Erhical Standards
Ethical Principles in Nursing
Justice: This refers to the nurse's obligation to be equitable in how and when they provide patient care to all individuals.
Beneficence: This principle dictates that the nurse must always act in the best interest of the patient.
Nonmaleficence: Rooted in the Hippocratic oath, this refers to the nurse's role to do no harm.
Accountability: Nurses must be answerable for their professional actions and decisions.
Confidentiality: This involves being mindful of healthcare records and private information in strict accordance with HIPAA standards.
Fidelity: This refers to the nurse's role to uphold promises and commitments in a safe and confident manner.
Autonomy: This involves accepting the opinions, values, and perspectives of the patient. It includes allowing patients to make decisions regarding their own health or to reject medical intervention entirely without facing judgment or criticism.
Veracity: This is the nurse's obligation to be completely truthful with patients, even in situations where the truth may causes distress.
Legal Regulatory Bodies and Career Protection
State Nursing Regulatory Bodies: These are official boards that oversee the issuance and renewal of professional nursing licenses. Their primary purpose is to ensure care aligns with state regulations.
State Regulations: These dictate education requirements, define the scope of practice, and ensure that care is rendered safely.
Staying Within Scope of Practice: Nurses must only perform functions they are licensed for. An example provided is that a nurse should never attempt to diagnose a patient, as that is the specific role of the physician.
Documentation: Every patient encounter must be thoroughly documented so the entire care team has access to the information required for treatment.
Verification Protocols: Before any intervention, nurses must confirm the correct patient, correct medication, and correct procedure.
Inquiry over Assumption: Nurses are encouraged to "ask, don't assume." This includes asking patients to repeat themselves, seeking clarification from supervisors, and inquiring about any observed deviations from the norm.
Privacy, Confidentiality, and HIPAA
Privacy vs. Confidentiality: Privacy includes treating patients with basic dignity and protecting personal info. Confidentiality is the professional safeguarding of patient information.
Health Insurance Portability and Accountability Act (HIPAA): A federal law protecting the privacy and security of individually identifiable information regarding past, present, or future physical or mental health.
The Privacy Rule: Establishes national standards for the privacy of Protected Health Information (PHI), which is individually identifiable information.
The Security Rule: A set of standards to safeguard electronic protected health information (ePHI), such as EHRs and physician order entry systems. Examples of breaches include external cyber attacks by hackers or internal breaches where employees illegally access data.
Protected Health Information (PHI) Examples: Names, admission and discharge dates, Social Security numbers, photos, addresses, phone numbers, and dates of birth.
Social Media and Conversations: Identifying details must never be mentioned on social media or in personal talk. Even deleted posts remain on servers.
Data Snooping: Accessing patient information out of curiosity (e.g., acquaintances or celebrities) without a legitimate and legal "need to know" is a serious breach.
Case Study: HIPAA Violation and Repercussions
Scenario: Emily, a nursing student, took a photo of Tommy, a -year-old leukemia patient in Room of a pediatric unit. Despite getting Tommy's verbal permission (his mother was in the cafeteria) and posting with a positive caption about being proud to be a nurse, the room number was visible in the photo.
Detection: A nurse from the hospital found the photo on Facebook and reported it.
Consequences for Emily: She was expelled from her nursing program for breaching patient confidentiality and HIPAA violations. She may also face civil and criminal liability.
Consequences for the Program/Hospital: The hospital faced a HIPAA violation, and the nursing program was barred from using that pediatric unit for future students.
Principles of Informed Consent
Definition: Per the American Medical Association (AMA), it is the communication between a licensed medical professional and a patient where the patient authorizes a specific intervention based on full understanding.
Requirements for Understanding: Patients must understand the risks, benefits, alternative options, and projected outcomes.
Eligibility: Must be a mentally competent adult. If a patient lacks capacity, consent comes from an authorized surrogate (parent, legal guardian of a minor, or a representative with medical Power of Attorney).
Assessment Component: The physician must assess the patient's ability to make a voluntary, independent decision.
Information Component: The physician must present the diagnosis, nature of intervention, risks, benefits, patient burdens, and consequences of declining.
Documentation Component: A signed acknowledgment must be placed in the medical record for legal purposes.
Role of Non-Physician Professionals: They serve as witnesses to the signature, provide support for fear/anxiety, explain potential discomforts, provide self-care directions, and gauge the patient's overall understanding (e.g., asking the patient to recite back instructions).
Implicit Bias in Healthcare
Implicit vs. Explicit Bias: Explicit bias is conscious prejudice. Implicit bias is the unconscious negative attitude or stereotype based on race, ethnicity, sexual preference, age, gender, weight, language, socioeconomic status, or insurance status.
Impact on Care: Can lead to reduced provider communication, under-prescription of narcotic pain meds, under-diagnosis, stereotypes regarding medical adherence, and unequal representation in research.
Specific Examples in Nursing: * Taking longer to assess patients of a different race. * Assuming a non-heterosexual patient needs an STD test due to "risky behavior." * Assuming darker skin is harder to inject because of thickness assumptions. * Dismissing pain in obese patients as merely related to weight. * Shouting at elderly patients. * Withholding a physician referral for a poorly dressed patient due to insurance/cost assumptions.
Tools for Improvement: Project Impact’s "Implicit Association Test" measures these attitudes.
Mitigation Strategies: Identifying personal biases, considering the patient’s perspective, slowing down to avoid instinctive responses, and building rapport to reduce stereotyping.
Data Collection: Subjective and Objective
Subjective Data: Qualitative, non-numerical, self-reported information (thoughts, feelings, symptoms). Examples include descriptions of pain or mechanism of injury. It provides context and insight into the patient's experience.
Tips for Subjective Collection: Use active listening, ask follow-up questions, be mindful of language barriers, refrain from judgment, and show compassion.
Objective Data: Quantitative, observable, and measurable data. Examples include vital signs, height, weight, physical exam findings, and lab results. It is considered more reliable as it is free of biased feelings.
Tips for Objective Collection: Write down observations immediately, conduct assessments thoroughly and without rush, and use appropriate medical equipment to ensure accuracy.
Critical Thinking and Professional Diligence
Application: Critical thinking is used in documentation, patient safety, problem-solving, and clinical judgment.
Clinical Judgment Example: If a patient has low blood pressure before scheduled medication, a nurse should not just complete the task. They should review trends in the chart and call the physician to see if the dose should be withheld.
Shortcuts to Avoid: * Skipping vitals/measurements because equipment is broken. * Hasty or incomplete assessments. * Delaying charting (information may be forgotten). * Poor hygiene (e.g., not changing gloves or washing hands between patients).
Cultural Competence and Language Barriers
Cultural Competence: The ability to tailor care to a patient's unique background to reduce social inequality and improve outcomes. This includes understanding beliefs regarding vaccinations, blood transfusions, or resuscitation.
National Center for Cultural Confidence Questions: Self-assessment questions include: "Do my biases impact the time I spend with patients?" and "Do I feel less comfortable with patients of a different race?"
Limited English Proficiency (LEP): Refers to individuals who do not speak English as their primary language. In the US, over languages are spoken; nearly people (approximately ) speak a language other than English at home.
Legal Protections for LEP: * Title VI of the Civil Rights Act of 1964: Prohibits discrimination based on national origin. * Executive Order 13166 (2000): Mandates that language services must be available to LEP individuals.
Interpreter Services: * Best Practice: Use a professionally trained Medical Interpreter (serves as a "cultural broker" and is bound by ethics/confidentiality). * Telephonic Services: Should be used if in-person interpreters are unavailable. * Inappropriate Sources: Google Translate (not HIPAA compliant/inaccurate), non-assessed staff (lack medical vocabulary), and family members (especially those under ) due to sensitivity and accuracy risks.
Ethical Principles in Nursing
Justice
Obligation for equitable patient care.
Beneficence
Nurses must act in patients' best interests.
Nonmaleficence
Commitment to do no harm (Hippocratic oath).
Accountability
Nurses are responsible for actions and decisions.
Confidentiality
Adherence to HIPAA standards regarding patient privacy.
Fidelity
Upholding promises and commitments.
Autonomy
Respect for patient beliefs and decisions; allow rejecting medical intervention.
Veracity
Obligation to be truthful with patients, even if it causes distress.
Legal Regulatory Bodies and Career Protection
State Nursing Regulatory Bodies
Oversee issuance and renewal of nursing licenses ensuring state regulation compliance.
State Regulations
Define education requirements and scope of practice, ensuring safe care delivery.
Staying Within Scope of Practice
Nurses must only perform licensed functions; e.g., not diagnosing patients.
Documentation
Essential for thorough patient encounter records available to the care team.
Verification Protocols
Ensure correct patient, medication, and procedure before interventions.
Inquiry over Assumption
Nurses should ask, not assume; confirm information with patients and supervisors.
Privacy, Confidentiality, and HIPAA
Privacy vs. Confidentiality
Privacy involves dignity and protection of personal info; confidentiality is safeguarding patient information.
Health Insurance Portability and Accountability Act (HIPAA)
Protects privacy and security of identifiable health information.
The Privacy Rule
Establishes national standards for privacy of Protected Health Information (PHI).
The Security Rule
Standards for safeguarding electronic health information (ePHI); addresses potential breaches.
Protected Health Information (PHI) Examples
Names, admission/discharge dates, Social Security numbers, etc.
Social Media and Conversations
Avoid sharing identifiable details online; even deleted posts are retrievable.
Data Snooping
Unauthorized access to patient info out of curiosity violates HIPAA.
Case Study: HIPAA Violation and Repercussions
Scenario
Nursing student Emily posts a photo of patient Tommy online despite obtaining verbal consent; room number visible.
Detection
Photo found and reported by hospital nurse.
Consequences for Emily
Expulsion from nursing program, potential civil and criminal liability.
Consequences for Program/Hospital
Hospital faces HIPAA violation, nursing program restricted from pediatric unit.
Principles of Informed Consent
Definition
Communication where a patient authorizes intervention after understanding.
Requirements for Understanding
Patients must understand risks, benefits, alternatives, and outcomes.
Eligibility
Must be mentally competent; authorized surrogates can give consent if necessary.
Assessment Component
Physicians assess voluntary independent decision-making ability.
Information Component
Physicians present diagnosis, intervention nature, risks, and benefits.
Documentation Component
Signed acknowledgment required in medical records for legality.
Role of Non-Physician Professionals
Serve as witnesses, support anxious patients, and verify understanding.
Implicit Bias in Healthcare
Implicit vs. Explicit Bias
Explicit bias is conscious; implicit bias is unconscious stereotype impacting care.
Impact on Care
Leads to reduced communication and inequitable treatment.
Specific Examples in Nursing
Longer assessment times, assumptions based on stereotypes, dismissing patient pain.
Tools for Improvement
Implicit Association Test measures attitudes.
Mitigation Strategies
Identify biases, patient perspective consideration, and rapport building.
Data Collection: Subjective and Objective
Subjective Data
Qualitative, self-reported information; provides context and insight.
Tips for Subjective Collection
Practice active listening, ask follow-ups, respect language barriers.
Objective Data
Quantitative, measurable data; more reliable when free from bias.
Tips for Objective Collection
Document observations promptly; conduct assessments thoroughly.
Critical Thinking and Professional Diligence
Application
Used in documentation, safety, problem-solving, and judgment.
Clinical Judgment Example
Review trends if low blood pressure; consult physician instead of hastily completing tasks.
Shortcuts to Avoid
Skipping vitals, incomplete assessments, and poor hygiene practices.
Cultural Competence and Language Barriers
Cultural Competence
Ability to customize care based on cultural backgrounds.
National Center for Cultural Confidence Questions
Self-assessment to evaluate biases and comfort with diverse patients.
Limited English Proficiency (LEP)
Refers to individuals not primarily speaking English; significant population statistics.
Legal Protections for LEP
Title VI prohibits discrimination; Executive Order mandates language services.
Interpreter Services
Best practice is using trained medical interpreters; avoid non-professional sources to ensure accuracy.
What is Veracity in Nursing?
Definition: Veracity, also known as truth-telling, is the ethical principle requiring nurses to provide objective truth about patient's diagnoses and treatments.
Importance: Upholding veracity is essential as it fosters trust between nurses and patients, promoting informed decision-making.
Examples of Veracity in Nursing
Nurse-Patient Veracity
Nurses must provide honest information, even if challenging, which empowers patients to make sound decisions aligned with their values.
Key Areas:
Informing patients about treatment side effects while being supportive.
Preparing for difficult questions using methods like the SPIKES protocol.
Own up to mistakes during care.
Explain medical data in simple terms.
Veracity Among Colleagues
Honesty with peers ensures teamwork and safe patient care.
Examples:
Disclosing one’s abilities to prevent errors.
Admitting mistakes to create a forgiving work culture.
Documenting accurate patient information during handovers for safety.
Why Veracity in Nursing Matters
Building Trust: Honesty is crucial for patient rapport and leads to better care outcomes.
Fostering Transparency: Openness helps patients express concerns without fear, improving their engagement.
Encouraging Accountability: Patients must understand their conditions and care plans to make responsible health choices.
Consequences of Lack of Veracity
Patient Impact: Dishonesty can damage trust, complicate care dynamics, and lead to poor health outcomes.
Team Dynamics: Lack of honesty can erode relationships between nursing staff, affecting overall morale and patient safety.
Ethical Principle Summary
Veracity is critical in nursing to ensure high-quality, patient-centered care and outcomes.
It is tied to a nurse's professional responsibility and ethical obligation to maintain transparency and honesty in all patient interactions.
Challenges in Upholding Veracity
Balancing honesty with compassion—delivering sensitive news without causing distress.
Navigating cultural differences in understanding and receiving bad news.
Ensuring clear communication even in high-stress clinical situations.
Strategies for Implementing Veracity
Creating a supportive environment for open dialogues with patients.
Developing strong communication skills through training and practice scenarios.
Utilizing protocols like SPIKES to guide conversations about difficult topics.
Conclusion
Upholding the principle of veracity is vital for ethical nursing practice and is instrumental in providing holistic, patient-centered healthcare.
Nursing Ethical Principles Outline
1. ACCOUNTABILITY
Definition: Accountability is defined as being answerable for one's actions, both personally and professionally.
Importance:
Establishes trust and strong nurse-patient relationships.
Enhances job performance, benefiting patients and peers.
Leads to personal success and appreciation from employers.
Application:
Nurses must stay within their designated scope of practice, ensuring care is safe and effective through delegation and follow-up.
Example: Nurse Vicky manages an assessment and care plan, ensuring proper delegation and follow-up for patient care.
Consequences of Lack of Accountability:
Poor nurse-patient relationships due to lack of trust.
Possible reprimands or job loss from management.
Loss of nursing license in severe cases of unaccountability.
2. AUTONOMY
Definition: Autonomy refers to the ability to act in accordance with one’s knowledge and judgment within the scope of nursing practice.
Importance:
Strengthens critical thinking and confidence in decision-making.
Application: Nurses demonstrate autonomy by performing tasks independently within their competence.
Example: Nurse William holds medication for a patient showing concerning symptoms, prioritizing patient safety.
Consequences of Lack of Autonomy:
Increased nurse burnout due to lack of empowerment.
Depersonalized patient care leading to poor relationships.
3. BENEFICENCE
Definition: Beneficence involves acting with kindness and concern for the welfare of others, prioritizing patient well-being.
Importance:
Ensures nurses provide care tailored to individual circumstances, promoting positive outcomes.
Application:
Acts of kindness, such as emotional support during difficult times.
Example: Nurse Leah comforts a grieving husband in the hospital.
Consequences of Lack of Beneficence:
Increased risk to patient safety and poor relationships with patients, leading to compliance issues and negative outcomes.
4. FIDELITY
Definition: Fidelity is the commitment to keep promises and be loyal, maintaining trust in nurse-patient relationships.
Importance:
Essential for building trustworthy and competent relationships that improve patient outcomes.
Application:
Meeting the reasonable expectations of nurse roles and responsibilities.
Example: Nurse Michaels checks on a patient post-medication administration.
Consequences of Lack of Fidelity:
Poor nurse-patient relationships and risk of non-compliance to care plans.
5. JUSTICE
Definition: Justice in nursing involves fairness and impartiality in patient care.
Importance:
Ensures all patients receive equitable treatment regardless of backgrounds.
Application:
Prioritizing care objectively based on need rather than bias.
Example: Nurse Brooks fairly triages patients based on urgency rather than demographics.
Consequences of Lack of Justice:
Patients may feel rejected or abandoned, leading to delay in treatment and compromising patient care.
6. NONMALEFICENCE
Definition: Nonmaleficence means to do no harm, emphasizing patient safety in all actions.
Importance:
Protects patients from unnecessary risks and injuries.
Application:
Actions taken to prevent harm in patient care.
Example: Nurse Adam withholds medication due to potential allergic reactions.
Consequences of Lack of Nonmaleficence:
Increased risk to patient safety, potential job loss, or disciplinary action from nursing boards.
7. VERACITY
Definition: Veracity refers to the principle of truth-telling in nursing.
Importance:
Fosters trust between nurses and patients, promoting shared decision-making.
Application:
Honest communication regardless of the difficulty of the information.
Example: A nurse explains a terminal prognosis truthfully to a patient’s family.
Consequences of Lack of Veracity:
Breakdown in nurse-patient communication leading to mistrust and poor health outcomes.
Importance of Communication Skills in Nursing
Essential for Patient Care
Good communication skills help Nurse Practitioners (NPs) provide better care.
Without empathetic communication, it's tough to connect with patients and their families.
Patient-Centered Communication
Impact on Care Quality
Patient-centered communication is vital for high-quality care.
Most U.S. medical schools now require communication courses.
Medical boards test communication skills for licensing.
Nursing programs teach these skills, but students must practice them in real situations.
Faculty should model these skills to help students integrate them into practice.
The National Organization of Nurse Practitioner Faculty mandates patient-centered care that respects cultural diversity.
Evolving NP Education
Growing Educational Requirements
Doctoral programs for NPs stress the importance of building therapeutic relationships with patients.
This emphasizes the role of communication in improving patient outcomes.
Delivering Bad News
Breaking Bad News
An important communication skill for NPs is delivering bad news to patients and families.
This skill is critical in end-of-life care but applies to various patient situations.
Bad news: Any information that negatively alters a person’s outlook on the future.
NPs need to recognize that all news can be perceived differently by patients.
SPIKES Protocol for Breaking Bad News
What is SPIKES?
SPIKES is a structured approach for delivering bad news effectively.
Components:
Setting up: Prepare the environment and what to say.
Perception: Understand how much the patient knows.
Invitation: Ask for permission to share the news.
Knowledge: Give news gently, using clear language.
Empathy: Respond to emotions with compassion.
Strategy: Discuss future plans and support available.
Key Steps in SPIKES
Setting Up
Prepare the space and information.
Ensure privacy and comfort to ease the conversation.
Show confidence and calmness to build rapport.
Perception
Assess the patient's understanding of their situation.
Gauge their emotional state and coping mechanisms.
Invitation
Ask for consent to share the bad news.
Knowledge
Use a gentle approach to start the conversation, preparing the family for the news.
Avoid jargon; be clear and visual when explaining details.
Empathy
Acknowledge the patient’s emotional reactions with compassion.
Strategy for the Future
Clarify next steps and involve the patient in their care plan.
Ensure both the NP and the patient understand their roles moving forward.
Refining Communication Skills
Training and Practice
NP programs must include communication skill-building.
Skills should be taught in practice, not just theory.
Simulation and real-world practice are ideal for breaking bad news effectively.
Patient Experience and the Role of Personal Background
Impact of Background on Healthcare
A patient's unique personal, cultural, and social background significantly influences their healthcare journey in several ways:
The specific way they experience and report symptoms.
The conditions, beliefs, or thresholds that prompt them to seek healthcare.
Their willingness and ability to follow recommendations from healthcare providers.
Their perception of who should be involved in health decisions (family, spiritual leaders, or themselves).
Practitioner Benefits
Understanding these personal factors allows healthcare providers to:
Educate patients according to their specific needs.
Provide care that respects and aligns with the patient's unique background.
Managing Implicit Bias in Healthcare
Definition of Implicit Bias
Implicit biases are unconscious biases associated with an individual's own culture.
Significance of Self-Assessment
Self-assessing one’s own biases is crucial for effective communication, helping prevent the imposition of personal beliefs on patients.
Maintaining an Open Mind
Every patient is unique; thus, practitioners must remain receptive to and respectful of differences, even if they conflict with personal values.
Communication Strategies
When educating patients, information should be conveyed in various ways to enhance understanding:
Verbally.
In writing (manually written notes).
Through physical demonstrations.
Self-Assessment Framework: National Center for Cultural Competence
Source
Developed by the National Center for Cultural Competence at Georgetown University, providing self-assessment questions to identify personal biases.
Key Questions for Self-Reflection
Do my biases affect the time I dedicate to patients?
Do my biases influence my communication with patients and their families?
Do my biases hinder my empathy towards patients?
Do my biases affect my treatment recommendations?
Do my biases interfere with positive interactions with patients and families?
Do my behaviors reflect bias?
Have patients or families expressed concerns regarding my attitude or communication?
Limited English Proficiency (LEP) in the Healthcare Setting
Demographics in the U.S.
Approximately people in the U.S. speak a language other than English at home.
Essential Competency
Due to increasing linguistic diversity, overcoming communication challenges is vital for effective healthcare delivery.
Impact
Addressing language barriers leads to better health outcomes and enhanced communication between healthcare workers and patients.
Legal and Regulatory Framework for Language Access
Title VI of the Civil Rights Act of 1964
Prohibits discrimination based on national origin.
Executive Order 13166 (2000)
Expanded upon Civil Rights Act of 1964, mandating language services be accessible for individuals with Limited English Proficiency.
Professional Medical Interpreters
Role and Facilitation
Medical interpreters are trained professionals who assist communication between patients and healthcare providers.
Additional Functions
They often serve as a cultural bridge, helping navigate differences between clinicians and patients.
Ethical Standards
Interpreters must adhere to professional ethics, similar to other healthcare professionals.
Accessing Services
Consult a supervisor to determine how to access professional interpreting services in busy office settings.
Risks Associated with Inappropriate Interpreter Usage
Validation of Technology
Non-validated translation applications (e.g., Google Translate) should be avoided due to lack of accuracy and compliance.
Utilization of Staff Members
Using bilingual staff members as interpreters poses risks:
They may lack accurate medical vocabulary for effective translation.
Only staff with formally assessed language skills should provide patient translation.
Family Members as Interpreters
Patients may bring family members, but this poses significant risks:
High chance of inaccurate translation of medical information.
Family members under should not be used for interpretation.
Utilizing family members may violate legal and ethical healthcare standards.
1. Respect for Human Dignity
Fundamental Principle:
Respecting the inherent dignity, worth, and unique attributes of every individual.
Compassion:
Recognizing all humans deserve dignity and respect.
Key Aspects of Ethical Nursing Practice:
Fair treatment
Transparency
Integrity-preserving compromise
Building trust
Conflict resolution
Dehumanization:
Nurses affirm personhood through allyship and partnership.
Advocacy and support to eliminate harmful behaviors.
Bias and Prejudice:
Nurses work to mitigate bias (e.g., racism, ableism, sexism).
Address health disparities through culturally concordant care.
Nurse-Patient Relationship:
Ethical moments should be appreciated and practiced.
Collaborate to improve individual and community health.
2. Relationships with Patients and Recipients of Nursing Care
Trust:
Building trust through respectful nursing services.
Self-reflection:
Identifying and addressing personal biases.
Patient-Centric Care:
Consider culture, values, beliefs, and identity in care planning.
Respecting Patient Decisions:
Nurses can disagree with but must respect a patient's choices.
Address dangerous choices with education and resources.
3. The Nature of Health
Universal Right:
Health should not depend on life circumstances or status.
Individual Needs:
Care should reflect unique preferences and values.
Quality of Life:
Patients must have access to care that aligns with their views on quality of life.
4. The Right to Self-Determination
Patient Rights:
Right to determine their own medical treatment.
Access to clear, understandable information for informed decisions.
Support in Decision-Making:
Involvement of family and alternate decision-makers.
End-of-Life Decisions:
Nurses support discussions on treatment choices and advance directives.
5. Personal Health and Safety
Nurse’s Well-being:
Nurses must take care of their health to provide optimal care.
Workplace Safety:
Environment must foster safety and respect.
Mental Health Considerations:
Be aware of psychological stress and seek support when needed.
6. Wholeness of Character and Integrity
Authentic Self:
Nurses should embrace their individuality and unique perspectives.
Conscience-based Refusal:
Nurses have the right to refuse participation in care conflicting with personal values.
Maintaining Integrity:
Responsibility to uphold moral values in practice despite external pressures.
7. Professional Competence and Growth
Lifelong Learning:
Commitment to stay updated with skills and knowledge.
Reflective Practice:
Continuous self-assessment and commitment to improvement.
8. Nurses’ Responsibility in Advocacy and Society Engagement
Advocacy Role:
Nurses must stand up against injustices like racism and discrimination.
Healthcare Policy Engagement:
Contribution to health-related social policies for a healthier society.
9. Conclusion
Commitment to Ethical Practice:
Nurses support and advance ethical values in their practice and within society through evidence-based advocacy for justice and equity.
Community Health Impact:
Collaborative efforts among healthcare systems, nurses, and communities are necessary to dismantle structural barriers and promote health equity.
Provision 1
The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
1.1 Respect for Human Dignity
Fundamental principle of nursing practice, emphasizing the dignity, worth, and rights of individuals.
Ethical nursing practice requires compassion and a commitment to treating all humans with dignity.
Nurses maintain caring relationships, fair treatment, transparency, and integrity in conflict resolution.
Committed to creating an ethical environment for the nurse-patient relationship.
Condemnation of dehumanization and affirmation of personhood through allyship and partnership.
Allyship involves intentional interventions, advocacy, and support to eliminate harmful acts.
Create space to amplify underrepresented voices and mitigate bias and prejudice.
Recognize and address racism and biases (ableism, ageism, sexism, classism) as harmful to care quality.
Importance of culturally concordant care and patient-centered communication to address health disparities.
Practice everyday ethics in patient interactions as opportunities for ethical decision-making.
Collaborative efforts to change negative systemic structures affecting community health.
1.2 Relationships with Patients and Recipients of Nursing Care
Establishing trust is essential for providing nursing services based on patient needs.
Engage in self-reflection to identify and mitigate biases affecting the nurse-patient relationship.
Acknowledge that biases can be both explicit and unconscious.
Consider individual patient attributes (culture, beliefs, language, identity) when planning care.
Promote health and wellness while respecting patient decisions, regardless of personal nurse beliefs.
Address dangerous or risky patient choices through appropriate interventions, education, and resources.
Focus on mitigating risks and modifying harmful behaviors when patients are in immediate danger.
1.3 The Nature of Health
Health is recognized as a universal right transcending individual differences, unaffected by socioeconomic or personal circumstances.
Nursing care is customized to individual preferences, needs, and values.
Respect for all individuals receiving nursing care across various health aspects, from health promotion to illness and pain management.
Nurses provide evidence-based interventions to optimize health and well-being.
Shared decision-making to align interventions with patient values and goals.
Acknowledge subjective nature of quality of life, respecting that what is right for one may differ for another.
1.4 The Right to Self-Determination
Recognition of patient rights to self-determination as fundamental for respect to human dignity.
Patients have the right to make decisions regarding their own bodies, including treatment acceptance or refusal.
Nurses provide accurate and comprehensible information to facilitate informed decisions.
Morally and legally, nurses should support patient autonomy, aiding in decision-making alongside families when necessary.
Nurses must be aware of legal rights and support them within their practice scope.
Create opportunities for patient engagement based on cognitive development and cultural backgrounds.
Addressing end-of-life decisions thoughtfully, promoting advance care planning, and relieving end-of-life symptoms in alignment with palliative care standards.
Recognizing that laws may sometimes conflict with ethical practices regarding individual rights.
Consideration for public health and the rights of others in situations requiring limits on self-determination.
Conclusion
Ethical nursing practices fundamentally respect the dignity and self-determination of each individual, necessitating thoughtful and compassionate relationships.
Nurses actively engage in practices that support patient autonomy while balancing the needs of the wider community.
Provision 2:
A nurse’s primary commitment is to the recipient(s) of nursing care, whether an individual, family, group, community, or population.
2.1 Primary Commitment to Recipients of Nursing Care
Nurses prioritize recipients of nursing care over institutions in clinical encounters and care plans.
Commitment to the inherent dignity, worth, unique attributes, and human rights of patients.
Patients are given opportunities to participate in assessing, planning, and implementing their care.
Facilitate informed decision-making as part of the healthcare team.
Address language needs and accommodations, and disclose all treatment options, including unavailable interventions.
Provide information in a nondirective manner about treatment options within the nurse's scope of practice.
Recognition of patient’s values and preferences is essential.
Nurses help resolve conflicts between patient wishes and others' opinions.
Commitment to the patient persists even when conflicts arise.
Nurses act to preserve life and promote health based on patient values.
Escalate concerns about limited treatment options due to institutional restrictions.
2.2 Conflicts of Interest and Conflicts of Commitment in Nursing
Nurses may face conflicts of interest and commitment, requiring examination and management.
Conflicts occur when personal or professional interests interfere with patient responsibilities.
Nurses must follow professional guidance to identify and disclose conflicts.
Types of conflicts:
Conflicts of Interest: Personal, business, or financial interests affecting professional responsibilities.
Conflicts of Commitment: Inattention to care recipients impacts the ability to perform professional responsibilities.
Nurses are responsible for managing conflicts to protect themselves and patients.
Disclosure of conflicts is vital to maintaining the standard of care.
Resources include seeking second opinions, referrals, or leadership consultation when conflicts arise.
2.3 Professional Boundaries
Nursing relationships are personal; boundaries protect the patient and mitigate power imbalances.
Nurses must examine behaviors to ensure adherence to professional roles.
Awareness of over- or under-involvement with patients is essential.
Nurses should identify behaviors that compromise professional boundaries.
Compassionate enforcement of boundaries is necessary; escalate for support when needed.
Awareness of policies regarding gratitude tokens from patients is important.
2.4 Issues of Safety in the Nurse-Patient Relationship
Safety is paramount in maintaining nurse-patient relationships.
Nurses assess safety concerning physiological, physical, psychological, and emotional threats.
Unsafe behaviors must be addressed promptly to restore safety and uphold patient participation in healthcare.
Provision 3:
The nurse establishes a trusting relationship and advocates for the rights, health, and safety of recipient(s) of nursing care.
3.1 Privacy and Confidentiality
Nurses are entrusted with comprehensive information about patients, exercising moral discernment to differentiate between clinically relevant and personal information.
Privacy:
The right of recipients to control access to their personal information and determine when and how it is disclosed.
Nurses create environments with sufficient physical privacy to enable discussions of personal nature.
Sensitive disclosures (e.g., abuse, trauma) may occur in clinical settings with patients' consent for referrals to support services.
Confidentiality:
Refers to the nondisclosure of personal information communicated within the nurse-patient relationship.
Nurses have a duty to maintain confidentiality regardless of the venue, including social media.
Vigilance is necessary to protect patient information from breaches due to evolving communication technologies.
Disclosure of Information:
Required for continuity of care under defined protocols.
Anonymized data may be used for education, peer review, and quality improvement.
Mandatory Reporting:
Public health laws mandate reporting of communicable diseases and safety issues.
Nurses must evaluate the impact of reporting on patients, especially with conflicting legislative demands versus ethical obligations.
Transparency in communicating reporting obligations is essential to maintain trust.
3.2 Advocating for Persons Who Receive Nursing Care
Nurses recognize the vulnerability of patients and support ethical informed consent within an interprofessional team.
Individuals must be free from undue influence when making care decisions consistent with their values.
Informed consent includes clear explanations of purposes, risks, benefits, alternatives, and outcomes in a suitable manner (language, literacy level).
Building trust through relational consent, ensuring collaboration in decision-making.
Nurses must remain unbiased and responsive to patient values and preferences.
As technology alters healthcare landscapes, nurses balance clinical judgment with augmented intelligence (AI) tools to enhance patient care.
3.3 Responsibility in Promoting a Culture of Safety
Nurses actively participate in policy development to ensure patient safety and reduce errors.
Immediate assessment and reporting of errors or near misses to appropriate authorities are critical.
Communication should follow a responsive approach based on event severity.
Respect for patients includes disclosing errors responsibly.
Accountability is paramount, with adherence to standards of care and institutional policies.
Collaborative investigations into errors and advocating for systemic changes to enhance patient safety.
Support for nurses involved in errors, with focus on process improvement over individual blame.
3.4 Protection of Patient Health and Safety by Acting on Practice Issues
Nurses must act when patient rights or standards of practice are threatened.
Knowledge of the Code of Ethics for Nurses and relevant regulations is essential.
Report concerns directly to involved parties when conditions allow, focusing on patient welfare.
Escalate unaddressed issues through proper channels, including external regulations if necessary.
Support whistleblowers to ensure practice concerns are reported factually and safely.
3.5 Protection of Patient Health and Safety by Acting on Impaired Practice
Nurses must protect patients by identifying impaired practice due to personal circumstances in colleagues.
Compassion is vital, with attention to signs of impairment.
Reporting impairment is ethically appropriate and nurses should be shielded from negative repercussions.
Support recovery efforts while being aware of relevant policies and legal frameworks.
Leadership should facilitate intervention programs for impaired practice, guiding affected nurses towards support services.
Provision 4:
Nurses have authority over nursing practice and are responsible and accountable for their practice consistent with their obligations to promote health, prevent illness, and provide optimal care.
4.1 Responsibility and Accountability for Nursing Practice
Nurses must deliver competent, compassionate, person-centered care within their scope of practice.
Responsibility and accountability are inseparable concepts in nursing practice.
Ethical responsibilities are grounded in the profession’s values and goals.
Nurses are accountable for fulfilling their ethical responsibilities, including choices to act or not act.
Systems and technologies assist clinical practice but do not replace the nurse’s knowledge and skill.
Nurses are accountable for practice even if systems or technology fail.
Accountability may also involve the institution if the situation warrants it.
Acceptance or rejection of role demands should be based on the nurse's education, knowledge, competence, experience, and risk assessment for patient safety.
Nurses must bring forward difficult patient care issues and advocate for ethical considerations in deliberation.
Access resources such as ethics services and nursing organizations when issues exceed their ability to remedy.
Combat health misinformation and disinformation effectively.
Be aware of regulatory documents relevant to nursing practice (nurse practice acts, standards of care, state and federal laws).
Seek guidance when regulations conflict with patient interests.
Maintain accountability for outcomes of decisions impacting patients, colleagues, or institutions.
Responsible for maintaining professional standards and engaging in professional development activities.
4.2 Addressing Barriers to Exercising Nursing Practice Authority
Identify and navigate negative influences on patient care individually and collectively.
Challenges often arise from hierarchical structures, rigid protocols, and economic pressures focused on profit.
Social, environmental, political, legislative, and economic factors can constrain nursing practice authority.
Examples include pressure to discharge patients to unsafe environments.
Experiences of workplace violence can impede the exercise of authority.
Technological advances can impact practice authority if not implemented carefully.
Build inclusive and supportive environments; engage in team and institutional decision-making.
Leaders should support nurses in articulating their perspectives to enhance patient care and the work environment.
Utilize resources such as literature and interprofessional team members when constraints exceed the nurse's ability.
4.3 Ethical Awareness, Discernment, and Judgment
Recognize that all nursing actions carry ethical implications aligning with nursing goals.
Moral identity in nursing involves the internalization of moral values, virtues, and ethical comportment.
Ethical judgment integrates clinical knowledge and is responsive to the context and subjective experiences of patients.
Ethical awareness means engaging with social structures to promote health and alter harmful influences.
Ethical discernment is applied in everyday nursing encounters to address dilemmas or conflicts.
Resources may be sought to inform ethical judgment.
Nurses advocate for social change when ethical problems stem from social disadvantages or political issues.
4.4 Assignment and Delegation
Nurses are accountable for assigning and delegating nursing activities per standards and policies.
Assess individual competence beforehand, considering knowledge, skill, experience, and patient needs.
Monitoring and evaluating delegated care quality and outcomes are crucial responsibilities.
Delegation of nursing assessment and evaluation is restricted to qualified nurses.
Leadership roles involve fostering ethical environments that support safe assignment and delegation practices.
Ensuring adequate staffing, skill development, and policies to protect patients and nurses.
Encourage open communication with nurses regarding assignments and enabling them to refuse unprepared tasks.
Responsible for overseeing student nurses to ensure competence in care provided.
Expect institutional support for supervising students without compromising safety.
Provision 5:
The nurse has moral duties to self as a person of inherent dignity and worth including an expectation of a safe place to work that fosters flourishing, authenticity of self at work, and self-respect through integrity and professional competence.
5.1 Personal Health and Safety
Nurses have a duty to maintain their own health and safety.
Define health, risk tolerance, and work-life balance for themselves.
A nurse’s professional performance may be affected by the demands of care, leading to fatigue or burnout.
Signs and symptoms indicating negative health impacts must be recognized.
Health and safety of nurses are intertwined with those of patients.
Ethical obligations do not require unreasonable sacrifices of nurse safety for patient benefit.
A safe work environment and supportive conditions are vital.
Respect must be afforded to nurses, who should not tolerate abuse from any source.
Mental health considerations, particularly psychological stress, must be addressed.
Identify signs of depression, anxiety, insomnia, or suicidal ideation.
Nurses should seek remedies that address their situations and personal needs.
5.2 Wholeness of Character
Wholeness of character involves being authentic and acknowledging individuality in nursing practice.
Requires courage and vulnerability from nurses to be their true selves.
Respect for individuality fosters safe, expressive environments in nursing.
Creates a moral space for discussions of values impacting health equity.
Condemnation of prejudicial discrimination within the nursing profession.
Patients must receive compassionate and respectful care regardless of their attributes or lifestyles.
Conscience-based objection must balance personal integrity with patient dignity.
Timely communication of any objections to care is crucial for patient arrangements.
5.3 Integrity
Personal integrity reflects a self-regarding duty requiring reflection and discernment.
Distinction between acting with integrity versus simply following rules.
Threats to integrity may arise from unethical requests or requirements, such as deception or withholding information.
Nurses must act according to values and accept compromise only if their moral integrity is maintained.
Express concerns regarding compromised integrity at individual or collective levels.
5.4 Professional Competence
Maintaining professional competence is a self-regarding duty linked to self-respect and quality of care.
Nurses strive for excellence in practice across different roles and settings.
Leadership in nursing entails developing evaluation criteria and supporting adherence to competencies.
Career-long learning is essential for personal and professional growth.
Engages both formal and informal learning experiences.
5.5 Human Flourishing
Flourishing is an aspirational state tied to relational and community well-being.
Dependence on care and healthy environments is recognized; this nurtures relationships that support growth.
Interdependence as a member of the nursing community fosters personal and professional development.
Emphasis on values such as inclusivity, compassion, and ethical comportment.
Provision 6:
Nurses, through individual and collective effort, establish, maintain, and improve the ethical environment of the work setting that affects nursing care and the well-being of nurses.
6.1 The Environment and Virtue
Virtues in nursing are learned attributes of moral character developed through practice and education.
Core values include compassion, dignity, integrity, and respect.
Nurses expect a moral milieu that supports flourishing and fosters virtuous nursing.
Encouragement of mutual caring, moral equality, and transparency in practice.
6.2 The Environment and Ethical Obligation
Knowledge of the Code of Ethics for Nurses and related position statements underpins a moral community.
Barriers to ethical practice must be identified and transformed by nurses acting as moral agents.
Establishing a supportive ethical environment requires intentional effort.
Addressing harmful social norms like incivility and discrimination.
Need for self-reflection to identify biases affecting colleagues and the profession.
6.3 Responsibility for the Healthcare Environment
Nurses are responsible for fostering respectful interactions and addressing ethical issues.
Advocacy for the inclusion of ethics in nursing education and professional development.
Leadership in nursing ensures fair treatment and involvement in practice-related decisions.
Nurses should collectively address unsafe or inappropriate practices.
Collective and interprofessional advocacy is essential for ethical environments.
Address concerns through appropriate channels while recognizing the potential for organizational reprisal.
Provision 7:
Nurses advance the profession through multiple approaches to knowledge development, professional standards, and the generation of policies for nursing, health, and social concerns.
7.1 Contributions through Knowledge Development, Research, and Scholarly Inquiry
Nurses engage in knowledge production that informs nursing practice, drawing from sciences and humanities.
Research and scholarly inquiry expand the nursing knowledge base through theory, philosophy, ethics, science, and practice.
Utilization of diverse methodologies from natural and social sciences enhances nursing knowledge.
Integration of non-nursing disciplines such as history, philosophy, and ethics is essential.
The arts contribute to understanding the human experience in nursing.
Rigorous research enables integration of findings into practice protocols, advancing health outcomes and shaping policy development.
Nurses involved in empirical research hold various roles (e.g., principal investigators, research coordinators).
Ethical research practices include social value, scientific merit, informed consent, and respect for participants.
Evidence-based practice, derived from research, improves care across settings.
7.2 Protection of Human Participants in Empirical Research
Ethical obligation to protect research participants and uphold ethical conduct.
Informed Consent:
A process requiring ongoing consideration of capacity, engagement, and understanding.
Participants must be free from coercion and provided information in their preferred language.
Nurses are responsible for obtaining informed consent and ensuring participants’ understanding.
Research integrity emphasizes honesty, accountability, transparency, and dissemination of findings.
Misconduct defined by plagiarism, falsification, and fabrication; undermines research integrity.
Engage in community-based participatory approaches for ethical inquiry.
Recognize and address historical biases in research involving marginalized populations.
7.3 Contributions through Developing, Maintaining, and Implementing Professional Practice Standards
Professional practice standards evolve with nursing knowledge and must reflect ethical, competent practice.
Development of Nursing Scope and Standards of Practice guided by research and ethics.
Understanding obligations informed by nurse practice acts and foundational documents (Code of Ethics for Nurses).
Nurse educators promote standards of education and practice essential for nursing development.
7.4 Contributions through Nursing, Health, and Social Policy Development
Nurses shape health-related policies through ethical commitments and knowledge.
Engage in advocacy for policies affecting health and wellness in various areas (e.g., climate, healthcare).
Participation in shared governance boards and committees is encouraged to impact policy effectively.
Nurse educators model political and civic engagement in nursing education.
Leaders empower evidence-based practice and ethical comportment.
7.5 Considerations Related to Ethics, Technology, and Policy
Integration of technology is essential in nursing; nurses influence technology adoption in practice.
Considerations for ethics in technology include access, implications for care, and data governance.
Healthcare technologies must consider equitable access and transparency.
Nurses must understand the impact of ML and AI on nursing practice and patient care.
Ethical concerns regarding genetics and genomics research include consent, privacy, and justice.
Nurses should critically assess technology's implications and reflect values in care provision.
Provision 8:
Nurses build collaborative relationships and networks with nurses, other healthcare and non-healthcare disciplines, and the public to achieve greater ends.
8.1 Collaboration Imperative
Collaboration across disciplines is essential to address complex health issues.
Involves networking, advocacy, leadership, and diplomacy among various stakeholders.
Effective collaboration requires mutual trust, transparency, shared decision-making, and open communication.
Nurses serve as patient advocates to elicit and communicate patient wishes to the healthcare team.
Partnerships enhance collective power to address significant health challenges.
8.2 Collaboration to Uphold Human Rights, Mitigate Health Disparities, and Achieve Health Equity
Physical and mental health are universal human rights.
Nurses advocate for communities, leveraging their knowledge for policy and health-related initiatives.
Create opportunities for equitable access to healthcare.
Collaboration addresses complex issues such as human trafficking and environmental sustainability.
8.3 Partnership and Collaboration in Complex, Extreme, or Extraordinary Practice Settings
Nurses address human rights violations, particularly in extreme practice settings.
Engage in discernment to protect human rights while managing emergencies.
Collaborate with interprofessional teams to ensure fair resource distribution during crises.
Provision 9:
Nurses and their professional organizations work to enact and resource practices, policies, and legislation to promote social justice, eliminate health inequities, and facilitate human flourishing.
9.1 Assertion of Nursing Values
Professional organizations should exemplify nursing values, prioritizing human dignity and health rights.
Advocate against dehumanization and support marginalized voices.
Nurses' collective efforts promote societal well-being and influence healthcare.
9.2 Commitment to Society
Society's covenant with nursing empowers nurses to provide care for all.
Civic engagement affirms nursing’s relationship with society through advocacy and accountability.
Nursing education promotes advocacy skills to create just systems.
9.3 Advancing the Nursing Vision of a Good and Healthy Society
Nurses articulate and advance a vision for a just society rooted in respect and dignity.
Focus on sustainable changes reflecting nursing values and virtues.
Professional organizations assess strategic plans to align with nursing’s mission and values.
9.4 Challenges of Structural Oppressions: Racism and Intersectionality
Address the history of racism in nursing to build inclusive and equitable organizations.
Nurses must condemn oppression and advocate for social justice impacting health outcomes.
Understanding intersectionality helps nurses recognize the compounded challenges faced by marginalized communities.
9.5 National Policies, Programs, and Legislation
Engage in political processes affecting public health and social determinants.
Advocacy efforts should focus on pressing health and social policy issues.
Support collective action to strengthen nursing's voice and mitigate risk while addressing health equity and justice.