Ethical Principles in Nursing Practice

Ethical Principles in Nursing

CLO 1: Discuss Ethical Principles, Theories, and Concepts

  • Focus on how these ethical elements impact professional nursing practices.

Learning Objectives

  • Discuss the principles of ethical practice:

    • Autonomy in terms of patients’ rights, informed consent, advocacy, and noncompliance.

    • Beneficence related to nursing practice.

    • Nonmaleficence and weighing actions based on harm and benefit.

    • Veracity in nursing practice.

    • Confidentiality recognizing its legal implications and limits.

    • Justice in healthcare delivery.

    • Fidelity related to nursing’s commitment to society.

    • Address conflicts between ethical principles.

Ethical Principles

  • Key principles in ethical nursing practices include:

    • Autonomy

    • Beneficence

    • Nonmaleficence

    • Justice

    • Veracity

    • Fidelity

    • Confidentiality

Definitions of Ethical Principles

1. Autonomy

  • Definition: Self-determination; the freedom to make choices affecting one’s life.

    • Autonomy implies respect for individuals’ choices and is essential for ethical nursing practice.

    • Autonomy hinges on freedom from coercion or deceit, enabling individuals to make independent decisions.

2. Elements of Autonomy

  • Four basic elements ensure autonomy:

    • Respect for the autonomous person.

    • Ability to determine personal goals.

    • Capacity to decide on a plan of action:

    • Understanding implications and deliberating options are essential for informed decision-making.

    • Freedom to act upon choices:

    • Autonomy recognition goes awry if patients are unable to act on decisions due to external factors (e.g., financial constraints).

3. Factors Threatening Autonomy

  • Intrinsic Factors:

    • Limited knowledge, health beliefs, cognitive impairments, emotional distress, and dependence on others can compromise autonomy.

  • Extrinsic Factors:

    • Systemic constraints, legal pressures, power imbalances, dependent care norms, lack of support, and poor clinician relationships also threaten autonomy.

4. Recognizing Violations of Patient Autonomy

  • Misassumptions by Healthcare Workers:

    • Nurses may assume shared values or knowledge bases, leading to misjudgments about patients’ decisions:

    • A nurse may incorrectly assume a patient’s wishes align with the norm or medical advice (e.g., prioritizing aggressive treatment without understanding the patient's preference for quality of life).

  • Inadequate Patient Communication:

    • Patients might feel overwhelmed by medical jargon, leading to misunderstandings and feelings of incompetence.

5. Informed Consent

  • Definition: A process where patients receive information regarding medical treatments, including risks, allowing them to make informed choices about care plans.

  • Informed consent upholds respect for patient autonomy and is critical for ethical nursing practice.

6. Parentalism**

  • A concept reflecting protective actions taken toward patients, potentially compromising their autonomy.

  • Appropriate only when patients lack the capacity for informed decision-making, as in cases of cognitive impairment.

7. Noncompliance

  • A term for patients who refuse or seem unwilling to follow a care plan, though informed and capable.

  • Noncompliance can disconnect patients from care, raising ethical dilemmas about respect for autonomy versus beneficence.

8. Beneficence

  • Definition: The obligation to act in ways that promote the well-being of others; to contribute positively and remove harm.

  • This principle puts the interests of others above self-interest.

  • Key components include:

    • Promoting good (acts of kindness, compassion, etc.)

    • Preventing harm (educational interventions, screenings)

    • Removing harm (effective healthcare practices, addressing pain, and adverse conditions).

9. Conflict in Beneficence

  • Challenges arise when determining what constitutes "good."

  • Questions often surface regarding the appropriateness of interventions and whether one action causes more benefit than harm (e.g., continuing futile chemotherapy).

10. Nonmaleficence

  • Definition: The principle of avoiding harm; commonly associated with the Hippocratic oath of "do no harm."

  • Essential to evaluate risks versus benefits in treatment plans, ensuring minimization of harm while pursuing beneficial outcomes:

    • Example: Vaccinations may cause minor pain (harm) but serve to prevent significant health issues (benefit).

11. Justice

  • Definition: The commitment to treat individuals fairly, equitably, and appropriately.

    • Two main frameworks:

    • Justice as Fairness, treating similar cases similarly.

    • Justice as Equal Distribution, addressing how resources and constraints are shared in society.

  • Ethical dilemmas must be confronted in resource allocation and equity of care (e.g., who qualifies for organ transplants).

12. Veracity

  • Definition: The importance of truth-telling and honesty in healthcare.

  • Essential for fostering trust, communication, and shared responsibility between patients and health providers.

  • Issues with truth-telling arise when there are concerns about harming patients with information, raising ethical questions regarding manipulating information.

13. Fidelity

  • Definition: The commitment to keep promises and remain true to one’s ethical responsibilities.

  • Involves promise-keeping in the patient-nurse relationship, commitment to ethical obligations, and providing consistent care.

14. Confidentiality

  • Definition: The obligation to keep patient information private and secure.

  • Essential for building trust and ensuring protection of sensitive information while acknowledging legal and ethical guidelines in practice.

  • Violations can have serious consequences for patient well-being and trust in healthcare providers.