The practice of having a particular profession obliges to take and follow a set of rules and principles that are common for that profession. The Nightingale pledge, which is considered as a form of the Hippocratic Oath, consists of the ethical principles that ought to be followed and adopted by all nurses (Miracle, 2009). However, today, there are many arguments against the use of the Nightingale Pledge in schools of nurses. Therefore, this paper aims to discuss the historic role of the pledge, its purpose and functions, as well as ethical beliefs and limitations in order to evaluate the role of pledging in todays nursing.
Historic Role of the Pledge
The Florence Nightingale pledge adopted in nursing in 1849 was named after Florence Nightingale, the founder and pioneer in the field of nursing, though it was created by Lystra E. Gretter, a nursing instructor at the Harper Hospital of Detroit, in collaboration with the Farrand Training School for Nurses. At that time, in medicine there was used the Oath of Hippocrates that had existed already since the fifth century before Christ (Herman, 1985). However, the Hippocratic Oath, named after the famous Greek physician Hippocrates, was predominantly taken by the doctors rather than nurses.
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By taking the Hippocratic Oath, the physicians swore to apply measures for the benefit of the sick according to their abilities and ethics and keep them from harm and injustice (Herman, 1985, p. 18). They rejected practicing abortion and euthanasia, as well as surgery as this job was separated from the physicians tasks. They also swore to treat their teacher of the medicine with respect, as a father, and similarly obligated to share their knowledge freely further with their students. The physicians asked for honor and fame if they lived and worked according with the oath and disgrace and blame if they failed. However, in the 19th century, the Hippocratic Oath was not followed by all nurses and, moreover, the nurses could use it for their own purposes. Therefore, in 1893, Lustra Gretter modified and adapted the Hippocratic Oath to the new requirements of health care so that it could be used by all the nurses when they graduated from the U.S. nursing schools (Miracle, 2009).
It should be noted that the role of the Florence Nightingale pledge in nursing significantly differs from one of the Hippocratic Oath. Most variants of the modern Nightingale pledge do not call for free teaching or for refrain from euthanasia, abortion, and surgery. Some modern medical schools provide the oath with modified tenets for students when they graduate from them, while some schools do not require to pledge at all. Nowadays, the pledge is usually cited in ceremonies on the Nurses Day that is celebrated on May 6, during the National Nurses Week on May 6-12, and on the Nightingales birthday on May 12.
Purpose and Functions
The philosophy of the Nightingale pledge is based on the responsibility to adhere to professional rules and requirements, as well as ethical principles of nursing. Thus, the purpose of the pledge is to contribute to the development of nurses commitment to their job by adhering to ethical and professional basic values and principles of the practice of nursing.
The Nightingale pledge creates the image of nurses. According to Winslow (1984), nurses should be viewed as health missioners who are in a full responsibility of not only the health of their trusts, but also of their morale. Hereby, while physicians focus on curing, nurses should focus on caring. Caring is a considerable element of the nursing oath. In terms of caring, responsibilities of nurses include helping people to adapt to and overcome different stages of the disease. Besides, caring should include performing necessary tasks with high competence, maintaining belief in patients, encouraging them, as well as protecting them from harm. Thus, the pledge has introduced a new position in health care by claiming that compassion should be an inevitable part of providing public health (Winslow, 1984). Nursing oaths and ethical standards involve the nurses commitment to respect not only the care required by the patients, but also human rights.
Ethical Beliefs and Limitations
According to the pledge, the nurses should endeavor to serve physicians with loyalty will (Miracle, 2009, p. 134). Since there are many speculations on this topic, some institutes reject the Nightingale Pledge. The critics claim that nurses should be loyal to patients rather than physicians. Moreover, they claim that they have to be autonomous in providing care to the patients.
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Today, some of the schools have abandoned the use of the pledge at all, whereas some have modified it while trying to better describe the role of the nurses in the modern health care industry. Many schools have determined to extend the pledge because many words may have double meaning or may be interpreted in different ways. For example, the California State University has changed the pledges phrase of I solemnly pledge myself before God into I solemnly pledge myself before God of all faiths to meet different religious views of nurses (Miracle, 2009, p.135). Additionally, the phrase to pass life in purity provokes ambiguous attitude. Some may understand it as chastity, while others view it as the sense of genuineness (Herman, 1985, p. 18). Thus, the main arguments against using the Nightingale Pledge in nursing schools include such aspects as unclear reference to God, to purity, as well as appeal to aid and show loyalty to physicians. Additionally, the critics claim that the Nightingale Pledge ignores the modern complex decision-making in health care settings.
Nevertheless, many attributes of the pledge are applicable today. For example, the vital elements of the modern nursing care are such principles of nurses as I will not take or knowingly administer any harmful drug, as well as I will do all in my power to maintain and elevate the standard of my profession (Herman, 1985, p. 18). Similarly, the Code for Nurses states that protecting the rights of patients is the crucial task of nurses as patient advocates, while the Code of ANA refers to such primary nursing role as advocating in protection of the patients well-being (Woods, 2010). When dealing with dilemmas, nurses should remember that, according to the Declaration of Helsinki, the subjects interest must always predominate over the interest of science and society.
Role of Pledging in Todays Nursing
The critics argue that the principles that were appropriate in 1893 are outdated in the contemporary health care. Since the health care industry is constantly changing and evolving, the nurses have to meet these changes and adapt to them. However, it must be recognized that the Florence Nightingale Pledge has created a foundation for other ethical and nursing codes that the nurses must support. In this light, important guidelines are the already mentioned Code of the International Council of Nurses (ICN) and the Code of the American Nurses Association (ANA) (Woods, 2010).
There are many advocates of implementing the pledge in todays business practices to recognize and support the need for confidentiality and privacy of patients. The adherence to the phrase I will hold in confidence all personal matters is supported and controlled by the Health Insurance Portability and Accountability Act. Additionally, the ANA Guidelines for Research, the Royal College of Nursing Code for nurses in research, as well as the Human Rights Guidelines for nurses in clinical and other research provide a basement for adhering to the principles of confidentiality when conducting research and learning patients personal data.
Thus, all of the codes are based on the basic principles of the Nightingale Pledge, as well as ethical principles of the Hippocratic Oath such as be of benefit, do not harm and such key principles as Do not harm, Be compassionate, Be fair, and Make things better (Herman, 1985, 17-18). Thus, such moral values as honesty, responsibility, respect, compassion, and fairness should create the framework for determining what is moral in nursing.
Nurses must be aware of their personal moral and ethical views and stances, as well as professional and ethical principles of the occupation because they have crucial influence on the nurses decision-making. Self-examining must be the first step on the way to the ethical practice of nursing. The nurse should carefully consider her/his cultural, political, and religious beliefs, as well as personal experiences and then apply them to an ethical situation the nurse has met or may meet in the future. Hereby, she/he should also compare her/his personal considerations and beliefs to professional duty and check if they are in line with the Nightingale Pledge and other codes of ethics. While examining and analyzing the discrepancies in views, as well as personal biases, the nurse can prepare her/his ethical background for taking right decisions and providing the best care to the patients. Every time when the nurse has certain ethical doubts, she/he should turn to the basic ethical principles written in the Nightingale Pledge. Each nurse has to continuously develop and grow as a professional. Therefore, the frequent reviewing of the Nightingale Pledge and the Oath of Hippocrates by nurses can more remind them of the high principles and standards they are required to follow all the time rather than pledging once during the nursing career.