Ethical Principles in Nursing Practice

Confidentiality and Privacy

• Confidentiality refers to specific restrictions on private information revealed in confidence, with an understanding that it will not be disclosed to others.
• The Code of Conduct for Nurses principle 3.5 states that nurses must maintain confidentiality and respect patients' privacy.

Case Study 1: Social Media Breach of Confidentiality

• A nurse posted a comment on social media about a patient, revealing the patient's weight and medical condition, which is a breach of confidentiality.
• The post allowed others to identify the client, which is a violation of confidentiality.

Case Study 2: Using Patient Images without Consent

• A nurse educator used pictures of a client's lesions in a presentation poster without consent, which is a breach of confidentiality and privacy.
• The nurse needs to consider the patient's privacy and obtain consent before using their images.

Case Study 3: Patient Refusal of Treatment

• A patient, Marcus, refused treatment due to his belief that he did not have cancer, despite being diagnosed with dehydration and delirium.
• The patient has the right to make an informed decision, but his refusal may not be informed due to his misunderstandings about cancer.
• The healthcare team must consider whether to override the patient's refusal and respect his autonomy.

Bioethical Dilemmas

• Bioethical dilemmas involve decision-making problems between two possible moral imperatives, neither of which is unambiguously acceptable or preferable.
• Examples of bioethical dilemmas include abortion, euthanasia, "do not resuscitate" (DNR) orders, voluntary assisted dying, reproductive technology, tissue transplantation, organ donation, quality of life, and conscientious objection.

Ethical Principles in Healthcare

Beneficence and Non-Maleficence

• Beneficence refers to the obligation to make a situation better by doing good.
• Non-maleficence refers to the obligation not to harm patients.

Justice

• Justice involves fairness and equality, with no discrimination based on race, gender, religion, etc.
• Equal distribution of resources is necessary, and treatment must be given according to individual needs.

Veracity

• Veracity refers to telling the truth and maintaining trust relationships between clients and nurses.
• Breaches of veracity include lying, withholding information, partial disclosure, and deception.

Privacy and Confidentiality

• The Privacy Act 1988 governs the handling of personal information by Commonwealth agencies and organizations.
• Nurses must maintain confidentiality and respect patients' privacy.

Open Disclosure

• Open disclosure involves informing patients about adverse events or incidents that occurred during their care.
• The nurse who administered the wrong medication is responsible for open disclosure.
• Open disclosure discussions should involve the patient, their family, and the healthcare team.

Key Terms

• Harm: impairment of structure or function of the body, including disease, injury, suffering, disability, and death.
• Incident: any event that could have or did lead to unintended and/or unnecessary psychological or physical harm.
• Near Miss: an incident that did not cause harm but had the potential to do so.