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Faith and Ethics I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practise my profession faithfully. I shallFaith abstain and from whatever Ethics, is deleterious and mischievous, and shall not takeCovenant or knowingly administer and Code any harmful drug. THE 2015 REVISION OF THE ANA CODE OF ETHICS FOR NURSES WITH INTERPRETIVE STATEMENTS I shallBy Marsha do all D. Fowler in my power to maintain and elevate the standard of my profes- ABSTRACT: How does and should the sionAmerican and Nurses will Association Code hold of Ethics forin confidence all personal matters committed to my keeping Nurses with Interpretive Statements, with foundations from the late 1800s, impact today’s nursing practice? How can the Code help you? and Theall earlier 2001 family Code was revised and affairs became coming to my knowledge in the practice of my calling. effective January 2015. The nine provisions received modest revision, as did the corresponding interpretive statements. However, Provisions 8 and 9 and their interpretive statements received more substantial revision. This article explains the Code and summarizes the 2015 revisions, considering I shallpoints of particular be interest loyal for nurses of faith. to my work and devoted towards the welfare of those committed KEY WORDS: Code of Ethics, conscien- to mytious objection, care. covenant, creation care, ethics, evangelism, faith, nursing, religion, social ethics, spiritual care Images/Alamy Stock Photo Vintage 216 JCN/Volume 34, Number 4 journalofchristiannursing.com Copyright © 2017 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. I solemnly pledge myself before God and in the presence of this assembly to he American Nurses morally binding. The provisions are Association (ANA) broad ethical statements, whereas the 2.0 contact hours Code of Ethics for interpretive statements address parti­ Nurses with Interpretive cular practice issues and questions. pass my life in purity and to practise my professionStatements (ANA, faithfully. Thus, the provisions need revision 2015) has a long, infrequently, whereas the interpretive distinguished history. Beginning with a statements begin to chafe and require sizable body of ethics literature in the revision approximately every decade. late 1800s, an official ANA Code followed some years after the Nightin­ THE 2015 REVISION PROCESS gale Pledge of 1893 (an oath written The 2015 Code went through a by Lystra Gretter). The Code has gone process of revision, discussed here in I shall abstain from whatever is deleteriousthrough and numerous mischievous, iterations, including highly abbreviated form. and A task force shall not the precursor codes of 1926 and 1940 decided whether a revision was (Fowler, 2010). The current (2015) necessary and concluded that the Code Code consists of nine provisions, each has stood up well, but Provisions 8 and take or knowingly administer any harmfulwith drug. a set of interpretive statements. The 9 were most in need of revision. A Code is a non-negotiable standard of ethics group was formed to proceed with the for all nurses, in all venues, in all revision. Drs. Marsha Fowler and domains of practice. Unlike other Martha Turner were named as colead standards, there are no “levels” based writers. The 2001 Code was posted on levels of practice (ANA, p. 9). The openly online, and comments for Code is one standard, universally change were solicited. Eventually, the applicable to all nurses. proposed revision was posted, and I shall do all in my power to maintain andOver elevate the decades, the interpretive the additionalstandard comments solicited. of my profes- statements for each of the provisions in Dr. Turner did yeoman’s work in the Code have moved from being reading, collating, and categorizing Blend Images/Alamy Stock Photo descriptive and explanatory, to being over 8,500 comments. Her work then normative. To clarify, the provisions informed the writing. The broader THE CODE IS A NON- sion and will hold in confidence all personalhave moved frommatters explaining the committedcommittee reviewed and critiqued to the myNEGOTIABLE keepingSTANDARD OF meaning of the provisions or descrip­ revision, passed the final draft, and sent it ETHICS FOR ALL NURSES, tions of how the provisions might be to the ANA Ethics Advisory Board for applied, to being normative statements approval. The ANA Board of Directors IN ALL VENUES, IN ALL and all family affairs coming to my knowledgeof how the provisions in ought tothe or must practicesubsequently approved the Code,of which my DOMAINScalling. OF PRActICE. be applied. Thus, the nine provisions went into effect in January 2015. and respective interpretive statements, This article offers a brief overview together, comprise the Code and are of the 2015 revision of the Code, and consideration of points of contact for persons of faith. The reader is encour­ Marsha D. Fowler, PhD, MDiv, MS, aged to have a copy of the current In the interest of full disclosure, I RN, FAAN, served as colead writer (with Col. Martha Turner, PhD, RN), Code at hand (free at http://nursing have a long history with the Code. I I shall be loyal to my work and devoted towardsand “Historian the and Code Scholar”welfare on world.org/DocumentVault/Ethics of those­1/ servedcommitted on the ANA Committee on the 2015 revision of the ANA Code of Code­of­Ethics­for­Nurses.html). It is Ethics, 1985 to 1989 (chair 1987–89); Ethics for Nurses with Interpretive State- ments. She is senior fellow and professor also useful to have a copy of the as a consultant to the revision of the of ethics, spirituality, and faith integration at Azusa previous (2001) Code at hand for 1985 Code; as a member of the Task Pacific University, Azusa, California. comparison. Space allows for highlight­ Force for the revision of the Code, Conflict of Interest: The author was colead writer of ing some, rather than all, of the changes 1996 to 2001; as a member of the Task the 2015 ANA Code of Ethics for Nurses with Interpretive Statements, and wrote Guide to the Code of Ethics with or the full content of each interpretive Force for the Review of the Code, Interpretive Statements and Guide to Nursing’s Social Policy statement. (For a deeper discussion of 2012–13; as a member of the Steering Statement recommended in this article. the changes, see ANA’s Guide to the Committee for the Revision of the Accepted by peer­review 4/3/2017. Code of Ethics with Interpretive State- 2015 Code, was named committee Copyright © 2017 InterVarsity Christian Fellowship/USA ments: Development, Interpretation and “Historian and Code Scholar,” and doi: 10.1097/CNJ.0000000000000419 Application [Fowler, 2015a]). colead writer of the 2015 Code. I’ve journalofchristiannursing.com JCN/October-December 2017 217 Copyright © 2017 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. I shall abstain from whatever is deleterious and mischievous, and shall not take or devoted 35 years to the study of TABLE 1: New Emphases in the 2015 Revision nursing ethics from the 1850s to the present. I believe nursing ethics to be of the Code distinguished, distinctive from bioeth­ ics, rooted in social ethics (Fowler, 2016), a source of pride­of­profession, and embodied, in part, in the Code of • Ethical practice environments Ethics for Nurses. • Moral distress, incivility, bullying, mobbing, and workplace violence • End-of-life care GENERAL CHANGES TO THE CODE • Research and evidence-informed practice The nine provisions of the 2001 Blend Images/Alamy Stock Photo • Social media Code were retained in the 2015 Code, • Genetics with minor revision for clarity and • Nursing leadership and advocacy • Interprofessional work and collaboration incisiveness. Interpretive statements were • Nurses’ voice in social justice and health reorganized to make sure that the policy sequence in the interpretive statement • The social determinants of health followed the sequence in the provision. • Nursing as a global, unified profession There also was minor shuffling of • The global collaboration to address climate destabilization, violence, and other content of the interpretive statements global threats to health among the provisions to improve placement. An attempt was made to make the revision language timeless, that is, to avoid language that might become dated (necessitating another revision), as century, as well as virtually all the other Provision 2 acknowledges that the well as to make the language more ethical issues now being raised. patient may be an individual, family, direct and incisive, with greater use of It is important to note that the moral group, community, or population. It formal ethical language and content. A concerns remain the same, even though specifically accounts for the fact that new preface, introduction, glossary, technology and clinical practice have resources are not infinite, and that care and index were added. Weblinks were changed: confidentiality is confidentiality, is limited to available resources. added to the digital version. In terms of whether related to 1800s’ nurse–patient Whereas previous versions of the Code substantive revision, Provisions 1–7 were conversations or to today’s computer­ had discussed conflicts of interest, this modestly revised, whereas Provisions ized patient records. Heightened and revision acknowledges that conflicts of 8–9 received more dramatic revision new emphases in the 2015 revision are interest occur in many roles and are because, to quote singer Bob Dylan, The listed in Table 1. not limited to financial conflicts of Times They Are a-Changin’. interest. The revision expands the Changes in the times have necessi­ PROVISIONS & INTERPRETIVE content on gifts, to be less opaque and tated the inclusion of new topics in the STATEMENTS REVISIONS more direct concerning professional Code. Although these topics may be For Provision 1, the full inclusive­ boundaries regarding gifts, bribes, new to the Code, they are not new to ness of the Code for all nurses in all dating, and sexual relationships with nursing ethics literature.
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