Written By: Darby Faubion Darby Faubion BSN, RN
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» BSN, RN
Are you a nurse with a genuine desire to give the best care possible to patients and their families and to become a strong member of your nursing team? Maybe you are a nursing student eager to learn as much as possible to help you succeed in nursing. If so, the most important lesson you can learn is how to establish ethical nursing practices.
There are several ways to demonstrate strong ethics, and knowing the main ethical principles of nursing is a great place to start. Perhaps you are wondering, "What are the 7 main ethical principles in nursing, and why they are important?”
In this article, you will learn about ethical nursing principles and how they apply to you. As you continue reading, you will find an in-depth look at the 7 main ethical principles in nursing, why they’re important, and examples of how they are applied in the four main areas of nursing.
An ethical principle refers to the general judgments serving as justification for a person's behavior or actions. Ethical principles in nursing are the foundation upon which nursing actions are based. They describe what is expected of nurses in terms of right and wrong, good and bad, and correct and incorrect.
The American Nurses Association Code of Ethics is the source of ethical principles in nursing. The Code of Ethics was established as a guide for carrying out nursing responsibilities in ways consistent with the ethical obligations of the profession, promoting quality patient care.
Ethical principles in nursing provide a framework for assessing the behavior of nurses in practice.
1. Using ethical principles as the foundation of practice assists nurses in making good judgment calls.
2. Ethical principles in nursing guide nurses in providing high-quality care within the laws that govern nursing practices.
3. Nurses who work within the guidelines of ethical principles support the emotional, physical, and mental health of each patient, acting with their best interest in mind.
4. Applying principles of ethics in nursing is beneficial to developing strong nurse-patient and interdisciplinary relationships, which is essential for collaboration and quality patient care.
5. Patients cared for by nurses with solid ethical standards are typically more compliant than those whose nurses disregard ethical principles. When patients are compliant with prescribed health and nursing care plans, they experience improved health outcomes.
6. Ethical nursing practices help reduce risks to patient and nursing safety. Because the ethical principles of nursing focus on acceptable behaviors and promoting the welfare of others, nurses who demonstrate these behaviors are instrumental in reducing patient and staff safety risks.
7. Healthcare organizations that have nurses who exercise ethical nursing principles typically have higher patient satisfaction scores, higher employee satisfaction, and lower employee turnover rates.
Sources vary regarding the actual number of ethical principles in nursing. Any behavior that is honorable and professional, upon which a set of rules is established, may be considered an ethical principle. For the purposes of this article, we will discuss the following seven main ethical principles all nurses should demonstrate:
1. Accountability
2. Justice
3. Nonmaleficence
4. Autonomy
5. Beneficence
6. Fidelity
7. Veracity
Perhaps the most common conflict regarding ethical principles in nursing is the one that arises between the patient’s right to autonomy versus the nurse’s responsibility to practice under the principle of beneficence. Autonomy is the right of competent adults to make decisions about their medical care based on informed consent. The nurse must find a way to balance autonomy and beneficence by facilitating open communication, educating the patient, and finding ways to manage care that satisfies the patient and goes along with standards of ethical practices.
There are seven primary ethical principles of nursing: accountability, justice, nonmaleficence, autonomy, beneficence, fidelity, and veracity. The following is detailed information about the seven ethical principles in nursing, why they are important, and examples of ways to apply them in the four main areas of nursing: clinical practice, nursing leadership, nursing education, and nursing research.
Establishing an atmosphere of accountability in nursing is every nurse's responsibility. There are several key reasons being an accountable nurse is essential, including the following.
• When nurses practice accountability, they build stronger nurse-patient relationships based on increased trust and reduced fear.
• Accountable nurses demonstrate higher quality job performance, which benefits patients, peers, organizations, and the profession.
• Nurses who act with a high level of accountability are more likely to succeed in their roles. As a nurse, if you take personal responsibility for your actions, right or wrong, employers and peers appreciate you and your efforts, increasing your chance for success.
The best way to demonstrate accountability in nursing is to stay within your designated Scope of Practice. The scope of practice describes the care and services a qualified health professional is competent to perform and permitted to accept within the terms of their professional license. Each state's legislature passes a "Nurse Practice Act." Regulatory bodies then create and implement the rules and regulations of the nurse practice act intended to protect the nurse and the public.
Nurse Vicky, RN and charge nurse at a local hospital, completed an admission assessment on a newly admitted patient, Mr. Hendrix. Following the admission assessment, Nurse Vicky created a nursing care plan specific to Mr. Hendrix, including establishing which tasks the licensed practical/vocational nurse will complete. Although she delegates the patient's routine care to the LPN/LVN, Nurse Vicky realizes she is responsible for ensuring Mr. Hendrix is cared for within the boundaries of the patient care plan. She follows up with Mr. Hendrix by performing assessments as needed and ensuring all delegated tasks are completed promptly and efficiently.
Lack of accountability in nursing can result in significant consequences. Nurses must understand their roles and perform within their scope of practice to prevent risks to patients, themselves, and their organization. The following are a few examples of the far-reaching consequences of nurses failing to be accountable.
• Poor nurse-patient relationships: Patients expect nurses to provide quality, professional care to promote their well-being and improve their health. Nurses who do not demonstrate accountability lack professional responsibility, leading to distrust from patients and their loved ones. The lack of trust can compromise nurse-patient relationships, leading to a risk of non-compliance and resulting in negative patient outcomes.
• Reprimand at work and/or loss of job: Depending on the level of unaccountability, nurses could face a reprimand from management or risk losing their jobs.
Accountability in nursing leadership is instrumental in establishing strong nursing teams, promoting positive patient outcomes, and contributing to the success of the healthcare facility or organization. The following are a few reasons why nurse leaders should demonstrate accountability.
• Effective nurse leaders lead by example. If a nurse leader is accountable for her actions, the likelihood of the nurses on the team being accountable increases.
• The behavior of accountable nurse leaders positively impacts employee morale, making teams happier and more content with their jobs.
The best way to ensure accountability among nursing teams is for nurse leaders to model accountability in their behaviors and practices. Nurse leaders are accountable for their actions and the actions of their nursing team. At times, accountability in nurse leadership involves assessing a situation, delegating responsibilities, and following up to ensure work is complete.
Nurse Kristy is the charge nurse in a busy emergency department with a team of registered nurses under her supervision. After a multi-car pileup on the interstate, several crash victims came to her emergency room for care. Nurse Kristy assigned additional nurses to work triage to determine which patients require immediate care. She also distributes nurses for each area of care in the emergency department, carefully following the nurse-to-patient ratio as designated by the hospital policies and procedures. Nurse Kristy monitors the status of patient flow, ensures supply cabinets are stocked to accommodate the needs of all patients, including those in the car crash, and offers assistance as needed.
In this scenario, the charge nurse demonstrates accountability by making sure the staff she supervises have appropriate supplies, patients are triaged and treated in a timely manner, and offering her assistance.
Nurse leaders play an integral role in developing strong teams. Positive leadership behaviors lead to favorable outcomes. Conversely, poor leadership behaviors lead to unfavorable outcomes. If nurse leaders fail to demonstrate the ethical principle of accountability, subordinate nurses are likely to follow their behavior, leading to negative consequences like the ones listed below.
When leadership lacks essential ethical principles, it doesn't take long to see a breakdown in the team's structure.
Lack of accountability not only affects professional relationships but it can also affect patient outcomes. Nurse leaders who lack accountability rarely demand it from their teams, which impacts patient care, leading to poor health outcomes.
There are three main types of nurse educators:
Instructional nurse faculty teach nursing students in academic settings such as colleges or universities.
Clinical nurse educators typically work in hospitals or other healthcare facilities, helping nurses gain hands-on experience as they learn facility processes and best practices. CNEs also teach staff nurses about new policies and procedures and may educate nurses about new equipment.
Staff development nurses train nursing staff in new roles and provide ongoing mentorship and training to help nurses enhance their skills. All nurse educators play a vital role in healthcare and promoting ethical principles in nursing.
The following are a few reasons nurse educators must exercise accountability in their practice.
• Nurse educators bear significant responsibility for educating current and future nurses. Demonstrating accountability shows other nurses the importance of accepting responsibility for their own behavior.
• Nurse educators are influential in advocating for change in nursing education in higher institutions of learning and within healthcare organizations. Acting with professional accountability makes their efforts more appealing to decision- and policymakers, as those who make vital nursing and healthcare decisions desire to work with nurses they can depend on.
Nurse educators are obligated to provide the education and tools nurses, and nursing students need to become better nurses, which impacts patients, their families, healthcare facilities, and the nursing profession.
Mrs. Stennett is the clinical nurse educator at a large university hospital. Part of her job description includes having the responsibility to update staff nurses about new policies and procedures within the organization. The administration recently approved new guidelines for reporting errors related to patient care. In response to the updates, Mrs. Stennett scheduled four in-service meetings to accommodate nursing staff and update them on the new policies and procedures. At each in-service, the staff in attendance sign the attendance log to verify their presence. Mrs. Stennett logs information about the in-service in her activity logbook and attaches each sign-in sheet.
Although Mrs. Stennett could have conducted the in-service and expected administration or state surveyors to take her word that the staff was aware of policy changes, she understands the importance of being accountable for her own work. By logging information about the in-services and attaching sign-in sheets, Mrs. Stennett protects herself. Suppose a staff member acts outside the scope of the new policies and procedures but attended the in-service. In that case, Mrs. Stennett can show the sign-in sheet to her supervisor, removing any risk of repercussion due to the other staff member's actions.
The lack of accountability in any nursing position can have dire consequences. In nursing education, the lack of ethical principles like accountability can have significant long-term effects. Here are a few things to consider about the lack of accountability in nursing education.
If nurse educators lack accountability, the nursing students they teach are likely to conduct themselves with a lack of accountability, as well. This blatant lack of accountability can result in shifting blame, poor patient care, and negative patient outcomes.
Nurse researchers are at the forefront of clinical efforts to find new treatments and improve patient care. It is of utmost importance for nurse researchers to be accountable in their practices. Here are a few reasons why:
• The results of nursing research are instrumental in determining future steps in patient care. Nurses must be accountable for conducting research according to the plan so results can be validated.
• When nurse researchers demonstrate accountability, investors and other funding sources have confidence in their intentions, making it easier for them to offer financial resources to support research.
Nurse researchers are accountable to themselves, their team, study participants, supporting organizations, and financial contributors, to name a few. One of the best ways to demonstrate accountability in nursing research is to use resources for their intended use.
Nurse Researcher Ava is working on a research project with a group of colleagues. After securing their project's funding, Nurse Ava and her team realize they may have a significant amount of the funds remaining when the project is complete. Some colleagues suggest moving the extra money to another project, stating that since the money was for a research grant, it shouldn't be a problem. However, Nurse Ava objects to the suggestion arguing that the funds they received were designated for a specific project. She recommends completing the research project and then assessing how much, if any, of the funds remain available. She also suggests if funds are still available, the team should notify the grantor and request permission to use the funds toward another project.
When nurses act outside the boundaries of ethical principles and behaviors, it can lead to several consequences, of which some may be severe. Here are a few possible consequences of lack of accountability in nursing research.
If nurse researchers do not act with accountability in nursing research, they may be viewed as unreliable or untrustworthy and lose future research opportunities.
Autonomy is essential in all aspects of nursing practice. This vital ethical nursing principle goes hand-in-hand with the principle of accountability. The following are a few reasons why autonomy is important in nursing practice.
• Autonomy helps nurses strengthen their critical thinking and decision-making skills.
• Nurses who practice with autonomy typically have more confidence and freedom to make critical patient care decisions.
Any time a nurse acts within their scope of practice and knowledge to perform a patient care task independently, this is considered an act of autonomy in nursing practice. Nurses can demonstrate autonomy by administering PRN medications, delegating tasks to appropriate personnel, and checking vital signs when a patient's condition concerns them.
Mr. Phillips is a patient at Mercy Hospital, where Nurse William is his primary nurse. Upon entering Mr. Phillips' room to give routine medications, Nurse William observes that Mr. Phillips is pale, diaphoretic, and complaining of dizziness. Nurse William checks Mr. Phillips' vital signs, finding his blood pressure is extremely low. Nurse William holds Mr. Phillips' medications, including an antihypertensive, notifying the physician of Mr. Phillips' current status and continues monitoring the patient until the doctor responds with new orders.
Autonomy is one of the nursing ethical principles that often directly affects the nurse's outlook on their job. Lack of autonomy can significantly impact the way nurses relate to others and how they feel their employers feel about them. The following are a few consequences of lack of autonomy in nursing practice.
Nurses who experience a lack of autonomy, whether it is related to their choice not to exercise autonomy or because of employer restrictions, experience burnout at a much higher rate than nurses who have higher levels of autonomy.
Autonomy in nursing leadership gives leaders the authority to enrich nursing practices within their teams and organization. Nurse leaders who demonstrate autonomy contribute their unique nursing knowledge and experiences, helping to strengthen the profession and positively impact patient outcomes.
Nurse leaders make autonomous decisions daily. A few ways nurse leaders act with autonomy include collaborating with staff to develop nursing care plans, delegating assignments to staff nurses, implementing emergency measures according to policies and procedures, and handling conflicts within their team.
Nurse Mitchell is the Assistant Director of Nursing at Magnolia Long-Term Care Facility. It has been brought to his attention that staff nurses on the west wing are unhappy with their assignments. Nurse Mitchell meets with the nurses to discuss their concerns and possible resolutions. He explains to the nurses that the team's primary concern is patient-centered teamwork and the delivery of high-quality care. After meeting with the nurses and determining which nurses are better suited to care for specific patients, Nurse Mitchell updates and distributes new nursing assignments.
Nurse Mitchell exercised the principle of autonomy by initiating communication with the nursing team and trying to find ways to resolve their issues and concerns. He was not required to change the assignments. However, his willingness to listen to his staff and adjust assignments with patient care at the center of his decisions shows genuine concern for his staff as well as the patients, which promotes employee satisfaction and retention.
Strong nursing teams require strong nursing leadership. Nurse leaders must understand the importance of their role and how their leadership impacts teams and patient care. The following are a few examples of what could happen if there is a lack of autonomy in nurse leadership.
Nurse leaders set the tone for how teams collaborate. If they fail to exercise authority in decision-making and establishing means of effective, respectful communication, it could result in poor collaborative efforts, negatively impacting patient outcomes, interdisciplinary relationships, and organizational order.
Nurse educators impact nursing students and current nurses on many levels. Implementing the ethical principle of autonomy in nursing education is vital for several reasons, including the following.
• Nursing Students Learn Autonomy by Their Educators’ Example: Nurse educators teach nursing students how to conduct themselves in practice. They teach the ethical principles of nursing, including autonomy, in theory, and then demonstrate them in clinical settings.
• Autonomy in Nursing Education Promotes Independence While Supporting Teamwork: Although nurse educators work with a level of independence or autonomy, their actions impact everyone on the nursing team. Nurses and nursing students observe how nurse educators handle situations and learn to engage in the same behaviors in nursing care.
Nurse educators apply autonomy in several ways. Whether they establish class schedules, assign clinical rotations, or arrange for continuing education classes for staff at healthcare facilities, applying autonomy in nursing education is essential.
Mrs. Williams is a nurse educator working at a local university school of nursing. She primarily works with fourth-year students. Her students are preparing for final clinical skills exams, including demonstrating their ability to make sound clinical judgments and work independently. Mrs. Williams creates clinical lesson plans and schedules assignments for each student. She also works with nursing leadership at various clinical sites to arrange preceptors for students.
Mrs. Williams' ability to work independently and oversee nursing students is an example of practicing autonomy in nursing education. The students who accept assignments and work within their scope of practice as nursing students also practice autonomy, within designated guidelines.
Nursing education is multi-faceted, requiring independent decision-making and critical thinking skills. A lack of autonomy in nursing education could result in the following consequences.
Nurse educators are responsible for arranging clinical contracts and assignments for students. Although the director of nursing may approve or assist with procuring contracts, most instructors have some level of freedom to choose sites where they prefer to work and train students. If nurse educators fail to act responsibly and independently to arrange clinical training sites and assignments, nursing students may not have adequate experiences to meet the requirements for graduation or to sit for the licensure examination.
Autonomy in nursing research relates to the researcher and study participants alike. Nurse researchers make autonomous decisions throughout the course of a study based on study guidelines. They must also respect the autonomy of participants or prospective participants to decide whether to be involved in the research study.
• Recognizing the participant's right to autonomy and respecting their decisions helps ensure willing participation in studies. This is vital, as coercion or manipulation of a potential participant to encourage participation in a study is unethical.
Nurse researchers must develop an understanding of autonomy and how to apply this ethical nursing principle in nursing research.
Nurse Holyfield is responsible for collecting and reviewing surveys from research participant applicants and presenting suitable candidates to her research team. She independently reviews each application and makes notes about the applicants. Nurse Holyfield then schedules interviews with the top prospects from the applicant pool. She provides each applicant with detailed information about the research project, the expected outcomes, and an explanation of the participant's role in the study. Nurse Holyfield gives each applicant the opportunity to ask questions about the study and consider if they wish to continue with the application process.
In this example, Nurse Holyfield demonstrates autonomy in two ways. First, she acts independently to review applications and interview applicants. She then promotes the individual autonomy of the applicants by providing them with pertinent information so they can make an informed decision about participation in the study.
When there is a lack of autonomy in nursing research, the consequences may affect the study, persons conducting the study, and participants negatively. Here are a few examples.
If nurse researchers fail to contribute to the autonomy of study participants or applicants, that means they fail to adhere to the patient/participant’s rights. Violating ethical principles related to one’s right to autonomy can be grounds for disciplinary action, loss of job, or cancellation of a research project.
Beneficence is vital to effective nursing practice. The following are a few reasons why beneficence in nursing practice is important.
• Beneficence in nursing practice ensures the nurse considers the individual circumstances of each patient, recognizing that what is good or helpful for one patient may not be the best option for another.
• The principle of beneficence requires nurses to provide nursing care to the best of their ability, which promotes positive patient outcomes.
Nurses apply beneficence in practice in several ways. The most common acts of beneficence involve simple acts of kindness, such as holding a patient's hand, offering to sit with a loved one, or ensuring privacy for patients and loved ones as they say their final goodbyes.
Mr. Douglas, whose wife has stage IV breast cancer, just learned his wife's condition has worsened. She is not responding to verbal commands and has little response to tactile stimulation. The doctors have advised Mr. Douglas all they can do for Mrs. Douglas at this time is to help make her comfortable. Mr. Douglas is visibly shaken. Nurse Leah demonstrates beneficence when she offers to sit with Mr. Douglas for a while, holding his hand and letting him talk. At the appropriate time, Nurse Leah asks Mr. Douglas if there is anyone he would like for her to call to be with him and his wife, stating she wants to help as much as possible so he can spend time at his wife’s bedside.
Because the principle of beneficence is based upon promoting the welfare of others, a lack of beneficence can be counterproductive, resulting in profound consequences.
If nurses fail to promote the best interest of patients, the risk of safety issues increases. Safety events may include medication errors, not using the most appropriate equipment, or failure to chart vital information.
Nurse leaders should strive to demonstrate beneficence in every aspect of their roles. The following are a few reasons why beneficence in nursing leadership is important.
• Nurse leaders who practice beneficence support efforts to not only improve patient care but also work to ensure safe work environments with leadership support for staff nurses. When nurses feel safe and supported, they are typically happier with their jobs which improves job performance and employee satisfaction rates. It also contributes to higher employee retention rates.
• Beneficence reflects the nurse leader's ability to contribute to the welfare of patients, staff, and organizations. As nurse leaders act with beneficence, everyone within their leadership grasp is positively influenced and benefits from their ethical behavior.
Beneficence in nurse leadership may be a simple act, or it could require a nurse leader to step out of their comfort zone to get things done that benefit patients and staff.
Nurse Mark works in a small community hospital and is the nurse leader in the surgical unit. Despite nurses on his team making maintenance requests, some equipment on the unit needs repair. Nurse Mark also contacted maintenance and received no response. He understands the maintenance department is busy, but he also realizes patient and staff safety is his priority. Because requests for maintenance have been overlooked, Nurse Mark contacts the nursing supervisor and asks if the supervisor will contact the maintenance supervisor for assistance.
In this example, Nurse Mark followed the chain of command, which is a good leadership quality. He made the safety of the patients and staff on the surgical unit a priority and chose to seek help from upper management to help promote the safety and well-being of everyone on his team.
Beneficence is one of the essential ethical principles in nursing. Because beneficence involves promoting the best interests of others, the lack of the principle can have far-reaching, serious consequences. A few examples follow here:
A lack of beneficence in nursing leadership typically leads to a lack of beneficence among all nursing staff, which impacts the level of patient care they provide, often leading to poor outcomes.
Nurse educators are responsible for teaching student nurses and other nurses, preparing them to provide the best possible nursing care. One of the most important lessons nurse educators can teach students is the principle of beneficence, and the most effective way to teach it is by demonstrating it in action.
• Beneficence in nursing education creates an atmosphere conducive to developing strong bonds between students, nurses, and nurse educators. As bonds strengthen, nursing teams become more effective in providing patient care and improving outcomes for patients and the profession.
• Beneficence in nursing education seeks to promote the greater good of students and staff. As nurse leaders demonstrate beneficence, students and staff learn how to apply this ethical nursing principle.
Nurse educators must demonstrate beneficence on behalf of patients, students, and staff. Sometimes, acting with beneficence means making difficult decisions.
Dr. Jones, DNP, is making rounds at a local hospital where students in her nursing program are involved in clinical rotations. Students have been assigned to work with preceptors in various specialty areas, such as Med-Surg, Labor and Delivery, Emergency, and Pediatrics. As Dr. Jones visits the various stations to check on students, she finds several preceptors have allowed the first-year nursing students to work alone, stating it is the best way for them to learn. The school of nursing policy is that all first-year nursing students must be accompanied by a preceptor or nursing instructor any time hands-on patient care is provided.
The Director of Nursing at the hospital is unavailable to discuss the dilemma, and the charge nurse on the floor reports they are too short-staffed to require preceptors to accompany students. Dr. Jones makes the decision to end the clinical day and instructs students to return to campus tomorrow for an update and possible new assignments.
Dr. Jones acted with beneficence on behalf of the patients, her students, and the hospital staff. Allowing students to continue providing care unsupervised could lead to liability against the school, Dr. Jones, the students, and the hospital.
Nurse educators have a great responsibility to prepare nurses to provide high-quality care focused on improving patient outcomes. Acting with beneficence is critical in nursing education. The lack of beneficence, on the other hand, can also have serious consequences.
Nurse educators who fail to demonstrate beneficence send a message that it may not be necessary to promote the well-being of others at all costs. This is false and can lead to compromised patient outcomes.
The nursing code of conduct emphasizes the need to care for patients, offer beneficial services, and do no harm. The ethical principle of beneficence is as important to nursing research as it is to clinical nursing, nursing leadership, and education. Beneficence requires the nurse researcher to weigh the balance of potential risks and benefits and make judgment calls about beginning, continuing, or stopping research based on that assessment.
Although all principles of ethics in nursing are vital, beneficence is especially important in nursing research. Research should benefit individuals and society. However, no matter how beneficial research is to society, it should never be more important than the safety of patients and participants.
Researchers must place more emphasis on the safety and well-being of research participants than the potential effects the results could have on society.
Nurse Brown is working on a nursing research project involving four participants. At the midpoint of the research project, two participants experience unexpected negative effects. Although the other two participants show no significant changes or complications, the risk to participants at this point seems greater than the potential benefits. Therefore, Nurse Brown consults with her research team and chooses to conclude the study until sufficient data is gathered and a new plan is developed.
Beneficence is perhaps the most important of the ethical principles in nursing research. Beneficence in nursing research operates with the understanding that it is unethical to involve research participants or patients in any type of research that is not expected to demonstrate benefits to patients and/or society. Lack of beneficence on the part of nurse researchers could result in the following consequences.
If it is determined that nursing research is being conducted without the expectation of beneficial results, a research organization could lose funding. Loss of funding may be temporary until the goals and anticipated outcomes are more clearly defined. In some cases, funding may be withdrawn permanently, especially if there is evidence that positive outcomes were never anticipated.
Fidelity addresses the nurse’s responsibility to be honest and loyal in their relationships with others. The following are a few reasons fidelity in nursing practice is important.
• In nursing practice, fidelity supports fulfilling professional commitments and being trustworthy.
• Fidelity in nursing is associated with more positive patient outcomes, increased patient satisfaction scores, and more trusting relationships.
Nurses demonstrate the ethical principle of fidelity by meeting the reasonable expectations of their role and the nursing profession. Simple acts such as following up on medication or treatments or delegating a job to appropriate staff are ways to show fidelity in nursing practice.
Mr. Grayson is a patient at an inpatient rehabilitation center following left knee surgery. Following physical therapy this morning, Mr. Grayson complained of increased pain and asked the nurse for pain medication. Nurse Michaels administered pain-relieving medicine as per the physician's order at 1:20 p.m. and told Mr. Grayson she would check on him in an hour. At 2:15 p.m., Nurse Michaels returned to Mr. Grayson's room to evaluate the effectiveness of the pain medication and verify if he requires any other assistance.
Nurses are in a unique position to create an atmosphere of trust where patients feel safe and cared for and can make this happen by being open and honest and delivering quality patient care. Solid nurse-patient and interprofessional relationships are built upon a foundation of trust and confidence, which are basic characteristics of fidelity. Lack of fidelity in nursing practice can result in serious consequences. Here are a few examples of the consequences of lack of fidelity in nursing practice.
Patients often feel vulnerable and unsure of who they can trust or depend on. Failure to demonstrate fidelity in nursing leaves patients questioning whether the nurse is dedicated to their care or has their best interests at heart, negatively impacting nurse-patient relationships.
Nurse leaders impact every aspect of patient care in every healthcare setting. A few reasons nurse leaders must practice fidelity include the following.
• It is no secret that subordinates tend to follow the behavioral patterns of their leaders. Therefore, nurse leaders should strive to create an acceptable model of behavior for other nurses to follow.
• When nurse leaders demonstrate fidelity, it helps strengthen relationships with patients, families, team members, and other healthcare professionals.
An excellent way for nurse leaders to show fidelity is to fulfill commitments associated with their role. As nurse leaders fulfill commitments, patients, staff, and interdisciplinary colleagues typically consider them dependable and trustworthy.
Charge Nurse Victoria was recently assigned to lead a nursing team at her hospital. To her surprise, she learned two nurses on her team were classmates and graduated from her nursing class with her.
When making morning rounds, one of the patients asked to speak to Nurse Victoria privately. The patient reported that his nurse did not give his morning medication and that she was rude every time she entered his room. He asked for a new nurse. Nurse Victoria discovered the nurse in question was one of her former classmates. Despite her care for the nurse on her staff, Nurse Victoria was obligated to provide fair patient care in the most responsible way. She discussed the situation with the nurse and stated another nurse would take over the patient's care.
Fidelity in nursing leadership requires leaders to promote competent patient care in the most honest, fair, and responsible way possible. Although she could have told the patient she would make sure his medications were given on time and that the nurse would be more cheerful, that response could have left the patient guarded, which would have been counterproductive. Instead, Nurse Victoria assessed the situation as a whole and made the appropriate judgment call.
Lack of fidelity in nursing leadership can have significant effects on patients, nurses, healthcare organizations, and the profession of nursing. The following are a few examples of consequences of lack of fidelity in nursing leadership.
Fidelity means demonstrating honesty and integrity. When nurse leaders lack those qualities, they may be viewed as unreliable or unprofessional and lose credibility with their team and among peers.
Fidelity in nursing education is of utmost importance. A few reasons fidelity in nursing education is important are listed below.
• Nurse educators play an integral role in developing desired characteristics in nursing students and nursing staff through staff development. Practicing fidelity gives students and staff a positive model upon which to base their own practices.
• Fidelity involves promoting all ethical principles of nursing and promoting positive patient outcomes. When nurse educators act with fidelity, they create an atmosphere conducive to learning and implementing good nursing practices in those they teach.
One of the best ways to demonstrate fidelity in nursing education is to teach students the importance of promoting patient autonomy. If students realize how patient autonomy impacts decision-making and nursing care, they soon realize that it is wise to be supportive of that right, which is an act of fidelity. Nurse educators are instrumental in helping students learn this.
Nurse Joseph is working with a small group of students at a local long-term care facility. One of the students is concerned about a patient who has been given a poor prognosis related to colon cancer. The student feels it is important for the patient to try any means necessary to prolong his life, despite doctors saying the only option is to keep him comfortable.
Nurse Joseph talks with the student and reiterates the importance of the patient's right to choose what care, if any, to pursue. He explains that if the patient is competent to make decisions, it is the nurse's job to be loyal and supportive and to continue providing competent, efficient care.
It is essential to have fidelity in nursing education. The principle is based on the nurse’s obligation to be faithful to their professional promises and responsibilities. A lack of fidelity in nursing education can result in consequences like the following.
Patient care requires the collaborative efforts of everyone on the healthcare team. If nurse educators fail to promote fidelity among students and staff, it can cause conflicts, resulting in difficult interprofessional relationships. Nurses can promote better relationships between themselves and other healthcare team members by acting with fidelity. The stronger the relationships between nurses and other team members, the higher the chances of improved patient outcomes and employee satisfaction.
Fidelity is an important aspect of nursing research. It is the research principle concerned with building trusting relationships between nurse researchers and research participants. Everything nurse researchers do impacts clinical nursing, nursing leadership, and nursing education, making the need for fidelity paramount.
Research participants entrust themselves to the researcher. This trust creates an obligation for the nurse researcher to safeguard the participant and their welfare throughout the research period. The best way to apply fidelity in nursing research is to be honest and open with participants.
Nurse Kayla is the lead nurse researcher working on a new project. As the time to initiate the study begins, she meets with participants to discuss the goal and anticipated outcomes for the study. Nurse Kayla understands the importance of informed consent and discusses known and potential risks associated with the research, and explains her role in ensuring her commitment to their care, demonstrating fidelity to the prospective participants. She also discusses the fact that some risks remain unknown, as this is new research, and there are no previous studies to base conclusions upon.
Lack of fidelity can negatively impact all aspects of nursing research. Some of the consequences nurse researchers may experience due to lack of fidelity include the following.
When nurse researchers lack fidelity, participants or prospective participants can lose confidence in them and their ability to provide safe, effective care.
The ethical nursing principle of justice is centered on achieving and maintaining equity, obligation, and fairness in nursing by applying moral rules, principles, and standards. It is crucial for nurses to understand the impact justice has on nurse-patient and interprofessional relationships. When nurses apply justice in clinical practice, patients feel valued and are typically more compliant with care, improving patient outcomes. Justice also reflects the level of fairness and impartiality expressed by employers, impacting the way nurses and other healthcare team members feel about their jobs and their employers.
Applying justice in nursing practice means treating patients fairly. Fairness means providing the same quality of care for all patients.
Nurse Brooks is working in the after-hours pediatric clinic. Two families arrived within a few minutes of one another. One family has a fifteen-month-old son with a severe rash and cough. His parents report he has had an elevated temperature for the past eight hours. The second family has three children suspected of being exposed to COVID. None of the children is currently symptomatic. Nurse Brooks must decide which patient to treat first and what protocol to follow.
Some people may think that fairness would be for Nurse Brooks to see the children potentially exposed to COVID first. Nurse Brooks understands the importance of preventing the spread of COVID. However, the three children who may have been exposed are asymptomatic. Therefore, she takes the family to an isolation room to await triage and the physician. She then takes the fifteen-month-old patient to an examination room, gets all his vital signs and health history, and notifies the physician the child is ready to be evaluated.
In this situation, Nurse Brooks understood the importance of reducing the risk of possible COVID exposure but also realized the children were asymptomatic. Conversely, the fifteen-month-old patient had a fever, rash, and a cough, which warranted immediate attention.
It is important for nurses to understand how to apply justice in nursing practice. It is equally important to know the consequences which could arise if there is a lack of justice in nursing. Here are a few examples of what could happen if nurses do not apply justice in their practices.
Justice in clinical practice involves acting fairly and requires nurses to utilize critical thinking and decision-making skills. Without utilizing those skills to implement justice, it is possible that treatment for patients requiring priority care could be delayed. In some cases, delay of treatment could result in dire consequences for the patient and the nurse.
It is especially vital for nurse leaders to treat the nurses on their teams with fairness and impartiality. Nurses who feel they are as equally valued by their leaders as others on their team feel appreciated and tend to work well with others. Further, staff nurses often mimic the behavior of their leaders. When nurse leaders demonstrate justice within their roles, the nurses they lead usually do, as well.
Justice in nursing leadership can take many forms. For instance, nurse leaders make decisions about schedules, patient assignments, and work to resolve conflicts within their teams.
Nurse Collins is the RN, nurse leader in the Medical-Surgical unit. The med-surg unit typically staffs ten nurses per shift. In addition to making daily nurse assignments and ensuring proper nurse-patient ratios, Nurse Collins is responsible for reviewing requests from nurses for time off work. Two nurses have made formal requests for a week off for vacation. Consequently, the nurses have asked for the same week off. Like other hospitals and healthcare facilities nationwide, there is a shortage of nurses at Nurse Collins' facility, making it difficult to approve vacation for two nurses at the same time.
To be fair, Nurse Collins reviews both requests. She speaks to each nurse privately to tell them another nurse has requested the same vacation time and asks if they have an alternate date that will work for them. This is her attempt to be fair and allow the nurses to find a solution. Because neither nurse wants to change their vacation date, Nurse Collins must decide whose request to approve. The nurses have the same amount of experience and have worked at the facility for the same length of time, meaning neither has seniority. However, one nurse turned her request in for consideration two days before the other. With no other information to consider and neither nurse willing to change their request, Nurse Collins made the impartial decision to approve the request she received first.
Lack of justice in nursing leadership can be detrimental to the success of nursing teams and healthcare organizations and can negatively impact patient and organizational outcomes. Here are a few examples of the consequences of lack of justice in nursing leadership.
Nurses who feel like their leaders value others more than them or believe their leaders make unfair decisions typically have a poor outlook on their job. These negative feelings can affect the whole team resulting in poor morale. This dissatisfaction leads to lower-quality care, poor patient outcomes, and higher rates of employee turnover.
Nurse educators must provide adequate education to nursing students to help them understand the concept of justice and develop ways of implementing this ethical principle in practice. Students must learn to promote justice in contemporary healthcare while caring for diverse patient populations.
Nurse educators apply justice in several ways. They must first demonstrate fairness and impartiality when dealing with students, such as when making clinical assignments, grouping students for class work, and the way they interact with students' individuality.
One of the most influential methods nurse educators use to apply justice in nursing education is to use mock scenarios and laboratory intensives. In these situations, students interact with one another in a supervised environment, allowing them to act out planned scenarios and giving feedback on how to improve their judgment, critical thinking, hands-on skills, and the way they demonstrate ethical nursing principles.
Ms. Bayles is reviewing ethical principles in nursing with second-year nursing students. Today, she has separated the class into groups, with some acting as patients and others acting as staff nurses. The group of "patients" is comprised of male and female students from diverse ethnic and religious backgrounds. Two of the students in this group are openly members of the LGBTQ population.
Ms. Bayles gathers the group of students acting as nurses, gives a mock report, and then asks each "nurse" which "patient(s)" they prefer to care for. She asks the students to write down the patient they want to care for and give an explanation of why they chose that patient. After gathering the student's requests, she assigns patients without reading the requests.
At the end of class, Ms. Bayles reads each student nurse's request and their reason for choosing the patient they wanted. She then gives the students an opportunity to discuss how justice may or may not have been served if the students were assigned the patient they chose. They also discuss how Ms. Bayles' decision to assign patients without input from the nurses demonstrated justice, as there were no conditions for care, no partiality, and no opportunities to deny care based on the student nurse's opinions.
The lack of justice in nursing education can negatively impact students, nurse educators, nursing schools, and the healthcare facilities that host students and later employee graduates. Here are a few consequences that could result.
Perhaps the most profound consequences of the absence of justice in nursing education relate to how nursing students perform in the clinical setting during and after graduating. If nurse educators do not teach justice and demonstrate the principle in the classroom and in clinicals, students may lack the ability to apply justice themselves. Until they learn the importance of justice and how to effectively apply the principle in their practices, they may find it difficult to establish good nurse-patient relationships or to work well within a team.
Justice is a crucial ethical principle in nursing research. This principle requires the nurse researcher to be fair to research participants. One of the biggest obstacles to utilizing the principle of justice in nursing research is knowing how to select appropriate research participants based on populations. For example, the mentally ill, the elderly, and prisoners are considered vulnerable and should not be used simply because researchers may have convenient access to them.
It is essential for nurse researchers to carefully choose study participants. Anyone from a vulnerable population or whose health history contradicts the reason for the study should not be included.
Nurse Hillman is screening applications for potential participants in a new research study focused on the effectiveness of a new cardiac medication. Ten people applied to participate in the study. Nurse Hillman may choose six participants.
As she reviews applications, Nurse Hillman finds one applicant is seventy-nine years old and has no family. Another applicant was recently discharged from an inpatient psychiatric unit due to complications of paranoid schizophrenia. Seven applicants have little or no significant health history other than cardiac-related issues. The final applicant has no history of any health issues. That applicant answered the screening questionnaire and included a statement about her need to "earn some money as a guinea pig" to help pay for college.
Nurse Hillman demonstrates justice in nursing research by first eliminating the two applicants from vulnerable populations, the seventy-nine-year-old applicant and the applicant who was recently treated in the psychiatric unit. She also declines the applicant who wants to earn money for college, as this client has no significant health history. Nurse Hillman then schedules one-on-one interviews with each of the remaining applicants to determine those who best meet the criteria for the study.
While there are consequences for the lack of any of the ethical principles in nursing, the consequences of lack of justice can be significant. Here are a few examples.
Nurse researchers must choose targeted participants based on the type of research they are conducting. If researchers use participants because of their ease of access instead of carefully considering each applicant and choosing the most appropriate, it could raise questions as to the validity of the participant pool.
Nonmaleficence in nursing is a vital part of safe, effective, and high-quality patient care. Intentionally exercising nonmaleficence helps the nurse ensure every possible effort is made to protect patient safety and improve patient outcomes.
Nonmaleficence in nursing may include measures such as withholding a medication until a patient’s allergies are confirmed, stopping a medication that is causing adverse reactions, or discontinuing a treatment strategy that seems to be causing more harm than good to the patient.
Nurse Adam received an order to administer Sumatriptan to his patient, Mrs. Elliott, for the treatment of migraines. When Nurse Adam asked Mrs. Elliott if she had ever taken Sumatriptan, she reported she had never tried the medication and stated, "Let's try it. The only medicine I'm allergic to is Azulfidine." Nurse Adam recognizes Azulfidine as a sulfa-containing drug and knows that Sumatriptan also contains sulfa. He asks Mrs. Elliott to describe the type of reaction she has when taking Azulfidine. Mrs. Elliott reports that when she took Azulfidine, she experienced a severe sunburn-like rash and tightness in her chest and throat. With this information, Nurse Adam chooses to hold the Sumatriptan and notify the physician of her sulfa-allergy and request an alternative non-sulfa-containing medication.
Nurse Adam demonstrated nonmaleficence by acting in the best interest of Mrs. Elliott. With the knowledge he had of her severe allergic reaction to a sulfa drug previously, had Nurse Adam administered the new medication, he would be held accountable for any adverse events.
If nonmaleficence is lacking in nursing practice, it can result in dire consequences affecting patients, their loved ones, nurses, and the profession. Here are a few examples of what happens when there is a lack of nonmaleficence in nursing.
Nonmaleficence is based on the principle of preventing harm. When nurses fail to practice nonmaleficence, the risk of medication errors and other safety risks increase.
While all nurses must practice nonmaleficence in practice, it may be easy to overlook the importance of this ethical principle in the nursing leadership role. Nevertheless, it is vital for nursing leaders to demonstrate nonmaleficence in their roles. The principle of doing no harm applies to our actions toward patients and peers. For nursing leaders, this also encompasses the way we relate to the nurses in our charge.
• Nurse leaders may demonstrate nonmaleficence by removing risks to safe work environments, which helps staff feel more at ease in the performance of their duties.
• Nonmaleficence in nursing leadership is instrumental in promoting strong interprofessional relationships based on goals to serve the greater good of patients and staff.
Nonmaleficence in nursing leadership is not only demonstrated in the way we care for patients and our expectation for the nurses on our team to do the same, it also includes implementing measures to protect the nurses we lead. Nurse leaders must implement measures to promote the safety and well-being of nurses to reduce the risk of harm and should never intentionally cause harm to another.
Nurse leaders can be very influential, and that influence can be positive or negative, depending on the leader's behavior. If nurse leaders lack nonmaleficence in their practices, it can cause severe issues and dire consequences.
If nursing leadership has a lack of nonmaleficence, it is likely every member of the team will be affected. Whether other nurses demonstrate the same behavior or simply avoid addressing the issue, it still creates issues related to patient care and outcomes.
Nurse educators must demonstrate desirable behavior in the classroom and in clinical settings. Promoting an attitude that supports nonmaleficence is of utmost importance. Here are a few reasons why nonmaleficence in nursing education is vital.
• Nonmaleficence in nursing education promotes the delivery of high-quality patient care and supports any action by the nurse to ensure patient safety and well-being.
• Nurse educators who act with nonmaleficence are excellent role models for how to put patient needs first without causing harm.
Acting with the patient's best interest at heart and implementing measures to promote patient safety and prevent harm are at the heart of nonmaleficence. It is essential for nurse educators to demonstrate this behavior to students and staff.
Nurse Wilson is a registered nurse employed in clinical staff development. One of the staff nurses at her facility has asked for guidance on how to administer a new medication the physician ordered for a client. Nurse Wilson is unfamiliar with the medication, so she consulted the pharmacist, who told her the medication is in a trial period and has not yet been proven to be effective. He also states that some serious side effects are associated with the medication.
Based on the information she gathered from the pharmacist, Nurse Wilson decided the medication may not be in the best interest of the patient. She informs the staff nurse she is not comfortable educating about administering a drug that has not been proven effective. She also notifies the nursing supervisor and physician of her findings, requesting the medication order be reconsidered.
Although the physician wrote an order for the medication, Nurse Wilson could not in good conscience be a party to giving the drug to the patient because she felt the risk was too high. Her refusal to take part in the education and administration of this drug at this time also protected the staff nurse who came to her for guidance. This is one way to demonstrate nonmaleficence in nursing education.
Nonmaleficence is one of the most important ethical principles in nursing and is closely linked to all other ethical principles. It is crucial for nurse educators to understand the risks associated with a lack of nonmaleficence and to make those risks clear to the students and nurses they teach.
In nursing research, nonmaleficence assumes no harm will come to any research participant as a result of participating in the research study. While all research studies have the potential to cause harm, nonmaleficence ensures no intentional harm will come to any participant.
• Nonmaleficence is important in nursing research as it involves a conscientious act on the part of the nurse researcher to ensure participant safety throughout the study.
• Practicing nonmaleficence in nursing research creates a positive reputation for the research team, which can have a positive impact on future research endeavors.
The principle of nonmaleficence is based on the concept of doing no harm. It is every nurse's responsibility to demonstrate this ethical nursing principle. Although all nursing research has the potential to cause some degree of harm, nurse researchers must identify the risks and determine the extent to which participants may be affected. They must also determine if a study should continue, be stopped, or never start at all.
Nurse Phillips is the head nurse researcher at a local research center. As she reviews data related to a scheduled research study, Nurse Phillips must determine the category of risk the study falls under and ensure it is safe to proceed.
After careful consideration of all available data, Nurse Phillips discovers some data indicate risk of permanent damage while other data suggest certainty of permanent damage. Although data also suggests some benefits are likely, the risk of permanent damage to participants outweighs the chance of benefit. Therefore, Nurse Phillips concludes the study is not safe and cancels the research study.
The lack of principles of ethics in nursing, especially nonmaleficence, can carry dire consequences in nursing research. The following are a few examples of what could happen if nurse researchers do not practice nonmaleficence.
Some nursing research is considered highly questionable, even if it has the potential to create benefits. Nonmaleficence in nursing research ensures that nurse researchers act in the best interests of the participants, causing no intentional harm. A lack of nonmaleficence could result in research studies that cause permanent damage to participants.
Although implementing veracity may feel a little overwhelming, especially in difficult patient situations, it is an essential ethical principle in nursing. Here are a few reasons why demonstrating veracity is so important.
• Veracity creates a bond of trust between patients and nurses. It helps bind and strengthen nurse-patient relationships, which are essential in developing treatment plans and establishing attainable goals.
• Veracity in nurses helps promote patient autonomy. Honesty between nurses and patients allows patients to make informed decisions about their care, which is the right of every competent patient.
Veracity in nursing practice requires the nurse to tell the truth in every situation, regardless of how others may respond to that truth.
Mr. Douglas has congestive heart failure and lung cancer that has metastasized to his spine. The doctor came to his room to explain the severity of his condition and told Mr. Douglas they had tried all possible treatments and his life expectancy is less than six months. The doctor recommends hospice at home.
After the doctor leaves, Mrs. Douglas questions the nurse stating, "As soon as we get him home, the hospice people will take good care of him. He will be better in no time, right?" The nurse understands that Mrs. Douglas is grasping for hope and wants the nurse to give her something to cling to. However, the principle of veracity demands the nurse to explain what the doctor said to Mrs. Douglas without giving her false hope.
Although nurses may wish to withhold all or part of the information to help ease a patient or loved one, it is crucial to avoid that. Even with the best of intentions, a lack of veracity in nursing practice can cause more problems than good.
When nurses are dishonest with patients and family members, it creates barriers to effective communication, which complicates patient care even more.
Nurses count on nurse leaders to be honest and forthcoming with them about all issues related to patient care or other pertinent information affecting their roles. It is vital for nurse leaders to grasp the need for veracity and implement it in every way possible.
• Veracity in nursing leadership helps establish trusting nurse-nurse leader and interprofessional relationships.
• Nurse leaders who act with honesty and integrity usually experience higher employee morale and job satisfaction rates within their teams, leading to decreased nurse turnover.
Nurse leaders can positively impact patients, nurses, and their organizations by always demonstrating veracity.
Nurse Brister is the primary nurse leader for a large outpatient clinic located within the university hospital. The outpatient clinic includes several sub-clinics that each employ five to ten nurses. Nurse Brister announced to his staff during a staff meeting that he plans to meet with the nursing administration and seek allocation of funds to improve the outpatient facility. Several of the clinics have old furniture and have not been cosmetically updated for several years. So, this announcement made the nurses happy.
Despite being told the administration would likely deny his request for funds, Nurse Brister typed a proposal and asked for an appointment with the hospital administrator and chief financial officer. He presented his request and made a cordial argument as to how the updates could be a positive change for the hospital. After considering the request, the administration approved a plan to allocate funds to update the clinic.
After being discouraged about approaching administration, Nurse Brister could have simply told his staff he was unable to secure an appointment with them. However, his word to his staff meant more than the risk of being denied a request. This is an excellent way for a nurse leader to demonstrate honesty toward their team members.
Lack of veracity in nurse leadership can cause challenges at every level of the organization. Here are a few examples of consequences of lack of veracity.
If staff nurses feel they cannot trust their leaders, they are less likely to develop strong relationships, which could impact patient care and organizational outcomes.
Veracity in nursing education is vital to the development of ethically strong nurses. Here are a few reasons why it is an important ethical nursing principle.
• Nurse educators who act with honesty and integrity are instrumental in cultivating those behaviors in student nurses and staff nurses.
• Veracity in nursing education encourages students to approach any situation with honesty, facing the consequences, good or bad, and learning how to overcome challenges.
Nurse educators can demonstrate veracity in a number of ways. The following is an example of how a nursing instructor may apply veracity in a clinical setting with students.
Mrs. Adams is the nursing instructor supervising students on the Medical-Surgical unit at a local hospital. After students complete assignments and are dismissed to go home, Mrs. Adams remains at the hospital to discuss the next day’s clinical assignments with the nursing supervisor.
The nursing supervisor expresses concerns about one of the students stating she feels the student “may not make it” in the program. She asks Mrs. Adams’ opinion about the student.
Mrs. Adams responds to the nursing supervisor by assuring her that each student in the clinical rotation has strengths and weaknesses. She tells the nursing instructor she is aware of which students need more hands-on skills development and who may need coaching to develop better communication skills, etc. She does not discuss a student by name, but thanks the nursing supervisor for her input and agrees to pay special attention to any student who needs help to succeed.
Lack of veracity can be detrimental to the success of nursing students, staff, and healthcare organizations. The following are a few consequences associated with a lack of veracity in nursing education.
If nurse educators do not teach the need for veracity in patient care, students may fail to exercise veracity, negatively impacting relationships with patients, nursing staff, and instructors.
The principle of veracity in nursing research highlights the obligation of the nurse researcher to be honest about the research project. The following are some reasons veracity in nursing research is vital.
• Veracity in nursing research gives investors and prospective participants the opportunity to make decisions about the research and their level of involvement based on facts, not assumptions.
• Nurse researchers who practice veracity are more likely to be respected, making future research opportunities easier to procure.
Veracity in nursing research is vital for the success of any research project. In nursing research, its veracity involves several aspects.
The research team at ABC Research Lab wishes to conduct a study on patients with paranoid schizophrenia. The team develops a question upon which they wish to base their research. They discuss criteria for research participants, meet with applicants, and ensure informed consent. The team also meets with investors to describe the nature of the research and anticipated outcome. They answer questions and present evidence to support their proposal.
By being open and honest with everyone involved with the proposed research project, nurse researchers allow each person or group to make an informed decision about their involvement before moving forward.
Lack of veracity in nursing research, like the lack of other ethical nursing principles, can result in unpleasant consequences, including the following.
• Lack of veracity in nursing research undermines one’s respect for autonomy, which leaves prospective participants feeling as though their wants, needs, or concerns are not important.
Even the most experienced nurses face challenges related to ethical principles in nursing. Identifying challenges and knowing how to overcome them is key to nursing success. The following are a few of the most common challenges you will face when you apply the seven ethical principles in nursing featured in this article, along with suggestions for how to overcome them.
Autonomy vs. Beneficence is one of the most common challenges related to ethical principles in nursing. Autonomy deals with respecting the patient's wishes, while beneficence means doing what is good and right for the patient. Both principles are important and should be upheld. The challenge arises when the patient's wishes and what the nurse feels is best for the patient do not agree.
Legal precedents declare patient autonomy is the most important ethical principle between autonomy and beneficence. The only time exceptions to this rule apply is if the patient is a minor or lacks the ability to make informed decisions. If the patient's wishes conflict with what medical professionals feel is in the patient's best interest, nurses and other healthcare workers should make every effort to educate the patient and ensure his understanding of the implications of their decisions. However, if the patient is competent and of legal age, his wishes must be upheld.
Veracity is the ethical nursing principle associated with truthfulness. Although it is appropriate to be completely honest with patients, it is not uncommon for nurses to face issues that make them question if withholding information may be the better option.
Nurses are obligated to be honest with patients, even if the outcome of truthfulness leads to distress or sadness. It may be easier to approach difficult conversations or situations if you have a charge nurse with you. Also, if the patient has a family member or loved one who can be present with them, it may make it easier for them to deal with the situation.
Autonomy deals with the patient's right to make decisions for himself, based on his own wants or needs. Challenges to patient autonomy may arise related to informed consent if the nurse is concerned that a patient or their family has not been properly informed about a treatment or procedure or that they do not understand the information provided.
Nurses can overcome this challenge by asking the patient and/or family questions about the education they received and offering them opportunities to ask questions and clarify any information. The nurse should ensure the patient understands details of the treatment plans, benefits and risks, and expected outcomes. This allows the patient to maintain a sense of autonomy while the nurse ensures the patient has been properly informed.
Fidelity is an important aspect in developing and maintaining strong nurse-patient and interprofessional relationships. Nurses may face challenges with fidelity for several reasons. For example, if the nurse promises to follow up or check on a patient and they are suddenly transferred to another department unless proper follow-through occurs, the patient can feel neglected.
If you give your word to do something for a patient, family member, or team member, it is best to keep your word if possible. However, if circumstances are beyond your control, you can still uphold fidelity by notifying you're the person of your situation. You may need to tell a patient you have been reassigned, but assure them that the next nurse will be in to follow up with them.
Nurses demonstrate nonmaleficence by selecting nursing interventions that cause the least harm while achieving the most beneficial outcomes. In some situations, implementing appropriate interventions may border on compromising the patient’s right to privacy. For example, if a patient poses a threat to himself or others, the nurse’s priority is to ensure the safety of the patient and others. If the patient does not give consent to share his information, the nurse faces the dilemma of choosing between nonmaleficence and the patient’s right to privacy.
Nurses must weigh the benefits against the risks of any nursing intervention. If the patient or others are at risk due to unsafe conditions, the principle of nonmaleficence demands that nurses place the safety and the community first.
Acting with a high level of ethical integrity is vital to the success of every nurse, which is why we have addressed the question, “What are the 7 main ethical principles in nursing and why they are important?” Throughout this article, we have discussed 7 main ethical principles in nursing, why they’re important, and examples of how they are applied in the four main areas of nursing. Developing an understanding of these principles and applying them to practice can help promote higher-quality patient care, improve patient outcomes, reduce employee and patient turnover, and further the profession.
Darby Faubion BSN, RN
Darby Faubion is a nurse and Allied Health educator with over twenty years of experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels. Because of her love of nursing education, Darby became a test-taking strategist and NCLEX prep coach and assists nursing graduates across the United States who are preparing to take the National Council Licensure Examination (NCLEX).
