17.1 Ethical principles in nursing practice

Ethical principles guide nurses in providing compassionate, patient-centered care. Autonomy, beneficence, non-maleficence, and justice form the foundation of ethical nursing practice. These principles help nurses navigate complex situations and make decisions that prioritize patient well-being.

Nurses face ethical dilemmas that require careful consideration and decision-making. By using structured frameworks and collaborating with healthcare teams, nurses can resolve conflicts while advocating for patient rights. Upholding confidentiality and promoting ethical practices are crucial aspects of nursing care.

Ethical Principles in Nursing Practice

Key ethical principles in nursing

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• Autonomy upholds the right of patients to make their own informed decisions about their healthcare
  • Nurses must respect and support patient autonomy by providing accurate information and allowing patients to make choices without coercion (informed consent)
• Beneficence prioritizes doing good and acting in the best interest of the patient
  • Nurses should prioritize actions that promote the well-being and health of their patients (pain management, patient education)
• Non-maleficence emphasizes avoiding harm to patients
  • Nurses must take steps to prevent or minimize any potential harm that may result from their actions or decisions (medication safety, fall prevention)
• Justice ensures the fair and equitable distribution of healthcare resources and treatment
  • Nurses should advocate for the just allocation of resources and ensure that all patients receive appropriate care regardless of their background or socioeconomic status (access to care, non-discrimination)

Ethical dilemmas and decision-making

• Ethical dilemmas arise when there are conflicting moral principles or obligations
  • Situations involving end-of-life care (withholding or withdrawing treatment)
  • Patient autonomy vs. best interest (refusal of treatment)
  • Resource allocation (prioritizing care during a pandemic)
• Ethical decision-making frameworks provide a structured approach to resolving dilemmas
  • The Four Quadrants approach considers:
    1. Medical indications
    2. Patient preferences
    3. Quality of life
    4. Contextual features
  • The MORAL model involves:
    1. Massaging the dilemma
    2. Outlining options
    3. Reviewing criteria and resolving
    4. Affirming position and acting
    5. Looking back
• Nurses should collaborate with the healthcare team, patient, and family to gather relevant information and perspectives
• The resolution should aim to balance the key ethical principles and prioritize the patient's well-being and rights (shared decision-making)

Nurse advocacy for patient rights

• Nurses have a professional obligation to advocate for their patients' rights and interests
  • Ensuring informed consent (providing clear explanations of procedures and risks)
  • Protecting patient privacy (maintaining confidentiality of health information)
  • Promoting autonomy (respecting patient choices and values)
• Nurses should be familiar with relevant laws, regulations, and professional codes of ethics that guide their practice (Nursing Code of Ethics)
• Advocating for patients may involve speaking up against unethical practices or policies
  • Using appropriate channels to report concerns (chain of command, ethics committees)
• Promoting ethical nursing practice involves ongoing education, self-reflection, and a commitment to upholding moral principles
  • Nurses can serve as role models and mentors to foster a culture of ethical practice within their organization (leading by example)

Strategies for patient confidentiality

• Adhere to the Health Insurance Portability and Accountability Act (HIPAA) regulations
  • Protect patient information from unauthorized access, use, or disclosure (secure storage of records)
  • Use secure communication methods when sharing sensitive information (encrypted email, secure messaging)
• Implement physical and electronic safeguards to maintain confidentiality
  • Keep patient records and documents in locked or password-protected locations (secure filing cabinets, electronic health records)
  • Ensure that computer screens and conversations are not visible or audible to unauthorized individuals (privacy screens, closed doors)
• Limit access to patient information on a need-to-know basis
  • Only share relevant information with healthcare team members directly involved in the patient's care (role-based access)
• Obtain patient consent before sharing information with family members or other parties (release of information forms)
• Educate patients about their privacy rights and the measures in place to protect their confidentiality (patient handbooks, verbal explanations)
• Promptly report any breaches of confidentiality and take corrective actions to prevent future occurrences (incident reporting, staff training)