nursing code of ethics essay

What is the Nursing Code of Ethics?

History of the nursing code of ethics.

4 Ethical Principles in Nursing

Nursing Code of Ethics Interpretive Statements

Making ethical decisions as a nurse, how nurses use the nursing code of ethics.

According to the American Nurses Association (ANA) , the nursing code of ethics is a guide for “carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.”

Ethics, in general, are the moral principles that dictate how a person will conduct themselves. Ethical values are essential for ALL healthcare workers, but ethical principles in nursing are particularly important given their role as caregivers.

There are 4 main principles that are part of the nursing code of ethics. They are:

Autonomy in Nursing
Beneficence in Nursing
Non-maleficence

These principles are ideally what every nurse should be aware of in their daily nursing practice. While ethical principles are sometimes confusing and often taught briefly during undergraduate nursing -- they should be constants in nursing practice in order to provide the best, safest, and most humane care to all patients.

Interestingly, the nursing code of ethics is suggested to have been founded in 1893 and named the “Nightingale Pledge” after Florence Nightingale , the founder of modern nursing. As a modification of the Hippocratic Oath, taken by medical doctors, the Nightingale Pledge has been recited by nursing students at graduations with little changes since inception.

The formal code of ethics was developed in the 1950s by the American Nurses Association (ANA) and has undergone numerous modifications since. The most significant recent change was in 2015 when 9 interpretative statements or provisions were added to the code of ethics to help guide nursing practice in a more definitive way.

Many states include the ANA’s nursing code of ethics in their practice statements. Even though the code of ethics is primarily ethics-related, it also has legal implications. Given the importance of the code to the nursing profession, revisions continue on a regular basis.

4 Ethical Principles in Nursing

1. autonomy .

Autonomy is recognizing each individual patient’s right to self-determination and decision-making. As patient advocates, it is imperative that nurses ensure that patients receive all medical information, education, and options in order to choose the option that is best for them. This includes all potential risks, benefits, and complications to make well-informed decisions.

Once the patient has all the relevant information, the medical and nursing team can make a plan of care in compliance with the medical wishes of the patient.

It is important that nurses support the patient in their medical wishes and ensure that the medical team is remembering those wishes. Sometimes, nurses will need to continue to advocate for a patient despite the wishes being verbalized because the medical team might not agree with those wishes.

Many factors may influence a patient's acceptance or refusal of medical treatment, such as culture, age, gender, sexual orientation, general health, and social support system.

2. Beneficence

Beneficence in nursing is acting for the good and welfare of others and including such attributes as kindness and charity. The American Nurses Association defines this as “actions guided by compassion.”

Justice is that there should be an element of fairness in all medical and nursing decisions and care. Nurses must care for all patients with the same level of fairness despite the individual's financial abilities, race, religion, gender, and/or sexual orientation.

An example of this is when working at a free flu clinic or diabetes screening clinic. These are open to all individuals in the community regardless of the previously mentioned factors.

4. Nonmaleficence

Nonmaleficence is to do no harm. This is the most well-known of the main principles of nursing ethics. More specifically, it is selecting interventions and care that will cause the least amount of harm to achieve a beneficial outcome

The principle of nonmaleficence ensures the safety of the patient and community in all care delivery. Nurses are also responsible for reporting treatment options that are causing significant harm to a patient, which may include suicidal or homicidal ideations.

Revised in 2015 to include 9 provisions, the ANA’s nursing code of ethics now includes interpretative statements that can provide more specific guidance for nursing practice.

9 Provisions of the Nursing Code of Ethics

Currently, the nurse’s code of ethics contains 9 main provisions:

The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care.
The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
The profession of nursing, collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

The aforementioned nine provisions were implemented to help guide nurses in ethical decision-making throughout their practice.

Unfortunately, nurses are often unable to make complex ethical decisions based solely on the four principles and nine provisions. In these instances, it is important to consult the ethics committee before making any major decisions. Often, other resources are needed when making major ethical decisions.

Enter to Win Nurse.org's $1,500 "No Essay" Nursing Scholarship!

Knowing the nursing code of ethics is essential for nurses because it will help guide everyday practice and navigate the daily complexities of the healthcare profession. Nurses often use the four major ethical principles throughout a shift, even if not fully aware of them.

This may include,

Providing pain medication to a post-operative hip replacement
Holding the hand of a dying patient who is alone
Advocating for the patient that wants to end chemotherapy and enter hospice care

Nursing is consistently regarded as the most honest and ethical profession and practicing with the nursing code of ethics is essential to ensuring that patients and their families receive the care they have come to know and expect. Utilizing the ethical codes of justice, nonmaleficence, autonomy, and beneficence on a daily basis allows nurses to provide the safest and most compassionate care for their patients.

What are the five codes of ethics in nursing?

The 5 nursing ethic codes are: nonmaleficence, beneficence, autonomy, justice, and privacy/confidentiality.

What is the Professional Code of Ethics for Nurses?

The Professional Code of Ethics for Nurses is the guiding outline for how nurses should behave ethically within their profession and how they should decide to act if they encounter barriers that prevent them from fulfilling their professional obligations.

Why is the code of ethics important in nursing?

It can guide nurses’ professional behavior, provide a framework for decision-making when faced with challenges, and provide support and help prevent moral distress.

What is the code of ethics in healthcare?

There is not one board ethical code for every healthcare professional, although it has been proposed. Instead, each branch of healthcare, from quality control to medical directors to physicians to nursing, has its own ethical codes.

What is scholarly ethics in nursing?

Find nursing programs.

Kathleen Gaines (nee Colduvell) is a nationally published writer turned Pediatric ICU nurse from Philadelphia with over 13 years of ICU experience. She has an extensive ICU background having formerly worked in the CICU and NICU at several major hospitals in the Philadelphia region. After earning her MSN in Education from Loyola University of New Orleans, she currently also teaches for several prominent Universities making sure the next generation is ready for the bedside. As a certified breastfeeding counselor and trauma certified nurse, she is always ready for the next nursing challenge.

Plus, get exclusive access to discounts for nurses, stay informed on the latest nurse news, and learn how to take the next steps in your career.

By clicking “Join Now”, you agree to receive email newsletters and special offers from Nurse.org. We will not sell or distribute your email address to any third party, and you may unsubscribe at any time by using the unsubscribe link, found at the bottom of every email.

Home — Essay Samples — Nursing & Health — Nursing — Nursing Code Of Ethics In Nursing

Nursing Code of Ethics in Nursing

Categories: Nursing

About this sample

Words: 604 |

Published: Mar 13, 2024

Words: 604 | Page: 1 | 4 min read

Cite this Essay

Let us write you an essay from scratch

450+ experts on 30 subjects ready to help
Custom essay delivered in as few as 3 hours

Get high-quality help

Dr. Heisenberg

Verified writer

Expert in: Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

2 pages / 985 words

2 pages / 829 words

3 pages / 1407 words

1 pages / 582 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Nursing

A Better NHS. (2011). Patient autonomy and choice. Retrieved from 71-77.

To further my education and interest in nursing, I decided to become a HOSA member through my school. This year, I am participating in the Clinical Nursing event and have started studying for the competitive event for the [...]

Ball J. & Pike G. (2009). Shift length: A literature review. Nursing Management (Harrow), 16(4), 22-25.Bogossian, F., Winters-Chang, P., & Tuckett, A. (2014). Extended work shifts and the impact on patient safety, productivity, [...]

Chatfield, S., Nolan, R., Crawford, J., & Hallam, J. (2016). Factors affecting adherence to hand hygiene in nursing: A systematic review. Journal of Hospital Infection, 92(4), 305-314.Gould, D. J., Moralejo, D., Drey, N., & [...]

In the ever-evolving field of nursing, understanding the metaparadigm is essential for providing effective and holistic care to patients. Fawcett's Metaparadigm Summary offers a comprehensive framework that encompasses the core [...]

Bureau of Labor Statistics. ( 2019, September 4). Registered nurses. Retrieved from

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

Instructions Followed To The Letter
Deadlines Met At Every Stage
Unique And Plagiarism Free

AdventHealth University

The Importance of Ethics in Nursing

Share on Twitter
Share on Facebook
Share on LinkedIn
Share on Pinterest

Nurses perform hundreds of critical, health-related tasks every day. In some cases, the decisions they must make test their professional and personal morality. The nursing code of ethics helps caregivers consider patient needs from several viewpoints and maintain a safe recovery environment. Ethical guidelines remind caregivers to treat all people equitably and individually, while protecting the privacy rights of patients in ways that may not seem overtly obvious. These recommendations also call on caregivers to advocate and seek justice for those in their care, and to take full responsibility for their work as nurses.

RNs looking to advance their careers should explore the benefits of a Bachelor of Science in Nursing (RN-BSN) program.

What Are Ethics in Nursing?

Professional nurses sometimes experience situations in the workplace that challenge their personal and professional ethics. Morally courageous healthcare professionals, however, find a way to make ethical decisions even if they are alone in their beliefs. Nurses who exercise this ability strive to behave according to the nursing code of ethics, regardless of negative personal outcomes that may arise. These outcomes may include a tainted reputation, personal embarrassment, angst, ostracism by peers, employer or peer backlash, and career ramifications.

Moral practitioners create a safe, non-judgmental caregiving environment. When unforeseen danger occurs, nurses take action to protect patients and themselves. They also express empathy through words and actions, while forming strong connections with their patients. These relationships foster a dialogue that helps healthcare professionals find personalized and effective care solutions.

Nurses need to practice professional humility and flexible thinking. The nursing code of ethics encourages healthcare professionals to incorporate these moral guidelines into their personal lives as well. According to the American Nurses Association (ANA), nursing ethics cover several common areas.

End-of-life issues
Moral courage, moral distress, and moral resilience

Cultural Competency in Nursing

An important area of ethics in nursing is cultural awareness. Nurses are increasingly seeing patients from different cultures, with different languages and different beliefs. Those patients rely on nurses to make culturally appropriate ethical decisions regarding their care. That is, nurses should try to understand how social and cultural differences influence a patient’s healthcare-related beliefs, attitudes, and actions.

The code of ethics can help nurses remember that each patient has a unique background and unique needs. In addition, nurses can improve their cultural competency by communicating openly, withholding judgment, normalizing cultural differences, and examining their own biases.

Having a keen sense of cultural awareness can serve caregivers well, especially when they are faced with dilemmas regarding care for patients from diverse backgrounds. Ultimately, cultural competency helps nurses serve individual and community interests by working toward the best possible health-related outcomes.

Examples of Ethics in Nursing

Key examples of ethics in nursing cover a variety of areas.

Confidentiality

Under HIPAA, nurses cannot disclose sensitive information about their patients. In addition, the nursing code of ethics emphasizes the importance of keeping the details of patient cases confidential. This guideline goes beyond making sure that unauthorized persons do not gain access to private records. The code encourages caregivers to discuss cases only when others are not present or are unable to hear their dialogue. This applies especially in the care setting, where nearby staff or patrons may overhear clinical discussions.

Accountability

Nursing professionals take responsibility for their actions. They are honest and exercise strong moral practices in the workplace. Ethical nurses never attempt to provide services beyond their proficiency and do all they can to keep their patients safe.

Valuing Individual Patients

Caregivers educate themselves about the individuals and communities they serve, and encourage their peers to be equally proactive in following this same standard. Additionally, nurses treat everyone with respect and maintain appropriate professional boundaries at all times.

Wholistic Treatment

Responsible nurses do everything in their power to promote a wholistic care approach, taking into account patients’ physical, mental, and spiritual well-being. They network with other healthcare professionals to meet and apply this goal as universally as possible. They also work to mitigate threats to responsible wholistic care, such as public health initiatives that misalign with community health needs.

Advocating for Patients

Nurses must dedicate themselves as patient advocates, ensuring every patient’s unique needs and preferences are incorporated into their care. The Nursing code of ethics sets forth the principle that people have the right to decide how they want treatment and to be informed about that treatment in a manner that meets their preferences. It is important, however, that patients be mentally fit to make those types of decisions. If they are not, nurses must help them with the decision-making process.

Promoting Equality

The nursing code of ethics promotes fair treatment toward all individuals and denounce discrimination for any reason. This includes making sure they distribute limited healthcare resources based on need. By exercising fair treatment, caregivers create trusting relationships with their clients.

Pursue a Nursing Career

The history of nursing education at AdventHealth University Online stretches back to 1908, providing students with a strong foundation of academic excellence. Today, that education is marked by cutting-edge courses taught by experienced faculty who are dedicated to helping individuals pursue an online Bachelor of Science in Nursing (RN-BSN) degree .

If you are passionate about caregiving, and want to exemplify the importance of ethics in nursing in your career, consider earning an online Bachelor of Science in Nursing (RN-BSN) degree from AdventHealth University Online.

Recent Blogs

Nursing Code of Ethics Report

Introduction, goals of the nursing code of ethics, ethical principles, reference list.

Nursing practice is guided by a set of code of ethics which constitutes an essential part of the profession. For a long time now, nursing practice has integrated the concern for the welfare of patients and the vulnerable population as well as for social justice. From a functional perspective, nurses work towards the normalization of those elements that detract from health. Not only are the nursing career prospects obliged to abide by the moral and ethical standard of nursing profession, but also to embrace them as a critical aspect of the health care profession.

To serves as concise reminder of the ethical duties and commitment of all the persons who choose the nursing career.
To outline the nursing profession’s invariable ethical standards.
To highlight the professional’s own awareness of its obligation to the community.

In the code of ethics, the term practice has been used to signify the various functions of the nurse in whatever position he or she assumes, such as immediate patient care provider, policy developer, researcher, administrator, educator among other. Therefore, the principles and commitment outlined in this code of ethics fits all the nursing positions and context (Lubkin & Larsen, 2006).

The nurses in all the aforementioned positions and context, performs with respect and compassion for the innate distinctness, worth, and dignity of each person, without any regard for his or her social or financial status, personal characteristics, or the nature of the health issue. Thus the ethical obligations of nursing practice can be summarized under the following principles (Lubkin & Larsen, 2006):

Respect for human dignity: – represents a fundamental principle that drives the general nursing practice. This pertains to regard for human rights, self-esteem, and value of all people, including the client, colleagues, physician, and the general public. Nurses have been taught to take into consideration the demands and morals of every person in all professional liaisons (Lubkin & Larsen, 2006).
Interaction with patients: – the nurse must develop a relationship in their provision of nursing services, taking into account respect for human requirements and standards, with no bias. Nurses, while planning a patient’s health care, must take into account an individual’s lifestyle, religious orientation, and value system. This consideration reflects the respects for the patient personality, as opposed to condoning or agreement with specific individual preferences.
The characteristics of health condition: – the nurse expresses respect for privileges, dignity, and worth of each human being regardless of the characteristics of the health condition. This principle upholds that the approach fo any patient’s provision should not be influenced by the nature of the disease or injury, propensity for death, or functional potential. This perception extends to those who need the services of the nurse for improving health, prognosis, normalization of health, relief of suffering, as well as provision of compassionate care to the terminally ill individuals.
The right to freewill: – regard for human dignity concerns the identification of certain patient’s privileges, especially, the right of freewill. Freewill or autonomy forms the philosophical basis with regard of informed consent in all medical care contexts. Patients are morally and lawfully entitled to involvement in the determination of the process that will be followed including; (a) right to accurate, comprehensive, and understandable instructions in a way that allows an informed decision; (b) to be helped with evaluating the benefits, challenges, and alternatives in their management, as well as the option of no treatment; (c) to allow, refuse, or cease treatment devoid of falsehood, undue persuasion or penalty; and (d) to be afforded considerable support in the entire decision-making and management procedure. The patient should be allowed to consult with family and other crucial persons in regard of decision making under the support and guidance of competent nurses and other health specialists. Noteworthy, patient should be allowed to participate in determining their health care extent possible and willing to participate.
Association with peers and others: – respect for persons applies to every individual with the work context of the nurse. The nurse upholds a compassionate and caring attitude when interacting with peer and others with dedication to unbiased treatment of patient, to conflict resolution, and to integrity-preserving conciliation. This concept should be observed in all the possible nursing positions, such as direct care provider, consultant, educator, researcher, and administrator. This standards of conduct disqualify any biased action, any harassment or intimidating behavior, or disregard for the repercussion of own conduct on other people. The nurse acknowledges the unique role of different person or teams, and collaborates to achieve the common objective of availing quality health care services.

All nurses are responsible for creating, sustaining, and contributing to a practice environment that upholds nurses in observing their ethical obligations. A practice background typically involves physical attributes, including the working condition, and inscribed policies and protocols outlining the prospects for nurses, and less tangible attributes like informal peer standards.

Organizational framework, function description, safety and health strategies, grievance procedure, penalty procedures, compensation system, and ethics committee, collectively contribute to the working context that impedes or enhance professional accomplishment and ethical practice.

Settings within which staff are afforded unbiased hearing of grievances, are facilitated based on the level of care, and are fairly handled to allow the accomplishment of the principles of the nursing profession that are in alignment with a proper nursing practice (Oermann & Henrich, 2005).

The ethical code focuses largely on health care practice, although level of practice is dependent on availability of resources. Because of this relation, an ethical code concurrent to the nursing code of ethic should be designed, so that nurses are in a position meet their ethical obligations.

American Nurses Association. (2001). Code of Ethics for Nurses with Interpretive Statements. New York: The American Nurses Association Inc.

Lubkin, I. M., & Larsen, P. D. (2006). Chronic illness: impact and interventions. London: Sage.

Oermann, M. H., & Heinrich, K. T. (2005). Annual review of nursing education: strategies for teaching. Stamford, Mass: Cengage Learning.

Chicago (A-D)
Chicago (N-B)

IvyPanda. (2019, December 15). Nursing Code of Ethics. https://ivypanda.com/essays/nursing-code-of-ethics-report/

"Nursing Code of Ethics." IvyPanda , 15 Dec. 2019, ivypanda.com/essays/nursing-code-of-ethics-report/.

IvyPanda . (2019) 'Nursing Code of Ethics'. 15 December.

IvyPanda . 2019. "Nursing Code of Ethics." December 15, 2019. https://ivypanda.com/essays/nursing-code-of-ethics-report/.

1. IvyPanda . "Nursing Code of Ethics." December 15, 2019. https://ivypanda.com/essays/nursing-code-of-ethics-report/.

Bibliography

IvyPanda . "Nursing Code of Ethics." December 15, 2019. https://ivypanda.com/essays/nursing-code-of-ethics-report/.

The Logical Problem of Evil and the Freewill Defense
Normalization of Intersexual Kids Through Surgery
Linguistic Normalization and Otherness
Faith or Free Will Used in the Movie – Minority Report and the Drama – Antigone
The Three Themes of the "Oedipus the King" by Sophocles
Database Normalization: Minimization of Data Redundancy
Legal Rights Afforded to the Accused
Data Normalization and Its Main Advantages
Free Will and Determinism: Discussion
An Overview on Application of Data Normalization
“On Moral Medicine: Theological Perspective in Medical Ethics” by Stephen Lammers and Allen Verhey
The Problem of Assistance in Self-Deliverance
Commercialization of Organ Transplants
Pros and Cons of the Commercialization of Organ Transplants
The Importance of Consent in Research

Undergraduate
High School
Architecture
American History
Asian History
Antique Literature
American Literature
Asian Literature
Classic English Literature
World Literature
Creative Writing
Linguistics
Criminal Justice
Legal Issues
Anthropology
Archaeology
Political Science
World Affairs
African-American Studies
East European Studies
Latin-American Studies
Native-American Studies
West European Studies
Family and Consumer Science
Social Issues
Women and Gender Studies
Social Work
Natural Sciences
Pharmacology
Earth science
Agriculture
Agricultural Studies
Computer Science
IT Management
Mathematics
Investments
Engineering and Technology
Engineering
Aeronautics
Medicine and Health
Alternative Medicine
Communications and Media
Advertising
Communication Strategies
Public Relations
Educational Theories
Teacher's Career
Chicago/Turabian
Company Analysis
Education Theories
Shakespeare
Canadian Studies
Food Safety
Relation of Global Warming and Extreme Weather Condition
Movie Review
Admission Essay
Annotated Bibliography
Application Essay
Article Critique
Article Review
Article Writing
Book Review
Business Plan
Business Proposal
Capstone Project
Cover Letter
Creative Essay
Dissertation
Dissertation - Abstract
Dissertation - Conclusion
Dissertation - Discussion
Dissertation - Hypothesis
Dissertation - Introduction
Dissertation - Literature
Dissertation - Methodology
Dissertation - Results
GCSE Coursework
Grant Proposal
Marketing Plan
Multiple Choice Quiz
Personal Statement
Power Point Presentation
Power Point Presentation With Speaker Notes
Questionnaire
Reaction Paper
Research Paper
Research Proposal
SWOT analysis
Thesis Paper
Online Quiz
Literature Review
Movie Analysis
Statistics problem
Math Problem
All papers examples
How It Works
Money Back Policy
Terms of Use
Privacy Policy
We Are Hiring

The Nurses’ Code of Ethics, Essay Example

Pages: 1

Words: 298

Hire a Writer for Custom Essay

Use 10% Off Discount: "custom10" in 1 Click 👇

You are free to use it as an inspiration or a source for your own work.

The nurses’ code of ethics dictates professional health care provision to patients without favor or prejudice, a concept that should be applied to every patient under the hospital care. This aspect placed me in a controversial position. A patient required round the clock attendance due to their wealth and this meant I had to devote most of time taking care of him contrary to my job description. The situation placed me in a conflicting situation with my superiors and colleagues who required me to take care of all the assigned patients. In solving the situation, I applied some level of firmness while at the same time giving the patient all due respect and deserved opinion. I ensured the patient familiarized himself with the laid down regulations and assured him that I would always attend to his needs promptly. This established a cordial relationship with mutual respect and understanding ensuring I carried on with the assigned tasks.

The provision of health care is a complex and dynamic process that dictates and necessitates the collaboration between different departments in problem solving. Many instances have arisen at the work place, which have required my collaboration with other nurses, dietary, and physician in particular involving a patient with a displaced hip joint. The elderly female patient was due for surgery, but was placed under medical care for a month due to her high blood pressure. The patient had weight problems that required working on and with the assistance of a dietary specialist, we were able to solve the problem related to her weight with a consistent diet plan. The physician came in handy in assisting me to convince the patience on the necessity of taking prescribed medication. Other nurses played a central role in complementing my efforts of consistent monitoring of the patient.

Stuck with your Essay?

Get in touch with one of our experts for instant help!

Bill de Blasio's Victory, Essay Example

Racial Identity Development Models, Essay Example

Time is precious

don’t waste it!

Plagiarism-free guarantee

Privacy guarantee

Secure checkout

Money back guarantee

Related Essay Samples & Examples

Voting as a civic responsibility, essay example.

Words: 287

Utilitarianism and Its Applications, Essay Example

Words: 356

The Age-Related Changes of the Older Person, Essay Example

Pages: 2

Words: 448

The Problems ESOL Teachers Face, Essay Example

Pages: 8

Words: 2293

Should English Be the Primary Language? Essay Example

Pages: 4

Words: 999

The Term “Social Construction of Reality”, Essay Example

Words: 371

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
Iran J Public Health
v.42(Supple1); 2013

The Code of Ethics for Nurses

1 Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran

2 Medical Ethics and History of Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran

A Parsapour

Ss bagher maddah.

3 University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

MA Cheraghi

4 Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

GH Mirzabeigi

5 Iranian Nursing Organization, Tehran, Iran

M Vahid Dastgerdi

6 Minister, Ministry of Health and Medical Education, Iran

7 Dept. of Gynecology & Obstetrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Nurses are ever-increasingly confronted with complex concerns in their practice. Codes of ethics are fundamental guidance for nursing as many other professions. Although there are authentic international codes of ethics for nurses, the national code would be the additional assistance provided for clinical nurses in their complex roles in care of patients, education, research and management of some parts of health care system in the country. A national code can provide nurses with culturally-adapted guidance and help them to make ethical decisions more closely to the Iranian-Islamic background. Given the general acknowledgement of the need, the National Code of Ethics for Nurses was compiled as a joint project (2009–2011). The Code was approved by the Health Policy Council of the Ministry of Health and Medical Education and communicated to all universities, healthcare centers, hospitals and research centers early in 2011. The focus of this article is on the course of action through which the Code was compiled, amended and approved. The main concepts of the code will be also presented here. No doubt, development of the codes should be considered as an ongoing process. This is an overall responsibility to keep the codes current, updated with the new progresses of science and emerging challenges, and pertinent to the nursing practice.

Introduction

Nurses are responsible to provide their clients/patients with the high-quality care. They are undoubtedly confronted with various ethical challenges in their professional practice, so they should be familiar with ethical codes of conduct and the essentials of ethical decision making.

The codes of ethics have been adopted for many professions in recent decades. In nursing, as one the most-trusted professions, the ethical codes have been also published by nearly every recognized professional group worldwide. The first international code of ethics for nurses was adopted by the International Council of Nurses (ICN) in 1953 ( 1 ). The two codes prepared by American Nurses Association (ANA) ( 2 ) and Canadian Nurse Association (CAN) ( 3 ) are the examples of national codes of ethics for nurses. The codes outline how the nurses should behave ethically as a profession, and how they should decide when encounter barriers preventing them from fulfilling their professional obligations. The codes can also support nurses in their practice and reduce their moral distress.

In Iran, studies have shown nurses’ weaknesses in the knowledge of ethics and its application in practice ( 4 , 5 ). In a qualitative study carried out by Negarandeh et al, the nurses identified “lack of code of ethics” as a barrier to patient advocacy in Iran ( 6 ). Sanjari et al, also, reviewed nursing codes of ethics and emphasized the necessity of compiling a national code of ethics for nurses in healthcare setting in 2008 ( 7 ). They suggested an adapted code considering cultural context and Islamic background of the country.

Considering the growing activities in the field of medical and healthcare ethics in Iran ( 8 , 9 ), and in order to address the needs and help to fulfill goals of health care system in the country, the National Code of Ethics for Nurses was prepared under supervision of the Ministry of Health and Medical Education (MOHME). It is expected that the Code will serve the interests and needs of the profession more efficiently, since it illustrate moral and professional obligations of nurses for prevention of diseases, promoting health in the society, communicating with colleagues, management of health care systems, and research activities.

The goal of this paper is to provide the nurses with the information about the National Code and help them to apply the provisions in their profession. The manuscript will introduce the main concepts of the recently published codes.

The project of “Compiling the National Code of Ethics for Nurses” was initiated by the Ethics Group of the Endocrinology and Metabolism Research Center (EMRC) of Tehran University of Medical Sciences (TUMS) in 2009.A working group composed of 3 nurses and one general practitioner prepared the first draft of the code through a study including the wide search of international and national codes of ethics for nurses in other countries. After compiling the draft, the project was continued as a joint project with Medical Ethics and History of Medicine Research Center (MEHRC) of TUMS and the Secretariat of High Council for Medical Ethics of Health Policy Council of MOHME.

At first, the preliminary draft was presented at special discussion secession at MEHRC and was challenged by professors, researchers and PhD and MPH students of TUMS. According to the discussions held, the draft was revised. Then, a Task Force that was appointed by the Secretariat of High Council for Medical Ethics of Health Policy Council of MOHME actively engaged in the process of reviewing and modification of the second draft of the code. The Task Force was composed of invited supervisors or head-nurses from main hospitals of TUMS, professors of Faculty of Nursing and Midwifery of TUMS, specialists in different fields of ethics, law, religion, and the representatives of Iranian Nursing Organization (INO), Medical Council of Islamic Republic of Iran, Office of Nursing Advisor to MOHME, Academy of Medical Sciences and Nursing Board of MOHME.

Owing to the sincere cooperation of all members of the Task Force, the final code was prepared after some discussion sessions. Then, it was proposed to the Health Policy Council of MOHME for evaluation and approval. The code as the National Code of Ethics for Nurses was delivered in the country in early 2011.

National Code of Ethics for Nurses

The Code is an entirely new document produced for nursing ethics in the country, which was published in Farsi ( 10 ). It is also available through the website of MOHME ( 11 ). The English version is enclosed here as annex1 . The target audience includes all nurses in the fields of nursing education, research, administrative, and clinical care, in the whole.

The National Code defines the values which are comprehensive and culturally-adapted. Then, it classify the ethical responsibilities as five main parts of “Nurses and People”, “Nurses and the Profession”, “Nurses and Practice”, “Nurses and Co-workers”, and “Nursing, Education and Research”, including 71 provisions in total.

The code sets out the required elements for ethical conduct and empowers nurses to make ethical decisions more perfectly as they perform as clinical nurses, researchers, administrators and policy-makers. It also reminds the nurses of the valuable state of their profession and what they should attempt to uphold as a nurse in providing direct care to clients/patients, teaching nursing students, performing research, and the supervision and management.

As a main general conceptual background of the National code, the patients are not considered as only people who receive the nursing care, and others including the patients’ family and healthy people in the society are considered in the plans and services. Another essence of the Code is that the individual dignity should be respected, regardless of who is receiving the care, or from which nationality, ethnicity, religion, culture, socio-economic class, gender, etc the patient/client is. Meanwhile, under the provisions of the National Code, nurses must recognize and respect cultural sensitivity in everyday practice, even in this era of globalization.

According the Code, the nurses should be sensitive to the ethical challenges and do their best to fulfill their moral duties. It also emphasizes the importance of informed consent, and addresses main ethical issues in everyday practice such as respect to privacy and confidentiality of patients/clients, relationship with colleagues, efficient performance of the professional duties, conflicts of interests, ethics in educational activities and protection of participants in research.

The Code also deals with the administrative duties of nurses. Moreover, it elucidates the concern of how the nurses should communicate with the hospital ethics committee for decision-making when are confronted with ethical cases.

Considering the experiences in compiling national ethical codes and guidelines ( 12 – 18 ), the National Code of Ethics for Nurses is developed as a guide for performing nursing responsibilities and the ethical obligations of the profession. Although there are authentic international codes of ethics for nurses, the national code would be the additional assistance provided for clinical nurses in their complex roles in care of patients, education, research and management of some parts of health care system in the country. Most nurses may be either too busy or exhausted to think about their behavior in practice. However, accountability through meeting the obligations is essential in nursing which is one the most-trusted professions in all societies.

Development of the codes should be considered as an ongoing process, so it is expected that nurses reflect their ideas when they deal with the shortcomings of the codes in their practice. The inputs will enable authorities to improve the code and pave the way for its effective implementation. The codes should be revised and updated in regular intervals considering reflections from nurses across the country. This is an overall responsibility to keep the codes current, updated with the new progresses of science and emerging challenges, and pertinent to the nursing practice.

Ethical considerations

Ethical issues (Including plagiarism, Informed Consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc) have been completely observed by the authors.

Acknowledgments

It is noteworthy that, this could not be accomplished without dedication and sincere contribution of university lecturers, researchers, and experts in the field. The collaborators (excluding the authors) and members of the Task Force are listed (in alphabetical order) as follows: Adibzade A, Ajali A, Alipor A Z, AzimiLolati H, Bararpour F, Biabangardi Z, DehghanNayeri N, Eesazadeh N, Ghadyani MH, Ghasemzadeh N, Ghorbanpour M, Hashemi F, Heidari A, Joudaki K, Joulaie S, Karimi M, Kashaninia Z, Kazemian M, Milanifar AR, Mobasher M, Namazi HR, NazariEshtehardi M, Parsayekta Z, Saber S, Sahebjam S, Salemi S, Shojaee AA, Soufizadeh M, Tafti F, VaskooeKh, YadavarNikravesh M.

The representatives of Health Policy council of MOHME, The Institution (Nahad) of Representative of the Supreme Leaderin TUMS, Medical Ethics and History of Medicine Research Center of TUMS, Iranian Nursing Organization, Medical Council of Islamic Republic of Iran, Office of Nursing Advisors to MOHME, Academy of Medical Sciences and also Nursing Board of Ministry of Health and Medical Education were among the members of the Task Force. The authors declare that there is no conflict of interest.

ANNEX 1. The Code of Ethics for Nurses in Islamic Republic of Iran

Nurses have the responsibility that within their career limit, make decisions and act based on their professional values. Values are intrinsically valuable concepts, and can be defined as the basis by which an individual or community selects the criterion of right or wrong. Taking into account the exalted position of nursing, professional values are determined by qualified associations and organization. In our country, the limits and boundaries of the actions, in many cases, are determined by Islam and our Constitution. As much as the ethical values are in compliance with religious principles, they are universal and transnational.

The most important principles that should be considered in nursing profession are:

Respecting the patient/client and preserving human dignity
Altruism and sympathy
Devotion to professional obligations
Accountability, responsibility and conscience
Justice in services
Commitment to honesty and loyalty
Maintaining patient’s privacy, and commitment to confidentiality, and trust
Continuous improvement of scientific and practical competence
Promote the awareness of professional rules and ethical guidelines, and respecting them
Mutual respect and appropriate communication with other health care providers
Respecting autonomy of the patient/client
Compassion and kindness

ETHICAL GUIDELINES

1. nurses and people.

The Nurse should:

1-1. Make effort for: improvement of community health, prevention of diseases, restoration of health and alleviation of pain and suffering of patients; and consider these as her/his main mission.
1-2. Offer the nursing care regardless of race, nationality, religion, culture, gender, age, socioeconomic status, political conditions, physical or mental illness, or any other factor; and strive to eliminate injustice and inequality in society.
1-3. Provide the nursing care to client/patient with respect to the human rights while considering; to the extent it is possible; values, socio-cultural traditions, and religious beliefs of patient/client.
1-4. Educate the community in term of health promotion and disease prevention and consider it as one of his/her most important responsibilities. Nursing care and standard teaching must be presented in a way to fit the culture, beliefs, values and individual’s needs.
1-5. Be sensitive to the challenges and ethical issues, in both community and workplace, that could undermine the sanctity of the nursing profession; and offer the appropriate solution when is necessary.
1-6. While cooperating and coordinating with other individuals, groups and social institutions, try to address social needs and resolve ethical issues raised in the area of health care.
1-7. Pay special attention to vulnerable groups and individuals such as children, elderly, people with physical disability, mental illness, and so on.
1-8. While have attention to the medical health at the local level, endeavor to achieve the health goals in national and international levels.
1-9. Perform his/her responsibilities, in crises and natural disasters such as war, earthquake, flood, and disease epidemic, while taking the necessary precautions.

2. Nurses and the Profession

2-1. Take into account ethical responsibilities, as well as the legal and professional liabilities, when implementing the nursing interventions and making the clinical decisions.
2-2. 2-Whitin the limits of his/her power and duties, attempt to provide a safe and healthy environment for the client / patient.
2-3. Maintain the safety of the client / patient by: being on time, efficient performance of the professional duties, and accurate and complete recording of the performed care.
2-4. Provide the best care to the client / patient; based on professional standards which is resulted from valid research and reliable evidence.
2-5. Carry out all the nursing interventions with respect to the client / patient and his/her family.
2-6. Do his/her maximum effort to conserve patient’s confidentiality and privacy, and respect autonomy, and obtain the informed consent.
2-7. Prevent the probable damage to the client / patient by detecting and reporting the professional errors of medical team.
2-8. In case of mistake in nursing interventions, explain honestly to the client / patient, and proceed with truthfulness and fairness in any circumstances.
2-9. Maintain and enhance his/her physical, mental, social, and spiritual abilities.
2-10. Keep his /her knowledge and skills up to date, in order to maintain the professional competence.
2-11. Have the capability and knowledge of effective and safe nursing care, without direct supervision, and be accountable for his/her actions.
2-12. Perform in a way that nobody could question his/her professional credibility and dignity.
2-13. Be cautious about misuse of his/her name and position for commercial advertising of products.
2-14. Avoid the acceptance of any gift or benefit from the client / patient or their relatives, which may cause any limitation either now or in the future.

3. Nurses and Practice

3-1. Introduce him /herself with name, title and his/her professional role to the client / patient.
3-2. Provide all the nursing interventions with respect to the client / patient and preserving their dignity.
3-3. Consider the client / patient’s demands regardless of their age, sex, race, economic status, lifestyle, culture, religion, political beliefs and physical abilities.
3-4. Perform the nursing care based on current knowledge and common sense.
3-5. Produce a gentle behavioral and verbal communication, in a way that with attracting the client/ patient trust, their needs and concerns could be understood.
3-6. Before performing any nursing interventions, obtain the patient or his/her legal guardian consent. In this regard, the nurse should provide sufficient information about nursing intervention for the patient, so that she/he could have the possibility of well-informed acceptance or rejection of the service.
3-7. When presenting or applying a new product in clinical practice, have a complete knowledge of its risks. Moreover, provide the client / patient with the necessary information about benefits and disadvantages of the product, hence they could have the possibility of informed choice.
3-8. Be aware that no one has the right to consent in place of a competent adult. In case of children, giving the consent is one of the legal guardian’s responsibilities.
3-9. In order to empower the client / patient, educate him/her and their family; in frame of care plan and discharge program.
3-10. As an exception, in case of an emergency, when the immediate therapeutic action is mandatory for saving the client / patient’s life, start the necessary intervention without patient’s consent.
3-11. Perform the appropriate intervention based on existing standards and patient’s higher interests; when obtaining the informed consent or realizing the patient’s wishes is not possible.
3-12. Apply the safety measures to be sure that nursing interventions are harmless, and when is necessary, consult this matter with other health team members.
3-13. Consider all the information given or obtained during the care process as the professional secrets, and do not reveal them without client / patient’s permission except in legally permissible cases.
3-14. Employ the medical information of client / patient only for health related purposes (treatment, research) and in patient’s interest. Inform the client / patient that part of his/ her medical record might be disclosed to other team members for medical consultation.
3-15. Using the medical information of the client / patient in research or education should be with their permission. Presentation of the result must be done without mentioning the name, address or any other information that could lead to identification of the patient.
3-16. Respect the patient privacy when performing any nursing intervention.
3-17. When performing the ideal service is unfeasible, continue the health care, in best of his /her ability, until establishment of a new health care program.
3-18. Provide the care for injured or patients in emergency situations, even outside the workplace.
3-19. In case of dissatisfaction of the client / patient or other problem, respect their right to change the charged nurse or other health care providers, and as much as possible, try to satisfy the client / patient in this matter.
3-20. In case of noticing a violation of standards of care, inform the authorities who have sufficient power for improvement of condition.
3-21. Report any objection or problem of patient to the ward supervisor.
3-22. Avoid any action, even in patient’s request, that requires ethical, legal or religious violation.
3-23. Assist the patients who spend the last days of their life for accepting the reality and to appropriately planning of their demands, including performing the religious practices or recording their wills.

4. Nurses and Co-workers

The Nurse should

4-1. Cooperate with medical team members, the client / patient and their family, for more efficient presentation of nursing interventions.
4-2. Contribute the client / patient or legal guardian in making decision about nursing interventions.
4-3. Share his/her professional knowledge and experience with other colleagues.
4-4. Establish a good relation based on mutual trust, with medical team.
4-5. Have a respectable conduct with other nurses, professors and students.
4-6. In case of any conflict of interest in the care of the client / patient, discuss it with senior colleagues and the principals, while giving the priority to preserving the clients / patients’ rights.
4-7. Establish a respectful professional relationship with co-workers in various levels, including the head nurse, supervisor, nursing director and department heads
4-8. Confronting any ethical challenge, consult the hospital ethics committee for decision-making.

Nursing Director should:

4-9. Act as a role model for other nurses in all aspects of professional carrier.
4-10. Put his/her maximum efforts into the transfer of legal and ethical information to other nurses.
4-11. Provide the necessary conditions for participation of nurses in continuous training program.
4-12. When required, consult ethicists, in order to resolve the ethical problems occur during nursing interventions.
4-13. According to the hierarchy, collaborated with other colleagues, act in line with client / patient’s interest.
4-14. With the aim of improving the service quality, do his/her maximum effort to maintain a good working environment and increase professional motivation.
4-15. Behave fairly in the process of evaluation and promotion of nurses while considering the professional standards and nursing ethics code.

5. Nursing, Education and Research

5-1. Nursing professors should employ their maximum efforts to update their scientific knowledge, and to promote ethical knowledge and conduct.
5-2. The relationship between professors and students in scientific, educational and research environments should be based on professional ethics and mutual respect.
5-3. Nursing professors should make effort to improve students’ knowledge and skills, and promote their ethical and professional performance.
5-4. Consider carefully and accurately the patient’s rights and ethical concerns, in cases of using the patients for educational purposes.
5-5. Medical services should not be affected if client /patient or their family do not wish to-cooperate in education of the students.
5-6. To improve the healthcare services, the quality of nursing training courses, existing guidelines and standards must be continually reviewed and revised.
5-7. Nurses, who are involved in research, must pass the specific training courses, have knowledge about the research regulations, and be familiar with national, general, and specific ethical guidelines and be pledged to these regulations.
5-8. Nurses should not use their professional positions to convince the client / patient to participate in the research project.
5-9. Refusal of participation in the research project by the patient or his/her family should not influence the delivery of the nursing interventions.
5-10. Clinical nurses should make effort to enhance the expertise and clinical capacities of nursing and midwifery students.

Common Ethical Dilemmas in Nursing and their Solutions

Healthcare professionals, including nurses, face ethical dilemmas fairly regularly. Most of the dilemmas are usually serious and very stressful because when faced with a dilemma, a nurse must make a decision, which is easier said than done.

As a nursing student, you might be assigned to write an essay where you identify, analyze, and resolve an ethical dilemma. We have noticed over the years that many students struggle with writing an ethical dilemma nursing essay. If that sounds like you, read this post that comprehensively explores ethical dilemmas in nursing, including their examples and solutions.

In most cases, essays about ethical dilemmas in nursing take the reflective essay approach, where you reflect on real, researched, or imagined clinical scenario or encounter. It could be during your placement, clinical rotations, or shadowing experiences. As you do so, you will borrow from various ethical theories and decision-making models.

If you could use some help, our experienced online nursing essay writers can help you get a bespoke ethical dilemma essay at an affordable fee.

Let's get started with the basics to more advanced concepts.

What is an Ethical Dilemma in Nursing?

An ethical dilemma is a scenario where it is not easy to decide one way or another. Nurses are faced with ethical dilemmas almost every day. They have to make serious and difficult decisions fairly regularly. The decisions can sometimes mean life or death. Therefore, as a student nurse, it is vital to learn about ethical dilemmas nurses face, how to identify them, and how to solve them correctly.

When facing an ethical dilemma, you should always follow the nursing code of ethics . This is because most dilemmas can be solved by following the nursing code of ethics. The nursing code of ethics is a bunch of rules nurses has to follow to provide quality, safe, and unquestionable care to those who need it.

While most dilemmas can be solved by following the code of ethics in nursing, some dilemmas cannot be solved in this manner. The reason is that the nursing code does not guide every ethical dilemma or situation.

If faced with a situation that makes it difficult for you to follow the nursing code of ethics, you should use your judgment to weigh the pros and cons of both decisions to make the right decision.

Examples of ethical dilemmas nurses face regularly include: how to deal with a non-compliant patient, how to deal with a patient that is refusing treatment, and whether to disclose confidential information to help a patient.

Ethical Dilemma Versus Moral Dilemma

The terms ethical and moral are often used interchangeably in speech. However, the two terms do not always mean the same thing. For example, there is a slight difference between ethical and moral dilemmas.

An ethical dilemma involves two morally correct choices, but one is slightly more ethically problematic than the other. In contrast, a moral dilemma is a situation with two morally correct choices, but neither is preferable. For the moral dilemmas, the nurses know the right action yet might be limited to acting by forces outside their control.

As a nurse, you are more likely to face ethical dilemmas than moral dilemmas. Because ethical dilemmas are anticipated, a code of conduct has been created to help you always make the right decision.

Reasons Nurses Face Ethical Dilemmas in Healthcare

There are many reasons why nurses face ethical dilemmas frequently when providing care to patients. The following are the eight main ones:

Inadequate staffing. When a healthcare facility has fewer staff than it needs to function optimally, nurses sometimes must make a tough decision. They have to decide whether to work longer to care for patients or to prioritize their mental and physical health and work only as much as possible.
Incompetent peers. As a registered nurse, you will have a big dilemma if you notice a colleague showing incompetence. You will have to choose one of two options – to ignore your colleague's incompetence because they are a friend and they probably will not do it again, or report your colleague to a supervisor to ensure high standards are maintained. This is an ethical dilemma since the former is more ethically problematic than the latter.
Religious/cultural beliefs. Your religious or cultural beliefs may present an ethical dilemma as a practicing nurse. For instance, you might be given a nursing assignment that contradicts your religious beliefs, e.g., you are asked to clean up the private parts of a male patient after a procedure as a Muslim female nurse (this is forbidden according to Islam). It is easy to see how this situation would present an ethical dilemma.
Patient refusing treatment. There are occasionally situations when patients refuse treatment. As a nurse, you know what is best for the patient. However, you also know that they have the right to make their own decision. So when a patient refuses treatment, this will always present you with an ethical dilemma – do you insist and look for ways to ensure they get the treatment or grant them their wish?
Artificial nutrition and hydration. Some patients and older adults do not want to be fed or hydrated using a tube. This presents a huge ethical dilemma for nurses. This is because nurses are trained to care for people who need it. Therefore, they feel bad about it when they see the need to provide artificial nutrition and hydration and get stopped because of a patient's wishes. They feel so bad because they know there is something they can do, yet they are asked not to do it.
Providing futile care. Being asked by a patient's family to continue providing care despite a patient's continued decline is one of the biggest ethical dilemmas nurses face. This is especially true for critical care nurses. Being trained medical staff, they can see when it is not in a patient's best interest to continue receiving aggressive interventions. However, most of the time, patient families don't want to give up on their loved ones. Therefore, they insist that interventions continue presenting nurses with a big ethical dilemma.
Opioid crisis. The opioid crisis across the United States presents nurses with several ethical dilemmas. For example, many nurses do not want to give patients opioid pain medications, especially when they believe they risk getting addicted. Now imagine knowing that a patient can benefit from a medication yet at the same time feeling like it could lead to them getting addicted to it
Anti-vaccine stance. Nurses who do not mind vaccines face a dilemma whenever they interact with those against vaccines. This is because, on the one hand, they know they have to provide care to everyone without discrimination. Yet, on the other hand, they know that people against vaccines pose a serious public health hazard.

Identifying Ethical Dilemmas in Nursing

As evident in the section above, ethical dilemmas can arise virtually anywhere in the nursing world. It is up to you as a nurse to identify dilemmas when they arise and deal with them as expected by the ANA code of conduct. In this section, we are going to focus on how to identify ethical dilemmas in nursing.

Here are the main indicators of ethical dilemmas in nursing.

Harm potential. When you face a healthcare situation that has the potential to impact a patient negatively, you are most likely facing an ethical dilemma. If it were so easy to spare the patient from the negative impact, the situation wouldn't be a dilemma because this is the option you would take.
Conflict of interests. When you face a healthcare situation with a conflict of interests between you and the patient or you and the case management team, it is likely an ethical dilemma.
Uncertainty. This is perhaps one of the biggest indicators of ethical dilemmas and dilemmas. When you face a healthcare situation in which you are unsure what to decide, you are most likely facing an ethical dilemma. Nurses are trained to judge situations and make decisions quickly. When you cannot do these things as a nurse, something is holding you back, and the situation is likely a dilemma.
Cautiousness. When you face a healthcare situation in which you are cautious about the outcome of the options you can take, you are most likely facing an ethical dilemma. People are cautious when making ethical dilemma decisions because they do not want to see negative consequences (if any) caused by their decision(s).
Delay. When you have a decision to make at work and keep delaying the decision-making, you are most likely facing an ethical dilemma. People delay making ethical dilemma decisions because they fear the consequences.

Principles of Nursing Ethics

Principles of nursing ethics were formulated to help nurses consistently make the right decisions when faced with ethical situations. There are many principles of nursing ethics, but the main ones are non-maleficence, beneficence, autonomy, and justice. These are the ones that are always integrated into nursing training programs to help nurses make the right decisions whenever they are faced with difficult situations.

1. Nonmaleficence

Nonmaleficence is probably the most well-known ethical principle in the healthcare world. It applies to nurses, doctors, and other medical professionals.

This principle teaches nurses that it is their responsibility to provide care, treatment options, and/or case management in a manner that does not harm the patient. When you internalize this principle as a nurse, you will always choose to provide care and treat patients safely.

Non-maleficence is an important part of providing patients with safe and quality care. Exercising this principle means doing everything possible as a nurse to provide care while ensuring the highest degree of patient safety.

An excellent example of non-maleficence in nursing practice is withholding the administration of a powerful medication until you get confirmation on whether a patient is allergic to it or not. Another example of maleficence in nursing practice is discontinuing medication when you notice signs of adverse reactions.

When a nurse lacks this principle, it can result in dire consequences for patients. More specifically, a lack of nonmaleficence can lead to reduced patient safety. And, of course, this can mean patient injury or even death. Patient injury or death resulting from lack of nonmaleficence can cause mental trauma, job loss, and even legal consequences.

Therefore, it is imperative to internalize and adhere to this nursing principle.

2. Beneficence

Beneficence is another important nursing principle. This principle is characterized by charity and kindness. It is basically all about ensuring your actions are guided by compassion and maximum consideration of the welfare of those you serve.

While some people choose to pursue nursing for the money or job security, most people in nursing are in it out of their love for serving others. Therefore, this beneficence principle is almost always naturally ingrained in the minds of most nurses.

The best way to apply this nursing ethical principle is to always act in the patient's best interest regardless of the circumstances. Practicing this principle regularly will ensure the patient is always cared for in the best way possible. You will also automatically improve positive patient outcomes.

An excellent example of beneficence in nursing practice is offering to sit with a patient to console them after giving them bad news about their situation. Another superb example of beneficence is drawing curtains to protect a patient's and his family's privacy when exchanging final goodbyes.

Lack of beneficence can result in poor nurse-patient relationships and reduced patient safety. When a patient realizes you are not kind or acting in their best interest, they will not be very interested in showing you kindness or respect. This can result in poor nurse-patient relationships and adverse patient outcomes.

As mentioned above, a lack of beneficence can also lead to reduced patient safety. When you don't act in the patient's best interest, it can lead to safety issues such as failure to record vital info, failure to use protective measures when providing care, and medication errors.

It is easy to see how following this principle can make it easier for nurses to provide quality care and make more ethical decisions.

3. Autonomy

Autonomy is a fundamental nursing ethical principle. It recognizes the right of the patient to make their own decisions. Nurses must never forget this right to avoid imposing their will or self-interest on the patient.

Of course, there is a right way to recognize patients' independence and ability to make their own decisions. This right way involves offering the patient all the necessary information to make the best decisions. This information includes available treatment options and the pros and cons of each option.

Once a nurse has offered a patient all the correct information, they have to respect whatever decisions the patient makes, even if they disagree.

Autonomy is essential in nursing practice because it helps nurses adhere to the patient's wishes. It is also important because it passes responsibility for some major care decisions to the patient they will affect the most.

A good example of autonomy is when a nurse agrees to respect a patient's choice not to get treatment, even if they believe the treatment benefits the patient. Another excellent example of autonomy is a nurse respecting a patient's wish to be seen or attended to by a nurse of the same sex for religious reasons.

When a nurse doesn't practice this ethical principle, they can make decisions that make patients feel disrespected. They can also make decisions that can lead to a breakdown of the nurse-patient relationship. Thus, it is always essential to have this ethical principle in mind.

Justice is a fundamental ethical principle. It is all about nurses showing fairness in the way they provide care. Nurses must provide quality care to patients regardless of their appearance, age, financial history, religious preference, race, and gender.

Even when faced with a situation that involves healthcare for a convicted murderer or any other criminal, a nurse must still offer the best care they can provide.

This nursing ethical principle is crucial because it ensures fairness and equity in nursing. In other words, it provides patients care regardless of who they are. This usually has the effect of making patients feel valued. This, in turn, usually has the effect of enhancing patient outcomes.

A good example of justice in nursing practice is providing care to a known anti-vaccine campaigner when they get COVID or any other vaccine-preventable illness. This is justice and fairness because it allows the person to become well again without considering the negative influence of vaccine use.

A nurse lacking this ethical principle can act in ways that make a patient feel rejected, leading to adverse patient outcomes. It can also lead to unfair prioritization in care provision, resulting in dire consequences for the patient.

By following the nursing ethical principles discussed above and adhering to the ANA code of conduct, you can handle different ethical dilemmas correctly and without serious negative consequences.

Examples of Ethical Dilemmas in Healthcare

Understanding some ethical dilemma scenarios you can write an essay about as a nursing student is essential. Remember, there is never a right or wrong answer; in the same way, there is no small or big ethical issue. As long as it impacts healthcare, it falls within nursing practice or medical ethics.

The following are some of the most common ethical dilemmas in nursing.

1. Pro-choice versus pro-life.

The pro-choice versus pro-life dilemma is common in nursing. For example, when a patient wishes to have an abortion because they do not want a baby, yet a nurse is pro-life because of religious beliefs, it becomes a big dilemma.

SOLUTION : Respect the wishes of the patient.

2. Religious beliefs versus science.

This dilemma is common in nursing practice. For example, it can occur when a patient refuses a specific procedure or treatment because of religious beliefs, yet a nurse knows what science says is best in the situation.

SOLUTION : Respect patient autonomy and do as they wish.

3. Beneficence versus autonomy.

As a nurse, you must practice beneficence (kindness and charity). You are also required to respect the patient's autonomy. Now imagine you have been ordered to give a patient medication to ease pain and suffering, yet they insist on not taking it to stay awake and spend their last minutes with their loved ones. This presents a great beneficence vs. autonomy dilemma.

SOLUTION : Obey the patient's wishes as long as they are conscious and can make their own decisions

4. Anti-vaccine stance.

As a nurse, you must follow exactly what the guardian wants for a child unless it is required by law to do otherwise. Now imagine a situation where a parent refuses to let their child get vaccinated, yet you know at the back of your mind that vaccines benefit children. You know what you must do, yet a guardian insists you must not do it. This is a significant ethical dilemma.

SOLUTION : Obey the guardian's wishes for their child.

5. Withholding information versus being honest.

Nurses are ethically expected to be open and transparent with patients. However, there are cases when you may feel as a nurse that explaining the gravity of a situation to a patient will worsen their stress and anxiety. You may, therefore, think it is more appropriate to withhold some information from them. This presents a big dilemma.

SOLUTION: Always be honest, especially when the situation is complex. Patients deserve to know the truth.

6. Limited resources versus healthcare needs.

Nurses occasionally face situations where their resources are not optimal for the people they serve. Remember the COVID-ventilator issue? Doctors and nurses had to decide whom to give ventilators initially at the start of the pandemic when there were not enough ventilators.

SOLUTION: When the resources are limited, choosing patients based on severity is recommended.

7. Questionable orders.

Doctors and other medical professionals are not perfect. They make mistakes from time to time. Therefore, you will have a big dilemma when a doctor prescribes treatment, and you feel it is not the best treatment in the back of your mind. Do you fulfill the doctor's order or intercede and question it?

SOLUTION: When you feel something wrong is about to happen, you should speak up to protect the patient's interest.

How to Address Ethical Dilemmas in Nursing

The best way to address ethical dilemmas is to internalize and follow the nursing ethical principles and the ANA code of conduct. However, not everyone constantly has the time and energy to review nursing ethical principles and the ANA code of conduct.

For this reason, we have shared the tips below to help you correctly address ethical dilemmas in nursing.

1. A Problem Shared Is a Problem Halved

When you feel uneasy about an ethical situation, you should share it with a trusted colleague or a supervisor. Communicating the problem with someone else invites a fresh perspective to the problem and increases the likelihood of arriving at a better decision.

2. Internalize Patient Autonomy

Remembering and recognizing patient autonomy or the right to make their own decisions is always important. It doesn't matter what you think is best for a patient – what they want is what you should do as long as it is legal and within your nursing responsibilities. Of course, you should present the patient with all the information they need to decide. So if you ever have to grapple with an ethical situation that makes you feel like ignoring patient autonomy, you shouldn't do it. You should choose the option that ensures patient autonomy.

3. Respect the Right to Privacy

Every patient has a right to privacy. This means you should treat their information as confidential and only to be shared with them or with persons they approve. It is not in your place to share patient information, especially when it is sensitive. You can only share info when given consent. Therefore, if you ever have a dilemma about sharing information, remember to respect the right to privacy and ask for consent to share info if you think it is necessary.

4. Transparency is Key

You should always be open and honest with patients. Doing this will help you to avoid many ethical situations. It will also make it easy for you to make ethical decisions. Therefore, whenever necessary, please share all the information you can share with patients to help them understand what is happening. Share with them the pros and cons of every treatment or management option. Let them be fully aware of the benefits and risks of everything.

5. Ask Yourself What Is in The Best Interest of the Patient

Whenever you need to make an ethical decision, in addition to all your other considerations, you should ask yourself what is in the patient's best interest. Asking yourself this question will help you act in a way that ensures the patient's best interests are taken into account. It will also force you to involve the patient in decision-making to know what they want or wish for. You can never go wrong by acting in a patient's best interest.

6. Stay Up-To-Date with Ethical Guidelines

Ethical guidelines change regularly. Therefore, to ensure you are always making the right ethical decisions, you should stay up to date with ethical guidelines (both professional guidelines and institution-specific guidelines). It is not always easy to do this, but you can subscribe to nursing blogs that discuss ethical guidelines. This will ensure you always have the latest information you need to make good ethical decisions. You can also stay up to date by enrolling in at least one online ethical nursing training program or course. This will help you to refresh your ethical principles knowledge and to be aware of the latest ethical issues in nursing.

7. Always Do Something as Soon as You Can

When faced with an ethical situation, never do anything and hope the situation will resolve itself. Always do something as soon as possible. This will ensure either the issue is solved or starts getting solved. When you ignore an ethical situation, it has the risk of snowballing and becoming a much bigger issue down the line. Therefore, please do something about an issue whenever you can do it quickly.

8. Negotiating Never Hurts Anybody

One of the best things you can do when facing a nursing ethical dilemma is to negotiate with the parties involved. When you do this respectfully and fairly, you can easily resolve most ethical situations. For example, if a patient refuses a specific treatment for religious reasons, you can convince them to accept it using various persuasion techniques. Of course, you should respect the patient's decision if they insist on a certain stance or position.

9. Talk to Somebody Higher Up

As a nurse, some ethical decisions are not yours; they are above your pay grade. In such a case, they should be referred to somebody higher up, e.g., the nurse manager or the nurse supervisor. Because the manager or supervisor is usually more experienced, they are often in a much better position to handle ethical decisions and teach you what to do when faced with the same situation again.

Consequences of Failing to Address Ethical Dilemmas in Nursing Properly

When you fail to address ethical dilemmas in nursing correctly, there are often negative consequences. The most common negative consequences nurses have to deal with include the following:

1. Loss of License

When you are faced with an ethical decision, you must make sure you act in the way expected of you according to the nursing code of conduct. Failure to act in the manner that is expected of you in the nursing code of conduct can lead to loss of licensure. This is especially true when your decision in an ethical situation is an egregious violation of the nursing code of conduct or the ethical principles of nursing. Therefore, when faced with an ethical decision, it is best to consider the options carefully and to act in the way that is expected of you.

2. Legal Issues

You could face legal issues when you fail to adequately address certain ethical dilemmas in nursing. As a nurse, you have specific responsibilities. You are also expected to adhere to the nursing code of conduct. If you fail to address ethical issues correctly, e.g., you leak confidential information about a celebrity patient for money to the public, you could face legal issues, including a lawsuit and/or criminal charges. Hence it is crucial to think long and hard about some ethical issues before deciding what to do.

3. Job Suspension or Termination

Most hospitals have a code of conduct that nurses and other healthcare professionals must sign when hired. They expect nurses to follow the code to the letter. Most hospitals also expect nurses to follow the ANA code of conduct and to always adhere to the ethical principles of nursing. So when faced with an ethical situation and failing to act correctly, you could end up before the ethics committee of your hospital, and they could recommend your suspension or the termination of your job contract.

4. Stress and Burnout

Ethical situations can cause a lot of stress and mental burnout. They can make it almost impossible for you to continue operating normally. When you ignore them or make the wrong decision, you can potentially make them worse. This can lead to even more stress and even physical burnout. Consequently, it is important to make the right decisions quickly when faced with ethical problems or issues.

5. Negative Patient Outcomes

The worse thing that could happen if you don't address ethical issues correctly is an adverse patient outcome, such as patient deterioration, patient injury, or death. It is always painful for nurses to realize or discover that their decisions caused an adverse patient outcome. It can lead to stress, loss of self-confidence, and so on. Of course, an adverse patient outcome can also lead to legal issues, job suspension, and job loss. So it is best to make the correct decision whenever faced with an ethical dilemma.

Takeaway about Ethical Dilemmas in Nursing Practice

Nursing training is all-rounded in anticipation of all the issues a trained nurse would experience in typical clinical settings. Learning about ethical dilemmas and how to solve them can be a stepping stone toward excellence as a nurse or medical/healthcare practitioner. You will be dealing with many ethical dilemmas in the workplace and an experience on how to solve them can always help you avert adverse situations.

Head-to-toe Assessment: A Comprehensive Guide for Students

List of Borrowed Non-Nursing Theories Used in Healthcare

How to Write a Great Nursing Process Essay: Format and Steps

NurseMyGrades is being relied upon by thousands of students worldwide to ace their nursing studies. We offer high quality sample papers that help students in their revision as well as helping them remain abreast of what is expected of them.

Scroll to top
Dark Light Dark Light

110 Ethics in Nursing Essay Topics, Ideas & Examples

Author Jermaine Huey
Published April 14, 2023

Nursing is a profession that is built on ethical principles, values, and obligations. Nurses are responsible for providing patient care that is both compassionate and ethical, while also upholding the standards and principles of the nursing profession. Ethics in nursing are important because they guide nurses in making decisions that are in the best interest of their patients, while also considering the ethical implications of those decisions. In this post, we will provide nursing students with essay topic ideas and examples that demonstrate the importance of ethics in nursing.

Tips for Students Writing an Essay on Ethics in Nursing:

Understand the Code of Ethics for Nurses: The American Nurses Association (ANA) has established a code of ethics for nurses that outlines the ethical responsibilities and principles that nurses should follow.
Consider Real-World Scenarios: Ethics in nursing can be complex and nuanced. Consider real-world scenarios and case studies to better understand the ethical considerations that nurses must navigate.
Discuss Ethical Dilemmas: Ethical dilemmas are common in nursing practice. Discuss how nurses can navigate ethical dilemmas while upholding their ethical obligations to their patients.
Address the Impact of Culture and Diversity: Culture and diversity can impact ethical considerations in nursing. Discuss how nurses can provide culturally competent care while also upholding ethical principles.
Consider the Role of Technology: Technology is changing the landscape of nursing practice, and it can also impact ethical considerations. Discuss how nurses can use technology ethically while also providing quality patient care.
Discuss the Importance of Confidentiality: Confidentiality is an important ethical principle in nursing. Discuss how nurses can maintain patient confidentiality while also providing quality patient care.
Address the Importance of Informed Consent : Informed consent is an essential aspect of nursing practice. Discuss the ethical considerations associated with informed consent and how nurses can ensure that patients fully understand their treatment options.

Ethics in nursing is a critical aspect of nursing practice that guides nurses in providing quality patient care that is both compassionate and ethical. By understanding the importance of ethical principles in nursing, students can better navigate the complex ethical considerations that arise in nursing practice. Consider the essay topics and tips provided in this post to gain a deeper understanding of ethics in nursing and its implications for patient care.

Ethics in Nursing Essay Topics/Ideas:

The Ethical Implications of Rationing Care During a Pandemic
The Role of the Nurse in Promoting End-of-Life Care that Respects Patient Autonomy
Ethical Considerations in the Use of Artificial Intelligence in Nursing Practice
The Ethics of Nurse-Patient Relationships: Boundaries and Professionalism
The Importance of Ethical Decision-Making in Nursing Leadership
The Ethics of Involuntary Hospitalization in Mental Health Nursing
The Ethics of Mandatory Vaccination for Healthcare Workers
Ethical Considerations in Nursing Research: Balancing Patient Autonomy and Scientific Progress
The Ethics of Resource Allocation in Pediatric Nursing
The Role of Ethics Committees in Nursing Practice
The Ethics of Nurses’ Participation in Capital Punishment
The Ethics of Nursing Practice in Correctional Facilities
The Ethics of Nurses’ Participation in Assisted Suicide
The Ethics of Nurses’ Participation in Clinical Trials
The Ethics of Nurses’ Participation in Organ Procurement and Donation
Ethical Considerations in the Use of Restraints in Nursing Practice
The Impact of Legalization of Medical Marijuana on Nursing Ethics
The Ethics of Nurses’ Participation in Euthanasia
The Ethics of Nurses’ Participation in Abortion Care
Ethical Considerations in Nursing Practice with Refugees and Asylum Seekers
The Ethics of Nurses’ Participation in Physician-Assisted Death
The Ethics of Nurses’ Participation in Fertility Treatments
The Ethics of Nurses’ Participation in Gender Confirmation Procedures
Ethical Considerations in Nursing Practice with Incarcerated Populations
The Ethics of Nurses’ Participation in Surrogate Pregnancy

Controversial Ethics in Nursing Essay Topics:

The Ethics of Nurses’ Refusal to Participate in Care Based on Religious or Moral Beliefs
The Ethics of Nurses’ Participation in Elective Cosmetic Procedures
The Ethics of Nurses’ Participation in Alternative Medicine Practices
The Ethics of Nurses’ Participation in Conscientious Objection to Medical Procedures
The Ethics of Nurses’ Participation in Death Penalty Executions
The Ethics of Nurses’ Participation in Torture and Interrogation
The Ethics of Nurses’ Participation in Unproven or Experimental Treatments
The Ethics of Nurses’ Participation in Genetic Testing and Counseling
The Ethics of Nurses’ Participation in Surrogate Decision-Making for Patients without Advance Directives
The Ethics of Nurses’ Participation in Human Embryo Research
The Ethics of Nurses’ Participation in Animal Research
The Ethics of Nurses’ Participation in Clinical Trials that Involve Placebo Treatments
The Ethics of Nurses’ Participation in Physician-Assisted Suicide
The Ethics of Nurses’ Participation in Physician-Administered Execution
The Ethics of Nurses’ Participation in Controversial Reproductive Health Services
The Ethics of Nurses’ Participation in Psychiatric Treatments that Involve Restraints or Seclusion
The Ethics of Nurses’ Participation in the Use of Chemical Restraints
The Ethics of Nurses’ Participation in the Use of Physical Restraints
The Ethics of Nurses’ Participation in the Use of Electroconvulsive Therapy
The Ethics of Nurses’ Participation in the Management of Sexually Violent Offenders
The Ethics of Nurses’ Participation in the Management of Substance Use Disorders
The Ethics of Nurses’ Participation in the Management of Sex Offenders
The Ethics of Nurses’ Participation in the Management of Chronic Pain in Opioid-Dependent Patients
The Ethics of Nurses’ Participation in the Management of Homeless Patients
The Ethics of Nurses’ Participation in the Management of Patients with HIV/AIDS

Latest Ethics in Nursing Essay Topics to Write About:

The Ethics of Nurses’ Participation in Medical Assistance in Dying
Ethical Considerations in Nursing Care for Patients with Substance Use Disorders
The Ethics of Nurses’ Participation in the Administration of Psychiatric Medications
The Role of Ethics in the Use of Restraints in Nursing Practice
Ethical Considerations in Nursing Care for Patients with Chronic Pain
The Ethics of Nurses’ Participation in Medical Tourism
The Ethics of Nurses’ Participation in Healthcare for Undocumented Immigrants
Ethical Considerations in Nursing Care for Patients with Eating Disorders
The Ethics of Nurses’ Participation in Cosmetic Surgery Procedures
The Ethics of Nurses’ Participation in Weight Loss Surgery Procedures
The Ethics of Nurses’ Participation in the Use of Medical Marijuana
The Ethics of Nurses’ Participation in Fetal Surgery
The Ethics of Nurses’ Participation in Stem Cell Research
The Ethics of Nurses’ Participation in Gene Therapy
The Ethics of Nurses’ Participation in the Use of Placebos in Medical Research
Ethical Considerations in Nursing Care for Patients with Disabilities
The Ethics of Nurses’ Participation in Surrogate Decision-Making for Pediatric Patients
The Ethics of Nurses’ Participation in Surrogate Decision-Making for Elderly Patients
The Ethics of Nurses’ Participation in the Use of Genetic Testing in Nursing Practice
Ethical Considerations in Nursing Care for Patients with Terminal Illnesses

Ethics in Nursing Research Questions:

What are the ethical considerations in nursing care for patients with chronic pain?
What is the role of ethics in nursing leadership?
How do ethical considerations impact nursing care for patients with eating disorders?
What is the ethical responsibility of nurses in promoting end-of-life care that respects patient autonomy?
How do cultural and religious beliefs impact ethical considerations in nursing practice?
What are the ethical implications of the use of technology in nursing practice?

What is the role of ethics committees in nursing practice?

How do ethical considerations impact nursing care for patients with mental health disorders?
What are the ethical implications of nurses’ participation in medical tourism?

What is the ethical responsibility of nurses in promoting patient-centered care?

How do ethical considerations impact nursing care for patients with substance use disorders?
What are the ethical implications of the use of placebos in nursing research?
What is the role of informed consent in nursing practice?
How do ethical considerations impact nursing care for patients with disabilities?
What is the ethical responsibility of nurses in promoting cultural competence?
What are the ethical implications of nurses’ participation in cosmetic surgery procedures?
How do ethical considerations impact nursing care for patients with terminal illnesses?
What is the role of ethics in nursing research?
How do ethical considerations impact nursing care for patients with HIV/AIDS?
What are the ethical implications of nurses’ participation in fetal surgery?
What is the ethical responsibility of nurses in promoting patient safety?
How do ethical considerations impact nursing care for patients with dementia?
What are the ethical implications of nurses’ participation in stem cell research?
How do ethical considerations impact nursing care for patients with cystic fibrosis?
What is the ethical responsibility of nurses in promoting end-of-life care for elderly patients?
What are the ethical implications of nurses’ participation in gene therapy?
How do ethical considerations impact nursing care for patients with spinal cord injuries?
What is the role of ethics in nursing education?
How do ethical considerations impact nursing care for patients with traumatic brain injuries?
What are the ethical implications of the use of artificial intelligence in nursing practice?

FAQs Related to Ethics in Nursing:

What is the importance of ethics in nursing practice.

Ethics in nursing practice is important because it guides nurses in making decisions that are in the best interest of their patients while also considering the ethical implications of those decisions.

What are some ethical considerations that nurses must navigate in their daily practice?

Nurses must navigate ethical considerations related to patient autonomy, informed consent, confidentiality, cultural competence, and end-of-life care, among others.

How can nurses ensure that they are practicing ethically?

Nurses can ensure that they are practicing ethically by staying up-to-date with the ethical principles and standards established by their professional organizations, seeking guidance from ethics committees, and reflecting on their own values and beliefs.

What should nurses do if they encounter an ethical dilemma in their practice?

Nurses should seek guidance from their colleagues, supervisors, or ethics committees when encountering an ethical dilemma in their practice.

Ethics committees provide guidance and support to nurses and other healthcare professionals when navigating ethical dilemmas in their practice.

What are some controversial ethical considerations in nursing practice?

Some controversial ethical considerations in nursing practice include nurses’ participation in assisted suicide, abortion care, and alternative medicine practices.

What is the impact of cultural diversity on ethical considerations in nursing practice?

Cultural diversity can impact ethical considerations in nursing practice by influencing patients’ values, beliefs, and preferences. Nurses must provide culturally competent care while also upholding ethical principles.

Nurses have an ethical responsibility to promote patient-centered care by respecting patients’ autonomy, preferences, and values, and by providing care that is compassionate and empathetic.

How can nurses use technology ethically while also providing quality patient care?

Nurses can use technology ethically by ensuring patient privacy and confidentiality, using evidence-based practices, and staying up-to-date with the latest technological advancements.

What are some ethical implications of nurses’ participation in medical research?

Ethical implications of nurses’ participation in medical research include ensuring informed consent, minimizing harm to participants, and ensuring that the research is conducted in an ethical and transparent manner.

Conclusion:

In conclusion, ethics in nursing practice is critical to providing quality patient care that is both compassionate and ethical. Nurses must navigate complex ethical considerations in their daily practice and ensure that they are practicing ethically by staying up-to-date with ethical principles and seeking guidance when encountering ethical dilemmas. By understanding the importance of ethics in nursing practice and navigating ethical considerations, nurses can provide patient-centered care that upholds the standards and principles of the nursing profession.

Call-to-Action:

If you are a nursing student struggling to write an ethics in nursing essay, or any other nursing-related paper, consider working with a top writer to help you achieve your academic goals. Click the link to order now!

Jermaine Huey

How to Enhance Cultural Competence in Nursing

Welcome to NursingWriters.net, your go-to resource for expert information and guidance on...

Top Tips for Preparing for the NCLEX-RN Exam

Ten Nursing Theories and Theorists that Impact Nursing Today

We use cookies to give you the best experience. Cookie Policy

Open access
Published: 28 March 2024

Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study

Rachel Gilbert 1 &
Daniela Lillekroken ORCID: orcid.org/0000-0002-7463-8977 1

BMC Nursing volume 23 , Article number: 216 ( 2024 ) Cite this article

244 Accesses

Metrics details

Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto’s theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its influence on caring within the nursing context, especially during the provision of end-of-life care. This study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

This study has a qualitative descriptive design. Data were collected by conducting five individual interviews and one focus group during a seven-month period between April 2022 and September 2022. Nine nurses employed at four Norwegian nursing homes were the participants in this study. Data were analysed by employing a qualitative deductive content analysis method.

The content analysis generated five categories that were labelled similar to Tronto’s five phases of the care process: (i) caring about, (ii) caring for, (iii) care giving, (iv) care receiving and (v) caring with. The findings revealed that nurses’ autonomy more or less influences the decision-making care process at all five phases, demonstrating that the Tronto’s theory contributes to greater reflectiveness around what may constitute ‘good’ end-of-life care.

Conclusions

Tronto’s care ethics is useful for understanding end-of-life care practice in nursing homes. Tronto’s care ethics provides a framework for an in-depth analysis of the asymmetric relationships that may or may not exist between nurses and nursing home residents and their next-of-kin. This can help nurses see and understand the moral dimension of end-of-life care provided to nursing home residents during their final days. Moreover, it helps handle moral responsibility around end-of-life care issues, providing a more complex picture of what ‘good’ end-of-life care should be.

Peer Review reports

In recent decades, improving end-of-life care has become a global priority [ 1 ]. The proportion of older residents dying in nursing homes is rising across the world [ 2 ], resulting in a significant need to improve the quality of end-of-life care provided to residents. Therefore, throughout the world, nursing homes are becoming increasingly important as end-of-life care facilities [ 3 ]. As the largest professional group in healthcare [ 4 ], nurses primarily engage in direct care activities [ 5 ] and patient communication [ 6 ] positioning them in close proximity to patients. This proximity affords them the opportunity to serve as information brokers and mediators in end-of-life decision-making [ 7 ]. They also develop trusting relationships with residents and their next-of-kin, relationships that may be beneficial for the assessment of residents and their next-of-kin’s needs [ 8 ]. Moreover, nurses have the opportunity to gain a unique perspective that allows them to become aware of if and when a resident is not responding to a treatment [ 9 ].

When caring for residents in their critical end-of-life stage, nurses form a direct and intense bond with the resident’s next-of-kin, hence nurses become central to end-of-life care provision and decision-making in nursing homes [ 10 ]. The degree of residents and their next-of-kin involvement in the decision-making process in practice remains a question [ 11 ]. Results from a study conducted in six European countries [ 12 ], demonstrate that, in long-term care facilities, too many care providers are often involved, resulting in difficulties in reaching a consensus in care. Although nurses believe that their involvement is beneficial to residents and families, there is a need for more empirical evidence of these benefits at the end-of-life stage. However, the question of who should be responsible for making decisions is still difficult to answer [ 13 ]. One study exploring nurse’s involvement in end-of-life decisions revealed that nurses experience ethical problems and uncertainty about the end-of-life care needs of residents [ 14 ]. Another study [ 10 ] reported patients being hesitant to discuss end-of‐life issues with their next-of-kin, resulting in nurses taking over; thus, discussing end-of-life issues became their responsibility. A study conducted in several nursing homes from the UK demonstrated that ethical issues associated with palliative care occurred most frequently during decision-making, causing greater distress among care providers [ 15 ].

Previous research has revealed that there are some conflicts over end-of-life care that consume nurses’ time and attention at the resident’s end-of-life period [ 16 ]. The findings from a meta-synthesis presenting nurses’ perspectives dealing with ethical dilemmas and ethical problems in end-of-life care revealed that nurses are deeply involved with patients as human beings and display an inner responsibility to fight for their best interests and wishes in end-of-life care [ 17 ].

Within the Norwegian context, several studies have explored nurses’ experiences with ethical dilemmas when providing end-of-life care in nursing homes. One study describing nurses’ ethical dilemmas concerning limitation of life-prolonging treatment suggested that there are several disagreements between the next-of-kin’s wishes and what the resident may want or between the wishes of the next-of-kin and what the staff consider to be right [ 18 ]. Another study revealed that nurses provide ‘more of everything’ and ‘are left to dealing with everything on their own’ during the end-of-life care process [ 19 ] (p.13) . Several studies aiming to explore end-of-life decision-making in nursing homes revealed that nurses experience challenges in protecting the patient’s autonomy regarding issues of life-prolonging treatment, hydration, nutrition and hospitalisation [ 20 , 21 , 22 ]. Other studies conducted in the same context have described that nurses perceive ethical problems as a burden and as barriers to decision-making in end-of-life care [ 8 , 23 ].

Nursing, as a practice, is fundamentally grounded in moral values. The nurse-patient relationship, central to nursing care provision, holds ethical importance and significance. It is crucial to recognise that the context within which nurses practice can both shape and be shaped by nursing’s moral values. These values collectively constitute what can be termed the ethical dimension of nursing [ 24 ]. Nursing ethos and practices are rooted in ethical values and principles; therefore, one of the position statements of the International Council of Nurses [ 25 ] refers to nurses’ role in providing care to dying patients and their families as an inherent part of the International Classification for Nursing Practice [ 26 ] (e.g., dignity, autonomy, privacy and dignified dying). Furthermore, ethical competence is recognised as an essential element of nursing practice [ 27 ], and it should be considered from the following viewpoints: ethical decision-making, ethical sensitivity, ethical knowledge and ethical reflection.

The term ‘end-of-life care’ is often used interchangeably with various terms such as terminal care, hospice care, or palliative care. End-of life care is defined as care ‘to assist persons who are facing imminent or distant death to have the best quality of life possible till the end of their life regardless of their medical diagnosis, health conditions, or ages’ [ 28 ] (p.613) . From this perspective, professional autonomy is an important feature of nurses’ professionalism [ 29 ]. Professional autonomy can be defined based on two elements: independence in decision-making and the ability to use competence, which is underpinned by three themes: shared leadership, professional skills, inter- and intraprofessional collaboration and a healthy work environment [ 30 ].

As presented earlier, research studies have reported that nurses experience a range of difficulties or shortcomings during the decision-making process; therefore, autonomous practice is essential for safe and quality care [ 31 ]. Moreover, autonomous practice is particularly important for the moral dimension in end-of-life care, where nurses may need to assume more responsibility in the sense of defining and giving support to matters that are at risk of not respecting ethical principles or fulfilling their ethical, legal and professional duties towards the residents they care for.

To the best of the researchers’ knowledge, little is known about nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents; therefore, the aim of this study is to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

Theoretical framework

Joan Tronto is an American political philosopher and one of the most influential care ethicists. Her theory of the ethics of care [ 32 , 33 , 34 ] has been chosen as the present study’s theoretical framework. The ethics of care is a feminist-based ethical theory, focusing on caring as a moral attitude and a sensitive and supportive response of the nurse to the situation and circumstances of a vulnerable human being who is in need of help [ 33 , 34 , 35 ]. In this sense, nurses’ caring behaviour has the character of a means—helping to reach the goal of nursing practice—which here entails providing competent end-of-life care.

Thinking about the process of care, in her early works [ 32 , 33 , 34 ], Tronto proposes four different phases of caring and four elements of care. Although the phases may be interchangeable and often overlap with each other, the elements of care are fundamental to demonstrate caring. The phases of caring involve cognitive, emotional and action strategies.

The first phase of caring is caring about , which involves the nurse’s recognition of being in need of care and includes concern, worry about someone or something. In this phase, the element of care is attentiveness, which entails the detection of the patient and/or family need.

The second phase is caring for , which implies nurses taking responsibility for the caring process. In this phase, responsibility is the element of care and requires nurses to take responsibility to meet a need that has been identified.

The third phase is care giving , which encompasses the actual physical work of providing care and requires direct engagement with care. The element of care in this phase is competence, which involves nurses having the knowledge, skills and values necessary to meet the goals of care.

The fourth phase is care receiving , which involves an evaluation of how well the care giving meets the caring needs. In this phase, responsiveness is the element of care and requires the nurse to assess whether the care provided has met the patient/next-of-kin care needs. This phase helps preserve the patient–nurse relationship, which is a distinctive aspect of the ethics of care [ 36 ].

In 2013, Tronto [ 35 ] updated the ethics of care by adding a fifth phase of caring— caring with —which is the common thread weaving among the four phases. When care is responded to through care receiving and new needs are identified, nurses return to the first phase and begin again. The care elements in this phase are trust and solidarity. Within a healthcare context, trust builds as patients and nurses realise that they can rely on each other to participate in their care and care activities. Solidarity occurs when patients, next-of-kin, nurses and others (i.e., ward leaders, institutional management) engage in these processes of care together rather than alone.

To the best of our knowledge, these five phases of caring and their elements of caring have never been interpreted within the context of end-of-life care. The ethics of care framework offers a context-specific way of understanding how nurses’ professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents, revealing similarities with Tronto’s five phases, which has motivated choosing her theory.

Aim of the study

The present study aims to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

The current study has a qualitative descriptive design using five individual interviews and one focus group to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

Setting and participants

The setting for the study was four nursing homes located in different municipalities from the South-Eastern region of Norway. Nursing homes in Norway are usually public assisted living facilities and offer all-inclusive accommodation to dependent individuals on a temporary or permanent basis [ 37 ]. The provision of care in the Norwegian nursing homes is regulated by the ‘Regulation of Quality of Care’ [ 38 ], aiming to improve nursing home residents’ quality of life by offering quality care that meets residents’ fundamental physiological and psychosocial needs and to support their individual autonomy through the provision of daily nursing care and activities tailored to their specific needs, and, when the time comes, a dignified end-of-life care in safe milieu.

End-of-life care is usually planned and provided by nurses having a post graduate diploma in either palliative nursing or oncology nursing– often holding an expert role, hence ensuring that the provision of end-of-life care meets the quality criteria and the resident’s needs and preferences [ 39 ].

To obtain rich information to answer the research question, it was important to involve participants familiar with the topic of study and who had experience working in nursing homes and providing end-of-life care to residents; therefore, a purposive sample was chosen. In this study, a heterogeneous sampling was employed, which involved including participants from different nursing homes with varying lengths of employment and diverse experiences in providing end-of-life care to residents. This approach was chosen to gather data rich in information [ 40 ]. Furthermore, when recruiting participants, the first author was guided by Malterud et al.’s [ 41 ] pragmatic principle, suggesting that the more ‘information power’ the participants provided, the smaller the sample size needed to be, and vice versa. Therefore, the sample size was not determined by saturation but instead by the number of participants who agreed to participate. However, participants were chosen because they had particular characteristics such as experience and roles which would enable understanding how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.

The inclusion criteria for the participants were as follows: (i) to be a registered nurse, (ii) had a minimum work experience of two years employed at a nursing home, and (iii) had clinical experience with end-of-life/palliative care. To recruit participants, the first author sent a formal application with information about the study to four nursing homes. After approval had been given, the participants were asked and recruited by the leadership from each nursing home. The participants were then contacted by the first author by e-mail and scheduled a time for meeting and conducting the interviews.

Ten nurses from four different nursing homes were invited to participate, but only nine agreed. The participants were all women, aged between 27 and 65 and their work experience ranged from 4 to 21 years. Two participants had specialist education in palliative care, and one was currently engaged in a master’s degree in nursing science. Characteristics of the participants are presented in Table 1 :

Data collection methods

Data were collected through five semistructured individual and one focus group interviews. Both authors conducted the interviews together. The study was carried out between April and September 2022. Due to the insecurity related to the situation caused by the post-SARS-CoV-2 virus pandemic and concerns about potential new social distancing regulations imposed by the Norwegian government, four participants from the same nursing home opted for a focus group interview format. This decision was motivated by a desire to mitigate the potential negative impact that distancing regulations might have on data collection. The interviews were guided by an interview guide developed after reviewing relevant literature on end-of-life care and ethical dilemmas. The development of the interview guide consisted of five phases: (i) identifying the prerequisites for using semi-structured interviews; (ii) retrieving and using previous knowledge; (iii) formulating the preliminary semi-structured interview guide; (iv) pilot testing the interview guide; and (v) presenting the complete semistructured interview guide [ 42 ]. The interview guide was developed by both authors prior to the onset of the project and consisted of two demographic questions and eight main open-ended questions. The interview guide underwent initial testing with a colleague employed at the same nursing home as the first author. After the pilot phase in phase four, minor language revisions were made to specific questions to bolster the credibility of the interview process and ensure the collection of comprehensive and accurate data. The same interview guide was used to conduct individual interviews and focus group (Table 2 ).

The interviews were all conducted in a quiet room at a nursing home. Each interview lasted between 30 and 60 min and were digitally recorded. The individual interviews were transcribed verbatim by the first author. The focus group interview was transcribed by the second author.

Ethical perspectives

Prior to the onset of the data collection, ethical approval and permission to conduct the study were sought from the Norwegian Agency for Shared Services in Education and Research (Sikt/Ref. number 360,657) and from each leader of the nursing home. The study was conducted in accordance with the principles of the Declaration of Helsinki of the World Medical Association [ 43 ]: informed consent, consequences and confidentiality. The participants received written information about the aim of the study, how the researcher would ensure their confidentiality and, if they chose to withdraw from the study, their withdrawal would not have any negative consequences for their employment at nursing homes. Data were anonymised, and the digital records of the interviews were stored safely on a password-protected personal computer. The transcripts were stored in a locked cabinet in accordance with the existing rules and regulations for research data storage at Oslo Metropolitan University. The participants did not receive any financial or other benefits from participating in the study. Written consent was obtained prior to data collection, but verbal consent was also provided before each interview. None of the participants withdrew from the study.

Data analysis

The data were analysed by employing a qualitative deductive content analysis, as described by Kyngäs and Kaakinen [ 44 ]. Both researchers independently conducted the data analysis manually. The empirical data consisted of 63 pages (34,727 words) of transcripts from both individual and focus group interviews. The deductive content analysis was performed in three steps: (i) preparation, (ii) organisation and (iii) reporting of the results.

During the first step—preparation—each researcher, individually, read the transcripts several times to get an overview of the data and select units of analysis by searching for recurring codes and meanings and to carefully compare the similarities and differences between coded data. These codes were labelled independently by both researchers and placed into an analysis matrix.

During the next step—organisation—the researchers met and discussed and then compared and revised the labels several times until they agreed about the preliminary findings. During the interpretative process towards developing an understanding of the empirical data, the content of the labels referred to nurses’ perceptions about how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents, revealing similarities with the five phases of Tronto’s theory of ethics of care [ 32 , 33 ], thus assigning them to the five phases of the theory. Following this final refinement, one main category and five categories, each supported by several subcategories, were identified, as presented in Table 3 .

Reporting the results was the last step in the analysis. To enhance the understanding of the study’s findings, the findings are presented with supporting excerpts from the participants.

In qualitative studies, trustworthiness is the main parameter for appraising the rigour of the study [ 45 ]. To enhance the trustworthiness of the study, four criteria—credibility, transferability, dependability and confirmability, as described by Lincoln and Guba [ 46 ]—were applied.

To support credibility, a detailed description of the sample and the sampling process was provided. Furthermore, the interview guide and the questions that the participants were asked during the interviews are made available to the readers. Moreover, although the data were collected from five individual interviews and one focus group, triangulation of two data collection methods allowed researchers to ensure that the study is based on diverse perceptions and experiences, strengthening the credibility and impact of the study’s findings [ 47 ].

Detailed information about the sample and setting supports the assessment of the transferability of the findings. In this way, the readers can recognise and evaluate whether the findings would be applicable to similar contexts with a similar sample. Quotes from the participants’ statements are given to support the findings. Each quote ends with a number representing the code that each nurse was given before conducting the interviews (i.e., Participant in interview 1, PI1 or participant 6 in focus group interview, P6FG).

To increase dependability, the same interview guide was used to ask all participants the same questions. Dependability was also increased by the researchers reading and analysing the interviews independently and then checking the consistency of the data analysis technique with each other and discussing the analytical process until a consensus was reached.

To enhance confirmability, excerpts from the participants’ statements were included when presenting the findings, thus verifying the concordance of findings with the raw data. This demonstrates that the data were not based on preconceived notions.

Trustworthiness was also supported by member checking, meaning that the researchers sent the participants the transcripts of the interviews immediately after data collection; then, the interviews were transcribed. The participants were asked to review the transcripts and check the accuracy of the data; hence, they had the opportunity to add, remove or clarify their statements. Only one participant answered this request, stating that the transcripts were accurate, and she did not have any further comments. Despite encountering a suboptimal response from participants, the authors remain confident in the trustworthiness of the study. Rich data, derived from a combination of individual and focus group interviews, yielded diverse and nuanced responses from participants, reinforcing the credibility of the findings.

Reflexivity is the researcher’s reflection on their position during the research process [ 48 ]. Both researchers have clinical experience in providing end-of-life care to nursing home residents. Therefore, it was critical to be aware of the impact that their clinical backgrounds might have on the research process from information seeking during the analysis of data and discussion of the findings. To avoid early interpretation of the data, the researchers were aware of their preunderstanding and tried to put it on hold. Both authors engaged in discussions regarding apprehensions and reflections, actively participating in the triangulation process throughout the study to prevent potential bias during data collection, analysis, and interpretation. The theoretical framework was brought in the end of the analysis process, which helped label the emerged findings.

The analysis of the empirical data combined with an ethical reflection helped researchers to identify and understand the moral dimension of nurses’ experiences with end-of-life care provided to nursing home residents. During the analysis, an overarching category emerged– ‘The moral dimension of the provision of end-of life care’– describing nurses’ perceptions about how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. The participants agreed that end-of-life care is a care process that undergoes several phases, with each phase having its own ethical quality or its own element of care, here according to Tronto’s moral qualities [ 34 ]. In the following section, the findings are described using Tronto’s identified moral qualities for each of the five phases of the care process [ 32 , 33 , 34 , 35 ].

Caring about—being attentive

For the participants, being autonomous was perceived as a feature that increased their awareness of the resident’s caring needs during their last days of life. The participants agreed that the caring process involves paying attention, listening and recognising residents’ unspoken needs. Moreover, it implies nurses being able to make autonomous decisions when deciding which needs to care about at one particular moment.

The participants agreed that the core values of providing end-of-life care were to alleviate suffering, maintain dignity and provide comfort care. The participants perceived caring about as having sufficient knowledge, along with the experience and autonomy in practice, as well as providing comprehensive end-of-life care for residents. For the participants, caring about during the end-of-life process means them being present and dedicated. This implies nurses carefully observing, autonomously acting, and making decisions based on their judgements, and thus, they can decide and choose their course of action promptly based on resident’s condition or side effects. Moreover, caring about involved participants being attentive to perceiving the residents’ needs when the residents could no longer articulate themselves. The participants expressed their worries about resident’s bodily deterioration, leading them to lose their ability to express needs, as shown by the following quote:

There is not much communication when residents go into their last stage of life. Well… some of them are consciously until their death, but most are sedated; therefore, it is necessary to use your knowledge and experience to assess not only their needs for food and liquids or bodily hygiene, but also, we have to monitor their response to pain killers and other medication, and if it’s too much or too little, we need to do what’s needed to reduce or increase the medication and not let them suffer (PI3).

Some of the participants expressed that attentiveness to the residents’ care needs was a skill based on their clinical gaze developed during their careers. Other participants discussed that building a close relationship with the residents while they still could walk and talk was a precondition that helped them develop a clinical gaze, hence facilitating the nurses’ being attentive. Attentiveness allowed the participants to do what was needed when knowing the residents’ needs during the provision of end-of-life care. This may be interpreted as the moral or ethical quality of caring about during the end-of-life caring process, as demonstrated by the following statement:

We have time to know the resident before their health condition worsens… We previously knew what they wanted and how they wanted… their stay at nursing home gives us the opportunity to know their preferences and needs. Morally, we are obliged to provide the same quality of care they received when they could express themselves (PI4).

Caring for—taking responsibility

According to several participants, another phase within the end-of-life caring process was taking responsibility to care for. The participants agreed that monitoring the residents in their last days implies assuming responsibility. Assuming responsibility was perceived as an autonomous caring activity. They also discussed taking this responsibility seriously, which is a moral dimension of the end-of-life caring process and, ultimately, of the nursing profession. Usually, this responsibility was taken by a nurse, but it also involved other healthcare personnel or even next-of-kin. Among these responsibilities, the participants mentioned that the end-of-life caring process included not only caring for the resident’s physiological and psychosocial needs, but also assigning permanent healthcare personnel to continuously monitor the resident. Although the participants were aware that they share responsibilities for the caring process, ‘who does what…’, they ultimately had the overall responsibility for the whole end-of-life caring process.

Another responsibility included communication, which included listening, providing information, and supporting the residents’ next-of-kin. One of the participants expressed this as follows:

When I observe that the resident’s health worsens, I inform the next-of-kin and invite the spouse or the children to a meeting together with the responsible doctor and I, and we inform the next-of-kin what they might expect. The end-of-life care is not only about the resident and their last days, but also is to care for their next-of-kin to meet their needs and to overcome guilt feelings, anger or sadness.… (PI1).

Another way to care for patients was to deliberately increase opportunities to exercise autonomy during the caring process. For instance, the focus group participants discussed issues around advanced life support during the resident’s last days of life. Being prepared and having knowledge were the preconditions that gave them the authority to identify and make decisions about residents’ needs in here-and-now moments, hence exercising their autonomy. Some participants shared their experiences with controversies between next-of-kins’ and nurses’ assessments of what is the best care for the residents during their last days of life. Therefore, the importance of taking the initiative to discuss and clarify the resident’s needs and preferences was emphasised during the focus group interview, as shown in the following quote:

Some next-of-kins express wishes for advance life support and hospitalisation for their loved ones… and sometimes, to meet their needs, we try this, but the resident is suffering. The resident comes back to us after one or two days… To avoid this, clear guidelines, and a dialogue between the resident, their next-of-kin and us at the very beginning [when the resident enters the nursing home] is important… I think that minimalising the occurrence of difficult or conflictual situations and relieving the sufferance is care for both resident and their next-of-kin (P8FG).

Care giving—knowing what, why, how and when

During the interviews, the participants also discussed the caregiving process and provided concrete examples of what their caregiving encompassed. Spending extra time with the resident, choosing to be in the room and holding their hand to maintain physical contact was perceived as an autonomous caring act and a deliberate choice. One participant described this as follows:

For me, it is important that the dying person feels or hears that I am here with him or her… how he or she feels in these moments matters to me. I do it because I want to do it.… (PI5).

Other participants said that being autonomous when they actually provided caregiving to residents helped them make continuous assessments based on knowledge about what , how , how much , when and why to care. Knowledge and skills were decisive factors in providing competent care and making autonomous decisions during the caregiving phase; hence, competence was perceived as a moral dimension of caregiving. One of the participants said the following:

Caregiving at end-of-life is not only about giving morphine according to the doctor’s prescription… it involves all the judgements you have to make, all the skills you have… from preventing the occurrence of bedsores to knowing when to stop feeding but preventing thirst… think about all this knowledge and experience you must have to be able to make autonomous bedside judgements about when , why and so on.… (PI2).

Care giving at the end-of-life was described as all the necessary activities a nurse does to provide comfort and compassionate care to a dying resident. Among these activities, providing fundamental care and keeping residents comfortable and free of pain were seen as parts of the caregiving process. Moreover, adequate pain relief and symptom management were described as the moral dimension of care giving at this stage of end-of-life care, as one of the participants from the focus group interview said:

You cannot be passive when you see that the resident is suffering. I cannot go home and think that I should have done one or the other. It is against the nurses’ code of ethics and my personal moral and ethical principles. You have to act… I have to do what is needed… first thing first… pain relief and then personal hygiene! (P9FG)

Some of the participants mentioned some challenges they encountered during the care giving process. They said that care giving implies also standing in demanding situations. The lack of healthcare personnel with necessary knowledge or formal palliative care education or handling ethical dilemmas was seen as demanding situations that influenced the provision of care giving. Most of the participants felt that they were alone during the decision-making processes, which increased their awareness of their professional autonomy:

Sometimes, during weekends or evenings, I am the only nurse among the healthcare staff, and I have an overall responsibility for all nursing home residents. I have to prioritise who gets my attention and who needs me the most. Things can happen, regardless of whether it is Friday evening or weekend. I have to make a decision and do what is needed: to be with the dying resident and to support his or her next-of-kin in that moment. (PI5)

Care receiving—assessing caregiving

Several participants stated that, during the care-giving process, it was important to assess how the resident receive the care provided at the end-of-life stage. This was possible by monitoring the resident’s state of being but to also assess the outcomes of their care giving activities. They also reflected on their assessments and how they subsequently dealt with those assessments.

All the participants were confident in their knowledge and with their care giving at the end-of-life stage. They were aware that their care activities had consequences for the residents’ physiological and psychosocial needs. The assessment of the resident’s state of being was made by nurses listening, observing and interpreting resident’s response to care giving as signs of comfort or discomfort. One of the participants explained this as follows:

When providing personal care, if the resident presents any signs that can be interpreted as discomfort, I think that priority number one is me not causing more pain or suffering. However, I also understand that this person needs more pain killers, so I have to make sure that this person receives adequate medicine. (PI5)

Some participants also discussed the importance of assessing their care giving activities. They mentioned the importance of their assessments of the benefits of all care giving against the burden of all interventions and treatments. Their professional autonomy allowed them to make decisions about how to eschew care giving that was inappropriately and burdensome and choose the best comforting care for the resident. The participants stated that knowledge and experience were important in making such decisions, and their professional autonomy facilitated making choices of the best and less burdensome care giving. One of the participants said the following:

We have to assess whether the care giving provided meets the resident’s needs or not, whether the care comforts or perceives it as a burden and how the resident responds to this provision of care. (PI4)

During the interviews, some of the participants revealed a feeling of guilt when assessing that care giving altered the resident’s state of being, thus leading to new needs for care. They also discussed that the moral obligation and intention to relieve the suffering of the resident should override the foreseen but unintended harmful effects of care giving, including medication or other care interventions. One of the participants shared her experience as follows:

I still remember the attitude some of us had for a while ago… too much or too often morphine depresses the respiration and leads to death… I was struggling with feelings of guilt and even moral distress when I observed residents were still suffering because the medication they received had little or maybe no effect. I called the doctor and explained the situation… usually, the experienced doctors listen to us… and he [the doctor] prescribed more morphine.… (PI3).

Documentation of the response to care giving was also an issue discussed during the interviews. Some participants emphasised the importance of keeping detailed reports for a proper assessment of the care giving and medication and its outcomes. All reports were digitally written. Informal discussions between nurses and next-of-kin were also documented, especially when next-of-kin evaluated the care their loved ones received. The participants indicated that the more written information there was, the better. One participant acknowledged the following:

There is no such thing as ‘too much information’… being open about the morphine’s side effects and what to expect in the next hours or days is important for them [next-of-kin]. It helps them understand that end-of-life care is a process, not a quick fix procedure. (PI5)

Caring with—It is a teamwork process

During the interviews, most of the participants reflected upon the end-of-life caring process and its occurrence within the context of care in nursing home. The participants discussed that end-of-life care is not only about the responsibilities nurses have towards residents and their next-of-kin, but also the responsibilities of others who may influence the caring process. They perceived the caring process as an interplay between residents, next-of-kin, and themselves, along with how they relate to each other, which influences the caring process. However, as several participants asserted, this process did not occur in a vacuum: it occurred within an organisational context, which then influenced the caring process from the very beginning. One participant emphasised the importance of stable healthcare personnel within a caring organisation:

High staff turnover does not facilitate good end-of-life caregiving. Both residents and their next-of-kin need continuity and predictability in caring for and among healthcare personnel. They need somebody they know and trust… being exposed to new people every day increases their stress levels. (PI1)

Other participants discussed the importance of the leadership style and how the leader’s support influenced the culture of end-of-life care at the ward. The participants revealed that, within a caring context where their natural potential was enhanced through an enabling leadership style, they felt that they could provide competent and compassionate end-of-life care. One of the participants from the focus group stated that a positive leadership style supports nurses’ professional autonomy, thus helping them control the caring process, to have independence and to increase their ability to make clinical decisions and competent judgements regarding resident’s end-of-life care. One participant shared her experience as follows:

My leader gives me the freedom to make decisions when it comes to deciding what is best for the resident… She [the leader] enables me to be autonomous during the caring process, and this makes me aware of what and how to care.… (PI2).

The participants from the focus group interview also discussed how the nursing home’s caring culture influences care practice. They perceived the nursing home’s caring culture as positive, enabling good end-of-life care but also defective and an obstacle to care. They emphasised the importance of providing dignifying end-of-life care for residents. During the focus group interview, two of the participants engaged in a dialogue:

End-of-life care is providing care to the most vulnerable people, and it should be dignified… To do so, I have to provide care in a ‘caring room’ filled with dignity. (P7FG) Although next-of-kin and I have different perspectives of what good end-of-life care might be, we care together, we are a caring team which ensures in our own way that the resident receives competent care.… Yes, you [P7] mentioned this ‘caring room’… maybe we should open the door more often into this room and invite next-of-kin. (P6FG)

The aim of the present study was to explore nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. In the following, we discuss these perceptions in relation to Tronto’s [ 32 , 35 ] ethics of care framework and other supporting literature. To identify the moral dimension of these perceptions, we have related them to the moral qualities corresponding to each phase of the care process, as described by Tronto [ 33 , 35 ].

In the first phase of the care process—caring about—the participants discussed the importance of being attentive to which type of care needs to be provided, which is the moral quality of the first phase of care. Similar to findings from another study [ 49 ], findings from the present study revealed that some participants perceived autonomous practice as carrying out actions based on their decisions. Caring about entails detecting the resident’s needs, hence obliging nurses to ‘do something’ [ 50 ]. This particular skill was seen as an autonomous caring activity, that is, the nurses’ deliberate choice of putting on hold their self-interest and/or agenda and ‘a capacity genuinely to understand the perspective of the other in need’ [ 35 ] (p.34) , here nursing home resident.

In Tronto’s view [ 33 ], nurses’ attentiveness contributes to building up a caring relationship with a patient. The findings from the current study reveal that nurses perceived the provision of competent and compassionate end-of-life care as a result of their clinical gaze developed through certain activities, attitudes and knowledge of the patient, and through mutual relationships between the residents, next-of-kin and them. These results are supported by findings from previous studies that emphasise the importance of the nurse’s past experiences with the resident [ 51 ] and the significance of developing a good relationship with the resident and their next-of-kin [ 8 , 23 , 52 , 53 , 54 ] to provide adequate care. Moreover, similar to findings from other studies [ 55 , 56 ], the present study reveal that, to respond to the resident’s end-of-life care needs, nurses must bring not only their professional knowledge, clinical experience and ability to work autonomously but even ethical sensitivity. These findings enforce Gastman’s [ 50 ] view on caring, in which caring should respond to the patient’s care needs. This involves nurses having empathy, capacity of judgement and the ability to see what is required in a specific situation (here, end-of-life care), which, according to Gastmans [ 50 ], is inherent in the moral dimension of nursing practice.

The second phase of care—caring for—refers to nurses taking on the burden of meeting the needs identified in the first phase, that is, caring about. There was no ambiguity, and the participants had no doubts regarding who had the responsibility for the provision of end-of-life care to nursing home residents. The nurses’ responsibility was seen as a moral dimension of care. In line with Pursio et al.’s study [ 30 ], the present findings indicate that the freedom to make patient care decisions and work independently has a positive impact on the moral dimension of end-of-life care for nursing home residents. However, nurses’ work was not only about meeting residents’ needs, but also to create a safe milieu, a communicative space together with each other and with the resident’s next-of-kin, thus sharing power and control over the care process. Similar findings are displayed in an integrative literature review [ 53 ], demonstrating that a positive culture of collaborative and reciprocal relationships, a willingness to engage and become engaged and nurses communicating with intent to share and support rather than inform all lead to facilitating decision-making in nursing homes. According to Tronto [ 35 ], to facilitate end-of-life decision-making, nurses must take the initiative to allocate responsibilities; otherwise, the nurses withdraw themselves from their responsibility. By exercising their professional autonomy to assign responsibilities, nurses strive to mitigate the power imbalance among residents, their next-of-kin, and themselves, thereby preventing the occurrence of potential power struggles in their relationships [ 34 ]. This proactive approach helps prevent the emergence of end-of-life care dilemmas that could undermine the moral dimension of end-of-life care.

The third phase of care—care giving—requires, according to Tronto [ 35 ], the moral quality of nurses’ competence, meaning nurses directly engaging with care. The findings revealed that the nurses provided end-of-life care, and to do so, they needed to have competence, which implies the nurses having the knowledge, skills and values necessary to know what, why, how and when to provide end-of-life adequately. In addition, good end-of-life care requires the competence to individualise care—to provide competent care based on the resident’s physical, psychological, cultural and spiritual needs [ 57 ] while considering the resident’s context of care. Nurses’ competence is crucial for their autonomy; however, to effectively utilize their competence, nurses must be capable of assessing care needs and responding promptly [ 30 ]. Otherwise, delays in assessing residents’ care needs could undermine the moral dimension of end-of-life care. To provide individualised competent care, it is necessary that nurses make continuous assessments. As the findings reveal, the nurses were concerned with providing competent care, that is, adequate pain management. If the care provided was incompetent and led to more pain for the resident, the nurses perceived psychological distress—a state of being that resulted in response to a variety of moral events—leading to the nurses feeling anger, frustration, guilt, powerlessness and stress [ 58 ]. According to Tronto [ 34 ] (p.17) , ‘incompetent care is not only a technical problem, but a moral one’; however, as the findings reveal, the provision of competent care also depends on the nurses’ ability to prioritise decision-making when standing alone. Although nurses’ professional autonomy enabled them to make decisions and choose the right what , how , how much , when , and why , the lack of adequately educated healthcare personnel make the decision-making process a technical problem, which could weaken the moral dimension of end-of -life care.

The fourth phase—care receiving—involves the moral quality responsiveness. This means nurses being responsive to the reaction of the nursing home residents to end-of-life care process. As the findings have revealed, nursing home residents are vulnerable to nurses’ act of care or lack of care. According to Gastmans [ 59 ], care is a reciprocal practice that occurs within the framework of a relationship between the care provider (nurse) and care receiver (resident). The reciprocity consists of nurses assessing that the care provided actually meets the resident’s needs for pain management and other physiological and spiritual needs. The nurses had to make autonomous end-of-life care decisions to meet the resident’s needs. This involved the nurse’s attention to care giving to not be perceived as power abuse, which could have negative consequences for the moral dimension of end-of-life care provision.

According to Tronto [ 33 ], vulnerability may lead to unequal relationships where power abuse may occur. Nursing home residents are in a vulnerable position because they rely on nurses’ competence and ability to alleviate suffering and assess and reassess the residents’ responsiveness to pain management. To avoid an unequal relationship between resident and nurse, nurses must assess whether the care provided is competent or incompetent. Besides assessing and documenting the care provided and its outcomes, informal discussions between the resident’s next-of-kin and nurses were also assessed as important for next-of-kin perceiving a balanced power and equal position within the relationship. However, because each end-of-life act of care may alter the resident’s state of being, responsiveness requires more attentiveness [ 34 ]. Nurses must therefore meet the resident’s new needs for care with compassion and a commitment to maintaining the highest quality of life throughout the evolving stages of the resident’s end-of-life journey.

The final phase of care—caring with—requires that solidarity and trust are the foundation of all care giving to meet caring needs [ 35 ]. The moral quality of this caring phase is solidarity. The findings from the present study suggest that the nurses felt solidarity with both the residents and their leaders. The nurses felt that they were given the support and freedom to act autonomously when making decisions regarding end-of-life care, but similar to findings from a previous study [ 22 ], they also recognised the impact that organisational factors, such as leadership and care culture, may have on the justice and equality of the care provided when they prioritise care to whom needed it the most. Similar to findings from another study [ 49 ], participants in the present study described autonomy as the ability to make independent decisions and prioritise care for those who needed it most. However, according to Tronto [ 35 ], all nurses have a responsibility to help determine how care activities and responsibilities should be allocated. Residents, their next-of-kin and other healthcare personnel may have different views on how they may perceive appropriate, compassionate and dignified end-of-life care [ 20 , 21 ].Therefore, it is important to have transparency in nurse–resident–next-of-kin relations if the element of power within the relationship should be replaced by trust. Otherwise, the nurses’ autonomy may negatively influence the moral dimension of end-of-life care provided to nursing home residents. By opening the door of the “caring room” and inviting next-of-kin to participate in the care process, nurses may contribute to a greater reflectiveness around what may constitute ‘good’ end-of-life care.

Strengths and limitations

One of the strengths of the study is the use of Joan Tronto’s theory of the ethics of care [ 32 , 34 , 35 ] and its five phases and elements of care to discuss the study’s findings. This allows a deeper understanding of how nurses’ professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents. Another strength lies in the utilisation of two distinct methods of data collection: individual and focus group interviews. These approaches provided diverse datasets that shed light on various aspects of how nurses’ professional autonomy impacts the moral dimension of end-of-life care. Furthermore, the inclusion of participants with varying work experiences from four nursing homes enhances the richness and depth of the data generated from the interviews, further strengthening the quality of the study. Member checking ensures that the researcher’s interpretations accurately reflect the participants’ experiences and perspectives, thereby enhancing the validity of the study. This practice can be considered one of the methodological strengths of the study.

The current study has also some limitations that need to be considered. First, a limitation may be related to the size of the participant sample. The sample consisted of only nine nurses, a number that may be seen as a limitation in data collection. To challenge this limitation, the researchers posed follow-up questions during the interviews, thus offering the participants the opportunity to provide rich descriptions of their experiences with end-of-life care. Even though the sample consisted of only nine nurses, these participants reflected on and described their everyday work experiences. The participants’ rich descriptions were evaluated as possessing sufficient information power [ 41 ], thereby enhancing the overall quality of dialogues during interviews– a notable strength.

Second, the findings are limited to these nine participants and their personal work experiences in four different Norwegian nursing homes. This means that the sample is small and context dependent, which may limit the transferability and generalisability of the findings.

A third limitation pertains to the potential influence of the chosen theoretical framework on researchers’ preunderstanding during data analysis. To avoid bias, the theoretical framework was introduced at the end of the data analyses and after the coding process was conducted. The theoretical framework contributed to situating the knowledge from the empirical data into theoretical knowledge and vice versa. However, to be certain about interpretations and knowing that the qualitative nature of the study cannot completely exclude the impact of the preunderstanding on the analysis of the data, both researchers were aware of their theoretical preunderstanding and tried not to make conclusions beforehand.

The ethics of care framework provides opportunities for nurses to analyse their own caring activities during the provision of end-of-life care to nursing home residents. The exploration of the moral dimension of the provision of end-of-life care, utilising Tronto’s theory, revealed that moral qualities, such as attentiveness, responsibility, competence, responsiveness, and solidarity are influenced to a certain extent by nurses’ autonomy. What is crucial for the provision of competent end-of-life care is the nurses’ awareness of acting properly in accordance with the moral qualities to each of the phases of caring. Therefore, to provide competent end-of-life care nurses must be attentive to residents’ care needs, take on the responsibility for the care provided to ensure that residents’ needs are met, provide competent care based on knowledge, skills and values and assess how residents respond to the care provided. In other words, this is the basic nursing process in action, and this problem-solving approach is needed for the provision of competent end-of-life care.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Oslo Metropolitan University.

Abbreviations

Participant in interview [number of the individual interview

Participant [number] in Focus Group interview

World Health Organization. Palliative Care. Key Facts. 2020. https://www.who.int/palliativecare/en/ . Accessed 13 February 2023.

Broad JB, Gott M, Kim H, Boyd M, Chen H, Connolly MJ. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health. 2013;58(2):257–67.

Article PubMed Google Scholar

Hoben M, Chamberlain SA, Knopp-Sihota JA, Poss JW, Thompson GN, Estabrooks CA. Impact of symptoms and Care practices on nursing home residents at the end of life: a rating by front-line Care Providers. JAMDA. 2016;17(2):155–61.

PubMed Google Scholar

World Health Organization. Nursing and midwifery. Key Facts. 2022. https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery . Accessed 22 February 2023.

Westbrook JI, Ampt A. Design, application and testing of the Work Observation Method by activity timing (WOMBAT) to measure clinicians’ patterns of work and communication. Int J Med Inf. 2009;78(Suppl 1):S25–33.

Article Google Scholar

Munyisia EN, Yu P, Hailey D. How nursing staff spend their time on activities in a nursing home: an observational study. J Adv Nurs. 2011;67(9):1908–17.

Hernández-Marrero P, Fradique E, Pereira SM. Palliative care nursing involvement in end-of-life decision-making: qualitative secondary analysis. Nurs Ethics. 2019;26(6):1680–95.

Bollig G, Gjengedal E, Rosland JH. They know!-Do they? A qualitative study of residents and relatives views on advance care planning, end-of-life care, and decision-making in nursing homes. Palliat Med. 2016;30(5):456–70.

Dillworth J, Dickson VV, Mueller A, Shuluk J, Yoon HW, Capezuti E. Nurses’ perspectives: hospitalized older patients and end-of-life decision-making. Nurs Crit Care. 2016;21(2):e1–11.

Shimada C, Hirayama R, Wakui T, Nakazato K, Obuchi S, Ishizaki T, Takahashi R. Reconsidering long-term care in the end-of-life context in Japan. Geriatr Geront Int. 2016;16(S1):132–9.

Low LPL. Decision-making experiences and patterns in Residential Care homes for older residents, Family members and Care Providers. In: Grazia DO, Antonio G, Daniele S, editors. Gerontology. Rijeka: IntechOpen; 2018.

Google Scholar

ten Koppel M, Pasman HRW, van der Steen JT, van Hout HPJ, Kylänen M, Van den Block L, et al. Consensus on treatment for residents in long-term care facilities: perspectives from relatives and care staff in the PACE cross-sectional study in 6 European countries. BMC Palliat Care. 2019;18(1):73.

Article PubMed PubMed Central Google Scholar

Paganini MC, Bousso RS. Nurses’ autonomy in end-of-life situations in intensive care units. Nurs Ethics. 2015;22(7):803–14.

Odachi R, Tamaki T, Ito M, Okita T, Kitamura Y, Sobue T. Nurses’ experiences of End-of-life care in Long-Term Care hospitals in Japan: balancing improving the quality of life and sustaining the lives of patients dying at hospitals. Asian Nurs Res (Korean Soc Nurs Sci). 2017;11(3):207–15.

Muldrew Née Preshaw DH, McLaughlin D, Brazil K. Ethical issues experienced during palliative care provision in nursing homes. Nurs Ethics. 2019;26(6):1848–60.

Munn JC, Dobbs D, Meier A, Williams CS, Biola H, Zimmerman S. The end-of-life experience in long-term care: five themes identified from focus groups with residents, family members, and staff. Gerontologist. 2008;48(4):485–94.

Karlsson M, Berggren I, Kasén A, Söderlund M. A qualitative Metasynthesis from nurses’ perspective when dealing with ethical dilemmas and ethical problems in end-of-Life Care. Int J Hum Caring. 2015;19(1):40–8.

Gjerberg E, Førde R, Pedersen R, Bollig G. Ethical challenges in the provision of end-of-life care in Norwegian nursing homes. Soc Sci Med. 2010;71(4):677–84.

Svendsen SJ, Landmark BT. Dying patients in nursing homes: nurses provide more of everything and are left to deal with everything on their own. Sykepleien Forskning. 2017;12:e63396.

Dreyer A, Forde R, Nortvedt P. Autonomy at the end of life: life-prolonging treatment in nursing homes—relatives’ role in the decision-making process. J Med Ethics. 2009;35(11):672.

Article CAS PubMed Google Scholar

Dreyer A, Førde R, Nortvedt P. Life-prolonging treatment in nursing homes: how do physicians and nurses describe and justify their own practice? J Med Ethics. 2010;36(7):396.

Dreyer A, Førde R, Nortvedt P. Ethical decision-making in nursing homes: influence of organizational factors. Nurs Ethics. 2011;18(4):514–25.

Bollig G, Schmidt G, Rosland JH, Heller A. Ethical challenges in nursing homes–staff’s opinions and experiences with systematic ethics meetings with participation of residents’ relatives. Scand J Caring Sci. 2015;29(4):810–23.

Scott PA. Nursing and the ethical dimension of practice. In: Scott PA, editor. Key concepts and issues in nursing Ethics. Cham: Springer International Publishing; 2018.

2021; Code of Ethics for Nurses. International Council of Nurses (ICN), Geneva. https://www.icn.ch/sites/default/files/2023-04/ICN_Code-of-Ethics_EN_Web_0_0.pdf . Accessed 5 March 2023.

2017; International Classification for Nursing Practice (ICNP), Geneva. https://www.icn.ch/sites/default/files/inline-files/Palliative_Care.pdf .

Poikkeus T, Numminen O, Suhonen R, Leino-Kilpi H. A mixed-method systematic review: support for ethical competence of nurses. J Adv Nurs. 2014;70(2):256–71.

Izumi S, Nagae H, Sakurai C, Imamura E. Defining end-of-life care from perspectives of nursing ethics. Nurs Ethics. 2012;19(5):608–18.

Ohnsorge K, Keller HR, Widdershoven GA, Rehmann-Sutter C. Ambivalence’ at the end of life: how to understand patients’ wishes ethically. Nurs Ethics. 2012;19(5):629–41.

Pursio K, Kankkunen P, Sanner-Stiehr E, Kvist T. Professional autonomy in nursing: an integrative review. J Nurs Manag. 2021;29(6):1565–77.

Kramer M, Schmalenberg C. The practice of clinical autonomy in hospitals: 20 000 nurses tell their story. Crit Care Nurse. 2008;28(6):58–71.

Fisher B, Tronto JC. Towards a Feminist Theory of Care. In: Abel E, Nelson M, editors. Circles of care. Albany, NY: SUNNY; 1990.

Tronto JC. Moral boundaries: a political argument for an Ethic of Care. 1st ed. New York: Routledge; 1993.

Tronto JC. An Ethic of Care. Generations: J Am Soc Aging. 1998;22(3):15–20.

CAS Google Scholar

Tronto JC. Caring democracy: markets, Equality, and Justice. NYU; 2013.

Edwards SD. Is there a distinctive care ethics? Nurs Ethics. 2011;18(2):184–91.

Jacobsen FF, Mekki TE. Health and the Changing Welfare State in Norway: a Focus on Municipal Health Care for Elderly Sick. Ageing Int. 2012;37:125–42.

Norwegian Ministry of Health and Care Services. Forskrift om kvalitet i pleie - og omsorgstjenestene (Regulation on quality of care). 2003. [In Norwegian]. https://lovdata.no/dokument/SF/forskrift/2003-06-27-792 . Accessed 20 February 2023.

Mæhre KS, Bergdahl E, Hemberg J. Patients’, relatives’ and nurses’ experiences of palliative care on an advanced care ward in a nursing home setting in Norway. Nurs Open. 2023;10(4):2464–76.

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 11th ed. Philadelphia: Wolters Kluwer; 2021.

Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by Information Power. Qual Health Res. 2016;26(13):1753–60.

Kallio H, Pietilä A-M, Johnson M, Kangasniemi M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. J Adv Nurs. 2016;72(12):2954–65.

World Medical Association Declaration of Helsinki. Ethical principles for Medical Research Involving human subjects. JAMA. 2013;310(20):2191–4.

Kyngäs H, Kaakinen P. Deductive content analysis. In: Kyngäs H, Mikkonen K, Kääriäinen M, editors. The application of content analysis in Nursing Science Research. Cham: Springer International Publishing; 2020.

Chapter Google Scholar

Kyngäs H, Kääriäinen M, Elo S. The trustworthiness of Content Analysis. In: Kyngäs H, Mikkonen K, Kääriäinen M, editors. The application of content analysis in Nursing Science Research. Cham: Springer Nature Switzerland AG; 2020.

Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, Calif.: Sage; 1985.

Book Google Scholar

Helen N, Roberta H. Triangulation in research, with examples. Evid Based Nurs. 2019;22(3):67.

Berger R. Now I see it, now I don’t: researcher’s position and reflexivity in qualitative research. Qual Res. 2015;15(2):219–34.

Oshodi TO, Bruneau B, Crockett R, Kinchington F, Nayar S, West E. Registered nurses’ perceptions and experiences of autonomy: a descriptive phenomenological study. BMC Nurs. 2019;18(1):51.

Gastmans C. Care as a moral attitude in nursing. Nurs Ethics. 1999;6(3):214–23.

Lachman VD. Applying the ethics of care to your nursing practice. Medsurg Nurs. 2012;21(2):112.

Roberts AR, Ishler KJ. Family involvement in the nursing home and Perceived Resident Quality of Life. Gerontologist. 2017;58(6):1033–43.

Lynch B, Ryan AA, O’Neill M, Penney S. The factors that influence care home residents’ and families’ engagement with decision-making about their care and support: an integrative review of the literature. BMC Geriatr. 2022;22(1):873.

Hedman M, Häggström E, Mamhidir AG, Pöder U. Caring in nursing homes to promote autonomy and participation. Nurs Ethics. 2019;26(1):280–92.

Alshammari F, Sim J, Lapkin S, Stephens M. Registered nurses’ knowledge, attitudes and beliefs about end-of-life care in non-specialist palliative care settings: a mixed studies review. Nurse Educ Pract. 2022;59:103294.

Ghaemizade Shushtari SS, Molavynejad S, Adineh M, Savaie M, Sharhani A. Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study. BMC Nurs. 2022;21(1):102.

Vanlaere L, Gastmans C. A personalist approach to care ethics. Nurs Ethics. 2011;18(2):161–73.

Morley G, Bradbury-Jones C, Ives J. What is ‘moral distress’ in nursing? A feminist empirical bioethics study. Nurs Ethics. 2020;27(5):1297–314.

Gastmans C. The care perspective in healthcare ethics. In: Davis AJ, Tschudin V, de Raeve L, editors. Essentials of teaching and learning in nursing ethics. New York: Churchill Livingstone Elsevier; 2006.

Download references

Acknowledgements

We would like to express gratitude to the nurses who participated in this study, thereby contributing to the data collection. Additionally, we extend our thanks to the Oslo Metropolitan University Library for granting approval and for their support in covering the publication fee of this article.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and affiliations.

Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4, St. Olavs Plass, N-0130, Oslo, Norway

Rachel Gilbert & Daniela Lillekroken

You can also search for this author in PubMed Google Scholar

Contributions

D.L. contributed to the study conception, data collection, and analysis, and wrote the main manuscript text. R.G. was involved in data collection, analysis, reflection, and manuscript writing. D.L. was responsible for administrative work related to journal submission and was also involved in reviewing and editing the manuscript. R.G. and D.L. have read and approved the manuscript before submission.

Corresponding author

Correspondence to Daniela Lillekroken .

Ethics declarations

Ethics approval and consent to participate.

The Norwegian Agency for Shared Services in Education and Research approved the study protocol (Sikt/Ref. number 360657) and concluded that the study was not subject to the Norwegian Health Research Act (LOV-2008-06-20-44; https://lovdata.no/dokument/NL/lov/2008-06-20-44 ). An English version of the Norwegian Health Research Act can be found at: https://www.uib.no/en/med/81598/norwegian-health-research-act . This study does not aim to get insight into participants’ health status, sexuality, ethnicity, and political affiliation (sensitive information), therefore, no additional approval from a local ethics committee or institutional review board (IRB) was necessary to be obtained to conduct the study. This study was performed according to principles outlined in the Declaration of Helsinki, and in accordance with Oslo Metropolitan University’s guidelines and regulations. Data were kept confidential and used only for this research purpose. The researchers provided verbal and written information about the study. Informed consent was obtained from all participants prior data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Gilbert, R., Lillekroken, D. Nurses’ perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents– a qualitative study. BMC Nurs 23 , 216 (2024). https://doi.org/10.1186/s12912-024-01865-5

Download citation

Received : 06 December 2023

Accepted : 13 March 2024

Published : 28 March 2024

DOI : https://doi.org/10.1186/s12912-024-01865-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

End-of-life
Moral qualities
Moral dimension
Nursing homes
Professional autonomy
Qualitative study

BMC Nursing

ISSN: 1472-6955

General enquiries: [email protected]

IMAGES

SOLUTION: The icn code and ana code of nursing ethics 538 words essay
Code of Ethics for nurses by ICN// ICN Code of Ethics for nurses
(PDF) The importance of ethical codes in nursing care
Code of Ethics for Nurses
Ethics Essay
nursing ethics essay

VIDEO

Nursing Ethics MCQs & Answers-NCLEX- Prometric- HAAD,DHA/Part 1 (2023)
Nursing Ethics: Code of Conduct for generic BSN student
Nursing Code of Ethics
Introduction To Nursing Ethics in Urdu/Hindi
Code of Ethics || Sir Rizwan || Nursing Ethics || Chap-4 , Part-2 || PNC and ICN || Urdu/Hindi
Code of Ethics. TORTS in Nursing

COMMENTS

What is the Nursing Code of Ethics?
According to the American Nurses Association (ANA), the nursing code of ethics is a guide for "carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.". Ethics, in general, are the moral principles that dictate how a person will conduct themselves. Ethical values are essential for ALL healthcare workers, but ...
View the Code of Ethics for Nurses
The Code of Ethics for Nurses with Interpretive Statements (The Code) was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. In an effort to provide easy access to The Code, we are providing "view only" access, not only for ANA members ...
Nursing Code Of Ethics In Nursing: [Essay Example], 604 words
The Code of Ethics is based on a set of fundamental principles that reflect the core values of nursing, including compassion, integrity, and respect for the dignity and rights of patients. One of the key principles of the Nursing Code of Ethics is the commitment to patient advocacy. Nurses are expected to prioritize the well-being of their ...
Essay about Nursing Code of Ethics
Essay about Nursing Code of Ethics. The nursing code of ethics has a very standard definition. It is the base on how nurses should guide themselves in conduct by making the right decision regarding ethical issues. According to the National Student Nurses Association "students of nursing have a responsibility to society in learning the ...
Ethics Essay
Ethics Essay The Code of Ethics for Nurses are housed by the American Nurses Association (ANA), which serves as an outline of guiding principles regarding ethics that "establishes the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making." (American Nurses Association [ANA], 2015 ...
Nursing Ethical Considerations
Ethical practice is a foundation for nurses, who deal with ethical issues daily. Ethical dilemmas arise as nurses care for patients. These dilemmas may, at times, conflict with the Code of Ethics or with the nurse's ethical values. Nurses are advocates for patients and must find a balance while delivering patient care.
PDF Code of Ethics for Nurses With Interpretive Statements
The Code of Ethics for Nurses serves the following purposes: It is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It is the profession's nonnegotiable ethical standard. It is an expression of nursing's own understanding of its commitment to society.
Use and impact of the ANA Code: a scoping review
This study focuses on Code of Ethics for Nurses with Interpretive Statements published by the American Nurses Association (hereafter the Code). 2 American Nurses Association (ANA) is a national nursing organization representing the interests of more than five million registered nurses. ANA advances the profession fostering high standards of nursing practice, promoting a safe and ethical work ...
Nursing Code of Ethics: Provisions and Interpretative Statements for
The American Nurses Association (ANA) describes the Nursing Code of Ethics as the non-negotiable ethical standard of the nursing profession,1 serving as an expression of nursing's commitment to society. The code consists of 9 provisions with interpretative statements (herein italicized under each provision). ... This call for papers offers ...
Why Ethics in Nursing Matters
It serves as a moral compass to promote high levels of care, an ethical standard for those entering the nursing profession, and a commitment to society affirming the responsibilities of the registered nurse. The Code of Ethics has been revised over time to reflect technological advances, societal changes, and the expansion of the nursing practice.
The Importance of Ethics in Nursing
The Nursing code of ethics sets forth the principle that people have the right to decide how they want treatment and to be informed about that treatment in a manner that meets their preferences. It is important, however, that patients be mentally fit to make those types of decisions. If they are not, nurses must help them with the decision ...
Nursing Excellence
Ethics Topics and Articles. For nurses to fulfill their ethical obligations to patients, it is vital to have access to a wide range of information and to keep up-to-date with advances in ethical practices. These articles and links offer context for nurses on difficult issues and best-practice recommendations. Bioethics/Biodefense.
Nursing Code of Ethics
Goals of the nursing code of ethics. To serves as concise reminder of the ethical duties and commitment of all the persons who choose the nursing career. To outline the nursing profession's invariable ethical standards. To highlight the professional's own awareness of its obligation to the community.
PDF American Nurses Association Code of Ethics for Nurses
Provision 9 The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. Source: American Nurses Association. (2015). Code of ethics with interpretative statements. Silver
The Nurses' Code of Ethics, Essay Example
The Nurses' Code of Ethics, Essay Example. HIRE A WRITER! You are free to use it as an inspiration or a source for your own work. The nurses' code of ethics dictates professional health care provision to patients without favor or prejudice, a concept that should be applied to every patient under the hospital care.
Principles of Clinical Ethics and Their Application to Practice
The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially ...
Nursing Code Of Ethics Essay
Nursing Code Of Ethics Essay. Sort By: Page 1 of 50 - About 500 essays. Decent Essays. Nursing : A Code Of Ethics In Nursing. 847 Words; 4 Pages ... The nursing code to ethics sets forth the rules that carry out the responsibility for nurses and also the ethical obligation nurses have for themselves and for the patients in their care. Within ...
The Code of Ethics for Nurses
National Code of Ethics for Nurses. The Code is an entirely new document produced for nursing ethics in the country, which was published in Farsi ().It is also available through the website of MOHME ().The English version is enclosed here as annex1.The target audience includes all nurses in the fields of nursing education, research, administrative, and clinical care, in the whole.
Informed Consent: The Nurses Code Of Ethics
The Nurses' Code of Ethics underscores the importance of upholding dignity, eliminating prejudice, exercising conscientious refusal, and fostering effective communication. The Code of Ethics emphasizes that every patient has inherent dignity and worth, regardless of their background or life choices. This means that a nurse should respect the ...
Importance of Code of Ethics in Nursing Profession
The Nursing and Midwifery Board of Australia, (2018), refer to the code of ethics for nurses' as an important document that outlines the legal requirements, professional behavior and conduct expectations as well as obligations for all nurses, in all areas of practice. The code further describes the principles of professional conduct guiding ...
Example Essay on Professional and Ethical Practice in Nursing
Ethics are found in the NMC Code of conduct and nurses are accountable for their ethical conduct (Kozier, 2008). Ethics and moral are sometimes used interchangeably in some literatures. Beauchamp & Childress (1989, 2009) developed a framework stated that there are four moral principles that nurses can work under.
Ethical Dilemmas in Nursing (Examples & Solutions)
The nursing code of ethics is a bunch of rules nurses has to follow to provide quality, safe, and unquestionable care to those who need it. ... Understanding some ethical dilemma scenarios you can write an essay about as a nursing student is essential. Remember, there is never a right or wrong answer; in the same way, there is no small or big ...
110 Ethics in Nursing Essay Topics, Ideas & Examples
Tips for Students Writing an Essay on Ethics in Nursing: Understand the Code of Ethics for Nurses: The American Nurses Association (ANA) has established a code of ethics for nurses that outlines the ethical responsibilities and principles that nurses should follow. Consider Real-World Scenarios: Ethics in nursing can be complex and nuanced ...
Nursing Ethics Essays: Examples, Topics, & Outlines
Nursing Ethics Ethical Dilemma Ethics Identify the potential ethical dilemma A nurse accused of stealing. She is a good nurse but cannot be allowed to continue stealing and breaking the law while she is performing her duties. Collect, analyze, and interpret data Nurses must protect clients' well-being, even while they strive to support other nurses. The case study is presented in such a manner ...
Nurses' perceptions of how their professional autonomy influences the
Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto's theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its ...
Ethics code references
References for ethics codes follow the same format as reports. When the author and publisher are the same (as in the examples), omit the publisher name to avoid repetition. To cite a specific section of an ethics code, create a reference to the full code and then indicate the specific section in the in-text citation.

What is the Nursing Code of Ethics?

Nursing Code of Ethics Interpretive Statements

4 Ethical Principles in Nursing

2. Beneficence

4. Nonmaleficence

9 Provisions of the Nursing Code of Ethics

What are the five codes of ethics in nursing?

What is the Professional Code of Ethics for Nurses?

Why is the code of ethics important in nursing?

What is the code of ethics in healthcare?

What is scholarly ethics in nursing?

Nursing Code of Ethics in Nursing

Cite this Essay

Related Essays

Still can’t find what you need?

Related Essays on Nursing

Related Topics

Get Your Personalized Essay in 3 Hours or Less!

The Importance of Ethics in Nursing

What Are Ethics in Nursing?

Cultural Competency in Nursing

Examples of Ethics in Nursing

Confidentiality

Accountability

Valuing Individual Patients

Wholistic Treatment

Advocating for Patients

Promoting Equality

Pursue a Nursing Career

Recent Blogs

Nursing Code of Ethics Report

The Nurses’ Code of Ethics, Essay Example

Related Essay Samples & Examples

Utilitarianism and Its Applications, Essay Example

The Age-Related Changes of the Older Person, Essay Example

The Problems ESOL Teachers Face, Essay Example

Should English Be the Primary Language? Essay Example

The Term “Social Construction of Reality”, Essay Example

The Code of Ethics for Nurses

A Parsapour

MA Cheraghi

GH Mirzabeigi

M Vahid Dastgerdi

Introduction

National Code of Ethics for Nurses

Ethical considerations

Acknowledgments

ANNEX 1. The Code of Ethics for Nurses in Islamic Republic of Iran

ETHICAL GUIDELINES

2. Nurses and the Profession

3. Nurses and Practice

4. Nurses and Co-workers

Nursing Director should:

5. Nursing, Education and Research

Common Ethical Dilemmas in Nursing and their Solutions

What is an Ethical Dilemma in Nursing?

Ethical Dilemma Versus Moral Dilemma

Reasons Nurses Face Ethical Dilemmas in Healthcare

Identifying Ethical Dilemmas in Nursing

Principles of Nursing Ethics

1. Nonmaleficence

2. Beneficence

3. Autonomy

Examples of Ethical Dilemmas in Healthcare

1. Pro-choice versus pro-life.

2. Religious beliefs versus science.

3. Beneficence versus autonomy.

4. Anti-vaccine stance.

5. Withholding information versus being honest.

6. Limited resources versus healthcare needs.

7. Questionable orders.

How to Address Ethical Dilemmas in Nursing

1. A Problem Shared Is a Problem Halved

2. Internalize Patient Autonomy

3. Respect the Right to Privacy

4. Transparency is Key

5. Ask Yourself What Is in The Best Interest of the Patient

6. Stay Up-To-Date with Ethical Guidelines

7. Always Do Something as Soon as You Can

8. Negotiating Never Hurts Anybody