Nursing Ethics
Ethics is a significant aspect of nursing practice. It is so integral that we often do not notice when we apply these ethical principles.
Nursing (and medical) practice in the USA is guided by these ethical principles: autonomy, beneficence, non-maleficence, justice, fidelity, and veracity. Let’s see what they mean and how they are applied to day-to-day practice.
Autonomy: This principle emphasizes that patients have the right to make informed medical decisions about their healthcare.
How it looks in real life: Obtaining informed consent before procedures, discussing and establishing code status, providing patient education, establishing a durable power of attorney for healthcare decisions, creating advance directives, and using interpreters for non-English speaking patients are all based on the principle of autonomy.
When cultural barriers may interfere with this principle, such as when a patient’s family makes medical decisions on their behalf, we first ask the patient, through an interpreter, if necessary, whether they want to know their healthcare information and if it is acceptable for the family to make decisions without involving them.
Beneficence: This principle establishes that medical providers should make medical decisions in the patient’s best interest. In short, the treatment should benefit the patient.
How it looks in real life: Administering treatments in a timely manner. For example, a patient coming in with symptoms of stroke needs a CT scan and treatment within the first hour. Hospitals make every effort to honor this “golden hour” rule because it brings maximum benefit to the patient. The same treatment implemented later may not benefit the patient as much.
A patient with a terminal illness may choose to enroll in an experimental treatment, which could have unknown and potentially harmful side effects. With informed consent, the principle of beneficence is upheld because, if the treatment is successful, it could save the patient’s life.
Non-maleficence: The most recognized phrase, “first, do no harm,” comes from this principle. Every treatment and medical decision should benefit the patient.
How it looks in real life: All the safety checks we perform while administering medications, the standards of care, various policies and procedures, time-outs in operating rooms, repositioning patients, fall prevention measures, and numerous other actions we take to prevent harm to patients, including checking and rechecking lab values, are all based on this principle.
Justice: This principle stresses fairness and equality. Simply, it means every patient will get the same treatment, and resources will be distributed equally.
How it looks in real life: This is my favorite principle. When I cared for patients, I did not consider their financial status, sexual orientation, religion, or any other personal characteristics. These factors did not influence the quality of care provided by staff. While these aspects may come up and can be known, they do not affect medical or treatment decisions except when necessary to provide appropriate support.
Fidelity: This principle establishes loyalty to the patients, being truthful about treatments, and maintaining confidentiality.
How it looks in real life: HIPAA regulations, patient-provider confidentiality provisions, reporting and refusing gifts over $20 in value, appropriate billing practices, and even tolerating challenging patient behavior while focusing on treatments that will improve their well-being are all healthcare aspects based on this principle.
For me personally, this principle meant that I was doing everything safely, following standards of practice, and avoided harm. Also, it meant to me that if I told a patient that I would come in 30 minutes to check on something, I made every effort to honor my promise. If I got delayed for any reason, I explained it when I did go back instead of not addressing it.
Veracity: This principle is about transparency and being truthful with the patient.
How it looks in real life: When administering medications, nurses review them individually with the patient and mention their purposes. If they ever make a mistake, good nursing practice is to be truthful, discuss the error’s effects and side effects, apologize, and improve the process to avoid the error in the future.
It also meant providing records to the patient when they requested them. For me, it meant being very honest about things I did not know during patient education, answering questions, or explaining treatment, educating myself and updating the patient.
Disclaimer: I wrote this content; I used AI to check for grammar and political correctness. If you would like to use this article, please contact me for permission.
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