Summary

5.1 Clinical Judgment and Ethical Dilemmas

• Clinical judgement is guided by ethical guidelines as outlined by the ANA.
• Clinical judgement is based on nursing knowledge, critical thinking, and clinical reasoning which is then used to understand and interpret information related to the delivery of care and how it affects care outcomes.
• The principles outlined in the Nursing Code of Ethics are the foundation that guides nurses to provide high-quality, patient-centered care.
• Common ethical principles include autonomy, beneficence, justice, nonmaleficence, and fidelity.
• Autonomy is an ethical principle that acknowledges a patient has the right to make their own informed decision that should be upheld and respected by the interdisciplinary team.
• Beneficence refers to the nurse’s responsibility to act in their patient’s best interest, the duty to do good, which the ANA defines as “actions guided by compassion.”
• Justice refers to the duty to treat all patients fairly and equally, regardless of social or financial status.
• Nonmaleficence refers to the duty to do no harm, which is a foundational principle of nursing practice.
• Common ethical issues faced by nurses involve topics such as confidentiality, the use of restraints, the maintenance of trust, and a variety of end-of-life issues that may be related to pain control, DNR orders, the use of life support, and the matter of continuing food and fluids.
• The ethical principles outlined by the ANA of autonomy, beneficence, nonmaleficence, and justice are a solid foundation for ethical decision-making. This foundation is a guide to help promote a logical, systematic framework for ethical decision-making.
• The approach to ethical decision-making can follow the steps of the clinical judgment measurement model, which includes recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

5.2 Patient Care and Safety

• The nursing profession is accountable to society.
• Nursing has been named the most trusted profession for 21 years in a row.
• Nurses continue to use strong ethical principles during the delivery of patient-centered care.
• Navigating ethical dilemmas can take a toll on a nurse’s caring nature.
• The ANA’s Code of Ethics for Nurses is the foundation of the nursing profession’s promise to provide and advocate for safe, quality care for all patients and communities.
• The Code of Ethics for Nursing with Interpretive Statements provides a systematic framework to help nurses navigate ethical dilemmas while also helping to preserve a nurse’s caring nature.
• It is a nurse’s duty to maintain confidentiality of all patient information, which includes personal and clinical information in the work setting as well as all venues when off duty.
• HIPAA created national standards to protect patient privacy by prohibiting health information from being disclosed without the patient’s consent or knowledge except in certain situations to ensure continuity of care.

5.3 Ethical Patient Education

• Health education is essential to promote optimal patient outcomes.
• Health education is vitally important to nursing care because it promotes the ability of patients and families to improve their behaviors for optimal self-care.
• The function of teaching in nursing is included in state practice acts and the ANA Code of Ethics for Nurses.
• Nursing care is directed toward promoting, maintaining, and restoring health, preventing illness, and assisting people to adapt to the residual effects of illness.
• It is important to maintain an ethical mindset when providing patient education, to ensure the teaching focuses on what a treatment does and not what the nurse believes.
• Effective health education promotes individual and community wellness and is directly related to positive patient care outcomes.
• Teaching is an integral tool used by nurses to help patients and families adopt effective health behaviors and alter lifestyle patterns that create a predisposition to health risks.
• Patient education that considers health disparities, health equity, cultural and religious differences, and health literacy is a win-win for the patient and the health-care team.
• Benefits of ethical teaching include improving health literacy and health equity, resulting in solid patient outcomes.

5.4 Ethical Challenges in Scope of Practice

• The ANA Code of Ethics for Nurses is the foundation of the nursing profession’s promise to provide and advocate for safe, quality care for all patients and communities.
• The ANA Code of Ethics for Nurses creates unity among nurses to support each other to ensure that nurses can fulfill their ethical and professional obligations.
• There are many ethical dilemmas that can be encountered as a medical-surgical nurse, including issues with provider orders, cultural or spiritual conflicts with patients, end-of-life decision-making, and situations involving social media.
• The hospital ethics committee is the primary source for dealing with ethical issues.
• Ethics committees provide support for health-care professionals when ethical challenges arise during clinical practice and are often consulted by nurses to help guide decision-making when ethical dilemmas are present during health-care delivery.