title: 'Practice what you preach': Nurses' perspectives on the Code of Ethics and Service Pledge in five South African hospitals.
abstract: BACKGROUND
  A recent focus of the global discourse on the health workforce has been on its quality, including the existence of codes of ethics. In South Africa, the importance of ethics and value systems in nursing was emphasised in the 2011 National Nursing Summit.
  
  
  OBJECTIVE
  The study explored hospital nurses' perceptions of the International Code of Ethics for Nurses; their perceptions of the South African Nurses' Pledge of Service; and their views on contemporary ethical practice.
  
  
  METHODS
  Following university ethics approval, the study was done at a convenience sample of five hospitals in two South African provinces. In each hospital, all day duty nurses in paediatric, maternity, adult medical, and adult surgical units were requested to complete a self-administered questionnaire. The questionnaire focused on their perceptions of the Code of Ethics and the Pledge, using a seven-point Likert scale. STATA(®) 13 and NVIVO 10 were used to analyse survey data and open-ended responses, respectively.
  
  
  RESULTS
  The mean age of survey participants (n=69) was 39 years (SD=9.2), and the majority were female (96%). The majority agreed with a statement that they will promote the human rights of individuals (98%) and that they have a duty to meet the health and social needs of the public (96%). More nuanced responses were obtained for some questions, with 60% agreeing with a statement that too much emphasis is placed on patients' rights as opposed to nurses' rights and 32% agreeing with a statement that they would take part in strike action to improve nurses' salaries and working conditions. The dilemmas of nurses to uphold the Code of Ethics and the Pledge in face of workplace constraints or poor working conditions were revealed in nurses' responses to open-ended questions.
  
  
  CONCLUSIONS
  Continuing education in ethics and addressing health system deficiencies will enhance nurses' professional development and their ethical decision-making and practice.
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Janine.white@wits.ac.za.
authors.forename: Janine
authors.initials: J
authors.lastname: White
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Maureen
authors.initials: M
authors.lastname: Phakoe
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Laetitia C
authors.initials: LC
authors.lastname: Rispel
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D032781:Codes of Ethics; D004509:Education, Nursing, Continuing; D004777:Environment; D005260:Female; D006806:Human Rights; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000941:ethics* / Q000523:psychology*; D028701:Patient Rights; D012456:Salaries and Fringe Benefits; D013019:South Africa; D017132:Workplace / Q000458:organization & administration / Q000523:psychology
keywords: South Africa; code of ethics; ethical dilemmas; nurses; nurses pledge