There are five principles to ethical nursing. The first principle, nonmaleficence, or do no harm, it is directly tied to a nurse’s duty to protect the patient’s safety. This principle dictates that we do not cause injury to our patients. A way that harm can occur to patients is through communication failures. These failures can be intentional or as a result of electronic or human error. Failing to convey accurate information, giving wrong messages, and breaking down of equipment, can cause harm to patients.
Some of these communication problems may certainly occur whether a patient is at a neighborhood clinic or 500 miles away, but distance and high reliance on electronic technology make close examination of communication and ethical issues vital. Examples of questions that need further investigation include: What type of back-up exists for equipment failure? What work can and cannot be delegated? The principle of nonmaleficence is considered before new treatments are tried on patients. We ask ourselves, and then patients and families ask us, “Can this harm the patient? We should ask this same question before we initiate new practices for nursing? While legal and financial issues are routinely discussed, ethical issues are not. Unless open discussion of ethical issues occurs, the harm to patients may not be clear until nurses are practicing. The second principle is beneficence and is at the heart of everyday nursing practice. Each of the following forms of beneficence requires taking action by helping to prevent harm, removing harm and promoting good.
The principle of beneficence may bring attention to ethical issues when there is conflict between what is good between nurses and patients, between patients and organizations, between patients themselves. Differences that may have ethical implications include: financial reimbursement, approved services, different laws on reporting sexually transmitted diseases or abuse, and protocols on who nurses can accept orders. While most agree in principle that a patient’s good comes before the organization’s or nurse’s good, nurses often confuse what is good for the patient with what the nurse believes is good for the patient.
The third principle is autonomy; it deals with the ability to practice as a nurse and also it refers to the patient being able to make the decisions they want on their own. The issue is what constitutes good for a patient without infringing on the patient’s autonomy or letting the patient come to serious harm. The fourth ethical principle is justice; it means giving each person or group what they are due. It can be measured in terms of fairness, equality, need or any other criteria that is material to the justice decision. In nursing, justice often focuses on equitable access to care and on equitable scarce resource allocation.
The fifth ethical principle relates to privacy and confidentiality. Privacy belongs to each person and it cannot be taken away from that person unless he/she wishes to share it. Confidentiality means that the information shared with other persons will not be spread abroad and will be used only for the purposes intended. A patient’s sharing of private information imposes a duty of confidentiality on health care providers. That duty means providers will share information only on a need-to-know basis. More patients equal more health care providers, administrators, regulatory agencies and financial decision makers with a need to know.
When telenursing is added to this, and more nurses are practicing across state lines, a potential ethical problem presents itself. There already exists hesitancy for patients to share information with health care providers; too many reported breaches of confidentiality have appeared in the media. “High risk” patients with HIV or AIDS, genetic diseases, or mental illnesses may feel particularly vulnerable. As a result, patients are limiting information they share with health care providers, protecting privacy at the cost of impairing their own health.
These are the five ethical principles that have been presented; nonmaleficence, beneficence, autonomy, justice, and privacy/confidentiality. These principles can help nurses to examine the ethical practices in nursing. Nonmaleficence goes hand-in-hand with beneficence in that you do no harm but also do what is right. Autonomy and justice are bound in the way that when a patient, whether it will help or harm, makes a medical decision it must be honored. Privacy and confidentiality will always be used together due to their ability to be used almost interchangeably.