Nursing Ethical Considerations


Article Author:
Lisa Haddad


Article Editor:
Robin Geiger


Editors In Chief:
Bette Bogdan
Lori Kerley
Robin Geiger


Managing Editors:
Frank Smeeks
Scott Dulebohn
Erin Hughes
Pritesh Sheth
Mark Pellegrini
James Hughes
Richard Ciresi
Phillip Hynes


Updated:
10/27/2018 12:31:19 PM

Introduction

Ethical values are essential for any healthcare provider. Ethics comes from the Greek word “ethos,” meaning character. Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued.[1] Ethics are moral principles that govern how the person or a group will behave or conduct themselves. The focus pertains to the right and wrong of actions and encompasses the decision-making process of determining the ultimate consequences of those actions.[2] Each person has their own set of personal ethics and morals. Ethics within healthcare are important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them. To practice competently with integrity, nurses, like all healthcare professionals, must have regulation and guidance within the profession.[3] The American Nurses Association (ANA) has developed the Code of Ethics for this purpose.

Function

The onset of nursing ethics can be traced back to the late 19 century. At that time, it was thought that ethics involved virtues such as physician loyalty, high moral character, and obedience.[3] Since that early time, the nursing profession has evolved, and nurses are now part of the healthcare team and are patient advocates. The first formal Code of Ethics to guide the nursing profession was developed in the 1950’s. Developed and published by the ANA, it guides nurses in their daily practice and sets primary goals and values for the profession. Its function is to provide a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It provides a nonnegotiable ethical standard and is an expression of nursing’s own understanding of its commitment to society. The Code of Ethics has been revised over time. The current version represents advances in technology, societal changes, expansion of nursing practice into advanced practice roles, research, education, health policy, and administration, and builds and maintains healthy work environments.[3]

Issues of Concern

The Code of Ethics for Nurses is divided into nine provisions to guide the nurse. The following is a summary of the American Nurses Association Code of Ethics for Nurses: 

Provision 1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 

The nurse must have a high level of respect for all individuals, and allow dignity in regards to dealings in care and communication. It's important that patient's families are also treated with respect for their relationship to the patient. Nurses must understand the professional guidelines in communications and work with colleagues and patient families. It's important to understand the proper professional relationship that should be maintained with families and patients. All individuals, whether patients or co-workers have the right to decide on their participation in care and work.

Provision 2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

The patient should always be a first and primary concern. The nurse must recognize the need for the patient to include their individual thought into care practices. Any conflict of interest, whether belonging to external organizations, or the nurse's habits or ideals that conflict with the act of being a nurse, should be shared and addressed to not impact patient care. Collaboration with internal and external teams to foster best patient care is a necessity. Understanding professional boundaries and how they relate to patient care outcomes is important.

Provision 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

It is important for the nurse to understand all privacy guidelines with regards to patient care and patient identifiers. Nurses involved in research must understand all aspects of participation including informed consent and full disclosure to the patient of all aspects required to participate in the study. The nurse must understand any institutional standards set in place to review his/her performance; this includes measurements of progress and the need for further review or study to meet performance standards. To become a nurse, competence must be demonstrated in clinical and documentation prowess. Standards of competence will continue at institutions and academic organizations that employ the nurse. If there is witness or recognition of questionable healthcare practice, it is important that the patient is protected by reporting any misconduct or potential safety concern. And finally, the nurse will not provide patient care while under the influence of any substance that may impair thought or action, this includes prescription medication.

Provision 4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care.

As a nurse, it's inherent that accountability for all aspects of care aligns with responsible decision making. Use of authority must be professional and about all aspects of individualism and patient, ethical concerns. Nursing decisions must be well thought, planned, and purposefully implemented responsibly. Any delegation of nursing activities or functions must be done with respect for the action and the ultimate results to occur. 

Provision 5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

A nurse must also demonstrate care for self as well as others. An ideal nurse, will have self-regard towards healthcare practices and uphold safe practice within the care setting and at home. It's important for a nurse to have a high regard for care as an overall inert ability once the profession is entered. A character becoming a nurse would include integrity. Nurses should be concerned for personal growth in regards to continued learning of the profession. The ability to grow as a nurse with improvements to care, changes or trends in care should be adapted to maintain competence and allow growth of the profession.

Provision 6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.

As a nursing profession, standards should be outlined within and external to institutions of work that dictate ethical obligations of care and need to report any deviations from appropriateness. It's important to understand safety, quality and environmental considerations that are conducive to best patient care outcomes.

Provision 7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

Nurse education should include principles of research, and each nurse should understand how to apply scholarly work and inquiry into practice standards. Nurse committees and board memberships are encouraged to contribute to health policy and professional standards. The ability to maintain professional practice standards should continue, changing and enhancing as developments in practice may over time.

Provision 8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. 

Through collaboration within the discipline, maintaining the concept that health is a right for all individuals will open the channels of best practice possibilities. The nurse understands the obligation to continue to advance care possibilities by committing to constant learning and preparation. The ability of the nurse to practice in various healthcare settings may include unusual situations that require continued acts of diplomacy and advocacy.

Provision 9. The profession of nursing, collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Nurses must continue to gather for committees and organize groups where they may share and evaluate values for accuracy and continuation of the profession. It is within these organizations that nurses may join in strength to voice for social justice. There is a need for continued political awareness to maintain the integrity of the nursing profession. The ability of the nurse to contribute to health policy should be shared among the profession, joining nurses throughout the world for a unified voice.

American Nurses Association. (2015). Code of ethics with interpretative statements. Silver Spring, MD

Clinical Significance

Ethical values are essential for all healthcare workers. Ethical practice is a foundation for nurses, who deal with ethical issues daily. Ethical dilemmas arise as nurses care for patients. These dilemmas may, at times, conflict with the Code of Ethics or with the nurse's ethical values. Nurses are advocates for patients and must find a balance while delivering patient care. There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence.

Each patient has the right to make their own decisions based on their own beliefs and values.[4]. This is known as autonomy. A patient's need for autonomy may conflict with care guidelines or suggestions that nurses or other healthcare workers believe is best. A person has a right to refuse medications, treatment, surgery, or other medical interventions regardless of what benefit may come from it. If a patient chooses not to receive a treatment that could potentially provide a benefit, the nurse must respect that choice.

Healthcare workers have a duty to refrain from maltreatment, minimize harm, and promote good towards patients.[4] This duty of particular treatment describing beneficence. Healthcare workers demonstrate this by providing a balance of benefits against risks to the patient. Assisting patients with tasks that they are unable to perform on their own, keeping side rails up for fall precautions, or providing medications in a quick and timely manner are all examples of beneficence.

All patients have a right to be treated fair and equally by others. Justice involves how people are treated when their interest competes with others.[5]. A current hot topic that addresses this is the lack of healthcare insurance for some. Another example is with patients in rural settings who may not have access to the same healthcare services that are offered in metropolitan areas.

Patients have a right to no harm. Non-maleficence requires that nurses avoid causing harm to patients.[6] This principle is likely the most difficult to uphold. Where life support is stopped or patients have chosen to stop taking medication that can save their lives, the nurse is put in a morally challenging position.

Nurses should know the Code of Ethics within their profession and be aware and recognize their own integrity and moral character. Nurses should have a basic and clear understanding of key ethical principles. The nursing profession must remain true to patient care while advocating for patient rights to self-identify needs and cultural norms. Ethical considerations in nursing, though challenging, represent a true integration of the art of patient care.

Enhancing Healthcare Team Outcomes

Nurses have a responsibility to themselves, their profession, and their patients to maintain the highest ethical principals. Many organizations have ethics boards in place to review ethical concerns. Nurses at all levels of practice should be involved in ethics review in their targeted specialty area. It is important to advocate for patient care, patient rights, and ethical consideration of practice. Ethics inclusion should begin in nursing school and continue as long as the nurse is practicing.


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Nursing Ethical Considerations - Questions

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Complete the quote from The Code of Ethics for Nurses purpose statement: "It is an expression of nursing's own understanding of its commitment to _________."



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Complete the statement from the American Nursing Association's Code of Ethics for Nurses purpose statement: "It is the profession's ___________ ethical standard."



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Select the words that complete Provision 9 of The Code of Ethics for Nurses, "The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the __________________, and for shaping social practice."



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Complete the statement from Provision 8 of The Code of Ethics for Nurses: "Regarding the collaboration with other health professionals and the public in promoting __________________________."



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What term completes Provision 7 of The Code of Ethics for Nurses? "The nurse participates in the advancement of the profession through _____________ to practice, education, administration and knowledge development."



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Complete Provision 5 of the American Nursing Association Code of Ethics for Nurses. "The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain __________, and to continue personal and professional growth."



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What is the primary commitment of the nurse as stated in Provision 2 of the American Nurses Association's Code of Ethics for Nurses?



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Complete the statement from Provision 3 in the American Nursing Association's Code of Ethics for Nurses. "The nurse advocates for, promotes and strives to protect the health, safety, and________ of the patient."



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Complete the statement from Provision 1.1 in the American Nursing Association's Code of Ethics for Nurses that begins "The nurse, in all professional relationships, practices with compassion and _________."



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Which of these behaviors is not indicative of following the nursing code of ethics?



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Ethical values are essential for a healthcare provider to possess. What ethical value or principal is paired correctly with its definition? Select all that apply.



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Nursing Ethical Considerations - References

References

Östman L,Näsman Y,Eriksson K,Nyström L, Ethos. Nursing ethics. 2017 Jan 1     [PubMed]
Trobec I,Starcic AI, Developing nursing ethical competences online versus in the traditional classroom. Nursing ethics. 2015 May     [PubMed]
Epstein B,Turner M, The Nursing Code of Ethics: Its Value, Its History. Online journal of issues in nursing. 2015 May 31     [PubMed]
Suen KK, Ethical implications of population ageing in the intensive care unit. Irish journal of medical science. 2018 Aug 18     [PubMed]
Morrell TJ,Konda S,Grant-Kels JM, Response to a letter to the editor regarding     [PubMed]
Tiruneh MA,Ayele BT, Practice of code of ethics and associated factors among medical doctors in Addis Ababa, Ethiopia. PloS one. 2018     [PubMed]

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