JNA CODE OF ETHICS FOR NURSES
JAPANESE NURSING ASSOCIATION
2021

JNA CODE OF ETHICS FOR NURSES

PREAMBLE
People hope to maintain their dignity as humans, and to stay healthy and happy. The mission of nursing isto satisfy such universal human needs and contribute to the achievement of healthy living throughout
people’s lifetime.
The scope of nursing includes individuals, families, groups, and local communities of all generations.
Nursing aims to support people while empowering them so that they can fulfill their lives that suit themthroughout their lifetime, by maintaining and promoting health, preventing illness, recovering health, andrelieving suffering.
Nurses are persons who are authorized to practice nursing by license. In the practice of nursing, it isrequired to respect people's right to live, right to maintain dignity, right to receive respectful nursing, rightto receive equitable nursing, and other human rights. At the same time, nursing needs to be practiced withthe pride.
The Japanese Nursing Association (JNA) Code of Ethics for Nurses provides action guidelines for nurses
who practice in all kinds of settings and functions as a basis for reviewing their practice. The JNA Codeof Ethics also delineates, for society, the scope of responsibility that nurses undertake as professionals in
the practice of nursing.

1

CODE

1

Nurses respect human life, human dignity, and human rights.

All people have the right1 to enjoy the highest attainable standard of health, without being restricted bytheir nationality, race, ethnicity, religion, belief, age, sex, sexual orientation, gender identity, socialposition, economic status, lifestyle, or the nature of health problems. Nurses are professionals who
support the health and lives of people in all kinds of settings and always respect human life, dignity, andrights with high ethical standards in their actions.
Nurses respect human life, human dignity, and human rights in all kinds of settings, and always endeavor
to contribute to the attainment of healthy living that suits the person with warm humane sensitivity.

2Nurses provide equitable nursing to persons who are in their care.

Equitable nursing not only refers to the mere provision of equal nursing but signifies the provision ofnursing that matches the individual characteristics and needs of each person. The recognition of healthand lifestyles has been changing as society changes, and people's nursing needs have become increasingly
diversified and complicated. To satisfy people's diversified and complicated needs, nurses provide nursingthat matches the nature of health problems and the environment that surrounds people with highsensitivity and endeavor to contribute to their health and happiness.
Nurses are also respectful and receptive to the habits, attitudes, cultural backgrounds, and philosophies ofindividuals.

1 The World Health Organization (WHO) states, in the preamble to its Constitution, "The enjoyment of the highest attainable standard ofhealth is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition."
Referring to this principle, the JNA Code of Ethics for Nurses is based on the idea that it is one of the human rights to enjoy the highest attainable
standard of health.

2

JNA CODE OF ETHICS FOR NURSES

3

Nurses establish a relationship of trust with persons who are being
cared for and provide nursing based on that relationship.

Nursing is based not only on advanced knowledge and skills, but also on the relationship of trust
established with the persons who are being cared for.
Nurses endeavor to establish and develop a relationship of trust by cooperating with people for better
health, responding to their trust with sincerity, providing adequate explanation about their practice toobtain understanding and consent, and take responsibility for the outcome of practice.
Nurses are aware that the nursing they practice is the provision of professional support, and never develop
this supportive relationship into a personal relationship.
Nurses urge persons who are being cared for to proactively participate in the process of receiving
healthcare and welfare services so that their opinions and intentions will be incorporated. Nurses also
identify the apparent and potential abilities of people and support them in maximizing their abilities.

4Nurses respect people's rights and support them to make choices thatmatch their intentions and values.

People have the right to know and the right of self-determination. Nurses respect these rights, provide
adequate information, support their decision-making, and respect the values and intention of eachindividual concerning healthcare and welfare, and lifestyle. Nurses provide and share information to
support people's decision-making and accompany them in the process of forming decisions the best
choices for the person.
People may choose healthcare and welfare services based on adequate information, may choose not toknow such information, or may choose to entrust the decision-making to others. When it is difficult forthe person to express his/her will, nurses provide information suitable for the person, obtain the person'sunderstanding, infer his/her intention, and collaborate with all related persons to form the best agreement
for the person. Nurses act as advocates for people's rights, including representing them, when necessary,to ensure that people receive healthcare and welfare services consistent with their values and intentions,and achieve a life they desire. Nurses support people in making decisions and choices our best for themat the time.

3

5

Nurses respect the confidentiality of persons who are being cared forand properly handle personal information.

To practice appropriate personalized nursing, nurses frequently come to know confidential information ofpersons who are being cared for. Nurses must not disclose confidential information that they come toknow in the course of their duties without due reason.
To improve the health of persons who are being cared for, it is necessary to obtain personal information as
well as to share information closely and accurately with other professionals. Personal information not only
refers to names and dates of birth, but also includes images, audio recording, and genetic information.
When obtaining and sharing personal information, nurses take proper measures, including the explanationof the necessity of such information and the obtaining consent from the persons who are being cared for.
Nurses also make the maximum effort to obtain consent from the persons who are being cared for before
sharing information with their families.
Various social media have been developed based on the recent advancement of information andcommunication technology (ICT). The appropriate use of such media provides useful health informationand other benefits both for nurses and for persons who are being cared for. Nurses distinguish professionaluse from personal use and recognize not only the benefits but also the risks of the use of such media.
Nurses distribute and share information taking utmost precautions for the correctness of information, theprotection of the privacy of nurses and persons who are being cared for.

6If a risk or harm arises for persons who are being cared for, nurses
protect them and ensure their safety.

Nurses always act to support people's health and happiness. Nurses are in the position of uncovering actsthat may threaten people's lives and human rights, as well as inappropriate conduct. When nurses identify
such conduct, they do not turn away from it, but act to protect people and ensure their safety. In thisprocess, nurses share information with other professionals and take action based on careful consideration.
In the provision of healthcare and welfare services, nurses take an approach to protect people's lives andhuman rights, paying attention to all possible harm, including the possibility of an inappropriate decisionor action by any persons and the possibility of harm caused by nurses. Nurses raise questions when they
identify an unethical practice or situation and act to ensure that adequate healthcare and welfare services
will be provided.

4

JNA CODE OF ETHICS FOR NURSES

7

Nurses accurately understand their responsibilities and abilities and areresponsible for their nursing practice as individuals.

Nurses always accurately understand their responsibilities and abilities, and practice nursing accordingly.
Nurses are held accountable for their nursing practice and are responsible for the decisions outcomes ofthat they undertake.
The practice of nursing is stipulated in the Act on Public Health Nurses, Midwives and Nurses. Nurses
observe the applicable laws and practice nursing within the scope of their responsibilities and abilities.
When nursing beyond their abilities is required, nurses proactively seek support and guidance, or request
the adjustment of assignments, to provide safe and high-quality nursing. When nurses delegate
assignments to other nursing professionals, they accurately assess the abilities of their own and theircolleagues to avoid causing a harm to the persons who are being cared for.

8Nurses always endeavor to develop, maintain, and improve their abilities
through continuous learning as part of their individual responsibilities.

Nurses must be highly educated and have a high level of expertise in order to keep up with theadvancements of science and medicine, and to address people's changing health needs and diversifiedsocial values. To have a high level of expertise and provide quality nursing, nurses must, as part of their
responsibilities and duties, endeavor to develop, maintain, and improve their abilities by proactively
taking various learning opportunities after obtaining their license.
The opportunities for continuous learning include information from journals and publications, andcontinuing education programs at their facilities as well as e-learning and external learning opportunities
such as participation in academic meetings and seminars. Nurses proactively, take adequate opportunities
to improve their professional practice.
In addition to developing, maintaining, and improving their abilities, nurses are also responsible for
fostering the next generation in order to guarantee the ongoing provision of high-quality nursing.

59Nurses achieve better healthcare and welfare services in collaboration
with other professionals.

In collaboration with other professionals, nurses shared value that emphasizes making all possible efforts
for persons who receive nursing and medical care.
Nurses and related persons in healthcare and welfare services deepen their mutual understanding as thebasis for collaboration with other professionals, maximize their respective abilities, and aim to provide
healthcare and welfare services of higher quality.
To achieve better medical and nursing care and promote people's health, their participation in the process
is indispensable. Nurses establish partnerships with persons who are being cared for,2 promote their
participation in medical and nursing care, and seek to jointly achieve healthcare and welfare services ofhigher quality with their collaboration in research, medical safety, and other aspects.

10To provide nursing care of higher quality, nurses set a behavioral
standard for practice and behave to act with the standards.

It is an essential requirement for professionals to set behavioral standards for their practice and behave inaccordance with the standard as a matter of integrity. Such a behavioral standard stipulate criteria andresponsibilities required in the professional practice and duty and supports the professional value ofnurses.
Such a standard is established by the organization, and the individuals and organization endeavor to meetthe standard, while leveraging the standard as a criterion for evaluation. The standard is revised as
appropriate in response to changes in society and people's needs.
Nurses comply with standards and guidelines set by professional nursing organizations. Each facility
endeavors to guarantee nursing of higher quality by formulating more specific and practical standards thatconsistent with the characteristics of the facility and nursing.

2 Partnerships in healthcare and welfare services herein refer to relationships where nurses and persons who are being cared for cooperate witheach other in equal positions in order to achieve better health and livelihood.

6JNA CODE OF ETHICS FOR NURSES

11

Through research and practice, nurses endeavor to create and develop
professional knowledge and skills and contribute to the development ofnursing science.

Nurses always apply scientific findings and principles to nursing practice and make all possible efforts todevelop new professional knowledge and skills. The professional knowledge and skills that they develop
are collected and contribute to the provision of higher quality of nursing in the future. In other words,
through research and practice, nurses are responsible for contributing to the development of nursing
science and to people's health and welfare by endeavoring to create and develop professional knowledge
and skills and then to formulate nursing policies, as the core of nursing.
Nurse is respected the intentions of people concerning participation in any kind of healthcare and welfare
research, protect people's life, health, and privacy, respect their dignity and rights, and guarantee theprovision of appropriate healthcare and welfare services.

12

To practice nursing of higher quality, nurses endeavor to improve theirown well-being.3

For nurses to provide high quality nursing, it is indispensable to maintain their own well-being. The
healthy and happy state of nurses enables the provision of better nursing care and leads to more favorable
outcomes in the health and happiness of persons who are being cared for.
To improve their well-being, nurses endeavor to maintain their work-life balance and good mental healthcare.
Furthermore, the settings of nursing practice involve the risks of exposure to radiation, infection,harassment, violence, etc. Both individuals and organizations take measures to realize sound and safe
working environments for all nurses.

3 The Constitution of the World Health Organization, which entered into force in 1948, states, "Health is a state of complete physical, mental
and social well-being and not merely the absence of disease or infirmity." Referring to this principle, the JNA Code of Ethics interprets and uses
the term "well-being" as a favorable physical, mental, and social state.

7

13

Nurses always endeavor to maintain integrity and enhance social trustof all nurses.

Nursing cannot exist without the trust of people who need nursing care. Nurses always recognize thesocial mission and responsibility of their profession, have pride in their profession, and maintain highstandards of integrity.
Trust in nursing not only derives from the professional knowledge and skills of nurses but also depends ontheir behavior being sincere, polite, decent, clean, and modest. Because social trust is indispensable,nurses must enhance their cultural knowledge in fields other than their specialty and acquire adequate
social commonsense.
Nurses do not take advantage of their positions to conduct activities that may compromise trust in nursing
or conduct illegal activities.

14

To protect people's lives and health, nurses share responsibilities withsociety based on the idea of social justice concerning various issues.

From the standpoint of protecting and respecting people's lives, dignity, and rights, nurses share
responsibilities with society based on social justice from a global perspective, concerning issues such as,
all kinds of discrimination, poverty, various disparities, climate change, abuse, human trafficking,conflicts, violence, and other issues that severely affect lives and health. Nurses always endeavor toupdate their knowledge concerning such issues that arise in Japan and across the world, improve theirawareness, and distribute information to society concerning such issues. Nurses also proactively
participate in situations with potential issues and take appropriate measures as nursing professionals incollaboration with other professionals and related organizations.
Nurses also fulfill their responsibility to prevent environmental destruction caused by healthcare andwelfare activities, and take proactive measures to maintain the environment for protecting and promoting
people's health, including the acquisition of clean air, pure water, safe food, and noise control measures.
In this way, nurses aspire to achieve the achievement of a peaceful and inclusive society where the safety
and health of people's lives are protected.

8JNA CODE OF ETHICS FOR NURSES

15

Nurses belong to professional organizations, participate in activities toenhance the quality of nursing, and contribute to the achievement of abetter society.

To contribute to social welfare by providing high-quality nursing care at all times, nurses have a mission
to improve their abilities as professionals. To ensure that policies and systems regarding healthcare,welfare, and nursing congruent social changes and people's needs, nurses proactively participate in theimprovement of systems, policy-making, and the creation of new social resources.
Nurses belong to professional nursing organizations and participate in activities to enhance the quality ofnursing, including the above, thereby contributing to the achievement of a better society.

16In collaboration with various disaster relief providers, nurses make all
possible efforts to protect the lives, health, and livelihood of all people
affected by disasters.

Disasters cause the loss of people's lives, health, and livelihood, and seriously afflict individuals, local
communities, countries, and the global environment. Nurses improve disaster awareness as professionals
to protect people's lives, health, and livelihood, and provide healthcare and welfare services based on theirprofessional knowledge and skills.
To protect people's lives, health, and livelihood from disasters, nurses participate in policy-making at
normal times in order to reduce disaster risks. During times of disaster, nurses provide support thatappropriate for the different phases from first response to recovery and reconstruction, in accordance withthe type, scale, and damage of the disaster. During times of disaster, nurses act with limited resources andunder conditions that differ from those in normal times. Nurses secure their own safety and provide
healthcare and welfare services required by the continuously changing situations and needs.
In collaboration with various disaster relief providers, nurses endeavor to maximize their respectivefunctions and abilities to their full extend.

9

JNA CODE OF ETHICS FOR NURSES
March 15, 2021
Edited and published by: Japanese Nursing Association
5-8-2 Jingumae, Shibuya-ku, Tokyo 150-0001
Tel: +81 3 5778 8831, URL: https://www.nurse.or.jp/Contact:
Nursing Practice and Healthcare Safety Division
Department of Nursing Development
Japanese Nursing Association
TEL: +81 3 5778 8548
Printed by:Sankei Sougou Insatsu* Unauthorized duplication or reproduction of this document is prohibited.