Nursing Ethical Principles

Why This Matters

Ethical principles aren't just abstract philosophy—they're the decision-making framework you'll use every single shift. When a patient refuses a life-saving treatment, when resources are limited, when family members want information the patient hasn't authorized you to share, these principles guide your actions. You're being tested on your ability to identify which principle applies in complex scenarios and justify nursing interventions based on ethical reasoning.

Understanding these principles means recognizing that they often compete with each other. A patient's autonomy might conflict with your duty of beneficence; veracity might create tension with non-maleficence. The NCLEX loves scenarios where you must prioritize one principle over another—so don't just memorize definitions. Know how each principle shapes nursing action and when one principle takes precedence.

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Patient-Centered Decision Making

These principles place the patient at the center of care decisions, recognizing their inherent right to participate in and direct their own healthcare. The underlying mechanism is respect for persons as rational agents capable of self-determination.

Autonomy

• Patient's right to self-determination—this means accepting decisions that conflict with medical recommendations, as long as the patient has capacity
• Informed decision-making requires that patients receive complete, understandable information before making choices
• Capacity assessment is essential; autonomy applies to competent patients, not those with impaired judgment due to medical conditions

Informed Consent

• Three required elements: disclosure of information, patient comprehension, and voluntary agreement without coercion
• Nurse's role involves verifying understanding and witnessing consent—physicians obtain consent, nurses ensure patients truly grasp what they're agreeing to
• Ongoing process, not a one-time signature; patients can withdraw consent at any point during treatment

Respect for Human Dignity

• Intrinsic worth of every person regardless of diagnosis, socioeconomic status, or personal choices
• Cultural humility requires recognizing and honoring each patient's unique values, beliefs, and preferences in care planning
• Compassionate presence means treating patients as whole persons, not cases or room numbers

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Duty to Protect and Promote Well-Being

These principles define the nurse's obligation to actively benefit patients while preventing harm. They reflect the fiduciary nature of the nurse-patient relationship—patients trust nurses to act in their best interest.

Beneficence

• Positive duty to act in ways that promote patient health, comfort, and well-being—not just avoiding harm, but actively doing good
• Risk-benefit analysis requires weighing potential benefits of interventions against possible negative outcomes
• Advocacy role means speaking up for patient needs and ensuring care plans prioritize patient welfare

Non-Maleficence

• "Primum non nocere" (first, do no harm)—the foundational obligation underlying all nursing interventions
• Risk assessment involves identifying potential harms before acting, including medication side effects, procedural complications, and psychological distress
• Continuous evaluation of care practices ensures that interventions remain appropriate as patient conditions change

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Trust and Professional Relationship

These principles establish the foundation of therapeutic nurse-patient relationships through honesty, reliability, and protection of sensitive information. Trust is the mechanism that enables patients to be vulnerable and share information essential for their care.

Veracity

• Truthfulness in all communications—patients have the right to accurate information about their diagnosis, prognosis, and treatment options
• Therapeutic honesty balances complete disclosure with sensitivity to timing and emotional readiness
• Foundation for trust—deception, even with good intentions, undermines the therapeutic relationship and patient autonomy

Fidelity

• Keeping promises and commitments—if you tell a patient you'll return in 10 minutes, you return in 10 minutes
• Professional loyalty means following through on care plans and advocating consistently for patient needs
• Reliability builds trust—patients depend on nurses who do what they say they'll do

Confidentiality

• HIPAA compliance is both legal requirement and ethical obligation—share protected health information only with authorized individuals
• Need-to-know basis governs information sharing; not everyone on the healthcare team requires access to all patient details
• Breaches destroy trust and can cause tangible harm through discrimination, relationship damage, or psychological distress

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Fairness and Professional Responsibility

These principles address the nurse's obligations to society, the profession, and equitable treatment of all patients. They recognize that nursing occurs within systems that can perpetuate or challenge injustice.

Justice

• Fair and equitable distribution of healthcare resources, time, and attention across all patients regardless of personal characteristics
• Advocacy for access means identifying and addressing barriers that prevent vulnerable populations from receiving care
• Distributive justice requires difficult decisions when resources are scarce—allocation should be based on need, not bias

Accountability

• Answerable for actions and outcomes—nurses must be prepared to explain and justify their clinical decisions
• Professional standards provide the benchmark against which nursing practice is measured
• Continuous competence through ongoing education ensures accountability to patients who trust nurses' expertise

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Quick Reference Table

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Self-Check Questions

1. A competent patient refuses a blood transfusion that would save their life. Which two principles support honoring this decision, and how do they work together?

2. You discover a colleague has been accessing patient records for people not in their care. Which ethical principle has been violated, and what is your accountability obligation?

3. Compare and contrast beneficence and non-maleficence using the example of administering pain medication with sedating side effects.

4. A family member demands to know their adult child's diagnosis. The patient has not authorized disclosure. Which principle guides your response, and how does it relate to veracity when the family member asks, "Is it serious?"

5. During a disaster with limited ventilators, how does the principle of justice guide allocation decisions, and how might this conflict with beneficence toward individual patients?