How a Perioperative Nurse Upholds Provision 9 of the Code of Ethics
Perioperative nurses uphold Provision 9 by actively participating in quality improvement initiatives, contributing to evidence-based practice development, and advocating for systemic changes that improve patient care and professional standards.
Understanding Provision 9's Core Requirements
Provision 9 of the ANA Code of Ethics requires nurses to maintain the integrity of the profession through participation in professional organizations, advancement of nursing knowledge, and advocacy for healthcare policy improvements. In the perioperative setting, this translates into specific, actionable responsibilities.
Participation in Quality Improvement and Audit
The most direct way perioperative nurses fulfill Provision 9 is through systematic participation in quality improvement activities:
- Engage in national audit initiatives to ensure accuracy and completeness of submitted data, such as the National Emergency Laparotomy Audit and National Hip Fracture Database 1
- Develop and assess quality improvement metrics specifically designed for surgical patient populations 1
- Undertake continuous quality improvement using standardized audit recipes and adapting them for specific patient populations 1
These activities directly advance the profession's knowledge base and improve patient outcomes through systematic data collection and analysis.
Contributing to Evidence-Based Practice Development
Perioperative nurses must actively address the critical gap in surgical evidence:
- Participate in research initiatives that specifically examine perioperative interventions, as current evidence is largely extrapolated from younger or non-surgical populations 1
- Engage in before-and-after interventional studies and observational research, which may yield more relevant information than traditional randomized controlled trials for multimodal perioperative interventions 1
- Document and share clinical innovations that improve patient care, particularly for vulnerable populations 2
The evidence base for perioperative care requires urgent improvement, and nurses are positioned to contribute meaningfully to this knowledge development 1.
Professional Leadership and Advocacy
Perioperative nurses uphold Provision 9 through active advocacy for systemic improvements:
- Act as patient champions within the operating department, particularly for vulnerable populations like elderly patients who frequently experience dignity violations in hospital care 1, 3
- Advocate for appropriate staffing and resources that enable evidence-based practice implementation 2
- Promote standardized safety protocols such as the WHO Surgical Safety Checklist to improve care consistency 2, 4
Professional leadership is explicitly required to reverse attitudes that disregard patient dignity and contribute to poor outcomes 1.
Education and Professional Development
Nurses fulfill Provision 9 by advancing their own knowledge and teaching others:
- Pursue specialized training in areas like geriatric perioperative care, where expertise is currently insufficient to meet patient needs 1
- Participate in continuing education that addresses emerging evidence and evolving best practices 2
- Mentor and educate nursing students and colleagues in evidence-based perioperative practices 2
The current pool of specialized perioperative nurses is inadequate for anticipated patient needs, making professional development essential 1.
Ethical Practice and Policy Development
Perioperative nurses advance the profession through ethical leadership:
- Familiarize themselves with professional guidance on complex ethical issues like end-of-life care and advance care planning 1
- Advocate for policy changes that protect patient rights and ensure advance care plans are respected throughout the perioperative period 3
- Consult with legal representatives when uncertain about professional obligations, establishing precedents for ethical practice 1, 3
Implementation of Evidence-Based Protocols
Nurses uphold Provision 9 by translating evidence into practice:
- Apply standardized protocols for surgical site infection prevention, including evidence-based skin antisepsis and hair removal techniques 2
- Implement multimodal interventions to prevent postoperative complications like delirium, particularly in high-risk populations 2, 4
- Ensure proper documentation and communication of patient-specific considerations across care transitions 3, 4
Common Pitfalls to Avoid
Failing to document and share clinical observations that could contribute to evidence development represents a missed opportunity to advance the profession 1.
Remaining passive when witnessing dignity violations contradicts the advocacy role central to Provision 9, as professional leadership is specifically required to address these systemic issues 1, 3.
Practicing in isolation without engaging in professional organizations or quality improvement initiatives prevents nurses from fulfilling their obligation to maintain the profession's integrity 1.