Ethics in nursing care is the backbone of professional conduct. It refers to the moral principles and standards that guide nursing decisions and behavior in patient care.

Nurses interact with individuals during their most vulnerable moments — during illness, disability, or end-of-life situations. In such moments, ethical practice ensures that nurses act with compassion, integrity, and respect for human dignity.

1. Definition of Ethics in Nursing

Nursing ethics is a branch of applied ethics that addresses moral issues and dilemmas in nursing practice. It encompasses the values, principles, and rules that guide nurses in delivering patient care responsibly and professionally.

Ethical nursing care is not just about doing what is technically correct, but also about doing what is morally right, even under pressure or in difficult situations.

2. Importance of Ethics in Nursing Practice

a. Protection of Patient Rights and Welfare

Ethics help nurses safeguard the rights of patients such as autonomy, dignity, and confidentiality. Ethical care means prioritizing the patient’s best interests, even when facing institutional or societal pressure.

b. Guidance During Moral Dilemmas

Nurses often encounter ethical conflicts — for example, deciding whether to respect a patient’s wish to refuse treatment, or navigating end-of-life care decisions. Ethical principles offer a structured way to think and act in such situations.

c. Promotes Trust in the Nurse-Patient Relationship

A nurse who demonstrates honesty, fairness, and integrity fosters patient trust, which improves communication and outcomes.

d. Enhances Professional Reputation and Accountability

Ethical conduct reflects professionalism and adherence to nursing standards, which is essential for maintaining licensure and public confidence.

3. Ethical Principles in Nursing

These core principles serve as the foundation of ethical nursing care:

a. Autonomy

Patients have the right to make their own decisions regarding their care, even if those decisions involve risks. Nurses must respect these choices.

Example: A competent patient has the right to refuse chemotherapy, and the nurse must support that decision respectfully.

b. Beneficence

Nurses are obligated to do good and act in ways that benefit the patient, including promoting health, relieving pain, and preventing harm.

Example: Administering pain medication promptly to relieve suffering.

c. Non-maleficence

“Do no harm.” Nurses must avoid causing unnecessary harm or suffering, whether through action or inaction.

Example: A nurse must double-check medication doses to prevent errors that could harm the patient.

d. Justice

Fair and equal treatment must be provided to all patients, regardless of race, gender, socioeconomic status, or beliefs.

Example: Allocating limited ICU beds fairly, without favoritism.

e. Fidelity

This refers to being faithful to one’s professional promises and responsibilities, including maintaining patient confidentiality and delivering consistent care.

Example: Not disclosing a patient’s HIV status to others without consent.

f. Veracity

Telling the truth is vital in building trust. Nurses must provide honest information while maintaining sensitivity.

Example: Informing a patient honestly about the side effects of a prescribed medication.

4. Ethical Responsibilities of a Nurse

a. Maintaining Confidentiality

Patient information must not be disclosed without consent, except in legal or life-threatening situations.

b. Obtaining Informed Consent

Before procedures, patients must receive clear information about the risks, benefits, and alternatives, and voluntarily agree.

c. Reporting Unethical Behavior

Nurses are ethically obligated to report any misconduct or negligence by peers or other healthcare providers.

d. Providing Non-Judgmental Care

Nurses must care for all individuals impartially, even if they disagree with the patient’s lifestyle, religion, or choices.

e. Respecting Cultural and Religious Beliefs

Understanding and respecting a patient’s cultural background is part of ethical care.

5. Common Ethical Dilemmas in Nursing

a. End-of-Life Decisions

Patients or families may request withdrawal of life support, or insist on continuing futile treatment. Nurses must balance compassion, professional ethics, and patient rights.

b. Refusal of Treatment

A patient may decline medication or surgery that could save or improve their life. Ethical care means supporting their autonomy while educating them about the risks.

c. Resource Allocation

When medical resources (e.g., ventilators) are limited, deciding who gets care becomes a challenge involving justice and fairness.

d. Truth-Telling vs. Hope

Sometimes, telling the full truth (e.g., a poor prognosis) may seem harmful to a patient’s hope. The nurse must weigh honesty with sensitivity.

e. Conflicts of Interest

Nurses must avoid situations where personal interests interfere with patient care, such as accepting gifts from patients or promoting products.

6. The Role of Codes of Ethics in Nursing

a. International Code of Ethics for Nurses (ICN)

Developed by the International Council of Nurses, this code provides a global ethical standard for nursing practice.

b. ANA Code of Ethics (U.S. Based)

The American Nurses Association outlines 9 provisions that guide professional conduct, including respect for human dignity, advocacy, accountability, and commitment to lifelong learning.

c. National Nursing Regulatory Codes

Each country or region often has a national council or body (e.g., Uganda Nurses and Midwives Council – UNMC) that sets ethical standards and professional expectations for nurses.

Nursing Implication: Nurses must be familiar with and follow the ethical code set by their national regulatory body.

7. Ethical Decision-Making Process in Nursing

When faced with an ethical dilemma, nurses can follow these steps:

1. 1. Identify the problem – What is the ethical issue?

   2. Gather information – Medical facts, cultural considerations, patient preferences.

   3. Examine values – Assess your own values and those of the patient or family.

   4. Explore options – What are the potential actions and outcomes?

   5. Make a decision – Choose the most ethical and professional course of action.

   6. Act and reflect – Implement the decision, then evaluate its outcome and learn from the experience.

Example: A terminally ill patient wants to stop treatment but the family insists on continuing. The nurse uses ethical reasoning to support the patient’s autonomy while guiding the family compassionately.

8. Role of the Nurse as an Ethical Advocate

Nurses serve as advocates for their patients, especially when patients cannot speak for themselves or are vulnerable.

This includes:

• • Supporting patient choices.

  • Speaking up against unsafe practices.

  • Educating patients about their rights.

  • Ensuring equitable access to care.

Example: A nurse notices a physician ignored a patient’s Do Not Resuscitate (DNR) request and takes steps to protect the patient’s wishes.