6 Ethical Principles in Nursing|Critical Analysis for nurses

What are ethical and legal issues?

Ethical issues and legal issues are two distinct but often interconnected aspects that individuals and organizations must address in their daily proceedings while ethical principles in nursing practice are the base of moral ground.

Ethical issues refer to the problems or situations that require a person or organization to decide between alternatives that must be evaluated as right or wrong, ethical or unethical. Ethical issues often arise when the right course of action is unclear or when the interests of different stakeholders conflict.

On the other hand, legal issues refer to situations where the law dictates the course of action. These entail aspects that are governed by established laws and regulations, and failure to adhere to these legal provisions can result in penalties or legal action.

Legal issues usually have a clear course of action as they are guided by written laws and statutes. In many cases, these two types of issues intersect, creating a complex situation where both ethical and legal considerations must be taken into account.

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Differences between ethical and legal issues

When making decisions, individuals and organizations often encounter ethical and legal dilemmas. It is important to consider both aspects and make lawful and responsible choices.

Addressing both dimensions ensures a comprehensive approach to decision-making in different contexts. For example, a business can encounter legal problems if it fails to comply with contractual obligations. This, in turn, raises ethical concerns about trust and responsibility.

Issues	Definition	Nature	Resolution	Examples
Ethical Issues	Ethical issues pertain to moral principles and values that guide human behavior and decision-making. They involve considerations of right and wrong, fairness, and the impact of actions on individuals and society.	Ethical issues are often subjective and can vary based on cultural, religious, and individual beliefs. They involve questions about what is morally acceptable or unacceptable.	Ethical issues are typically addressed through ethical frameworks and moral reasoning, encouraging individuals to make decisions that align with principles of fairness, honesty, and respect.	· Patient confidentiality in healthcare · Environmental sustainability in business practices · Truthfulness and transparency in communication · Fair treatment and respect for diversity in the workplace
Legal Issues	Legal issues involve matters governed by laws and regulations established by a governing authority. These rules are created to maintain order, protect rights, and ensure justice within a society.	Legal issues are more objective and concrete compared to ethical issues. They are defined by statutes, regulations, and court decisions that dictate what is lawful or unlawful.	Legal issues are resolved through legal processes, which may involve courts, regulatory bodies, and enforcement agencies. Legal frameworks provide a structured way to address disputes and enforce compliance with established laws.	· Breach of contract in business · Violation of privacy laws · Criminal activities and their associated penalties Intellectual property infringement

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Ethical issues for nurses

Nurses encounter a range of ethical issues in their daily practice, given the nature of their work in healthcare and the close interactions with patients and their families. Here are some common ethical issues for nurses:

1. Patient Confidentiality

· Nurses must safeguard patient information and maintain confidentiality. Nurses have access to sensitive personal and medical information, and it is their ethical duty to protect this information.
Breaching patient confidentiality not only violates professional codes of conduct but also undermines the trust between the nurse and the patient.

2. Informed Consent

Obtaining informed consent is crucial before any medical procedure or treatment. Nurses need to ensure that patients fully understand the implications, risks, and alternatives before providing consent.

3. Allocation of Resources

Nurses may encounter situations where there are limited resources, such as a shortage of medications, beds, or staff. Ethical challenges arise when determining how to allocate these resources fairly and equitably.

4. Advocacy for Patients

Advocacy is a core nursing role, and nurses may find themselves in situations where they need to advocate for patients’ rights, especially when there are conflicts between patients, families, and other healthcare providers.

5. End-of-Life Care

Decisions regarding life-sustaining treatments, do-not-resuscitate (DNR) orders, and the withdrawal of life support can be ethically complex. Nurses may face dilemmas in providing appropriate end-of-life care while respecting the wishes of patients and their families.

6. Cultural Sensitivity

Providing care to a diverse patient population requires cultural competence. Nurses may face ethical issues related to respecting cultural beliefs, practices, and preferences, and ensuring that care is culturally sensitive.

7. Conflict of Interest

Nurses may encounter situations where personal or financial interests conflict with their professional responsibilities. Managing conflicts of interest and ensuring that patient welfare remains the top priority is essential.

8. Patient Autonomy

Respecting patients’ autonomy involves allowing them to make informed decisions about their care. Nurses may face ethical dilemmas when patients’ decisions conflict with what healthcare providers believe is in their best interest.

9. Whistleblowing

Nurses may witness unethical or unsafe practices within their healthcare institutions. Deciding whether to report such practices, known as whistleblowing, can be ethically challenging due to potential repercussions on the nurse’s career and relationships with colleagues.

10. Professional Boundaries

Maintaining professional boundaries with patients while providing compassionate care is crucial. Ethical challenges may arise when navigating relationships with patients or their families to ensure that care remains patient-centered and professional.

Nurses often rely on ethical frameworks and codes of conduct established by nursing organizations to guide their decision-making in these and other situations.

Open communication, collaboration with colleagues, and ongoing ethical education are vital for nurses to navigate these challenges while upholding the highest standards of patient care.

What are the ethical principles in nursing?

Ethical principles in nursing that are relevant to nursing practice include non-maleficence, beneficence, autonomy, justice, veracity, and fidelity.

Non-maleficence requires nurses to avoid causing harm to clients, while beneficence requires them to act in the best interests of their clients.

Autonomy refers to the right of clients to make decisions about their care, while justice requires that care be provided fairly and equitably.

Non-maleficence
Beneficence
Autonomy
Justice
Veracity
Fidelity

Non-maleficence

Nurses must prevent clients from any harm in their nursing practice. Nurses require doing no act which can cause any injury or harm to their clients and colleagues. This principle is essence of ethical principles in nursing practice.

Beneficence

Beneficence is an act of doing good to others. Nurses are obliged to act for the benefit of their clients. Nurses anticipate and maintain the balance between risks and benefits for their clients. This act is called paternalism in which a healthcare provider works against the wish of the client.
For example, if a diabetic client with a high sugar level asks the nurse for something sweet which is not healthy for the client the nurse will refrain to do so.

Autonomy

Autonomy is an act of respect for someone’s self-determination. Every client has the right to take decisions according to his or her wish.

Justice

Justice is the act of faithful distribution of all the benefits and prevention of all the risks and harms equally throughout the community and clients.

Veracity

The act of telling the truth and refraining from manipulating information and telling lies. Nurses must speak the truth.

Fidelity

Fidelity is an act of fulfilling promises with commitment and loyalty.

What is the ANA Code of Ethics for Nurses?

The nursing profession often adheres to a code of ethics that provides guidance and principles for ethical practice. The specific code of ethics may vary slightly depending on the nursing organization or country. However, one of the most widely recognized and influential nursing codes is the “Code of Ethics for Nurses” developed by the American Nurses Association (ANA) in the United States.

The American Nurses Association (ANA) code of ethics is a comprehensive guide designed to assist nurses in ethical decision-making. It offers a framework for ethical practice, emphasizing the importance of ethical values, commitments, and obligations in the nursing profession.

Here are the 9 provisions of the ANA Code of Ethics for Nurses:

Provision 1: Respect and dignity for all

The first provision of the ANA code of ethics emphasizes the fundamental respect for every individual, regardless of their social or economic status, personal attributes, or nature of health problems. It places the inherent dignity and worth of all individuals at the heart of nursing practice.

Provision 2: Patient as a primary commitment

The second provision requires nurses to prioritize the patient as their primary commitment. This means that the nurse, above all, is committed to the patient’s well-being, safety, and health.
This provision requires a delicate balance between devotion to the patient and respect for the rights of others involved in care.

Provision 3: Advocacy in the patient’s best interest

The third provision outlines the nurse’s obligation to promote, advocate for, and strive to protect the health, safety, and rights of the patient. This includes privacy and confidentiality rights, as well as advocating for patients who are unable or unwilling to advocate for themselves.

Provision 4: Responsibility and accountability for their actions

The fourth provision emphasizes that the nurse bears responsibility and accountability for individual nursing practices and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.

Provision 5: Preserving integrity and maintaining competence

The fifth provision focuses on preserving integrity and maintaining competence in nursing practice. It entails continuous personal and professional growth through lifelong learning, as well as maintaining moral self-respect.

Provision 6: Establishment and maintenance of ethical environment

The sixth provision underscores that nurses participate in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality healthcare. It highlights that nurses are responsible for contributing to an environment that supports ethical practice and respectful communication.

Provision 7: Professional advancement through research

The seventh provision states that nurses must advance their profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. This provision encourages nurses to contribute to their profession beyond their practice.

Provision 8: Collaboration with other healthcare professionals and public

The eighth provision stresses the significance of working together with other healthcare professionals and the public to safeguard human rights, promote health diplomacy, and decrease health inequalities. It urges nurses to extend their responsibility beyond individual patients to the entire society.

Provision 9: Professional organization

The ninth provision of nursing requires nursing associations and their members to uphold nursing values, maintain professional integrity, and integrate principles of social justice into nursing and healthcare policies.

The ANA code of ethics is a crucial resource for nurses that guides their professional conduct and decision-making. Adhering to this code ensures that nurses maintain the highest ethical standards in their practice, which leads to trust, respect, and dignity in all nurse-patient relationships.

What is the ethical dilemma?

An ethical dilemma occurs when a person faces a situation where they have to choose between two or more moral principles that conflict with each other. It is essentially a state of uncertainty or perplexity, especially when it comes to making a decision where one’s actions could potentially violate ethical standards.

This predicament often occurs in professional settings where individuals or groups are faced with a decision that tests their moral compass. For instance, an employee may be asked to perform an action that conflicts with their personal values or principles.

Ethical dilemmas are particularly prevalent in fields such as healthcare, law, and business, where professionals must constantly balance the needs and rights of their clients against their professional responsibilities and the rules of their employers or their profession.

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Many factors can contribute to the ethical dilemma such as religious beliefs, cultural values, and ethnicity. An Ethics Committee is an approach to solving ethical dilemmas within the organizations.

The Ethics Committee is responsible for providing ethical consultation to resolve the ethical dilemma. The crux of an ethical dilemma is the difficult choice between two or more options, none of which resolves the situation in a morally satisfactory manner. This means that no matter what course of action is taken, some ethical principle is compromised.

Thus, the decision-maker must weigh the pros and cons of each option and make the best possible choice considering all factors.

Overcoming an ethical dilemma requires a deep understanding of one’s ethical guidelines, critical thinking skills, and often consultation with others to gain different perspectives.

Every ethical dilemma is unique and there’s seldom a one-size-fits-all solution. Hence, while facing an ethical dilemma can be uncomfortable and challenging, it also offers individuals and organizations an opportunity to reaffirm their ethical framework and strengthen their commitment to conducting themselves with integrity.

What are the most common ethical issues encountered by nurses in clinical practice today?

In the contemporary healthcare landscape, nurses often encounter a range of ethical issues in their clinical practice. These ethical dilemmas can greatly impact patient care and nurses’ professional development. Some of the most common ethical issues encountered by nurses in clinical practice today include:

1. Informed Consent and Refusal

Informed consent and refusal are important ethical and legal issues in nursing practice. Nurses must ensure that clients have sufficient information to make informed decisions about their care and that they are respecting the client’s right to refuse treatment.
To ensure informed consent and refusal, nurses should provide clients with clear and accurate information about their care, including the risks and benefits of treatment. Nurses should also ensure that clients have the opportunity to ask questions and seek clarification about their care.

2. End-of-Life Care

One notable ethical dilemma that nurses frequently face is end-of-life decisions. This issue often arises when patients are in critical or terminal conditions.

Nurses are placed in a challenging position of balancing the patient’s wishes, the family’s desires, and the medical team’s recommendations. They must navigate through these conflicting perspectives to ensure that the patient’s dignity and comfort are maintained and that the principle of ‘do no harm’ is upheld.

3. Patient Autonomy

Another ethical issue prevalent in nursing practice is patient autonomy. Patients have the right to be informed and make decisions regarding their healthcare.

However, there can be instances where patients may not fully comprehend the complexities of their health condition or the implications of their choices, leading to an ethical dilemma for nurses. They must respect their patients’ autonomy while ensuring that they have adequate understanding and are making informed decisions regarding their care.

4. Cultural Diversity

Nurses also face ethical issues related to cultural diversity. In an increasingly multicultural society, nurses must provide culturally competent care. However, certain cultural practices or beliefs may contradict medical advice or standard procedures. In such cases, nurses must tread a fine line between respecting cultural diversity and ensuring optimal healthcare.

5. Patient Confidentiality

Confidentiality is yet another significant ethical issue in nursing practice. Nurses have access to sensitive and private patient information in their line of duty. It is ethically imperative that they maintain the confidentiality of such information.
Breaches can lead to loss of trust, and legal implications and can detrimentally affect the nurse-patient relationship.

Legal issues in nursing

In addition to ethical issues for nurses, nurses are also faced with a range of legal issues that can impact their practice. Nurses must be aware of the laws and regulations that govern their work, as well as the scope of practice for their profession.

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1. Nurse Practice Acts

Nurse Practice Acts is one example of the legal frameworks that impact nursing practice. These acts define the scope of practice for nurses in a particular state or jurisdiction and outline the requirements for licensure and continuing education. These acts are used to regulate nursing practices within the state.
These acts define the educational requirements for a nurse to practice in the state; it distinguishes the nursing practice from medical practices and defines the licensure requirements for the nurses.
All nurses must know the provisions of acts of a particular state in which they practice.

2. Negligence

Malpractice refers to a failure to provide care that meets the appropriate standard of care, while negligence refers to a failure to provide care that meets the expected level of care.

To minimize the risk of malpractice and negligence claims, nurses should ensure that they are providing care that meets the appropriate standard of care and that they are documenting their care appropriately.

Nurses should also be aware of the legal requirements related to informed consent and refusal and should ensure that clients have sufficient information to make informed decisions about their care. The acts of willful omission and willful commission are also known as negligence.

3. Malpractice

Nursing liability and malpractice are also important legal issues in nursing practice that nurses must be aware of. Nurses can be held liable for harm caused to clients if they fail to provide care that meets the appropriate standard of care. Malpractice claims can be costly and damaging to a nurse’s reputation, so it is important to take steps to minimize the risk of such claims.

4. Standard of Care

Standard of care is a set of guidelines that provides the essential principles of nursing care, the client’s expectations about nursing practice, and nurses’ responsibilities according to set standards of care.

5. Controlled Substances

Restricted items by state laws or the federal government such as opioids are kept under strict surveillance. These items are kept under lock and only authorized personnel should have access to them. Inventory of controlled substances is maintained strictly.
These items are properly signed by the administrating person. If a nurse is failed to maintain the proper storage and administration of controlled substances she will be liable for legal proceedings.

Areas of legal risks in nursing practice

1. False Imprisonment

A false imprisonment is an act when a health care provider does not allow a client to leave the health care facility without any legal justification. A client has the right to sign the Leave Against Medical Advice (LAMA) if he is competent to take the decision and refuses the care. Nurses must document the whole incident to avoid form legal allegations. False imprisonment is one of the legal issues in nursing practices.

2. Restraining

The use of restraining devices against the client’s consent is also known as false imprisonment. Four conditions must be tried before using physical restraint.

i. Chemical Restraining:

If the client’s clinical condition allows chemical restraining, it must be applied first for the safety of the client.

ii. One-to-One Nursing Care:

If the client is not fit for chemical restraining, a health care professional must try to calm the client by providing direct nursing care to prevent the client from self-injury and harm.

iii. Provide Family Assistance:

If the client is so aggressive and unable to control by a health care professional and there is a high chance of client self-harm, then ask family members to calm the client and remain with the client.

iv. Physician Discussion and Orders:

If the above three conditions cannot be met, the physician must discuss with the family the need for physical restraint to prevent the client from self-harm. Then physician must document the orders in the client’s medical record.

3. Assault

It is a condition in which a person threatens another person with offensive contact and possible harm. Assault can be physical and verbal. The victim believes that he will be harmed as a result of the threat. Nurses are obliged to refrain from any act which can cause the client’s fear of harm and injury.
For example, if a nurse tells the client “If you will press the call bell again and again I will not give you the medicine.” The nurse is liable for assaulting the client.

4. Invasion of Client’s Privacy and Confidentiality

Client privacy and confidentiality are important ethical issues for nurses and legal issues in nursing practice. Nurses must ensure that they are protecting the privacy and confidentiality of their clients and that they are only sharing client information with those who have a legitimate need to know.
To ensure client privacy and confidentiality, nurses should follow established protocols for storing and sharing client information and should be aware of the legal requirements related to client privacy and confidentiality.
Nurses should also be aware of the risks associated with social media and should avoid sharing client information on social media platforms.

5. Battery

Intentionally touching someone’s body without his or her permission is called the battery. Healthcare professionals are bound to take consent before touching the client. If a health care professional touches the client’s body without his or her permission or verbal consent he will be liable for battery.

6. Defamation

It is a wrong or false communication to damage someone’s dignity, reputation, and respect. Defamation can be verbal and in writing. Verbal defamation is known as Slander and written defamation is known as Libel.

Professional boundaries and relationship in nursing practice

Professional boundaries and relationships are important ethical and legal issues in nursing practice. Nurses must ensure that they are maintaining appropriate boundaries with their clients and that they are not engaging in relationships that could compromise their professional judgment.

To maintain appropriate professional boundaries and relationships, nurses should be aware of the potential risks and benefits of different types of relationships and should avoid engaging in relationships that could compromise their objectivity or judgment.

Nurses should also be aware of the legal and ethical requirements related to professional boundaries and relationships and should seek out support and consultation when faced with difficult situations.

Strategies for addressing ethical issues for nurses and legal issues in nursing

There are a range of strategies that nurses can use to address ethical issues for nurses and legal issues in nursing practice. One important strategy is to stay up-to-date with professional codes and guidelines, as well as the laws and regulations that impact their practice.

Nurses can also seek out continuing education opportunities to improve their knowledge and skills in ethical and legal practice. Many organizations offer free ethics CEUs, which can be a valuable resource for nurses looking to expand their knowledge.

Finally, nurses can seek out support from colleagues and supervisors when faced with difficult ethical or legal dilemmas. Collaboration and consultation can be valuable tool for navigating complex situations and making decisions that are in the best interests of clients.

Conclusion

Non-maleficence in nursing is a key ethical principle that guides nursing practice and is essential to ensuring that clients receive safe and effective care. Nurses are faced with a range of ethical and legal issues in nursing practice, from end-of-life care to client privacy and confidentiality.

By staying up-to-date with professional codes and guidelines, seeking out continuing education opportunities, and collaborating with colleagues and supervisors, nurses can ensure that they are providing care that is aligned with the principles of non-maleficence and other ethical principles in nursing.