Table 2 Italian Nursing Code of Conduct [15]: Categorization of each Article/unit to emerge the hidden perspectives as aspirational or mandatory ethics

1

The Nurse is the Health Professional, registered in the Nursing Professions Order,

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who acts in a conscious, autonomous and responsible manner

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He or she is supported by a set of values and scientific knowledge.

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Acts as an active agent in the social context to which he or she belongs and in which practices the profession, promoting a culture of caring and safety.

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2

The Nurse orients his or her actions to the good of the Assisted Persons, their Family and Community.

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His or her actions are realised and developed in the fields of clinical practice, organisation, education and research.

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3

The Nurse treats and cares for the Assisted Person, respecting his or her dignity, freedom, equality, life choices and conception of health and well-being, without any social, gender, sexuality orientation, ethnic, religious or cultural distinction.

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Refrains from any form of discrimination and blame towards all those encountered in his or her work.

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4

In his or her professional actions, the Nurse establishes a caring relationship, also using listening and dialogue.

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Ensures that the Assisted Person is never neglected

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by involving, with the consent of the Person concerned, any reference figures as well as other professionals and institutions.

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Relationship time is caring time.

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5

The Nurse is active in the analysis of ethical dilemmas and contributes to their investigation and discussion.

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Promotes the use of ethical counselling and dialogue, also involving the local Nursing Order.

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6

The Nurse undertakes to support the caring relationship even if the Person being cared for manifests ethical conceptions that differ from his or her own.

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If the latter persistently expresses a demand for activities that conflict with personal values or ethical and professional principles of the nurse, he or she ensures continuity of care, taking responsibility for his or her abstention.

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The Nurse can make use of the conscience clause, constantly seeking dialogue with the Person being cared for, other professionals and institutions.

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7

The Nurse promotes a culture of health by fostering healthy lifestyles and environmental protection from the perspective of health determinants, reducing inequalities

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and designing specific educational and informational initiatives for individuals, groups and communities.

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8

In his or her various roles, the Nurse is actively involved in the education and professional training of students and the onboarding of new colleagues.

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9

The Nurse recognises the value of scientific research and experimentation.

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Develops, carries out and participates in research concerning clinical care, organisation and educational, making the results available.

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10

The Nurse bases his or her work on knowledge validated by the scientific community and

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updates personal skills through study and research, critical thinking, reflection based on experience and good practice, in order to ensure the quality and safety of activities.

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Plans, conducts and participates in training initiatives and

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fulfils obligations under the Continuing Medical Education programme.

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11

The Nurse trains and

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seeks supervision where there are new activities or where there are limited case experience, and in any event whenever the need arises.

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12

The Nurse is committed to supporting cooperation with the professionals involved in the care pathway, adopting loyal and collaborative behaviour with colleagues and other professionals.

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Recognises and values their specific contribution in the care process.

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13

The Nurse acts based on his or her own level of competence

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and seeks advice and intervention from experienced nurses or specialists if necessary.

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Advises by making knowledge and skills available to his or her own community and other professional communities and institutions.

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Participates in the care pathway and ensures that the Person cared for has the same information shared with the team, which is necessary for the Person’s life needs and for an informed choice of the proposed care pathways.

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14

The Nurse who detects a state of alteration of a psycho-physical nature of a professional or other worker in his or her duties, at whatever level of responsibility, shall endeavour to protect and safeguard the Assisted Persons, the profession and the professional in question, including by making the appropriate disclosures.

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15

The Nurse ensures that the Person concerned, or the Person he or she refers to, receives accurate, complete and timely information about the person’s state of health, shared with the care team, respecting his or her needs and in a culturally appropriate manner.

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Does not replace other professionals in providing information that is not within his or her competence.

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16

The Nurse recognises intra- and inter- professional interaction and integration as fundamental elements for responding to the Person’s needs.

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17

In the care pathway, the Nurse values and welcomes the person’s contribution, their point of view and emotions and facilitates the expression of suffering.

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The nurse informs, involves, educates and supports the Person concerned and, with his or her free consent, the reference persons, in order to encourage adherence to the care pathway and to assess and activate available resources.

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18

The Nurse prevents, detects and documents the patient’s pain during the care pathway.

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Operates, applying good practices for the management of pain and related symptoms, while respecting the Person’s wishes.

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19

The Nurse guarantees and protects the confidentiality of the relationship with the Person being cared for and the confidentiality of data relating to them throughout their care pathway.

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Collects, analyses and uses data appropriately, limiting him or herself to what is necessary for nursing care, while respecting the rights of the individual and current legislation.

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20

The Nurse respects the explicit wish of the Assisted Person not to be informed about his or her state of health.

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If the refused information is necessary to prevent a health risk to third parties, the Nurse shall endeavour to make the Assisted Person aware of the risk and potentially harmful conduct.

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21

The Nurse supports the relationship with the Person cared for who is in a condition that limits their expression, through effective communication strategies and modes.

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22

Without prejudice to reporting obligations, the Nurse who detects and highlights deprivation, violence or mistreatment of the Person being cared for, takes action to ensure that there is prompt intervention to protect the Person concerned.

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23

The Nurse, considering the age and degree of maturity found, shall endeavour to ensure that due consideration is given to the minor’s opinion on curative, care and experimental choices, in order to enable him/her to express his/her wishes.

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When the minor consciously opposes the choice of care, the Nurse works to overcome the conflict.

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24

The Nurse provides nursing care until the end of the assisted person’s life.

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Recognises the importance of the caring gesture, shared care planning, palliation, environmental, physical, psychological, relational and spiritual comfort.

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The Nurse supports the Family members and Caregivers of the Person cared for in the final evolution of the illness, in the time of loss and in the grieving phase.

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25

The Nurse protects the Assisted Person’s wish to place limits on interventions that he or she believes are not proportionate to his or her clinical condition or consistent with the Person’s conception of quality of life, also expressed in advance by the Person.

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26

The Nurse promotes information on blood, tissue and organ donation as an act of solidarity;

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educates and supports those involved in donating and receiving.

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27

The Nurse always respects professional secrecy not only out of legal obligation, but out of intimate conviction and as a concrete expression of the relationship of trust with the Person being cared for.

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The death of the Assisted Person does not exempt the Nurse from respecting professional secrecy.

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28

In communication, including through information technology and social media, the Nurse behaves with decorum, fairness, respect, transparency and truthfulness;

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he/she protects the confidentiality of Persons and Assisted Persons,

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taking particular care when publishing data and images that may harm individuals, institutions, the decorum and the image of the profession.

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29

The Nurse, also through the use of information technology and social media, communicates in a scientific and ethical manner,

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seeking dialogue and discussion in order to contribute to a constructive debate.

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30

At the various levels of care, management and training responsibility, the Nurse participates in and contributes to the organisation’s choices, the definition of care, educational and organisational models, the fair allocation of resources and the enhancement of the nursing function and professional role.

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31

The Nurse contributes to the assessment of the organisational, managerial and logistical context in which the Person being cared for is located in order to protect him/her.

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Formalises and communicates the result of his or her evaluations in order to improve the context itself.

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32

The Nurse participates in clinical governance, promotes the best safety conditions for the Person being cared for, adopts procedures for the prevention and management of risks, including infectious ones,

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and actively adheres to operational procedures and methods for analysing events and ways of informing the Persons involved.

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33

The Nurse is responsible for the accurate drafting of the clinical documentation for which he/she is responsible,

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emphasising the importance of its completeness and truthfulness also for the purpose of the consent or refusal, knowingly expressed by the Person Assisted, to nursing treatment.

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34

Should the organisation request or plan clinical care, management or educational activities that are contrary to the principles, values and standards of the profession, at all levels of responsibility, the Nurse shall report the situation to the competent bodies and

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take action to propose alternative solutions.

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35

The Nurse recognises that physical restraint is not a therapeutic act.

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It is exclusively a precautionary measure of an exceptional and temporary nature; it may be implemented by the care team or, in cases of urgent need, even by the Nurse alone if the conditions of necessity are met, in order to protect the safety of the Person being cared for, the other Persons and the workers.

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In any case, physical restraint must be justified and noted in the clinical care documentation, it must be temporary and monitored over time to ascertain whether the conditions that justified its implementation persist and whether it has adversely affected the health of the Assisted Person.

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36

At the various levels of clinical and managerial responsibility the nurse plans, supervises and verifies, for the safety of the patient, the activities of the nurses’ aides who take part in the care process and are entrusted to him/her.

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37

Because of his or her high level of professional responsibility,

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the Nurse follows the relevant guidelines and good clinical care practices

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and ensures their correct application, promoting their continuous updating.

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38

The Nurse reports to his or her Nursing Professional Order inappropriate nursing care and assistance activities lacking a sound basis, scientific evidence and validated results.

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39

In his or her free professional practice, the Nurse endeavours to ensure that fair competition is respected

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and also valorises his or her work through the principle of fair remuneration.

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40

The Nurse, with transparency, fairness and in compliance with the regulations in force, formalises with the Assisted Person a special care contract that highlights the adequate and appropriate care needs, what the Person expresses in terms of informed assent/dissent with respect to the proposed treatment, the explicit elements of personal data protection and the elements that make up the professional fee.

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41

The self-employed Nurse safeguards the safety and continuity of care of the Persons being cared for by also respecting their own biological and physiological recovery time.

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42

The Nurse and the Nursing Professions Orders undertake to ensure that the professional’s actions are free from improper influences and interests as well as undue pressure from third parties, including reference persons, other professionals, companies and associations.

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43

Any Nurse who finds him or herself in a situation of conflict of interest shall expressly declare it.

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44

Nurses and the Nursing Professions Orders counter and denounce the illegal exercise of the nursing profession and undeclared work.

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45

The Nurse cares for his or her person and personal decorum.

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46

The Nurse exercises the representative function of the profession with dignity, fairness and transparency.

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Uses expressions and adopts behaviours that uphold and promote the decorum and image of the professional community and its institutional actors.

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He or she observes the indications of the Nursing Professions Orders in the information and advertising communication.

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47

The Nurse complies with the administrative, legal and deontological regulations and requirements that affect the profession, also by following the guidelines of the Nursing Professions Orders.

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48

The Nurse does not carry out activities of an advisory and expert nature unless he/she possesses the specific skills required by the case.

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In any event, this activity must be carried out in compliance with the deontological principles of the profession, avoiding any conflict of interest and situations in which its independence is limited.

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In the advisory context the Nurse interprets the evidence of the case based on the current scientific knowledge, providing opinions inspired by a prudent assessment of the conduct of the persons involved.

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49

The deontological rules contained in this Code of Ethics are binding for all members of the Orders of the Nursing Professions;

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failure to comply with them shall be sanctioned by the Nursing Order, taking into account the voluntariness of the conduct, its severity and any repetition thereof, in contrast with professional decorum and dignity.

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