurses (RNs). The National Federation of Licensed Practical Nurses (NFLPN) has one for licensed practical nurses/licensed vocational nurses (LPNs/LVNs). The rules of conduct in Box 4-1, p. 34 can guide your thinking and behavior. See Chapter 5 for ethics in the workplace.

Box 4-1

Code of Conduct for Nursing Assistants

• Respect each person as an individual.

• Know the limits of your role and knowledge.

• Perform only those tasks that are within the legal limits of your role.

• Perform only those tasks that you have been prepared to do.

• Perform no act that will cause the person harm.

• Take drugs only if prescribed and supervised by a doctor.

• Carry out the directions and instructions of the nurse to your best possible ability.

• Follow the center’s policies and procedures.

• Complete each task safely.

• Be loyal to your employer and co-workers.

• Act as a responsible citizen at all times.

• Keep the person’s information confidential.

• Protect the person’s privacy.

• Protect the person’s property.

• Consider the person’s needs to be more important than your own.

• Report errors and incidents at once.

• Be accountable for your actions.

Boundaries

A boundary limits or separates something. For example, a fence forms a boundary. You stay inside or outside of the fenced area. As a nursing assistant, you help residents and families. Therefore you enter into a helping relationship with them. The helping relationship has professional boundaries.

Professional boundaries separate helpful behaviors from behaviors that are not helpful (Fig. 4-1). The boundaries create a helpful zone. If your behaviors are outside the helpful zone, you are over-involved with the person or under-involved. The following can occur:

• Boundary crossing. This is a brief act or behavior outside the helpful zone. The act or behavior may be thoughtless or something you did not mean to do. Or it could be on purpose if it meets the person’s needs. For example, you give a crying patient a hug. The hug meets the person’s needs at that time. If giving a hug meets your needs, the act is wrong. Also, it is wrong to hug the person every time you see him or her.

• Boundary violation. This is an act or behavior that meets your needs, not the person’s. The act or behavior is not ethical. It violates the code of conduct in Box 4-1. The person could be harmed. Boundary violations include:

• Abuse (p. 38).

• Giving a lot of information about yourself. You tell a person about your personal relationships or problems.

• Keeping secrets with the person.

• Professional sexual misconduct. This is an act, behavior, or comment that is sexual in nature. It is sexual misconduct even if the person consents or makes the first move.

Some boundary violations and some types of professional sexual misconduct also are crimes. To maintain professional boundaries, follow the rules in Box 4-2. Be alert to boundary signs. Boundary signs are acts, behaviors, or thoughts that warn of a boundary crossing or violation (Box 4-3).

Box 4-2

Rules for Maintaining Professional Boundaries

• Follow the code of conduct listed in Box 4-1.

• Talk to the nurse if you sense a boundary sign, crossing, or violation.

• Avoid caring for family, friends, and people with whom you do business. This may be hard to do in a small community. Always tell the nurse if you know the person. The nurse may change your assignment.

• Do not date, flirt with, kiss, or have a sexual relationship with current residents. The same applies to family members of current residents.

• Do not make sexual comments or jokes.

• Do not use offensive language.

• Do not discuss your sexual relationships with residents or their families.

• Do not say or write things that could suggest a romantic or sexual relationship with a resident or family member.

• Use touch correctly (Chapter 8). Only touch or handle sexual and genital areas when necessary to give care. Such areas include the breasts, nipples, perineum, buttocks, and anus of both males and females.

• Do not accept gifts, loans, money, credit cards, or other valuables from a resident or family member.

• Do not give gifts, loans, money, credit cards, or other valuables to a resident or family member.

• Do not borrow from a resident or family member. This includes money, personal items, and transportation.

• Maintain a professional relationship at all times. Do not develop any personal relationship or friendship with the resident or family member.

• Do not visit or spend extra time with a resident who is not part of your assignment.

• Do not share personal or financial information with a resident or family member.

• Do not help a resident or family member with his or her finances.

• Do not take a resident home with you. This includes for holidays or other events.

• Ask these questions before you date or marry a person whom you cared for. Be aware of the risk for sexual misconduct.

• How long ago did you assist with the person’s care?

• Was the person’s care short-term or long-term?

• What kind and how much information do you have about the person? How will that information affect your relationship with the person?

• Will the person need more care in the future?

• Does dating or marrying the person place the person at risk for harm?

Box 4-3

Boundary Signs

• You think about the person when you are not at work.

• You organize your work and provide other care around the person’s needs.

• You spend free time with the person. You visit with the person during breaks, meal times, when off duty, and so on.

• You trade assignments with other staff so you can provide the person’s care.

• You give more care or attention to the person at the expense of other residents.

• You believe that you are the only person who understands the person and his or her needs.

• The person gives you gifts or money.

• You give the person gifts or money.

• You share information about yourself with the person.

• You talk about your work situation with the person.

• You flirt with the person.

• You make comments that have a sexual message.

• You tell the person “off-color” jokes.

• You notice more touch between you and the person.

• You use foul, vulgar, or offensive language when talking to the person.

• You and the person have secrets.

• You choose the person’s side when he or she disagrees with other staff or the family.

• You select what you report and record. You do not give complete information.

• You do not like questions about the care you give or your relationship with the person.

• You change how you dress or your appearance when you will work with the person.

• You receive gifts from the person after he or she leaves the center.

• You have contact with the person after he or she leaves the center.

See Focus on Communication: Professional Boundaries.

FOCUS ON COMMUNICATION

Professional Boundaries

Some residents and families want to thank the staff for the care given. Some send thank-you cards and letters. Some offer gifts—candy, cookies, money, gift certificates, flowers, and so on. Accepting gifts is a boundary violation. When offered a gift, you can say:

• “Thank you so much for thinking of me. It’s very kind of you. However, it is against center policy to accept gifts of any kind. I do appreciate your offer.”

• “Thank you for wanting me to have the flowers your friend sent. They are lovely. However, it is against center policy to receive gifts. Let me help you find a way to take them home.”

Legal aspects

Ethics is about what you should or should not do. Laws tell you what you can and cannot do. A law is a rule of conduct made by a government body. The U.S. Congress and state legislatures make laws. Enforced by the government, laws protect the public welfare.

Criminal laws are concerned with offenses against the public and society in general. An act that violates a criminal law is called a crime. If found guilty of a crime, the person is fined or sent to prison. Murder, robbery, rape, kidnapping, and abuse (p. 38) are crimes.

Civil laws are concerned with relationships between people. Examples of civil laws are those that involve contracts and nursing practice. A person found guilty of breaking a civil law usually has to pay a sum of money to the injured person.

Torts

Tort comes from the French word meaning wrong. Torts are part of civil law. A tort is a wrong committed against a person or the person’s property. Some torts are unintentional. Harm was not intended. Some torts are intentional. Harm was intended.

Unintentional torts

Negligence is an unintentional wrong. The negligent person did not act in a reasonable and careful manner. As a result, a person or the person’s property was harmed. The person causing the harm did not intend or mean to cause harm. The person failed to do what a reasonable and careful person would have done. Or he or she did what a reasonable and careful person would not have done. The negligent person may have to pay damages (a sum of money) to the one injured.

Malpractice is negligence by a professional person. A person has professional status because of training and the service provided. Nurses, doctors, dentists, and pharmacists are examples.