Original Article

An evaluation of adherence to ethical codes among nurses and nursing students


Ethical codes are instructions that shape ethical behavior and determine which values and beliefs should be accepted. These codes act as a practical guideline in the nursing profession. The present study aimed to compare adherence to ethical codes between the nursing students and working nurses of Valiasr Hospital, affiliated with Fasa University of Medical Sciences in Fars Province, Iran. In this descriptive-analytical study, the data collection tool was nurses’ self-reporting questionnaire on adherence to ethical codes devised by Mahdavi Lenji and Ghaedi Heidari, who have also confirmed its validity and reliability. This questionnaire consisted of 3 sections: personal information, ethical codes related to clinical service provision (23 items), and relationship with the treatment team (8 items). A total of 400 individuals (178 nursing students and 222 nurses) were selected through census sampling method. Data were analyzed through descriptive, ANOVA and t-test statistical methods using SPSS 22 software. There was no significant difference between nurses and nursing students in terms of adherence to ethical codes related to clinical service provision, but the latter achieved a significantly higher score in codes on relationship with the treatment team (P = 0.04). Although the score of nursing students was higher than nurses in comparison to the treatment team, they lacked the necessary technical competency to adhere to ethical codes. Therefore, we recommend that nursing instructors and educational managers pay more attention to teaching nursing ethics and supervise their implementation and practicality in clinical environments.

1. Heymans R, van der Arend A, Gastmans C. Dutch nurses’ views on codes of ethics. Nurs Ethics. 2007; 14(2):156–170.
2. Shahriari M, Mohammadi E, Abbaszadeh A, Bahrami M, Fooladi MM. Perceived Ethical Values by Iranian Nurses. Nurs Ethics. 2012; 19(1):30-44.
3. Heikkinen A, Lemonidou C, Petsios K, et al. Ethical codes in nursing practice: the viewpoint of Finnish, Greek and Italian nurses. J Adv Nurs. 2006; 55(3):310-9.
4. Verpeet E1, Dierckx de Casterle B, Van der Arend A, Gastmans CA. Nurses’ views on ethical codes: a focus group study. J Adv Nurs. 2005; 51(2): 188-195.
5. Chitty KK. Black BP. Professional Nursing, Concepts and Challenges, 7ed.USA: Saunders Publishing; 2013.
6. Scanlon C. A professional code of ethics provides guidance for genetic nursing practice. Nurs Ethics. 2000; 7(3): 262–8.
7. Numminen O, Leino-Kilpi H, der Arend AV, Katajisto J. Comparison of nurse educators’ and nursing students’ descriptions of teaching codes of ethics. Nurs Ethics. 2011; 18(5): 710-24.
8. Mahdavi Lenji Z, Ghaedi Heidari F. The Comparison of observing the ethical codes among nursing students and nursing practitioners in AL-Zahra Hospital in Isfahan in 2012. Journal of Medical Education Development. 2013; 7(13): 74-81. [in Persian]
9. Sanjari M, Zahedi F, Larijani B. Ethical codes of nursing and the practical necessity in Iran. Iranian Journal of Public Health. 2008; 37(1 Sup): 22-7. [in Persian]
10. Zahedi F, Sanjari M, Aala M, et al. The Code of Ethics for Nurses. Iranian J Public Health. 2013; 42 (1): 1-8.
11. Sanjari M, Zahedi F, Peymani M, et al. Codes Ethics for Iranian nurses. Med Ethics Hist Med. 2012; 5(1): 17-28. [in Persian]
12. Numminen O, Van Der Arend A, Leino-Kilpi H. Nurse educators’ and nursing students’ perspectives on teaching codes of ethics. Nurs Ethics. 2009; 16(1): 71–84.
13. Woods M. Nursing ethics education: are we really delivering the good(s)? Nurs Ethics. 2005; 12(1): 5-18.
14. Momennasab M, Rahmanin Koshkaki A, Torabizadeh C, Tabei SZ. Nurses' adherence to ethical codes: the viewpoints of patients, nurses, and managers. Nurs Ethics. 2015; 23(7):794-803.
15. Mohajjel Aghdam A, Hassankhani H, Zamanzadeh H, Khameneh S, Moghaddam S. Nurses' performance on Iranian nursing code of ethics from patients’ perspective. IJN. 2013; 26(84): 1-11
16. Joolaee S, Givari A, Taavoni S, Bahrani N, Rezapour R. Patients’ satisfaction with provided nursing care. Iranian Journal of Nursing Reaserch. 2008; 2(6-7): 37-44. [in Persian]
17. Borhani F, Alhani F, Mohammadi E, Abbaszade A. Development of nursing professional ethics competence, necessity and challenges in ethic education. J Med Ethics Hist Med. 2010; 3:3.
18. Jafari Manesh H, Ranjbaran M, Vakilian K, Tajik R, Almasi-Hashiani A. Nursing’s code of ethics: a survey of respecting the code among nursing students. Med Ethics Hist Med. 2014; 6(6):45-55.
19. Eshkevari KV, Karimi M, Asnaashari H, Kohan N. The assessment of observing patients’ right in Tehran University of Medical Sciences’ hospitals. Med Ethics Hist Med. 2009; 2(4): 47-54. [in Persian]
20. Erdil F, Korkmaz F. Ethical problems observed by student nurses. Nurs Ethics. 2009; 16(5): 589-98.
21. Hartrick Doane GA. Am I still ethical? the socially –mediated process of nurses’ moral Identity. Nurs Ethics. 2002; 9(6): 623-35.
22. Dobrowolska B, Wrońska I, Fidecki W, Wysokiński M. Moral obligations of nurses based on the ICN, UK, Irish and Polish codes of ethics for nurses. Nurs Ethics. 2007; 14(2): 171-80.
23. Khaki S, Esmaeilpourzanjani S, Mashouf S. The relationship of ethical observance of nurses with quality of care from patients’ point of view. Journal of Clinical Nursing and Midwifery. 2016; 4(3): 1-11.
24. Dadkhah B, Mohammadi MA, Taghavi N. The respect to territory and rights of patients in hospitals in Ardabil. IJNMR. 2004; 9(2). [in Persian]
25. Martin P, Yarbrough S, Alfred D. Professional Values Held by Baccalaureate and Associate Degree Nursing Students. J Nurs Scholarsh. 2003; 35(3): 291-6.
26. Di You A, Yukiko Maeda B, Muriel J. Gender Differences in Moral Sensitivity: A Meta-Analysis. Ethics & Behavior. 2011; 21(4): 263–82.
27. Forte A. Gender, Industries and the moral reasoning of managers. Journal of Diversity Management (JDM). 2008; 3(1): 39-54.
28. Numminen O, Leino-Kilpi H, Arend AVD, Katajisto J. Nurse educators teaching of codes of ethics. Nurs Educ Today. 2010; 30(2): 124-31.
29. Auvinen J, Suominen T, Leino-Kilpi H, Helkama K. The development of moral judgment during nursing education in Finland. Nurs Educ Today. 2004; 24(7): 538-46.
30. Tadd W, Clarke A, Lloyd L, et al. The value of nurses’ codes: European nurses’ views. Nurs Ethics. 2006; 13(4): 376-93.
IssueVol 10 (2017) QRcode
SectionOriginal Article(s)
Adherence Ethical codes Nursing students Registered nurse Nursing ethics

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How to Cite
Bijani M, Ghodsbin F, Javanmardi fard S, Shirazi F, Sharif F, Tehranineshat B. An evaluation of adherence to ethical codes among nurses and nursing students. J Med Ethics Hist Med. 2017;10.