5.2 Review of Ethical Principles

Ethical nursing practice is a crucial part of nursing care in any subspecialty. But the care of patients experiencing mental health disorders is unique in several respects. First, the therapeutic aspect of care is strongly based in the trusting relationship between the nurse and the patient. Second, people with mental health disorders have been exploited, marginalized, and subject to inequalities in healthcare services. The possibility of being held against their wishes can lead to suspicious and defensive behaviors. And finally, nurses are in the position of judging what outcomes are best for the patient, a position of great responsibility that demands self-reflection. ^[1] The nurse’s primary ethical obligation is patient autonomy.^[2] Based on autonomy, patients have the right to be informed about treatments and to ask questions. They have the right to refuse nursing care and medical treatment.

Beneficence

Beneficence is defined by the ANA as, “the bioethical principle of benefiting others by preventing harm, removing harmful conditions, or affirmatively acting to benefit another or others, often going beyond what is required by law.”^[3] When caring for patients with mental health disorders, nurses implement beneficence when advocating for evidence-based treatment or taking extra time to work with an anxious patient.

Nonmaleficence

Nonmaleficence is defined by the ANA as, “the bioethical principle that specifies a duty to do no harm and balances avoidable harm with benefits of good achieved.”^[4] A classic example of doing no harm in nursing practice is reflected by nurses checking medication rights three times before administering medications. In this manner, medication errors can be avoided, and the duty to do no harm is met. An example of nurses implementing nonmaleficence in mental health care is ensuring that patients are not harmed by adverse effects of psychotropic medications (such as lithium toxicity or metabolic syndrome). Nurses maintain their knowledge of what is harmful and good through continuing education.

Justice

Justice is defined by the ANA as, “a moral obligation to act on the basis of equality and equity and a standard linked to fairness for all in society.”^[5] The principle of justice requires health care to be provided in a fair and equitable way. 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. Nurses have a social contract to “provide compassionate care that addresses the individual’s needs for protection, advocacy, empowerment, optimization of health, prevention of illness and injury, alleviation of suffering, comfort, and well-being.”^[6] The Affordable Care Act of 2010 was intended, in part, to provide healthcare access to previously disadvantaged individuals.

Fidelity

Role fidelity is defined as being responsible for providing competent nursing care. An example of role fidelity in nursing is remaining up-to-date with evidence-based practice and implementing effective mental health interventions.

Veracity

Veracity means telling the truth. An example of veracity in health care is informed consent. Nurses ensure that clients have a good understanding of the benefits and risks of a prescribed procedure or psychotropic medication.

Ethics Competencies

Nurses use a patient-centered, care-based, ethical approach to nursing care that focuses on the specific circumstances of each situation. This approach aligns with the foundational nursing concepts of holism and caring in a nurse-patient relationship rooted in dignity, respect, kindness, and compassion.^[7] The American Nurses Association (ANA) designates Ethics as the first Standard of Professional Performance in Nursing: Scope and Standards of Practice, stating, “The registered nurse integrates ethics in all aspects of practice.”^[8] See the following box for competencies associated with the ANA’s Ethics Standard of Professional Performance.

American Nurse Association Code of Ethics

The American Nurses Association Code of Ethics for Nurses is an ethical standard that guides nursing practice and ethical decision-making. It states, “Individuals who become nurses are expected to adhere to the ideals and moral norms of the profession and also to embrace them as a part of what it means to be a nurse. The ethical tradition of nursing is self-reflective, enduring, and distinctive. A code of ethics makes explicit the primary goals, values, and obligations of the profession.”^[10].

The Code of Ethics for Nurses contains ten provisions. Each provision contains several clarifying or “interpretive” statements. Read a summary of the nine provisions in the following box.