Fidelity is the ethical principle in which medical professionals are expected to

Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always … More Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

You do not currently have access to this chapter.

Ethics

Ethics are principles of behavior adopted by a person or organization that elucidate whether conduct is positive and correct or negative and incorrect. For example, a nurse who acts in the health interest of a patient but does so against the patient's wishes may have acted unethically.

Ethical principles contained within the American Nurses Association (ANA) Code of Ethics are a standard by which a nurse may be judged. Ethics and ethical practice are integral to all aspects of nursing care.

The ANA published the first version of the code of ethics in 1950, and the most recent update was published in 2015. The American Nurses Association (ANA) Center for Ethics and Human Rights was established to help nurses navigate ethical and value conflicts common to everyday practice, inherent in life and death decisions, and ever so important during times of social stress. https://www.registerednursing.org/nclex/ethical-practice/#:~:text=Ethics%20and%20ethical%20practice%20are%20integrated%
20into%20all%20aspects%20of%20nursing%20care.&text=The%20ethical%20
principles%20that%20nurses,Justice%20is%20fairness

The ethical principles that nurses must adhere to are: justice, beneficence, non-maleficence, accountability, fidelity, autonomy, and veracity (honesty).

• Justice is fairness. Elements of fairness in all medical and nursing decisions. Nurses must be fair when they distribute care, for example, among the patients in the group of patients that they are taking care of. Care must be fairly, justly, and equitably distributed among a group of patients.
  
• Beneficence is doing good and the right thing for the patient. The ANA defines this as “actions guided by compassion”.
  
• Nonmaleficence is to do no harm, as stated in the historical Hippocratic Oath. Harm can be intentional or unintentional. It is choosing interventions and care that will cause the least amount of harm to achieve and best outcome
  
• Accountability is accepting responsibility for one's own actions. Licensure creates a duty to care for the interests of the client, employer and society and to perform these duties within the scope of the Nurse Practice Act. The nurses is responsible for the professional and personal consequences that occur as the result of their actions.
  
• Fidelity is keeping one's promises. The nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner.
  
• Autonomy recognizes the right of self-determination. As a patient advocate the nurse accepts the client as a unique person who has the innate right to have their own opinions, perspectives, values and beliefs. Nurses enable patients to make an informed decisions without coercion. The patient has the right to reject or accept any or all treatments options.
  
• Veracity is being completely truthful with patients; nurses must not withhold the whole truth from clients even when it may lead to patient distress.

Personal ethics and morals can influence our actions and decision-making, as well as how we perceive the consequences of those actions. In healthcare, personal ethics allow nurses and other professionals to identify moral dilemmas and apply good judgment to their decisions.

The Texas Nursing Practice Act requires nurses to demonstrate “good professional character” (Virtue) an individual is able to consistently conform his or her conduct to the requirements of the Nursing Practice Act, the Board’s Rules and Regulations, and generally accepted standards of nursing practice including, but not limited to, behaviors indicating:

• honesty
  
• accountability
  
• trustworthiness
  
• reliability
  
• integrity

Evidence of good professional character means the individual consistently acts in the best interest of patients and the public in any practice setting, including demonstration that the person is able to:

1. Distinguish right from wrong
   
2. Think and act rationally
   
3. Keep promises and honor obligations
   
4. Be accountable for his or her own behavior
   
5. Practice nursing in an autonomous role with patients, their families and significant others and members of the public who are or who may become physically, emotionally or financially vulnerable
6. Recognize and honor the interpersonal boundaries appropriate to any therapeutic relationship or health care setting; and
7. Promptly and fully self-disclose facts, circumstances, events, errors and omissions when such disclosure could enhance the health status of patients or the public or could protect patients or the public from unnecessary risk of harm.

Code of Ethics for Nurses

The history of the Code of Ethics for Nurses dates back to the Nightingale Pledge written in 1893.
The 2010 American Nurses Association publication, Guide to the Code of Ethics for Nurses: Interpretation and Application, traces the Code of Ethics development to the present day.

“Despite the changes over time in the Code’s expression, interpretation, and application, the central ethical values, duties, and commitments of nursing have remained stable” (Fowler, 2010, p. xiii). The 2010 publication provides a discussion of the code, which was last revised in 2001. (ANA, 2010)

International Council of Nurses Code of Ethics

Four fundamental responsibilities: Beneficence & Nonmaleficence

• Promote health
• Prevent illness
• Restore health
• Alleviate suffering

Respect the following patient rights:

• Autonomy
  
• Altruism
  
• Right to life
  
• Right to be treated with dignity

Maintain standard of personal health and social responsibility

Use judgment regarding individual competence when accepting and delegating responsibility Utility & Duty.

Case #1

What if a nurse wants to date or even marry a patient with whom the nurse has established a nurse/patient relationship and provided care?

Identify the ethical issues that should be considered in relation to the
continuum of professional behavior.

What would make this situation ok versus being a violation of professional boundaries?

Altruism, Nonmaleficence, & Beneficence:

1. What is the length of time between the nurse-patient relationship and dating?
2. What kind of therapy did the client receive?
   a.Short-term e.g. broken limb
   b. Long-term for a chronic condition
3. What was the nature of the nurse's knowledge and how will that affect the future professional relationship?
4. Will the “patient” need therapy in the future?
5. Is there a risk to the patient?
6. Do boundary violations always precede sexual misconduct?
7. Does patient consent or initiation of a sexual relationship make that relationship acceptable?
8. How can a nurse identify a potential boundary violation?

Case #2

Joe" is a 62-year-old building contractor. He had a heart attack on the job and was rushed to the hospital. He was unconscious? His wife arrived and agreed to have a left ventricular assistive device (LVAD) implanted to save his life. When alert, Joe was very quiet and refused to participate in his care. Finally, he stated I didn’t want this device or anything to be done, and “I wanted the machine to shut off”.

Going forward, what should be done for Joe--and his family?
His wife didn’t follow his advanced directives. Joe refused dialysis and all medical and nursing care. He eventually died. The case was referred to the ethics committee for review. Joe had the right to refuse care. But what about his wife? Did she behave ethically?

Case #3

Melissa Jones, RN, was taking care of a patient in an ICU. Mrs. Horne had surgery for a collapsed lung. She was still in pain but progressing well. She reports to Ms. Jones that when one night nurse is on, her pain medication does not work as well. She asks Ms. Jones not to say anything because she doesn’t want to get into trouble with the night staff.
What should Ms. Jones say and do?

References

American Nurses Association (n.d.). Etthics and Articles. Accessed 6/12/21 from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/ethics-topics-and-articles/

Fowler, M.D. (2010). Guide to the Code of Ethic for Nurses: Interpretation and Application. Silver Spring, MD: American Nurses Association.

Lachman, V.D., ( 2010) "Strategies Necessary for Moral Courage" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 3.

National Council of State Boards of Nursing. (nd). Professional boundaries: A nurse’s guide to the importance of appropriate professional boundaries. Chicago, IL: Retrieved on 6/19/2014 at https://www.ncsbn.org/ProfessionalBoundariesbrochure.pdf.

©RnCeus.com

What does fidelity mean in medical ethics?

What is the principle of fidelity in healthcare?

What is an example of fidelity in healthcare?

What is an example of fidelity?