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2.8 Ethical Practice Principles

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

2.8 Ethical Practice Principles

Key Takeaways Explain This Topic AI

Autonomy respects the patient's right to self-determination, including the right to refuse treatment even if refusal may result in death

Beneficence is the duty to do good and act in the patient's best interest at all times

Non-maleficence means 'do no harm' and includes preventing errors through practices like medication verification

Justice requires fair distribution of resources and treating all patients equitably regardless of personal characteristics

  • Veracity is the obligation to tell the truth, including honest communication about diagnoses and prognosis
  • Last updated: January 2026

Nurses are assessed on their ability to apply ethical principles to complex dilemmas. While laws tell us what we must do, ethics guides what we should do. Ethical principles provide a framework for decision-making when clear rules don't exist.

Core Ethical Principles

  • Principle Definition Focus
  • Autonomy Self-determination Patient's right to choose
  • Beneficence Do good Acting in patient's best interest
  • Non-maleficence Do no harm Preventing harm
  • Justice Fairness Equitable treatment and resource allocation
  • Veracity Truthfulness Honest communication
  • Fidelity Faithfulness Keeping promises, loyalty
  • Autonomy

Autonomy is the patient's right to self-determination — the right to make decisions about their own care.

Nursing Implications:

  • Respect patient choices, even if you disagree
  • Provide information for informed decision-making
  • Support refusal of treatment by competent adults
  • Ensure cultural preferences are honored

Autonomy in Practice:

  • Situation Autonomous Action
  • Patient refuses recommended surgery Document refusal, ensure patient is informed
  • Patient wants alternative treatment Provide information, respect choice
  • Family wants to override patient Support patient's expressed wishes
  • Patient from culture with family-centered decisions Assess patient's preference for involvement

Key Point: A competent adult has the absolute right to refuse treatment, even if refusal will result in death.

Beneficence

Beneficence is the duty to do good and act in the best interest of the patient.

Nursing Implications:

  • Advocate for patient's well-being
  • Provide competent, evidence-based care
  • Consider all aspects of patient welfare
  • Balance benefits against risks

Beneficence in Practice:

  • Action Example
  • Advocating for pain management Requesting adequate analgesia for suffering patient
  • Preventing complications Implementing fall prevention measures
  • Promoting health Providing patient education
  • Supporting coping Offering emotional support during crisis
  • Non-maleficence

Non-maleficence means "do no harm" — the duty to prevent harm to patients.

Nursing Implications:

  • Verify medications (rights of medication administration)
  • Recognize and report errors
  • Identify and correct unsafe conditions
  • Maintain competency to prevent harm from lack of skill

Non-maleficence in Practice:

  • Potential Harm Prevention
  • Medication error Verify right patient, drug, dose, route, time
  • Falls Assess risk, implement prevention measures
  • Infections Follow standard precautions, sterile technique
  • Skin breakdown Reposition q2h, assess skin integrity

Principle of Double Effect: Sometimes an action intended to help may also cause harm. This is ethically acceptable when:

  • The action itself is good or neutral
  • The intent is for good effect, not harm
  • The good effect is not achieved through the harm
  • There is proportionate reason for allowing harm
  • Example: Giving morphine for pain relief (good) even though it may hasten death (harm)
  • Justice

Justice is the fair distribution of resources and equitable treatment of all patients.

Nursing Implications:

  • Treat all patients with equal respect
  • Allocate resources fairly
  • Advocate for underserved populations
  • Recognize and address bias

Justice in Practice:

  • Situation Just Action
  • Multiple patients need nurse's attention Triage based on clinical need, not preference
  • Scarce resource (e.g., ventilator) Allocate based on clinical criteria, not social worth
  • Patient from different culture Provide culturally competent care
  • Uninsured patient Provide same standard of care as insured patient

Distributive Justice Considerations:

How should scarce resources be allocated?

Should everyone receive the same care, or care based on need?

How do we balance individual needs vs. societal needs?

Veracity

Veracity is the obligation to tell the truth.

Nursing Implications:

  • Provide honest information about care and condition
  • Do not deceive patients or families
  • Correct misinformation
  • Acknowledge errors honestly

Veracity in Practice:

  • Situation Truthful Action
  • Patient asks about diagnosis Provide information within scope; defer to provider for detailed disclosure
  • Medication error occurred Disclose to patient and provider
  • Patient has false hope Gently clarify realistic expectations
  • Family asks to withhold information Assess patient's wishes for information

Truthful Communication Includes:

  • Not withholding relevant information
  • Correcting false beliefs when appropriate
  • Documenting accurately
  • Reporting errors honestly
  • Fidelity

Fidelity is faithfulness to commitments, keeping promises, and loyalty.

Nursing Implications:

  • Follow through on commitments to patients
  • Maintain confidentiality
  • Be reliable and dependable
  • Honor the nurse-patient relationship
  • Ethical Dilemmas

An ethical dilemma occurs when two or more ethical principles conflict.

Common Nursing Dilemmas:

  • Conflict Principles in Tension
  • Patient refuses life-saving treatment Autonomy vs. Beneficence
  • Scarce resources, multiple patients Justice vs. Beneficence
  • Truth may harm patient Veracity vs. Non-maleficence
  • Family wants information withheld Fidelity to patient vs. Fidelity to family
  • Ethics Committee Consultation

When ethical dilemmas cannot be resolved at the bedside, consult the ethics committee :

  • Complex end-of-life decisions
  • Treatment futility questions
  • Conflicts between patient and family wishes
  • Resource allocation decisions
  • On the NCLEX

Expect questions about:

  • Applying ethical principles to clinical scenarios
  • Recognizing conflicts between principles
  • Respecting patient autonomy, especially refusal of treatment
  • Fair treatment regardless of patient characteristics

Exam Tip: When autonomy (patient's choice) conflicts with beneficence (what seems best), autonomy generally wins for competent adults. The patient's informed choice must be respected.