Nursing Ethics and Patient Care

Patient Autonomy

Definition: Patients aged 18 or older have the autonomous right to make their own treatment decisions without coercion or undue influence. This principle emphasizes the importance of informed consent and recognizes the individuality of each patient's preferences and values.

Example: A patient with diabetes refusing medication such as insulin.

• Healthcare professionals should take the time to explain the potential complications and risks associated with uncontrolled diabetes, including severe hypoglycemia, diabetic ketoacidosis, and long-term consequences such as neuropathy, retinopathy, and cardiovascular disease.

• Ultimately, it is crucial to respect the patient’s choice, even if it differs from medical advice, provided the patient has full capacity to make that decision and understands the implications.

Example: A cancer patient refusing chemotherapy treatment.

• It is essential to discuss the possible risks associated with refusal, including disease progression, terminal illness, or diminished quality of life.

• While engaging in comprehensive dialogue, healthcare providers must still respect the patient's right to refuse treatment, recognizing the profound emotional and personal factors influencing their choice.

Beneficence vs. Nonmaleficence

Beneficence: The ethical obligation to act for the benefit of the patient; promoting the well-being of patients through positive actions and interventions that enhance health outcomes.

• Example: Installing railings in patient care areas to prevent falls. This is a proactive measure that not only addresses safety but also enhances the overall patient experience by fostering an environment of care.

Nonmaleficence: The ethical principle of doing no harm; preventing harm and ensuring the safety of patients through careful and considered actions.

• Example: Removing obstacles from patient pathways to prevent falls, representing a reactive measure that addresses immediate safety concerns. By actively ensuring a safe environment, healthcare practitioners uphold the principle of nonmaleficence.

Key Difference: Beneficence advocates for positive action to contribute to the patient’s health, while nonmaleficence focuses on avoiding harm and ensuring that any interventions do not adversely affect the patient.

Justice in Healthcare

Definition: Justice in healthcare is defined as fairness and equity in treatment, ensuring that all patients receive appropriate care regardless of their background, ethnicity, socioeconomic status, or other factors that may lead to discrimination. This principle embodies the pursuit of equal access to healthcare services.

Example: Providing equal attention and resources to all patients, irrespective of any personal biases. For instance, ensuring that no favoritism occurs in treatment decisions and every patient receives equitable care based on their health needs, making healthcare just and ethical.

Fidelity

Definition: Fidelity involves keeping promises made to patients, which is fundamental to building trust and maintaining the integrity of the patient-care provider relationship. Trust is a pivotal component in effective healthcare.

Example: A nurse promises a patient they will return with assistance following a call for help. The nurse is obligated to follow through on this promise within an appropriate timeframe, demonstrating reliability and commitment to patient care.

Veracity

Definition: Veracity emphasizes the importance of truth-telling in healthcare; it involves providing accurate, honest information to patients to facilitate informed decision-making about their health.

Example: If a patient inquires about their biopsy results, the nurse must refrain from giving false reassurances. Instead, the nurse should provide correct information, ensuring the patient understands their health condition and the options available to them.

Ethical Dilemmas

Examples of ethical challenges faced by healthcare providers include:

• Minor patients making treatment decisions without having the full capacity to understand the implications of those decisions.

• Situations where patients refuse treatment based on religious beliefs while facing life-threatening medical conditions that necessitate timely intervention.

Resolution: In cases of ethical dilemmas, it is important to involve legal or ethical support teams to assist in navigating the complex situations that arise in healthcare settings. This can include ethics committees or legal counsel to ensure decisions made are ethically sound and legally compliant.

Moral Distress

Definition: Moral distress occurs when healthcare providers feel conflicted when their personal ethical values clash with the treatment requirements or institutional policies governing patient care.

Key Point: This distress can arise when a caregiver feels unable to act in the patient’s best interest due to external pressures, such as bureaucratic constraints or conflicting demands from colleagues. Addressing moral distress is crucial to promoting a healthy work environment and provider well-being.

Core Values in Nursing

Advocacy: The act of standing up for and promoting the rights and needs of patients, ensuring they have a voice in their care process.

Accountability: Taking responsibility for one's actions and decisions, ensuring that nursing practice meets professional standards and patient needs. Accountability fosters trust between healthcare providers and patients.

Responsibility: Ensuring the safety and care of assigned patients through vigilant practice and adherence to protocols.

Confidentiality: Protecting patient information from unauthorized disclosure, a vital component of patient trust and legal obligation of healthcare providers.

Nursing Process

Assessment: Involves systematic collection of both subjective (what the patient reports) and objective (measurable) data to gain a comprehensive view of the patient's health status.

Diagnosis: Identifying nursing diagnoses based on assessment findings and clinical judgement, which guide care planning.

Planning: The development of detailed care plans that outline specific, actionable goals aimed at improving patient outcomes based on individual assessments.

Implementation: Executing the established care plan and delivering interventions effectively to meet the patient’s needs.

Evaluation: Ongoing assessment of the effectiveness of nursing interventions and modifications to care plans as required, ensuring that patient care remains dynamic and responsive to changing needs.

SMART Goals

Specific: Goals must be clearly defined and precise; they should specify exactly what is to be achieved.

Measurable: Clearly define how success will be measured, using quantifiable indicators where possible.

Attainable: Ensure the goal is realistic and achievable, taking into consideration available resources and patient capabilities.

Realistic: Goals should be practical and relevant to the patient's circumstances and overall health objectives.

Timely: Set specific deadlines for goal achievement, creating a sense of urgency and accountability in the care process.

American Nurses Association (ANA)

The ANA establishes the standards of nursing practice and competencies required for the provision of safe and effective care. These standards serve as a framework for nursing education and professional development.

Each state’s Nurse Practice Act may vary regarding the regulations and requirements that govern nursing practice, impacting licensure, practice parameters, and scope of care provided by nurses.

Importance of Professional Conduct

Maintaining professionalism within healthcare environments is essential to protect patient welfare, uphold ethical standards, and preserve the overall integrity of nursing practice. Unprofessional conduct can lead to serious consequences, including suspension or revocation of nursing licenses.

Direct vs. Indirect Patient Care

Direct Care: Refers to hands-on care delivered directly to the patient, such as administering medication, performing physical assessments, and providing personal care. This interaction is often vital to patient recovery and comfort.

Indirect Care: Involves actions taken that benefit the patient indirectly, such as documenting care activities, coordinating with other healthcare team members, and managing patient records, which ultimately assist in improving future patient care.

Instrumental Activities of Daily Living (IADLs)

IADLs encompass tasks necessary for independent living, including shopping, managing finances, cooking, and transportation. These activities are crucial for maintaining autonomy and quality of life.

A distinction is made between IADLs (generally non-medical activities) and Activities of Daily Living (ADLs), which are essential for basic functioning, such as bathing, dressing, and eating, highlighting varying levels of care needs.