Ethical Principles in Nursing

Let’s consider a situation where a nurse is taking care of a patient who’s terminally ill. According to the principle of autonomy, the nurse would respect the patient’s decision to refuse further treatment, even if the nurse personally believes more could be done. At the same time, the principles of non-maleficence and beneficence compel the nurse to alleviate any suffering and improve the patient's quality of life. All of these actions should be carried out while preserving the patient’s dignity and privacy, under the confidentiality principle.

Misconception: Many believe the principle of non-maleficence means healthcare providers should avoid high-risk procedures to protect the patient from harm. Clarification: In reality, non-maleficence doesn't imply avoiding treatments or procedures that carry risks. Instead, it compels healthcare professionals to ensure that the potential benefits outweigh the risks involved.

Misconception: There is often a misunderstanding that the principle of justice means treating every patient the same way. Clarification: Justice isn't about offering identical care but about acknowledging the distinct needs of individual patients and treating them fairly according to those needs.

Misconception: Some believe fidelity is about being loyal to one's healthcare institution. Clarification: While institutional loyalty is important, fidelity in nursing refers primarily to the promise of providing competent, safe, and reliable patient care.

Scenario: A 16-year-old patient is admitted to the hospital after a severe car accident. The patient's injuries are life-threatening, and an immediate blood transfusion is required to save their life. However, the patient's parents refuse the treatment, citing religious beliefs prohibiting blood transfusions. The healthcare team is left in a complex ethical dilemma.

Respect for Autonomy: Despite the urgent need for a lifesaving treatment, healthcare professionals must respect the parents' wishes, aligning with the principle of autonomy. However, this poses an ethical conflict as the patient's life is at risk.

Beneficence, Non-maleficence and Justice: The nursing team is confronted with the principles of beneficence (doing good for the patient) and non-maleficence (doing no harm), in direct opposition to respect for parental autonomy. Justice adds a further layer of complexity – the fair treatment of all patients, including respecting religious beliefs, is hindered by the need to provide emergency medical treatment.

Fidelity and Veracity: Fidelity prompts the nursing staff to maintain their commitment to saving lives, and veracity provides the moral obligation to communicate honestly with the parents about the patient's condition and the risks involved without a blood transfraction.

Confidentiality: The patient's medical condition or critical medical decisions would not be shared with anyone outside the healthcare team and immediate family, maintaining confidentiality.

Scenario: A patient suffering from a terminal illness chooses not to share their disease prognosis with their family, fearing it will cause them emotional distress. The nurse is torn between respecting the patient’s autonomy, the belief in veracity demanding transparency, and beneficence nurturing the family’s well-being.

Application of Ethical Principles:

Respect for Autonomy: The nurse is bound to respect the patient's wishes and maintain the truth about the diagnosis from the family, adhering to the principle of respect for autonomy.

Beneficence and Confidentiality: However, the nurse might feel that sharing prognosis details with the family could allow them to provide the emotional support the patient may need, aligning with the principle of beneficence. Yet, breaching the patient's confidentiality is in violation of one of the key ethical principles.

Veracity: Veracity pulls in another direction entirely. The family has the right to be provided with truthful information which is crucial to the principle of honesty in nursing. This ethical principle might coax the nurse to divulge the information with the family.

In these scenarios, nurses must navigate the delicate balance between these principles, drawing upon their professional judgement to make the best possible decision.

Scenario 1: A diabetic patient insists on sticking to their traditional diet rich in carbohydrates, despite knowing the potential harm and increased risk of erratic blood glucose levels. Here, the nurse is torn between promoting nutritional guidelines for diabetes and respecting the patient's autonomy. The patient has the right to make dietary choices, and the nurse, while advising against harmful practices, must respect their decision.

Scenario 2: Consider a patient with terminal cancer who opts out of a proposed treatment plan due to the anticipated pain and discomfort from side effects. In this case, the nurse may feel the treatment could prolong the patient's life or improve their quality of life. Nevertheless, the principle of autonomy requires the nurse to respect the patient's decision.

For instance, when a nurse is faced with a challenging situation involving end-of-life decisions for a critically ill patient, the Code of Ethics becomes a crucial guide. It reinforces the importance of the patient's autonomy and dignity in decision making, highlights the concept of non-maleficence when considering possible pain and suffering, and supports the idea of beneficence through aiming for the overall well-being of the patient.

Suppose a nurse is confronted with a situation where a patient, suffering from a severe mental health disorder, doesn't want their family to be informed about their condition due to fear of stigmatisation. Here, the Nursing Code of Ethics serves as a compass. It advises respect for the patient's autonomy, maintains fidelity by honouring the patient's trust, and upholds confidentiality as confidential information cannot be disclosed without the patient's consent. Notably, the nurse continues to provide empathetic care for the patient and supports them in managing their mental health troubles, thereby showing beneficence.