Guest Contributors: Angela McClure and Katie Davis
Texas Tech University Health Sciences Center School of Nursing
Nursing education must be rooted in ethical standards that promote compassionate, competent, and equitable care for all individuals, including those with intellectual disabilities (ID). The American Nursing Association Code of Ethics guidesd the delivery of compassionate and skilled care, ensuring that all individuals receive equitable healthcare regardless of their background or condition (2025). While these principles are integral to nursing practice, many nursing programs provide insufficient education on caring for individuals with ID, leaving new nurses unprepared to deliver the ethical and competent care required for this population. As described by Carper’s (1978) Fundamental Patterns of Knowing, ethical knowing, the moral component of nursingknowledge, guides nurses in making just and principled decisions that honor human dignity and advocate for vulnerable populations. By aligning nursing education with the ANA Code of Ethics and a relevant nursing theoretical framework, we can ensure that future nurses are equipped with the skills, knowledge, and ethical foundations necessary to deliver high-quality care while advancing health equity for individuals with intellectual disabilities (ID).
Shifting from Biomedical Ethics to a Holistic Ethical Framework
Traditional nursing education has been largely grounded in biomedical ethics, which prioritizes principles such as beneficence, non-maleficence, autonomy, and justice. While these principles remain essential, they often do not fully address the complexities of caring for individuals with ID, who frequently experience systemic marginalization, communication barriers, and social stigma. The ANA Code of Ethics offers a comprehensive, holistic ethical framework that prioritizes human dignity, advocacy, social justice, and collaborative care. Shifting nursing curricula from a strict biomedical focus to this comprehensive ethical model ensures that nurses are skilled clinicians and strong advocates for equity, inclusivity, and patient empowerment. This transformation is critical in bridging healthcare gaps and improving health outcomes for individuals with ID.
Provision 1: Respect for Human Dignity and Self-Determination
Provision 1 of the ANA Code of Ethics emphasizes the nurse’s responsibility to practice with compassion and respect for the inherent dignity, worth, and unique attributes of every individual. This is especially relevant when working with individuals with ID, who often face discrimination and biases that undermine their right to equitable care. Nursing curricula should focus on fostering relationships with patients, recognizing the nature of health in diverse populations, and supporting the right to self-determination. Through education on patient advocacy, communication strategies, and cultural competence, nurses can ensure that individuals with ID receive the respect and autonomy they deserve in their healthcare decisions.
Provision 2: Commitment to Patients and Professional Boundaries
Nurses are primarily committed to care recipients, whether individuals, families, or communities. Provision 2 highlights the importance of professional boundaries and ethical obligations in nursing practice, for individuals with ID, conflicts of interest, safety concerns, and professional advocacy must be addressed in nursing education. By incorporating case studies and experiential learning, nursing programs can train students to navigate ethical dilemmas, maintain professional integrity, and ensure the safety and well-being of their patients.
Provision 3: Advocating for Patient Rights and Safety
Provision 3 underscores the nurse’s role in advocating for the rights, health, and safety of all patients. Individuals with ID often experience healthcare disparities due to a lack of understanding, inadequate communication, and systemic barriers. Nursing curricula should include education on privacy, confidentiality, and strategies for promoting a culture of safety. Students should also learn how to recognize and address practice issues that may compromise the care of individuals with ID, ensuring that all patients receive safe and effective treatment.
Provision 4: Accountability and Ethical Judgment in Nursing Practice
Nurses have the authority and responsibility to promote health, prevent illness, and provide optimal care (Provision 4). To effectively serve individuals with ID, nursing programs must instill a sense of responsibility and accountability in students. Ethical awareness, discernment, and judgment should be key components of nursing education, helping students understand the unique healthcare needs of individuals with ID and advocate for systemic changes that promote inclusivity.
Provision 5: Supporting Nurses’ Moral and Professional Integrity
Provision 5 highlights nurses’ moral duties, including the expectation of a safe and supportive work environment. To provide competent and ethical care to individuals with ID, nurses must also prioritize their own well-being. Nursing programs should integrate training on professional competence, integrity, and self-care, ensuring that students enter the workforce with the confidence and resilience needed to advocate for vulnerable populations while maintaining their own ethical standards.
Provision 6: Ethical Work Environments and Healthcare Advocacy
Through individual and collective efforts, nurses help shape ethical work environments (Provision 6). For individuals with ID, a lack of accessible healthcare facilities, inadequate provider training, and systemic neglect contribute to significant health disparities. Nursing programs must prepare students to advocate for policy changes that create ethical and equitable healthcare environments, ensuring that all patients receive appropriate and dignified care.
Provision 7: Advancing the Profession through Research and Policy Development
Nurses contribute to the advancement of healthcare through research, policy development, and knowledge dissemination (Provision 7). To better support individuals with ID, nursing education should emphasize the importance of evidence-based practice, advocacy for inclusive health policies, and research on health disparities affecting this population. By fostering a commitment to continuous learning, nurses can lead efforts to improve care standards for individuals with ID.
Provision 8: Collaboration for Health Equity
Collaboration is essential to achieving health equity for individuals with ID (Provision 8). Nurses must work alongside other healthcare professionals, policymakers, and community organizations to address disparities and promote inclusive healthcare models. Nursing curricula should include interdisciplinary training and community engagement initiatives to help students develop the skills necessary for effective collaboration.
Provision 9: Promoting Social Justice and Eliminating Health Inequities
Provision 9 calls for nurses and professional organizations to advocate for social justice and eliminate health inequities. Individuals with ID often experience discrimination and exclusion from healthcare systems. Nursing programs must integrate content on structural oppression, intersectionality, and health policy to prepare students to become change agents in addressing these disparities.
Provision 10: Global Nursing and Health Diplomacy
Finally, Provision 10 emphasizes nursing’s role in the global health community. Individuals with ID face challenges not only at the local level but also in international healthcare systems. Nursing education should incorporate global health perspectives, exposing students to diverse care models and encouraging them to participate in initiatives that support human and environmental health worldwide.
Theoretical Application
In order to successfully care for individuals with ID, nursing education requires a nursing theoretical framework. One application is Kaya’s Professional Values Model in Nursing (Kaya & Boz, 2019). This newer theory applies individual values, nursing professional values, and combines those with nursing care quality. This can help nursing students identify personal values, develop professional ones, and apply both in clinical training programs. The primary outcomes of this application would be nursing student and patient satisfaction.
Enhancing Student Perspectives and Nursing Practice
Incorporating the ANA Code of Ethics into nursing curricula not only improves care for individuals with ID but also enhances the overall professional development of nursing students. By shifting from a traditional biomedical approach to a more inclusive ethical framework, students gain a deeper understanding of patient-centered care, advocacy, and social justice. This approach fosters a more profound sense of professional responsibility, strengthens their commitment to ethical practice, and cultivates a more compassionate and informed nursing workforce. As a result, students graduate with a greater appreciation for diversity in healthcare, improved confidence in their ability to address complex ethical issues, and a strong foundation for lifelong learning and leadership in nursing practice.
By embedding the provisions of the ANA Code of Ethics into nursing curricula, we can ensure that future nurses are equipped with the ethical knowledge and practical skills necessary to provide high-quality, equitable care for individuals with ID. This transformation strengthens the nursing profession’s commitment to social justice, human dignity, and health equity, ultimately improving outcomes for individuals with intellectual disabilities and promoting a more inclusive healthcare system.
References
American Nurses Association. (2025). Code of ethics for nurses. American Nurses Publishing. https://codeofethics.ana.org/home
Carper, B.A. (1978) Fundamental Patterns of Knowing in Nursing. Advances in Nursing
Science, 1, 13-24. http://dx.doi.org/10.1097/00012272-197810000-00004
Kaya, A., & Boz, İ. (2019). The development of the professional values model in nursing.
Nursing Ethics, 26(3), 914-923.
About Angela McClure
Angela McClure, MSN, RN, is a Nursing Instructor in the Traditional Undergraduate Program at Texas Tech University Health Sciences Center School of Nursing. She brings over two decades of clinical and academic experience to her role, with a professional background spanning pediatric nursing, clinical quality administration, and nursing education. Angela is currently pursuing a PhD in Nursing at Texas Woman’s University, where her research focuses on the sexual health, safety, and healthcare access of individuals with intellectual disabilities.
Her work is grounded in a commitment to social justice, advocacy, and equity in healthcare. As a nurse, educator, and researcher, Angela’s standpoint is shaped by her direct care experience and her recognition of the systemic barriers faced by marginalized populations. She approaches her scholarship with the belief that understanding and elevating the voices of vulnerable individuals is essential to transforming care practices, influencing policy, and promoting health equity. Angela also serves as a board member of the Epilepsy Foundation of Texas and holds leadership roles in professional nursing organizations, reflecting her dedication to community engagement and professional service.
About Katie Rose Davis
Katie earned a Bachelor of Science in Nursing from the University of Arlington and a Master of Science in Nursing Administration from the University of Texas at Tyler. She is certified in infection prevention and has a nursing background in pediatrics, medical-surgical, and post-anesthesia care. She is pursuing a Doctor of Philosophy in Nursing Science at Texas Women’s University.
Hello Angela and Katie,
As a member of the 2025 Code revision group and a former caregiver and surrogate decision maker for a sibling with profound IDD, I appreciate your contribution to Nursology. The relational, clinical, and ethical skills needed to provide care to those with IDD is absent in most curricula unlike other countries such as Great Britain where that care is a nursing specialty.
Ethics education is often lacking in nursing curricula and, if included, focuses on bioethics rather than the relational and social activist foundations of nursing ethics as you have noted. This misaligned focus is componded by the cursory attention to ethics, again focused on bioethics, in the Essentials. To counteract this neglect, my colleagues and I offer a comprehensive approach to teaching ethics across the curriculum anchored in nursing ethics and integrated with the Four Component Model of James Rest (Robichaux et al., 2022).
One of the concepts introduced in the revised Code is human flourishing. While the term extends back to Aristotle, who was extremely ableist, the current use reflects a more contemporary and inclusive understanding. So, to quote the philosopher of disability, Licia Carlson, “how might we understand the nature and significance of human flourishing for persons with intellectual disabilities?” (Carlson, 2010, p. 182). Two approaches that have been explored in the context of flourishing and IDD which may complement the Professional Values model are Nussbaum’s Capability Theory and Kittay’s Ethics of Care, Dependence and Disability. Both are holistic and non reductionistic as they propose that well-being is not simply bodily health but built on relationships and interdependency among local, national, and global community members who respect and value each others’ inherent dignity and worth. Thus, these theories reflect the reciprocal relationships outlined in the ten Code provisions. As in the Professional Values Model, this respect includes determining what the individual with IDD values and, to the extent possible, empowering and supporting them, to decide what flourishing means to them.
I look forward to learning about your continued work in this critical area.
Carlson, L. (2010). The faces of intellectual disability: Philosophical reflections. Indiana University Press.
Gustavsson, M., & Söder, M. (2022). Using a capability approach to explore how people with intellectual disabilities can lead flourishing lives. Journal of Policy and Practice in Intellectual Disabilities, 19(1), 60–69. https://doi.org/10.1111/jppi.12392
Kittay, E. F. (2011). The ethics of care, dependence, and disability. Ratio Juris, 24(1), 49–58. https://doi.org/10.1111/j.1467-9337.2010.00473.
Robichaux, C., Grace, P., Bartlett, J., Stokes, F., Lewis, M. S., & Turner, M. (2022). Ethics education for nurses: Foundations for an integrated curriculum. Journal of Nursing Education, 61(3), 123–130. https://doi.org/10.3928/01484834-20220109-02
Sullivan, W. F., Björne, P., Heng, J., & Northway, R. (2022). Ethics framework and recommendations to support capabilities of people with intellectual and developmental disabilities during pandemics. Journal of Policy and Practice in Intellectual Disabilities, 19(1), 82–93. https://doi.org/10.1111/jppi.12393