Date of Award


Document Type

Master Thesis

Degree Name

Masters of Science (Research)


Nursing & Healthcare Sciences

First Advisor

Dr. Anna Marie Greaney

Second Advisor

Ms. Helena Butler


A new version of the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI, 2014a) was published in 2014. A nurse’s fitness to practice, and the associated patient experience, is determined by the extent to which the nurse accords with the duties outlined in the Code. Professional misconduct among members of the nursing profession has been highlighted within recent reports and enquiries. The failure to act on unethical care is also a feature. The literature suggests that Codes are poorly understood and can be problematic to integrate in practice. This study sought to; explore the impact of the current Code on nursing practice as perceived by a group of nurses and develop a strategy or tool to augment its integration.

Action Research was used as it facilitated participants to engage and collaborate to produce rich data towards identifying current impact and future integration strategies. Data collection consisted of Action Learning Sets, within two practice based sites (acute and community). The perspectives of relevant key personnel in nursing were also sought. Data was analysed using Ritchie and Spencer’s Framework Method (1994) and NVivo 11.

Lack of awareness, knowledge and inaccessibility of the new Code was evident amongst the nurses. The Code is necessary guidance for professionalisation, but can be hard to apply due to the ‘grey areas’ in nursing, sometimes making it aspirational and idealistic. Working environments impact on how the Code is integrated in practice, therefore, support and leadership is essential. Cognitive skills; reflection and critical thinking, along with internal attributes; moral agency and moral courage, are necessary to apply the Code in practice. The Code should be implemented in collaboration with other relevant professional, regulatory, legal, ethical and local guidelines.

Drawing on the study’s findings and in collaboration with the participants the ACT (Assess, Consider, Take Action) model for integration of the Code of Professional Conduct and Ethics was developed. This model aims to guide nurses through the process of ethical decision making. It helps bring the Code to life by making it practical and integrating it with other relevant guidelines and areas needing consideration when faced with an ethical dilemma/situation. Reflection and critical thinking is encouraged with this model. It is hoped this model will be piloted in a practice- based setting in future research to ultimately extend its use in patient care situations.

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