Learning Objectives
By the end of this section, you will be able to:
- Recall the key ethical principles related to nursing practice
- Outline the role of the nurse’s own moral philosophy in providing care to clients
Nursing and ethics are intertwined and inseparable; even student nurses encounter situations where they must make ethical decisions. The personal values that a person has, perhaps based on their religious or moral perspectives, influence any ethical decisions they may have to face. Ethical values differ from laws. Rather, they are universal rules of conduct that provide a practical and moral basis for identifying appropriate actions, intentions, and motives. Taking into consideration the complexity of mental health nursing, ethical issues abound. Nurses must deliver quality care and make quick decisions while juggling the client, families, and other health-care professionals. Health-care workers must make constant judgments, staying true to their own morals and values while staying within the laws and ethical standards that govern practice. To complicate matters, clients will likely have had different life experiences shaping their own moral compasses. Nurses must manage to balance their own moral philosophies with those of their clients. Being open-minded and understanding of the moral, religious, and philosophical differences will allow the nurse to provide holistic and ethical care for their clients.
The concept of nursing ethics has been around since the 1870s and became more formal in the 1950s with the ANA Code of Ethics (Haddad & Geiger, 2023). It was not until the 1970s, however, that ethics began being taught in the nursing curriculum. Over the years, nursing ethics has evolved from a generalized list of responsibilities to a guide for nurses in their decisions and conduct. By 2015, the Code “address[ed] individual as well as collective nursing intentions and actions; it require[d] each nurse to demonstrate ethical competence in professional life” (American Nurses Association [ANA], 2015, p. vii).
Ethical Principles
Ethical principles are used to define right from wrong action. Although there are many ethical principles that guide nursing practice, foundational ethical principles include respect for autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), fidelity (keep promises), and veracity (tell the truth).
Autonomy
The ethical principle of autonomy recognizes each individual’s right to self-determination and decision-making based on their unique values, beliefs, and preferences. The American Nurses Association (ANA) defines autonomy as the ability to make decisions with one’s own free choice, if competent to do so. One of the nurse’s primary ethical obligations is to uphold client autonomy. Based on this principle, clients have the right to give informed consent and to refuse nursing care and medical treatment. In mental health care, there may be barriers to maintaining autonomy if the client is a danger to themselves or others or lacks capacity. A person may be declared incompetent and therefore not have the ability to make their own decisions. In this case, the surrogate decision-maker can act to respect the autonomy of the person by acting on the person’s previously expressed wishes. In the case of a person who is under involuntary commitment, they cannot leave the inpatient setting, but they can have a part in making decisions on what they choose to participate in. They also have the right to refuse medications or treatments as long as they are not a danger to themselves or others.
Beneficence
The concept of beneficence is the act of helping others or taking them out of harm’s way, doing good for others beyond that which is required by law. When caring for clients with mental health disorders, nurses practice beneficence when, for example, they advocate for evidence-based treatment for clients’ mental health and make sure that client does not come to any harm.
Nonmaleficence
Opposite of beneficence, nonmaleficence is an ethical idea that dictates that providers not cause any detriment to clients. A classic example of doing no harm in nursing practice is reflected by nurses checking medication rights three times before administering them. Another example in mental health-care nursing is ensuring that clients are not harmed by adverse effects of psychotropic medications.
Justice
The ethical principle of justice is a moral duty to treat everyone in society in a fair and equitable manner. The principle of justice requires that health-care providers care for all people in a fair and equitable way, providing treatment and care for all those who need it. Nurses provide quality care for all individuals with the same level of fairness despite their personalities or characteristics, such as financial status, cultural beliefs, religion, gender, or sexual orientation. An example of a nurse using the principle of justice in mental health-care settings is ensuring provision of quality care to all clients, even those who do not have the cognitive ability to communicate their needs.
Fidelity
Role fidelity means responsible for providing competent nursing care and being loyal to the profession and to clients. An example of role fidelity in nursing is remaining up-to-date with evidence-based practice and implementing effective mental health interventions.
Veracity
The ethical principle of veracity simply means telling the truth. An example of veracity in health care is providing informed consent. Nurses ensure that clients have a good understanding of the benefits and risks of a prescribed procedure or psychotropic medication.
The Role of the Nurse’s Moral Philosophy in Ethical Caring
Nursing care entails that the nurse must see the client as a person, forming relationships, and taking responsibility. Caring can only happen with person-to-person contact. Lack of caring creates a disconnect that leads to poor client satisfaction and leads the client to feel like an object or like they are not a participant in their care. Leininger (1988) states that care is “one of the most essential and powerful forces to help people recover from illnesses, maintain health, and survive” (p. 11). Watson (1985) saw caring as a science, developed from a humanistic philosophy, which is at the core of nursing. Hildegard Peplau felt that nurses create a shared experience with a client that empowers the client to be engaged in their care (Nursing Theory, 2023).
A nurse’s beliefs, attitudes, and values, together with their reasons for entering the field, become their nursing philosophy. A person’s moral background, perhaps based in part on their religious values, leads to the ethical decisions that they make. In general, people take their moral feelings and beliefs and act on them to make ethical decisions and actions. People can learn to make critically thought-out ethical decisions, but it takes training and practice.
The ANA Scope and Standards of Practice, most recently revised in 2022, is updated on a routine basis. Wrapped into the scope of practice is the code of ethics. Since 2004, the scope of practice includes specific competencies that are measurable for each standard of professional practice. In terms of ethics, within the “what” involves advocacy for the care of individuals, groups, families, communities, and populations. The “why” involves outcomes and the obligation to society to care. Relationships and obligations are themes that run through both the scope of practice and the code of ethics and bind them together.
Link to Learning
The Code of Ethics for Nurses with Interpretive Statements is a guide for nurses that assists with ethical dilemmas and decision-making.