Juta’s Manual of Nursing
Chapter 2: Practising the profession of nursing
within the South African professional legal
framework ......................................................................................................... 28
Introduction ................................................................................................................... 32
The professional status of nursing ............................................................................. 32
The meaning of professionalism ........................................................................... 33
Criteria for the professional status of nursing and midwifery in
South Africa ............................................................................................................ 33
Criteria for recognition as a profession ............................................................... 34
Professional conduct of nurses ................................................................................... 35
The South African legal framework for nurses and midwives ............................... 36
The social contract in nursing and midwifery .................................................... 36
The importance of legal recognition of the nursing profession ....................... 37
Contractual obligations in the workplace ........................................................... 37
The content of the National Health Act 61 of 2003 ........................................... 38
The content of the Nursing Act 33 of 2005 .............................................................. 39
Regulations, codes and rules relating to nursing practice ...................................... 43
Government Notice R2598: Regulations relating to the scope of
practice of persons who are registered or enrolled under the Nursing Act .... 43
Government Notice R767: Rules setting out the acts or omissions in
respect of which the Council may take disciplinary steps ................................ 46
Code of Ethics for nursing practitioners in South Africa .................................. 51
Professional associations and organisations ............................................................. 51
Trade unions .................................................................................................................. 51
Functions of a professional association/organisation ....................................... 52
Professional indemnity .......................................................................................... 53
Industrial action ...................................................................................................... 53
Conclusion ..................................................................................................................... 54
Suggested activities for students ................................................................................ 54
Chapter 3: Practising the profession of nursing within
the South African professional-ethical framework .... 55
Introduction ................................................................................................................... 58
The philosophical basis of nursing ............................................................................. 58
Philosophical schools of thought ......................................................................... 59
Introductory ethics ....................................................................................................... 63
Ethics ........................................................................................................................ 63
The science of ethics .............................................................................................. 63
,chapter
Practising the
3 profession of nursing
within the South
African professional-
ethical framework
Learning objectives
On completion of this chapter, the student should be able to do the following:
• Provide an ethical service as demonstrated by his or her ability to explain, analyse
and apply aspects of the ethics of nursing to the nursing practice, as well as integrate
these with his or her personal norms and values.
• Demonstrate an understanding of the philosophical basis of nursing.
• Define personal norms and values, and relate these to the nursing situation.
• Identify the basis on which personal norms and values are established.
• Maintain high standards of professional behaviour and avoid unethical behaviour.
• Participate in the discussions relating to ethical issues/dilemmas, and bring a nursing
perspective to bear on ethical decision making.
• Be vigilant regarding the rights of patients, particularly the very vulnerable who are
unable to speak for themselves.
Key ethical principles
Ethical concepts in nursing underlying basic nursing care are as follows:
The principle of respect for persons
This includes:
• The duty to respect the rights, autonomy and dignity of others
• The duty to promote the wellbeing and autonomy of every individual
• The duty to be truthful, honest and sincere, as deceit is dishonourable.
The concept of a person as a bearer of rights and duties is a fundamental principle in
ethics and law, as well as politics.
The principle of justice
This includes:
• The obligation of universal fairness or equity
• The duty to treat people as individuals and in themselves, and not as a means to an
end ➙
55
, • The duty to avoid discrimination, abuse or exploitation of people on the grounds of
race, age, sex, sexual orientation, gender, social class or religion.
The principle of justice requires that, at least in theory, any personal guidelines for
action should be capable of being generalised to all people. For this reason, the
principle of justice is sometimes described as the principle of universality.
The principle of beneficence and non-maleficence
This includes:
• The duty to do good and to avoid doing harm to others
• The obligation of advocacy and the defence of the rights of the weak and
vulnerable.
‘Do unto others as you would have them do unto you.’ This principle is sometimes
referred to as the principle of reciprocity.
The principle of confidentiality
This includes the duty to keep all information about the patient confidential. This is
closely related to fidelity, which is about keeping a promise or secret. When a patient
is admitted to hospital, an unwritten agreement to look after his or her wellbeing and to
keep all information about his or her illness and diagnosis confidential already exists.
Key concepts and terminology
Bullying: Unwanted, offensive, intimidating, aggressive insulting behaviour or an abuse
of power by one group or person against others. The behaviour is ongoing, leaving the
target feeling upset, threatened, vulnerable and humiliated in the long term, undermining
their self-confidence.
Ethics: Viewed as the science of morals and therefore ‘ethics’ means character or habit.
An ethic is ‘what ought to be’.
Ethos: A concept that is indicative of the moral attitude, ideals and customs of
humankind.
Morals: Standards of behaviour reflecting right and wrong.
Norms: Recognised standards or patterns.
Rights: Moral or legal entitlements to have or do something.
Values: A worthwhile or desirable set of standards or qualities.
Value judgements: Consist of personal and objective value judgements. A personal
value judgement is subjective because it is based on personal values and therefore is
a personal choice or preference. An objective value judgement is independent of the
person making the judgement and is found, for example, in research projects where
information is evaluated and described objectively.
56
, Chapter 3 Practising the profession of nursing within the South African professional-ethical framework
Prerequisite knowledge
The nurse should have knowledge of the concept of human rights as contained in the
Constitution of the Republic of South Africa.
Medico-legal considerations
Nurses are accountable to the community they serve for the way in which they fulfil
their responsibilities in nursing and healthcare. They may be called to account for their
behaviour by the courts of the country and the nursing profession.
Key ethical considerations
Ethical norms, values and principles are all based on the great unifying principle that is
to be found in all the major religions and belief systems, namely to treat others as you
would like to be treated.
Key legal considerations
• Application of the principles of patient advocacy may result in conflict with other
health professionals, particularly if their approach and perspective differ from those
of the nurse.
• Conflict may also arise where the rights of the patient are being violated through the
actions of another health service practitioner.
• The response to unethical behaviour on the part of a colleague or other health
service professional has legal implications.
• Obtaining truly informed consent from the patient or the patient’s family is a legal
requirement.
• The major ethical principles of nursing are enshrined in the legislation which governs
nursing and healthcare in general, namely:
–– confidentiality, which means the protection of the name, person and possessions
of the patient
–– patient advocacy and the protection of the vulnerable
–– ensuring that all the needs of the patient are met
–– accountability, honesty and integrity in all that the nurse does
–– the duty of the nurse to take due care in all his or her activities
–– obtaining consent for nursing and healthcare interventions.
Essential health literacy
The ethical principles of beneficence, autonomy, justice, veracity and fidelity must be
observed when health education is given, with particular consideration of language
used and the cultural practices of the patient. ➙
57
Chapter 2: Practising the profession of nursing
within the South African professional legal
framework ......................................................................................................... 28
Introduction ................................................................................................................... 32
The professional status of nursing ............................................................................. 32
The meaning of professionalism ........................................................................... 33
Criteria for the professional status of nursing and midwifery in
South Africa ............................................................................................................ 33
Criteria for recognition as a profession ............................................................... 34
Professional conduct of nurses ................................................................................... 35
The South African legal framework for nurses and midwives ............................... 36
The social contract in nursing and midwifery .................................................... 36
The importance of legal recognition of the nursing profession ....................... 37
Contractual obligations in the workplace ........................................................... 37
The content of the National Health Act 61 of 2003 ........................................... 38
The content of the Nursing Act 33 of 2005 .............................................................. 39
Regulations, codes and rules relating to nursing practice ...................................... 43
Government Notice R2598: Regulations relating to the scope of
practice of persons who are registered or enrolled under the Nursing Act .... 43
Government Notice R767: Rules setting out the acts or omissions in
respect of which the Council may take disciplinary steps ................................ 46
Code of Ethics for nursing practitioners in South Africa .................................. 51
Professional associations and organisations ............................................................. 51
Trade unions .................................................................................................................. 51
Functions of a professional association/organisation ....................................... 52
Professional indemnity .......................................................................................... 53
Industrial action ...................................................................................................... 53
Conclusion ..................................................................................................................... 54
Suggested activities for students ................................................................................ 54
Chapter 3: Practising the profession of nursing within
the South African professional-ethical framework .... 55
Introduction ................................................................................................................... 58
The philosophical basis of nursing ............................................................................. 58
Philosophical schools of thought ......................................................................... 59
Introductory ethics ....................................................................................................... 63
Ethics ........................................................................................................................ 63
The science of ethics .............................................................................................. 63
,chapter
Practising the
3 profession of nursing
within the South
African professional-
ethical framework
Learning objectives
On completion of this chapter, the student should be able to do the following:
• Provide an ethical service as demonstrated by his or her ability to explain, analyse
and apply aspects of the ethics of nursing to the nursing practice, as well as integrate
these with his or her personal norms and values.
• Demonstrate an understanding of the philosophical basis of nursing.
• Define personal norms and values, and relate these to the nursing situation.
• Identify the basis on which personal norms and values are established.
• Maintain high standards of professional behaviour and avoid unethical behaviour.
• Participate in the discussions relating to ethical issues/dilemmas, and bring a nursing
perspective to bear on ethical decision making.
• Be vigilant regarding the rights of patients, particularly the very vulnerable who are
unable to speak for themselves.
Key ethical principles
Ethical concepts in nursing underlying basic nursing care are as follows:
The principle of respect for persons
This includes:
• The duty to respect the rights, autonomy and dignity of others
• The duty to promote the wellbeing and autonomy of every individual
• The duty to be truthful, honest and sincere, as deceit is dishonourable.
The concept of a person as a bearer of rights and duties is a fundamental principle in
ethics and law, as well as politics.
The principle of justice
This includes:
• The obligation of universal fairness or equity
• The duty to treat people as individuals and in themselves, and not as a means to an
end ➙
55
, • The duty to avoid discrimination, abuse or exploitation of people on the grounds of
race, age, sex, sexual orientation, gender, social class or religion.
The principle of justice requires that, at least in theory, any personal guidelines for
action should be capable of being generalised to all people. For this reason, the
principle of justice is sometimes described as the principle of universality.
The principle of beneficence and non-maleficence
This includes:
• The duty to do good and to avoid doing harm to others
• The obligation of advocacy and the defence of the rights of the weak and
vulnerable.
‘Do unto others as you would have them do unto you.’ This principle is sometimes
referred to as the principle of reciprocity.
The principle of confidentiality
This includes the duty to keep all information about the patient confidential. This is
closely related to fidelity, which is about keeping a promise or secret. When a patient
is admitted to hospital, an unwritten agreement to look after his or her wellbeing and to
keep all information about his or her illness and diagnosis confidential already exists.
Key concepts and terminology
Bullying: Unwanted, offensive, intimidating, aggressive insulting behaviour or an abuse
of power by one group or person against others. The behaviour is ongoing, leaving the
target feeling upset, threatened, vulnerable and humiliated in the long term, undermining
their self-confidence.
Ethics: Viewed as the science of morals and therefore ‘ethics’ means character or habit.
An ethic is ‘what ought to be’.
Ethos: A concept that is indicative of the moral attitude, ideals and customs of
humankind.
Morals: Standards of behaviour reflecting right and wrong.
Norms: Recognised standards or patterns.
Rights: Moral or legal entitlements to have or do something.
Values: A worthwhile or desirable set of standards or qualities.
Value judgements: Consist of personal and objective value judgements. A personal
value judgement is subjective because it is based on personal values and therefore is
a personal choice or preference. An objective value judgement is independent of the
person making the judgement and is found, for example, in research projects where
information is evaluated and described objectively.
56
, Chapter 3 Practising the profession of nursing within the South African professional-ethical framework
Prerequisite knowledge
The nurse should have knowledge of the concept of human rights as contained in the
Constitution of the Republic of South Africa.
Medico-legal considerations
Nurses are accountable to the community they serve for the way in which they fulfil
their responsibilities in nursing and healthcare. They may be called to account for their
behaviour by the courts of the country and the nursing profession.
Key ethical considerations
Ethical norms, values and principles are all based on the great unifying principle that is
to be found in all the major religions and belief systems, namely to treat others as you
would like to be treated.
Key legal considerations
• Application of the principles of patient advocacy may result in conflict with other
health professionals, particularly if their approach and perspective differ from those
of the nurse.
• Conflict may also arise where the rights of the patient are being violated through the
actions of another health service practitioner.
• The response to unethical behaviour on the part of a colleague or other health
service professional has legal implications.
• Obtaining truly informed consent from the patient or the patient’s family is a legal
requirement.
• The major ethical principles of nursing are enshrined in the legislation which governs
nursing and healthcare in general, namely:
–– confidentiality, which means the protection of the name, person and possessions
of the patient
–– patient advocacy and the protection of the vulnerable
–– ensuring that all the needs of the patient are met
–– accountability, honesty and integrity in all that the nurse does
–– the duty of the nurse to take due care in all his or her activities
–– obtaining consent for nursing and healthcare interventions.
Essential health literacy
The ethical principles of beneficence, autonomy, justice, veracity and fidelity must be
observed when health education is given, with particular consideration of language
used and the cultural practices of the patient. ➙
57
