Ethics is about good morals and doing the right thing according to universal rules laid down by society. It’s about making the right choices in our interactions with other human beings, nature, and our environment, to promote responsible behavior and avoid harm.
In the nursing profession, ethics is about treating people with integrity and dignity. In their day-to-day practice, nurses may come across situations where they are required to make judgment calls that are both morally sound and geared toward the patient’s wishes. To this end, the Code of Ethics for Nurses was designed by the American Nurses Association (ANA) to guide and regulate nursing practice.
What is ethical care in nursing?
Nurses’ primary concern is the wellbeing of their patients. Through their training and experience, registered nurses have acquired responsibility and authority that empowers them to advocate for safe and professional patient care. They may do this in their immediate environment or join up with a team of healthcare professionals to discuss and determine best practice within their clinical setting. Other nurses choose to work in state or government settings where their experience and input are valued in the making of new nursing policies and the amendment of existing ones.
In clinical settings, medical practices, and nursing homes, nurses treat patients with dignity and compassion, respecting the unique attributes of each patient and their choices. Patients have a right to autonomy — to make informed decisions about their healthcare options. Sometimes the choices made by the patient are influenced by cultural or religious beliefs, and these choices should be respected. In cases where nurses are aware of a conflict between sound medical practice and the patient’s wishes, the nurse should point out the consequences of patients’ decisions while retaining respect for the patient and their choices.
Nurses are required to safeguard patients’ personal information and privacy, treating their medical issues with sensitivity and confidentiality.
While caring for people, nurses must look after themselves as well. Ongoing training to ensure that they keep up with improvements in technology and methods of practice, as well as taking care of their personal health is key to a nurse’s ability to care for their patients.
Principles of ethics in medical care
A well-used model for determining ethical principles is the conceptual framework of Beauchamp and Childress, which uses the following four principles as a guideline:
- Autonomy: the patient’s right to choose freely
This is the right of the patient to exercise self-determination, if able to do so. Patients should have autonomy when making decisions that they believe are best for themselves. Often patients’ decisions are based on religious beliefs, and nurses must respect their wishes even when it means that they are rejecting treatment that will be beneficial.
- Beneficence: doing good
Nurses are duty-bound to consider the patient’s best interests and act accordingly. This includes putting up the sidebars on beds, giving medicine promptly, and assisting with tasks that patients are unable to perform on their own, such as bathing and dressing themselves.
- Non-malfeasance: do no harm
Medical professionals avoid actions, regulations, and interventions that are likely to harm residents. This is not always practical, however, in light of patients’ rights to make their own choices regarding the level of medical care they are prepared to accept. They may choose not to take medication or may indicate a desire to be taken off life support. In these cases, nurses’ ethics are challenged, and they are limited to giving advice and perhaps suggesting alternative treatments.
- Justice: ensuring fairness
Justice entails the provision of equal access to medical treatment and benefits for all people. This can apply to individuals, communities, ethnic groups, or people living in rural or underserved geographical locations.
The above four principles provide a framework for medical personnel when making decisions around best practices for treating patients in particular circumstances.
Advocacy of ethical standards in healthcare
Advocating for ethics in healthcare incorporates not only the basic ethical principles but also good medical practice in terms of working conditions, administration, and management in clinical environments. Without job satisfaction and a certain amount of autonomy, nurses are likely to become dissatisfied, and this affects the levels of good ethics in practice.
Nurse practitioners are ideally situated to improve the ethics within their environment as they interact with medical professionals and patients. As an aspiring nurse practitioner, consider an online specialization offered by the bsn to msn programs at Wilkes University, earning a master of science in nursing degree and professional recognition in your particular healthcare environment. In addition to your online studies, assistance with clinical placement helps to ensure that your practical instruction takes place at an approved institution.
Nurses advocate for person-centered care
In clinical and medical practice environments, nurses can advocate for the provision of person-centered care. This is the inclusion of the patient in the participation and decision-making process when it comes to their personal health care. It’s about taking the patient’s wishes into account – their social situations, desires, and values – and treating them with compassion and respect.
Person-centered care requires good communication skills. It is necessary to provide the patient with up-to-date information regarding the status of their health before and during medical intervention so that they may contribute to the decisions around their treatment. Ethical nurses ensure that patients are safe and well cared for. By giving them information and support, nurses can ensure a better chance of a successful recovery.
In addition, enabling people to take charge of their personal healthcare means that there is a greater likelihood of their receiving care promptly, hopefully easing some of the pressure felt by healthcare professionals, and ultimately improving the quality of care.
Anxiety about one’s health can exacerbate the problem, so providing patients with as much information as possible about their situation and giving them options when it comes to the methods of intervention go a long way to relieving their anxiety and improving the outcomes.
From the point of view of the medical professional, listening to a patient as they describe their symptoms and considering their views on how they would like to be treated enables the professional treating the patient to share the responsibility with them and relieves some of the pressure on the individual or team responsible for the treatment. It also enables them to offer a more holistic approach to treatment by including multi-disciplinary therapies such as physiotherapy or massage therapy to aid in the healing process.
Better working conditions for nurses and other personnel
Working under poor conditions will, over time, affect the quality of the work delivered. Nurses can advocate for improved safety and hygiene conditions or better working hours.
When there is a shortage of staff due to illness or leave, nurses are called upon to step in to take the pressure off the team. However, there are limits to how long they can continue putting in extra hours before they, too, experience burnout.
Nurses can advocate for improved conditions by joining professional organizations and through bargaining and union membership. They can also choose to work for a state or governmental organization where they get involved in policymaking and amendments.
Nurses who belong to a union can address issues such as poor working conditions and violence in the workplace. The downside to unions, however, is that it becomes difficult to dismiss incompetent nurses, and as members of a union, they are forced to partake in mandatory strikes without pay. Unions tend to create work environments where seniority takes precedence over competence and creates disparities between nurses and management staff.
Shared governance
Some organizations subscribe to a shared governance model in which management and employees work together to achieve a common goal. It includes the sharing of resources, knowledge around research and evidence-based practices, and responsibility for equipment.
This form of leadership-sharing encourages nurses’ autonomy, improves engagement and collaboration with their teams, and increases their accountability. It enhances job satisfaction, thus improving healthcare and patient outcomes. Shared governance has been shown to improve both staff and patient satisfaction, decrease job turnover and sick leave statistics, and result in cost savings.
When advocating for shared governance, however, nurse practitioners need to be aware that the implementation process can be long and laborious and needs to be introduced to nursing staff in ways that are not going to disrupt their already busy schedules. Getting nurses’ buy-in is an important part of the process.
Advocating for ethical healthcare in communities
The quality and efficacy of healthcare in communities are usually dictated by social determinants such as where people live, their access to education, and their economic status.
Nurse practitioners can open clinics and motivate the establishment of community centers in underserved areas. They have access to various non-profit organizations, such as feeding and housing programs. By addressing the inequalities relating to the above social determinants within communities, nurse practitioners are in effect addressing the justice principle of ethics in their environment. In addition, they advocate for ethics in communities in terms of fair and equal rights to medical care, reducing or eliminating discrimination and inequality in various socioeconomic groups.
Ethics in nursing homes and assisted living facilities
Nursing home environments offer support for elderly patients and those with disabilities, seeing to their needs in terms of bathing and dressing, providing meals, and managing their medication. In a slightly different vein, assisted living (AL) establishments provide long-term accommodation and non-medical care for elderly or disabled people when they are no longer able to look after themselves.
Nursing and assisted living homes have a formal structure that includes administrators, nurses, and caregivers and an informal structure that includes family members and visitors; ethics in these environments affect all concerned.
Given the physical and mental frailties of most of these residents, uncertainty about moral and ethical standards exists on many levels. With the best intentions, wishes expressed by residents or their families often contradict sound nursing practice. Ethical decision-making in these cases needs to consider not only the patient’s or family’s wishes but also the health and frailty of residents. Studies indicate that assisted living facilities tend to focus on the requirements of the family and not necessarily on those of the residents.
Research also indicates that as health care needs escalate, an increasing number of residents take an active part in the management of their own care.
Residents require care but still need to maintain as much of their independence as possible for the sake of their mental and physical health. They require autonomy to exercise their preferences regarding the level of care that they require and the activities that they wish to take part in.
Caregivers, administrators, and nurses are employed to treat all residents fairly and with respect. They consider residents’ best interests and avoid actions, regulations, and medical interventions that are likely to harm residents. Their aim is to promote wellbeing and safety while easing pain and suffering where they exist.
Advocacy and ethics
Registered nurses and nurse practitioners are in an ideal position to advocate for their patients and their own wellbeing. The value of ethical practice in nursing cannot be emphasized enough. Ethical principles begin with leadership in the workplace and ultimately affect the way nurses regard their patients and how they approach their wellbeing.
