Ethical Core Concepts of Nursing Practice

Professional nurses occupy the frontlines of the health care arena. So, it is no surprise that they are the part of the health care team patients trust most with their health and welfare. Along with this privilege, nurses carry equal duties of responsibility and accountability to follow ethical principles and standards of care integral to the profession. Greater efforts must be made from within the profession to apply evidence-based research data to daily practice systematically and deliberately, thereby increasing patient safety, improving outcomes, and reducing risk and adverse events. Transformation of the professional culture within the health care system itself would give nurses at the bedside the incentive to join in these efforts as full partners with leaders in health care. Additional measures might include protocol implementation, preceptor performance review, peer review, continuing education, patient satisfaction surveys, and the implementation of risk management techniques. However, in certain instances, either despite or in the absence of such internal mechanisms, claims are made for an alleged injury or alleged malpractice liability. Although the vast majority of claims may be without merit, many professional nurses will have to deal with the unfamiliar legal system. A system of ethical principles and standards of care will be beneficial in such situations. Therefore, it is preferable for the nursing profession to incorporate certain ethical and legal principles and protocols into practice to make sure that the patient receives only safe and appropriate care.

 

Clinical ethics literature identifies four principles and values that are integral to the professional nurse's practice: the nurse's ethical duty to respect the patient's autonomy and to act with beneficence, nonmaleficence, and justice.

 

RESPECT FOR THE INDIVIDUAL AND HIS AUTONOMY

• Respect for the individual's autonomy incorporates principles of freedom of choice, self-determination, and privacy.
• The professional nurse's duty is to view and treat each individual as an autonomous, self-determining person with the freedom to act in accordance with self-chosen, informed goals, as long as the action does not interfere or infringe on the autonomous action of another.
• See the National League of Nursing Statement on Patients' Rights (see Box 2-1).
• The Joint Commission has established National Patient Safety Goals based on such settings as ambulatory care, assisted living, and the facility. See www.jointcommission.org/patientsafety/nationalpatientsafetygoals for more information.

BENEFICENCE

The principle of beneficence affirms the inherent professional aspiration and duty to help promote the well-being of others and, often, is the primary motivating factor for those who choose a career in the health care profession. Health care professionals aspire to help people achieve a better life through an improved state of health.

 

NONMALEFICENCE

• The principle of nonmaleficence complements beneficence and obligates the professional nurse not to harm the patient directly or with intent.
• In the health care profession, this principle is actualized only with the complementary principle of beneficence because it is common for the nurse to cause pain or expose the patient to risk of harm when such actions are justified by the benefits of the procedures or treatments.
• It is best to seek to promote a balance of potential riskinduced harms with benefits, with the basic guideline being to strive to maximize expected benefits and minimize possible harms. Therefore, nonmaleficence should be balanced with beneficence.

 

JUSTICE

• Justice, or fairness, relates to the distribution of services and resources.
• As the health care dollar becomes increasingly more scarce, justice seeks to allocate resources fairly and treat patients equally.
• Dilemmas arise when resources are scarce and insufficient to meet the needs of everyone. How do we decide fairly who gets what in such situations?
• One might consider whether it is just or fair for many people not to have funding or access to the most basic preventive care, whereas others have insurance coverage for expensive and long-term hospitalizations.
• Along with respect for people and their autonomy, the complex principle of justice is a culturally comfortable principle in countries such as the United States. Nonetheless, the application of justice is complex and often challenging.