ethics is the philosophy of investigating , through analytical thinking , the values at the basis of relations between humans and the characteristics of the moral terms of good / bad and right / wrong .
this characteristic of analytical thinking distinguishes ethics from morals : ethics refers to a system of thought , while moral refers to the set of values that develop on their own with the rise and fall of different societies ( 1 ) .
ethics guides how people view the relevance of each decision made in the field of health , and is separated into two subcategories : theoretical ( philosophical ) and applied .
theoretical ethics is concerned with the subject , meaning , and purpose behind philosophical ethics and examines its areas of responsibility .
applied ethics helps in deciding on what is right and wrong . by laying out the liabilities that each individual physician or health practitioner has towards him or herself and
his or her patients , applied ethics teaches that physician the behavior that is in line with his or her own values .
it assists in the decisions they must make , as well as their fulfillment with the profession ; furthermore , it helps them avoid causing patients harm ( 2 , 3 ) .
the florence nightingale pledge , acknowledged as the first ethical code for the medical profession , included important guidance rules for nurses .
expressions such as  i will do all in my power to maintain and elevate the standard of my profession , and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling . with loyalty
will i endeavor to aid the physician in his work , and devote myself to the welfare of those committed to my care .
i will not take or knowingly administer any harmful drug  helped to orient the purpose and function of the nursing profession when the pledge was first introduced , setting forth new professional values for nursing . since then , nursing has become increasingly acknowledged as a profession with unique values and principles ( 4 ) . however , the way in which the nursing profession changed over the years made it necessary to review and even amend these ethical codes .
thus , the american nurses ' association ( ana , 1950 ) and the international council of nursing ( icn , 1953 ) reviewed the existing codes and established new versions .
these " nursing ethics codes " were presented with a new perspective on nursing , which demonstrated that nursing is an independent profession ( 5 ) . with the scientific and technological developments in the field of health , ethical codes specific to nursing had to be developed to help resolve the ethical dilemmas encountered by nurses ; since their development , these codes have become known as instruments describing the responsibilities and common values unique to the nursing profession .
these values guide nurses in their activities and decision making , as well as how they disseminate health information to the general public .
the ethical principles established by contemporary medical ethics fall into four categories , as follows : autonomy , beneficence , nonmaleficence , justice .
autonomy : this principle dictates that the individual is able to make decisions about his or her health according to his or her values , beliefs , and expectations without been exposed to any outside pressure .
this principle is based on the principle of self - determination , and aims to protect human dignity .
it asks nurses to respect each individual and their values , because everyone is entitled to make decisions on their own lives and expect health personnel to respect their decisions .
the most significant reflection of the principle of autonomy in the field of health is informed consent .
individuals are only able to exercise these rights by having actual information about the situation at hand .
the concept of informed consent , which is based on two fundamental ethics principles , places the responsibility on health professionals for informing patients and ensuring that patients understand what is happening to them during treatment ; in addition , it entitles patients the right to refuse treatment in line with the provided information .
this principle also refers to respecting the privacy of the patient during treatment and in any instance that the nurse is involved with the patient ( 6 , 7 ) .
beneficence : this principle is based on providing benefit to the patient . this principle provides guidance to nurses in prioritizing patient beneficence , doing good , and avoiding maleficence ( 7 , 8) .
maleficence : this principle is based on preventing maleficence . this means doing nothing that could harm someone else ( 7 , 8) . this principle consists of three hierarchically related elements : non - maleficence , preventing maleficence and eliminating maleficence .
it emphasizes the importance of being careful that resources at hand are shared , particularly when deciding on treatments ( 4 , 6 , 7 , 9 - 12 ) .
children are unable to defend their rights and require the advocacy of an adult , meaning that medical staff must also seek to protect the rights of the child ( 6 ) .
therefore , nurses must be able to overcome these problems and make correct decisions , which primarily requires them to know the basic concepts , laws , rules , and other information related to the issue , and to seek continual improvement of their own nursing skills ( 8) .
it is contemplated that number of people with enough information about these codes is quite low despite being a very important ethical codes especially in health - related fields .
one of the areas that most experienced of ethical issues is neonatal intensive care unit . after a literature review
, we found no study describing the information and applications related to ethical codes of pediatric nurses .
this study was done to determinate information and applications related to ethical codes of pediatric nurses .
participants were nurses attending the neonatal intensive care unit nursing course and the pediatric nursing course conducted in istanbul between september 2011 and december 2012 .
because nurses working in neonatal intensive care units from various provinces of turkey attended these specified courses , we believed that this sampling method would reflect a more objective assessment .
a total of nurses attending the courses at the specified dates and who agreed to participate in the study were included in the analysis .
data were collected through a questionnaire that we developed in accordance with current literature on nursing ethics ( 2 - 4 , 8 , 9 ) .
, six questions determining demographic information ( e.g. age , gender , marital status , period of work ) were located . in second part , 40 items that determinate the ethical codes such as autonomy , beneficence , nonmaleficence , justice that nurses have to know and to do were located .
these items were developed considering the research questions results of qualitative research , and evaluated taking into account the participants ' statements .
items answers were never or always form . to gather data from the specified course ,
we obtained ethics board permission from the faculty of medicine board of ethics at istanbul university . furthermore , before the data collection , all participants were informed of the study procedure and their informed consent was obtained .
the obtained data were analyzed on a computer using relevant statistical analyses ( percentages , means ) .
their average age was 29.9  5.55 years ( range : 19 - 42 ) and only four ( 2.9% ) were men .
half of nurses were single ( 50% ) and had an undergraduate degree ( 52.9% ) .
the average work experience was 8.76  6.54 years ( range : 1 - 24 ) .
the percentages of nurses who paid attention or had some knowledge of the studied ethical issues while working are shown in table 1 .  
all of the nurses stated that human life must be protected , and thus they integrated this into their practice .
nearly all participants stated that they attempted to provide nursing care with holistic approach ; that they attempted to prevent maleficence from affecting their patients during medical practice or research ; that they provided service according to the beliefs , values , and needs of individual patients ; and that they did not discriminate between patients in their practices . around
84.3% of nurses stated that they did not accept the patient as problem free if she or he had no physical / psychological complaints , while 77.4% stated that they devoted time to personal affairs when they had spare time at the hospital .
more than half of nurses stated that they attempted to solve problems with workers in the work environment using their own methods , without notifying their superiors .
when we examined the distribution in whether nurses reported the faults of their team members to superiors , we found that 37.1% notified their superiors and 62.9% did not ( table 1 ) .
nearly all nurses stated that during care they attempted to ensure the safety of the individual , respect their autonomy , prevent them from experiencing maleficence , and take measures against possible risks .
furthermore , 84.3% of the nurses stated that they did not prioritize relatives or acquaintances , 90.0% did not delay the care of disrespectful patients , 85.7% did not share their personal information with patients , and 95.7% did not look out for their own personal interests .
a large proportion of nurses stated that during care they were careful to protect patient privacy ( table 2 ) .  
a majority of nurses stated that they attempted to inform the patient regarding their care in a correct , adequate , and comprehensible manner .
about three - quarters of the participants attempted to inform persons other than the patient that needed to be informed about the provided care . finally , most did not share patient information with their friends as long as there was no medical justification ( table 3 ) .  
when nurses opinions on obtaining consent from patients during practice were examined , a large majority stated that they obtained verbal / written consent for procedures , oriented at the integrity of the patient or obtained consent from their lawful guardian if they were unable to obtain it from the patient .
furthermore , in emergencies , they did not obtain consent to provide necessary care for protecting patients lives ( 81.4% ) .
about three - quarters of nurses that had suspicions on the accuracy of medical instructions stated that they did not act on those instructions , while 12.8% stated that they did act on them . furthermore
, 82.8% stated that they assumed responsibility for errors occurring during practice ( table 4 ) .  
the sources of information for these nurses were nursing education ( 60.0% ) , in - service training ( 28.9% ) , periodical/ book/ friends ( 8.8% ) , and hospital management ( 2.2% ) .
of the nurses who knew about ethical codes , 93.3% stated that they had heard of the principle of nonmaleficence / beneficence , 93.3% of the principle of autonomy/ respect for individuals , 95.6% of the principle of the protection of privacy , and 97.8% of the principle of justice and equality . regarding nurses actual utilization of ethical codes in the field ,
more than half of nurses ( 52.2% ) stated that they utilized all of the ethical codes , 54.7% stated that they utilized some of them , and 2.2% stated that they never utilized them .
many ( 72.3% ) nurses stated that they had seen no written materials on these ethical codes in their workplace . of nurses who had heard of the ethical codes
all of the nurses stated that ethical codes should be known , 52.9% stated that ethical codes should be known because the nurses themselves did not know them , 35.7% stated that nurses should know these codes in order to be able to provide ethical care , and 11.4% stated that the codes should be known for worker safety nearly all of the nurses ( 95.7% ) stated that they would want information on ethical codes .
in studies conducted on the information and applications of pediatric nurses on ethical codes , the majority of nurses were found to comply with ethical guidelines .
ethical practices have vital importance in the field of health ) ( 3 , 4 , 8 , 13 - 16 ) .
all of the nurses participating in the study stated that they reflected this in their practice , because human life must be protected .
when the information and applications of nurses were assessed according to the principle of nonmaleficence , which is the foundation of nursing practice , we observed that nearly all of them complied with the principle of non - maleficence ( 4 , 6 , 7 , 10 - 12 , 15 ) .
for example , 94.3% of nurses stated that they attempted to prevent the individual from encountering maleficence from medical practice or clinic research . in the same manner ,
a majority of nurses ( 97.1% ) stated that they attempted to prevent patients from experiencing maleficence due to negligence experience .
one of the most important factors influencing patients experiences of maleficence during care is that their nurses are unaware of the risks that may occur .
a majority of nurses participating in the study ( 94% ) stated that they knew of the risks that may arise during care and took measures to prevent them from occurring or having an effect on patients .
another means of preventing patients from experiencing maleficence is not performing procedures that the nurses have reason to doubt the quality or correctness of .
thus , nurses must be aware that they do not necessarily need to perform treatment practices that have doubtful efficacy or correctness ( 15 , 17 ) .
a proportion of 74.3% of nurses in our study stated that they did not follow any instructions that they doubted and 25.7% stated that they would perform the medical application even if they knew it would cause maleficence for the patient .
medical procedures require responsibility ; it is necessary for nurses to accept the possible outcomes of all procedures performed ( 1 , 3 , 4 , 15 ) .
nearly all of the nurses in this study ( 92.9% ) stated that they assumed responsibility for the patient s outcome when they performed incorrect care or treatment .
the principle of autonomy / respect for individuals suggests that each individual must make decisions about his or her own health .
thus , the service provided to each patient must be in line with his or her needs , without discrimination .
however , in some cases , patients may be unable to make decisions on their own behalf .
one of these cases would be a medical emergency , where it may be necessary for the nurse to make a decision on behalf of the patient ( 11 ) . in this study
, 81.4% of nurses stated that they applied necessary nursing care in emergencies without obtaining the consent of the patient in order to protect the patient s life , while 58.6% stated that they performed emergency medication applications even when they had no written request forms .
another instance where patients would be unable to make decisions regarding their own health would be when they are not old enough to be capable of making good decisions .
in such a case , consent must be obtained from patients guardians . in this study , the majority of nurses ( 84.3% ) stated that they obtained consent from legal guardians for procedures oriented at individuals that were not competent in making decisions .
the consent of the patient is very important in any decision being made about health care ( 1 , 4 , 15 , 16 ) . in this study ,
more than half of the nurses stated that they would not leave the decision regarding care to the patient ( 67.1% ) , and if the patient refused care , they would not respect this ( 64.3% ) .
this suggests that many nurses do not pay attention to patients thoughts about their own health .
before any intervention can be applied to patients , it is necessary to obtain from them verbal or written consent ( 3 , 13 - 15 ) . in this study
, 80.0% of nurses stated that they typically received verbal or written consent and 20% stated that they typically did not .
one common unethical act is the sharing of patient information ( 14 ) . in the present study ,
nearly all of the nurses ( 91.4% ) stated that they did not share the personal information of patients with their friends in the ward or health personnel outside of the institution without medical justification , and 60% stated that they did not share this with family or relatives .
furthermore , a controversial issue is whether nurses should inform patients about the negative outcomes of their health condition .
we found that around 78.6% of nurses stated that they did not tell patients about negative outcomes .
discrimination is defined as acting with a feeling of prejudice and protecting the rights of and providing more opportunities to one group of persons , while at the same time causing maleficence to another group ( 15 ) . in this study , the majority of nurses ( 91.5% ) stated that they did not discriminate between individuals in their practice .
we found that a majority of the nurses ( 90.0% ) stated that they did not postpone the care of disrespectful patients .
nepotism is acting in a way that ignores official obligations and prioritizes emotional or traditional engagements ( 14 , 16 ) . in this study , a majority of the nurses stated that they did not prioritize treating patients who are acquaintances or relatives , and 15.7% stated that they did prioritize .
although the rates were low , some nurses did engage in actions that went against the ethical codes .
we think that this is because these nurses lacked sufficient knowledge about these ethical codes ( 35.7% ) and did not have access to written materials in their facility on ethical codes ( 72.3% ) .
furthermore , it was observed that most nurses are open to and seek information on the ethical codes .
the best - known ethical code was the principle of justice and equality . furthermore , while the rates were generally low , some nurses engaged in unethical practices such as patient discrimination and prioritizing acquaintances .
for this reason , we recommended that nurses working in clinics and future nurses in training informed of the appropriate ethical behavior and codes .
 background : ethics is defined as the entirety of moral principles that form the basis of individuals behavior ; it can also be defined as  moral theory  or  
 theoretical ethics.objectives:to determinate information and applications related to ethical codes of pediatric nurses.patients and methods : participants were nurses attending the neonatal intensive care unit nursing course and the pediatric nursing course conducted in istanbul between september 2011 and december 2012 . 
 a total of nurses attending the courses at the specified dates and who agreed to participate in the study were included in the analysis . 
 data were collected through a questionnaire that we developed in accordance with current literature on nursing ethics.results140 nurses participated in this study . 
 information and applications were related to ethical codes of nurses including four categories ; autonomy , beneficence , nonmaleficence , justice . 
 the principle of confidentiality / keeping secrets . 
 exactly 64.3% of nurses reported having heard of nursing ethical codes . 
 the best - known ethical code was the principle of justice . 
 furthermore , while the rates were generally low , some nurses engaged in unethical practices such as patient discrimination and prioritizing acquaintances.conclusions:we conclude that most nurses working in pediatric clinics act in compliance with ethical codes . 
 we also found that the majority of nurses wanted to learn about ethical codes . 
 for this reason , we recommended that nurses working in clinics and future nurses in training be informed of the appropriate ethical behavior and codes . 
1. Background
2. Objectives
3. Patients and Methods
4. Results
5. Discussion