Ethical Principles in Community Health Nursing

Ethical Principles of Community Health Nursing Practice

• Ethics is a system of moral principles and rules of conduct recognized for a particular class of human actions or a particular group of people.
• Ethical considerations involve evaluating the morals or principles of goodness behind an action.
• This includes determining the rightness or wrongness before the action occurs, and whether it aligns with professional or practice standards, particularly within the nursing profession.
• Ethical considerations in community health nursing practice lead to complex legal and ethical issues. Example includes the selling of drugs and toxins, or asking payment for services rendered in barangay health centers.
• According to George Washington Carver, once motives are wrong, nothing can be right, and there is no right way to do a wrong thing.
• Healthcare practitioners are responsible for preserving life and health, protecting bodily integrity, and respecting human dignity.
• Ethical issues occur when a decision or activity conflicts with societal moral principles. This may lead to legal conflicts due to possible alternatives breaching laws.
• A common ethical dilemma in community health nursing is setting boundaries with clients, especially when care providers may become manipulative, or the community becomes overly attached to the nurse.
• Moral uncertainty/conflict happens when a nurse isn't sure which moral principle to apply, a typical situation during a pandemic, where nurses struggle with making unbiased and fair decisions for all patients.
• Moral distress happens when a nurse knows the right action but organizational constraints prevent them from taking it, usually due to conflicting ideas with other care providers. Examples include excessive workloads, and working with incompetent colleagues.
• Moral outrage is a behavioral response to an immoral act by another healthcare provider, where the nurse feels incapable of intervening. An example of this in the context of Covid-19 is frustration from the high-risk treatments and care needed for front-line workers.
• As a nurse, you must practice within the moral standards of the nursing profession and the context of legal laws. Nurses need knowledge, judiciousness, and consideration when performing their duties and responsibilities.
• Key ethical principles include autonomy, beneficence, non-maleficence, justice, veracity, and fidelity.
• Autonomy refers to freedom of action. This includes the provision of informed consent, freedom of choice, and the right to refuse treatment.
• Community health nurses may lead educational campaigns to promote healthy behaviors. Examples include vaccinations, practicing safe sex, and smoking cessation. In some cases, they may use paternalistic approaches, believing these actions are in the best interest of the community.
• Instances involving paternalism restrict patient autonomy. Examples include the provision of information or deciding on behalf of a client when developmental issues and health challenges prevent them from deciding for themselves.
• The nurse must respect the rights of the community and treat individuals as autonomous objects, with the right to make their own decisions.
• Beneficence is acting in a way that benefits others. The nurse should apply hypothetical measures in order to ensure the best, and suitable measures for sick individuals.
• Preventing or avoiding harm during community practices is considered a part of beneficence. This includes a duty to provide healthcare services to community people.
• Non-maleficence is the principle of doing no harm. Healthcare practitioners should ensure that they do not harm patients while they provide care.
• Justice involves treating equals equally. Equitable healthcare is provided to all community members.
• Fidelity involves loyalty and faithfulness to commitments. Nurses should be faithful to their promises to provide quality care to patients.
• Fidelity concerns itself with explicit and implicit promises the nurse makes, keeping one's word of honor, loyalty, commitment and oaths and act in a reliable manner.
• Fiduciary responsibilities refer to the contract of relationship between the nurse and patient. This relationship is based on trust and confidentiality amongst the participants.
• Veracity involves truthfulness and honesty in all dealings with community members. Nurses should tell the truth and not misrepresent or deceive others.
• Confidentiality involves safeguarding privileged information from public disclosure. Harm to self or others, or needing permission to share particular information is considered a violation of confidentiality or requiring to be communicated.

Duty-Based (Deontology)

• Duty-based ethics focuses on the adherence to rules and obligations. Ethical choices are made based on duty rather than results/consequences of those choices.
• A duty may involve responding to/ refusing certain demands/services, such as responding to an emergency or refusing a service delivery at an unapproved hour.

Virtue Ethics

• Virtue ethics emphasizes the character of the decision-maker, and considers the ideal virtues to maintain when making choices.
• Examples include honesty, courage, compassion, and service.

Principlism

• Principlism involves applying ethical principles instead of theoretical approaches to evaluate actions. Nurses frequently use this approach in their practice. It involves using knowledge of ethical principles over ethical theories.

Ethics in Professional Nursing Practice

• Nursing practices are governed by the International Council of Nurses (ICN), including their Code of Ethics, which provides guidance based on social values and needs, and correlates the four primary nursing responsibilities.
• These fundamental responsibilities are: promoting health, preventing illness, restoring health, and alleviating suffering.
• The American Nurses Association (ANA) Code of Ethics applies to all nurses, including ethical principles, standards of conduct, and behaviors. It is the profession's ethical standards and aims to establish the commitment of nursing professionalism to the community.
• Key commitments/points involving ANA code of ethics consist of: primary commitment, compassion/respect, health welfare, accountability, knowledge/increase, healthcare environment, and commitment.

Professional Boundaries

• Professional boundaries define the appropriate limits in a therapeutic relationship with a patient, involving refraining to obtain personal gain at the expense of the patient, and to avoid jeopardizing the therapeutic relationship.

• Boundary violations involve unethical acts during therapeutic relationships that harm or exploit the patient. Examples involve exploitation, personal gain, including excessive self disclosure, secretive behavior, selective communication, becoming a “super-nurse”, singled-out client treatment, and the inability to protect a client.

•   Key terms associated with professional boundaries include: Boundaries, Crossings, Violations, Sexual Misconduct.

• Methods to establish boundaries include: not discussing client information with others, maintaining separate work and personal contact numbers, avoiding additional favors beyond the role.

• Considerations in setting boundaries: knowing yourself and your values, intervening in ethical questions, knowing the facility policy, understanding responsibilities regarding consent forms, respecting advanced directives.