Ethics and Professionalism among Village Health Nurses in Tamil Nadu, India

Abstract Background: Community Health Workers (CHWs) are the backbone of the public health system in India. They perform several activities at the community level, but little is known about the practice of ethics and professionalism in their work. The CHWs in Tamil Nadu are called Village Health Nurses (VHNs). Objectives: To explore the experiential wisdom of ethics and professionalism among community health workers in Tamil Nadu. Methods: We conducted a qualitative study using in-depth interviews and focus group discussions among 125 VHNs in six districts of Tamil Nadu. The data were collected by trained field investigators who were CHWs themselves. Thematic content analysis was done to identify codes, themes and build them into a conceptual model. Results: The VHNs went beyond the call of their duty to do good to the community. They served as advocates for matters beyond health care in their community. However, overburdened VHNs found it challenging to sustain doing good to the community. Their conceptualization of autonomy ranged from individual autonomous decision making to full paternalistic decision making and this was not uniform across VHNs. The VHNs were sensitive to issues of privacy and confidentiality, but the discussion on these topics were limited. The VHNs reflected the societal norms of gender, class, and caste hierarchies in their work. They had to work amidst difficult power struggles and had their own innovative strategies to subvert power. They faced several ethical conflicts but did not have a standard mechanism for resolving them. Conclusions: The lack of standard ethical practices among the VHNs indicate that they must be trained in ethics and professionalism and a code of ethics for VHNs is required to help them effectively deliberate on ethical issues during their work.