Ethical Dimensions in Nursing

A comprehensive vocabulary set covering the ethical principles, the American Nurses Association (ANA) Code of Ethics Provisions 1 through 9 with interpretive statements, resolving ethical dilemmas, and frequently occurring ethical dilemmas in healthcare.

Nursing Ethics

A system of principles concerning the actions of the nurse in relationships with patients, patients' family members, other health care providers, policy makers, and society as a whole.

Ethics

A domain dealing with the "rightness" or "wrongness" of human behavior that is concerned with the motivation behind that behavior.

Bioethics

The application of ethical principles to life-and-death issues.

Autonomy

The freedom to make decisions about oneself, which requires nurses to respect clients' rights to make choices regarding their health care.

Nonmaleficence

The ethical principle requiring that no harm be caused to an individual, either unintentionally or deliberately, and requiring nurses to protect individuals who cannot protect themselves.

Beneficence

The ethical principle meaning "doing good" for others, requiring nurses to assist clients in meeting all biological, psychological, and social needs.

Justice

The ethical principle stating that every individual must be treated equally, requiring nurses to maintain a nonjudgmental attitude.

Fidelity

Loyalty and the promise to fulfill all commitments, serving as the foundation of accountability.

Confidentiality

The ethical requirement that anything stated to nurses or health-care providers by clients must remain private and undisclosed.

Exceptions to Confidentiality

Circumstances under which client information may be disclosed: when clients indicate potential harm to themselves or others, or when the client explicitly grants permission to share the information.

Veracity

The ethical principle implying "truthfulness," requiring nurses to be truthful to clients to foster trusting relationships.

Accountability

The requirement that individuals take responsibility for their own actions, making nurses accountable both to themselves and to their colleagues.

Ethical Codes

Dynamic formal statements outlining the rules of behavior for a particular group of individuals to guide professional practice.

Provision 1 (ANA Code of Ethics)

Mandates that the nurse practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

Respect for Human Dignity

A core concept within Provision 1 emphasizing inherent worth, regardless of personal attributes or health status.

Right to Self-Determination

An interpretive element of Provision 1 recognizing clients' moral and legal right to determine what happens to their own bodies.

Provision 2 (ANA Code of Ethics)

States that the nurse's primary commitment is to the patient, whether an individual, family, group, community, or population.

Primacy of Patient Interests

An interpretive statement of Provision 2 affirming that the patient's needs and interests must always come first.

Conflict of Interest for Nurses

An interpretive area of Provision 2 addressing situations where competing personal or financial interests could compromise patient care.

Professional Boundaries

An interpretive guideline of Provision 2 establishing the appropriate parameters necessary to maintain therapeutic relationships with patients.

Provision 3 (ANA Code of Ethics)

Directs the nurse to promote, advocate for, and protect the rights, health, and safety of the patient.

Whistleblowers

Nurses who report unsafe, unethical, or illegal practices to safeguard patients, supported explicitly under the interpretive statements of Provision 3.

Impaired Practice

A condition addressed under Provision 3 where a healthcare practitioner's ability to practice safely is compromised, requiring intervention to protect patients.

Protection of Human Participants in Research

A responsibility outlined in the interpretive statements of Provision 3 ensuring that individuals involved in research studies have their rights and safety safeguarded.

Provision 4 (ANA Code of Ethics)

Affirms that the nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with promoting health and optimal care.

Accountability and Responsibility in Practice

Interpretive principles of Provision 4 establishing that registered nurses are answerable for all clinical decisions and actions they undertake.

Responsibility for Nursing Judgments

A Provision 4 mandate stating that RNs exclusively retain the professional responsibility for formulating and executing nursing judgments.

Assignment of Nursing Duties

A restriction specified in Provision 4 stating that non-nurses may not be assigned nursing duties.

Provision 5 (ANA Code of Ethics)

States that the nurse owes the same duties to self as to others, including promoting health and safety, preserving wholeness of character and integrity, maintaining competence, and pursuing personal and professional growth.

Duty to Self

A Provision 5 ethical obligation affirming that nurses must treat their own health, safety, and well-being with the same moral seriousness as they treat that of others.

Wholeness of Character

An aspect of Provision 5 requiring nurses to integrate personal and professional values to maintain authentic moral identity across settings.

Conscientious Objection

An explicit right recognized under Provision 5's preservation of integrity, enabling nurses to refuse participation in specific procedures that violate their moral beliefs.

Maintenance of Competence

A personal and professional duty under Provision 5 requiring continuous learning and professional development to ensure high-quality care.

Provision 6 (ANA Code of Ethics)

Instructs nurses, through individual and collective effort, to establish, maintain, and improve the ethical environment of work settings and employment conditions conducive to safe, quality care.

Moral Environment

A workplace culture required by Provision 6 that demands mutual respect, supports ethical obligations, and fosters patient safety.

Provision 7 (ANA Code of Ethics)

Directs nurses in all roles and settings to advance the profession through research and scholarly inquiry, professional standards development, and health policy generation.

Scholarly Inquiry in Nursing

The formal investigation, research, and generation of evidence emphasized in Provision 7 to expand nursing knowledge and clinical efficacy.

Professional Practice Standards

Authoritative criteria developed, maintained, and implemented by nurses to advance clinical practice under Provision 7.

Provision 8 (ANA Code of Ethics)

Obligates the nurse to collaborate with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.

Health as a Universal Right

A foundational statement within Provision 8 identifying health as a basic human entitlement globally.

16 Entitlements of Health

A set of universal rights cited in Provision 8 that includes access to care, emergency services, and prevention education.

Health Diplomacy

A collaborative global strategy addressed in Provision 8 aimed at negotiating and promoting human rights and healthcare equity internationally.

Health Disparities

Preventable differences in healthcare access, quality, and outcomes across populations that nurses are ethically called to diminish under Provision 8.

Provision 9 (ANA Code of Ethics)

Requires the profession of nursing, collectively through professional organizations, to articulate nursing values, maintain professional integrity, and integrate social justice into nursing and health policy.

Social Justice in Health Policy

The integration of fair distribution of resources, equality, and human rights into health legislation and nursing policy under Provision 9.

Global Health Focus

A Provision 9 emphasis highlighting the necessity for the collective voices of US nurses to be heard on international health platforms.

Assessment Phase (Resolving Ethical Dilemmas)

The initial stage of resolving an ethical dilemma involving asking "Am I involved?", collecting the facts, and clarifying which values are in conflict.

Planning Phase (Resolving Ethical Dilemmas)

The stage of ethical decision-making dedicated to determining goals of treatment, identifying decision-makers, and listing and ranking options.

Implementation Phase (Resolving Ethical Dilemmas)

The stage of ethical resolution that uses discussion and negotiation to work toward a mutually acceptable decision.

Evaluation Phase (Resolving Ethical Dilemmas)

The final stage of ethical resolution that determines whether desired outcomes have been reached and enables re-evaluation as necessary.

Informed Consent Dilemma

A frequently occurring ethical conflict centered on ensuring a client possesses adequate understanding and voluntary decision-making capacity prior to receiving care.

Refusal of Treatment Dilemma

A common ethical dilemma occurring when a client exercises autonomy by declining life-sustaining or medically recommended interventions.

Scarce Resources Dilemma

A frequently occurring dilemma involving the ethical rationing and distribution of limited medical equipment, supplies, or staff.

Cost-Containment Initiatives Dilemma

An ethical conflict that arises when healthcare organizational budget-reduction policies or fiscal cutbacks negatively affect client well-being.

Incompetent Health Care Providers Dilemma

A frequently occurring ethical dilemma involving clinical situations where a colleague lacks the skill, knowledge, or sobriety to deliver safe care.