In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to:
- Recognize ethical dilemmas and take appropriate action
- Inform client/staff members of ethical issues affecting client care
- Practice in a manner consistent with a code of ethics for registered nurses
- Evaluate outcomes of interventions to promote ethical practice
Ethics, simply defined, is a principle that describes what is expected in terms of right and correct and wrong or incorrect in terms of behavior. For example, nurses are held to ethical principles contained within the American Nurses Association Code of Ethics. Ethics and ethical practice are integrated into all aspects of nursing care.
The two major classifications of ethical principles and ethical thought are utilitarianism and deontology. Deontology is the ethical school of thought that requires that both the means and the end goal must be moral and ethical; and the utilitarian school of ethical thought states that the end goal justifies the means even when the means are not moral.
The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.
- Justice is fairness. Nurses must be fair when they distribute care, for example, among the patients in the group of patients that they are taking care of. Care must be fairly, justly, and equitably distributed among a group of patients.
- Beneficence is doing good and the right thing for the patient.
- Nonmaleficence is doing no harm, as stated in the historical Hippocratic Oath. Harm can be intentional or unintentional.
- Accountability is accepting responsibility for one's own actions. Nurses are accountable for their nursing care and other actions. They must accept all of the professional and personal consequences that can occur as the result of their actions.
- Fidelity is keeping one's promises. The nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner.
- Autonomy and patient self-determination are upheld when the nurse accepts the client as a unique person who has the innate right to have their own opinions, perspectives, values and beliefs. Nurses encourage patients to make their own decision without any judgments or coercion from the nurse. The patient has the right to reject or accept all treatments.
- Veracity is being completely truthful with patients; nurses must not withhold the whole truth from clients even when it may lead to patient distress.
The most commonly occurring ethical issues and concerns in healthcare include the allocation of scarce resources and end of life issues.
Bioethics is a subcategory of ethics. Bioethics addresses ethical concerns like those that occur as the result of advancing science and technological advances. Some of the most common, current bioethical issues revolve around stem cells, cloning, and genetic engineering.
Recognizing Ethical Dilemmas and Taking Appropriate Action
Nurses have the responsibility to recognize and identify ethical issues that affect staff and patients. For example, providing nursing care for clients undergoing an abortion may raise ethical and moral concerns and issues for some nurses; and some patients may be affected with a liver transplant rejection because donor livers are not abundant enough to meet the needs of all patients who request it.
Many hospitals, medical centers and other healthcare facilities have multidisciplinary ethics committees that meet as a group and resolve ethical dilemmas and conflicts. Nurses should avail themselves to ethicists and ethical committees within their facility when such ethical resources and mechanisms are present in order to resolve ethical concerns and ethical dilemmas.
In addition to utilizing these resources, the nurse can take appropriate actions when faced with an ethical dilemma by understanding and applying the ethical guidelines provided in the American Nurses Association's Code of Ethics, the American Medical Association's Code of Ethics, the World Medical Association's Code of Ethics, the American Nurses Association's Standards of Care and Standards of Practice, American Nurses Association's position papers such as that which describes the ethical use of narcotic analgesics at the end of life even if this medication hastens death, state board of nursing declaratory statements, and the International Nurses Association's Code of Ethics.
The steps of the ethical decision making process, like the problem solving process, are:
- Problem Definition. Problem definition is the clear description of the ethical dilemma and the circ*mstances revolving around it.
- Data Collection. During this phase of the ethical decision making process includes a review of ethical codes, published evidence based practices, declaratory statements, professional position papers and the professional literature.
- Data Analysis. The collected data is then organized and analyzed.
- The Identification, Exploration and Generation of Possible Solutions to the Problem and the Implications of Each. All possible solutions and alternatives to resolve the ethical dilemma are explored and evaluated.
- Selecting the Best Possible Solution. All potential solutions and alternatives are considered and then the best and most ethical action is taken.
- Performing the Selected Desired Course of Action to Resolve the Ethical Dilemma
- Evaluating the Results of the Action. Like the evaluation phase of the Nursing Process, actions to resolve ethical issues are evaluated and measured in terms of their effectiveness to resolve the ethical dilemma.
Informing the Client and Staff Members of Ethical Issues Affecting Client Care
Nurses have the responsibility to identify ethical issues that affect staff members and patients; and they also have the responsibility to inform staff members and affected clients of ethical issues that can and do affected client care. For example, providing nursing care for clients undergoing an abortion may raise ethical and moral concerns and issues for some nurses; and some patients may be affected with a liver transplant rejection because donor livers are not abundant enough to meet the needs of all patients who request it.
Although a rare occasions, a patient may, at times, ask you to do something that is not ethical. For example, a patient may ask a nurse to assist in their suicide at the end their life or they may inquire about another patient in terms of their diagnosis. When something like this occurs, the nurse must inform the client that they cannot do it for ethical and legal reasons.
Clients may also need information about ethics can affect the care that they choose or reject. For example, a client may ask the nurse about whether or not it is permissible ethically and legally to reject CPR at the end of life or to take pain medications even if it hastens their death.
Practicing In a Manner Consistent with The American Nurses Association's Code of Ethics and Other Ethical Codes
As previously discussed, nurses are expected to apply the ethical guidelines provided in the American Nurses Association's Code of Ethics, the American Medical Association's Code of Ethics, the World Medical Association's Code of Ethics, the American Nurses Association's Standards of Care and Standards of Practice, American Nurses Association's position papers such as that which describes the ethical use of narcotic analgesics at the end of life even if this medication hastens death, state board of nursing declaratory statements, and the International Nurses Association's Code of Ethics.
The American Nurses Association's Code of Ethics, for example, contains elements that emphasize and speak to advocacy, collaboration with others, the maintenance of client safety, the dignity and worth of all human beings, the prohibition of any discrimination, accountability, the preservation of patient rights, such as dignity, autonomy and confidentiality, and the provision of competent, safe and high quality care of nursing care.
Evaluating the Outcomes of Interventions to Promote Ethical Practice
As with all other aspects of nursing care, the outcomes of the interventions to promote ethical practice are evaluated and measured.
Some of the evaluation criteria that can be used to determine and evaluate the outcomes of the interventions to promote ethical practice can include one or more of the following:
- Is staff knowledgeable about ethics and ethical practice?
- Is staff effectively applying ethical principles to their daily practice?
- Are clients and staff fully knowledgeable and informed about ethics and ethical practice?
- Were all appropriate professional resources, including codes of ethics and the professional literature, employed to resolve the ethical dilemmas?
RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT:
- Advance Directives
- Advocacy
- Assignment, Delegation and Supervision
- Case Management
- Client Rights
- Collaboration with Interdisciplinary Team
- Concepts of Management
- Confidentiality/Information Security
- Continuity of Care
- Establishing Priorities
- Ethical Practice(Currently here)
- Informed Consent
- Information Technology
- Legal Rights and Responsibilities
- Referrals
SEE – Management of Care Practice Test Questions
- Author
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Alene Burke, RN, MSN
Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members.
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Ethics in nursing is a crucial aspect of providing quality care to patients. Nurses are expected to demonstrate their knowledge and skills of ethical practice in various ways, including recognizing ethical dilemmas, informing clients and staff members of ethical issues affecting client care, practicing in a manner consistent with a code of ethics, and evaluating outcomes of interventions to promote ethical practice.
Ethical Principles in Nursing
Ethics in nursing is guided by several principles that nurses must adhere to. These principles include:
- Justice: Nurses must distribute care fairly, justly, and equitably among a group of patients.
- Beneficence: Nurses must do good and act in the best interest of the patient.
- Nonmaleficence: Nurses must do no harm, whether intentional or unintentional.
- Accountability: Nurses are responsible for their own actions and must accept the consequences.
- Fidelity: Nurses must be faithful and true to their professional promises and responsibilities.
- Autonomy: Nurses must respect the patient's right to make their own decisions without judgment or coercion.
- Veracity: Nurses must be completely truthful with patients and not withhold information, even if it may cause distress.
These ethical principles serve as a guide for nurses in their daily practice and decision-making process [[1]].
Ethical Issues in Healthcare
Healthcare often presents ethical dilemmas and concerns. Two commonly occurring ethical issues include the allocation of scarce resources and end-of-life issues. The allocation of scarce resources refers to the challenge of distributing limited resources, such as organs for transplantation, in a fair and just manner. End-of-life issues involve decisions regarding life-sustaining treatments, palliative care, and the ethical considerations surrounding these choices [[1]].
Recognizing Ethical Dilemmas and Taking Appropriate Action
Nurses have the responsibility to recognize and identify ethical issues that affect both staff members and patients. For example, providing nursing care for clients undergoing an abortion or dealing with organ transplant rejections due to limited availability can raise ethical concerns. In healthcare facilities, multidisciplinary ethics committees are often established to resolve ethical dilemmas and conflicts. Nurses should utilize these resources and mechanisms to address ethical concerns and dilemmas. Additionally, nurses can refer to various ethical guidelines and codes of ethics, such as the American Nurses Association's Code of Ethics, to guide their decision-making process [[1]].
Informing Clients and Staff Members of Ethical Issues Affecting Client Care
Nurses have a responsibility to inform both staff members and affected clients about ethical issues that can impact client care. For example, if a patient requests assistance in their suicide or asks about another patient's diagnosis, the nurse must inform the client that they cannot fulfill these requests due to ethical and legal reasons. Nurses should also provide information to clients about how ethics can affect the care they choose or reject, such as decisions regarding CPR at the end of life or the use of pain medications that may hasten death [[1]].
Practicing in a Manner Consistent with Ethical Codes
Nurses are expected to practice in a manner consistent with ethical codes, such as the American Nurses Association's Code of Ethics. These codes emphasize advocacy, collaboration, client safety, dignity, autonomy, and the provision of competent and high-quality care. Nurses should familiarize themselves with these codes and apply them to their daily practice [[1]].
Evaluating Outcomes of Interventions to Promote Ethical Practice
As with all aspects of nursing care, the outcomes of interventions to promote ethical practice should be evaluated and measured. Evaluation criteria may include assessing staff knowledge about ethics and ethical practice, the effective application of ethical principles in daily practice, and the level of knowledge and understanding of ethics among clients and staff members. Additionally, the use of appropriate professional resources, such as codes of ethics and professional literature, should be considered when resolving ethical dilemmas [[1]].
In conclusion, ethics plays a vital role in nursing practice. Nurses must recognize ethical dilemmas, inform clients and staff members of ethical issues, practice in accordance with ethical codes, and evaluate the outcomes of interventions to promote ethical practice. By adhering to ethical principles and guidelines, nurses can provide safe, high-quality care to their patients.
