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In 2008, CNA plans to release a revised code of ethics for nurses in Canada. The purpose of this article is to provide a brief history of nursing codes of ethics as a way of illustrating the need for revisions and what can be accomplished through the revision process.
The Nightingale Pledge, considered "one of the earliest written expressions of the ethical principles of nursing" (Stewart & Austin, 1962, p. 141), was formulated in 1893 by Lystra Gretter, likely as an analogue to the Hippocratic oath (Fowler, 1984). It was never adopted by a nursing body in Canada as a code of ethics, but it was used extensively at capping ceremonies and graduations. As an illustration of why codes of ethics need revision, consider the words of the pledge:
I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous.... With loyalty will I endeavor to aid the physician in his work....
Florence Nightingale considered ethical conduct in nursing to be largely dependent on character and she sought such attributes as honesty, kindness and truthfulness in potential nurses (Lamb, 2004). But barriers to ethical practice were also an unfortunate aspect of the reality in which Nightingale, and the nurses who followed her, practised. Ethics was seen as embodying a primary loyalty to the physician and the organization - with the patient as secondary. Protection from disclosure of error and support for hierarchical structures in health care were seen to benefit hospitals and health care (Ashley, 1976; Mauksch, 1966).
The Nurses' Associated Alumnae of the United States and Canada wrote a requirement for the establishment and maintenance of a code of ethics into the first article of its constitution in 1897 (Dock, 1912; Mooney, 1980, p. 22). This group was reorganized in 1911 into the precursor bodies of the American Nurses Association (ANA) and CNA. Although a code of ethics had been prepared for the American nurses' first national convention in 1898, it was put aside when a physician urged that a code would be more trouble than it was worth, adding that being "good women" was all that was needed (Dock, 1912)....