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The basic obligation to maintain a patient's privacy and confidentiality has existed since the time of Hippocrates, yet many nurses violate this principle without thinking. For example, suppose a friend asks you about your neighbor who's been admitted to the hospital unit where you work. Even a casual reply about his condition violates his privacy. In fact, so does simply verifying his admission to the hospital. Respecting the patient means not invading or denying his privacy. If you commented about your patient to your friend, even though you weren't acting out of malevolence, you'd fail to demonstrate the virtue of respect and integrity.

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Your patient has a right to expect that you'll hold his diagnosis, prognosis, and personal history in utmost confidence. Share information about his condition only with those involved in his care who need to know. Communicating honestly. Veracity is the ethical principle that obligates you to tell the truth. At times the truth may be painful for the patient or his family to hear, but honesty is a core virtue; only under unusual circumstances is violating it acceptable. To act from the virtues of honesty and compassion requires you to make sure that bad news is delivered in an honest and compassionate way.

Here's a six-step model to help you discuss unwelcome news in a competent way. Ask the patient if he'd like to have any family members present when the physician discusses the results of tests or surgery. As much as possible, prevent interruptions to the conversation. Encourage the physician to sit down to deliver news to the patient or his family.

Have a box of tissues close by. For example, when the physician leaves and the patient begins to ask you questions, you can ask, "What do you understand about your illness? Ask him, "Did you receive enough information to understand your condition? As a nurse, you won't be the first person to break bad news about a diagnosis, a prognosis, or test results. But the patient may ask you to clarify the message he's received. For example, you may need to say, "I'm sorry to have to tell you this. Yes, your physician said the scan did show a tumor in your abdomen. Then pause and wait for his reaction.

Don't try to soften or minimize the severity of the situation because this may confuse him. You could say, "This is difficult news. How can I help you now? Discuss potential sources of support. Assess the safety of the patient if he's leaving after receiving bad news. You'll sometimes need the virtue of courage when you tell the truth to a patient or family and in many other circumstances you encounter as a nurse.

I've defined moral courage as the capacity to overcome fear and stand up for one's core values.

What Makes a Good Nurse

Besides physical harm, these forces include the threat of humiliation, rejection, ridicule, unemployment, and loss of social standing. Conducting an ethically valid informed-consent process. What's your responsibility in the process of informed consent? Most nurses believe they're responsible only for witnessing the signature of the patient. But according to the Code, you're responsible for ensuring much more see Criteria for informed consent.

His cognitive abilities may fluctuate because of medication, surgery, unfamiliar surroundings, or his disease. As his nurse, you're in the best position to assess his ability to understand issues related to his care and give valid consent. This relationship also helps you determine if his consent is truly voluntary.

Imagine that an year-old patient with diabetes confides that she doesn't really want to have an above-knee amputation; she's doing it only to please her daughter, who's unwilling to face her death. She asks you not to tell her daughter and says she feels better just telling someone her true feelings. She's already signed the consent form and is scheduled for surgery in the morning. This situation calls for patient advocacy and probably a family meeting as well.

The virtue of caring will likely trigger the nurse's desire to help the patient, but the virtue of courage will be needed to confront this difficult situation. The nurse now experiences an ethical conflict between maintaining confidentiality and supporting a valid informed consent. The nurse is obligated to contact the surgeon because of possible coercion by the patient's daughter.

According to the Code, "duties of confidentiality [aren't] absolute and may need to be modified[horizontal ellipsis]to protect the patient. The family meeting, orchestrated by patient relations, the ethics committee, or an ethics consultant, could be uncomfortable for all concerned. However, as her nurse you must take responsibility for caring for the patient, respecting the truth, and advocating for the patient.

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Such a meeting is time-consuming, and the surgeon and the patient's daughter aren't likely to welcome it. But the question is simple: How will you feel if you send the patient to surgery without speaking up, knowing what you know? The treatment decision could change from surgery to a referral for hospice care, which would provide family support for the patient's daughter.

Advocating for the patient's best interests. This is what puts action into your obligations. Being passive or active is a choice. Positioning yourself as the patient's advocate in the case we just discussed would be very difficult, especially if you suspect the surgeon will be angry and know that the patient may back down in the face of pressure from her daughter.

I hope that you would choose to act with courage, which involves supporting your professional obligations, standing up to an angry physician, and doing what you think is right for the patient. Advocacy is often inhibited by the institutional bureaucracy. Nurses must feel free to engage in advocacy roles in health care environments; otherwise, patient self-determination will be truly lost in the morass of rules, regulations, and nurse timidity. Standing up in advocacy requires overcoming the challenges of moral blindness, moral complacency, and moral distress.

To act ethically, you need to know more than your professional obligations outlined in the Code.

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Virtue theory provides a framework for key areas of character development. You can learn obligations and strengthen your character. Both require education, perseverance, and often the virtue of courage. The virtue of professional competence calls for continual professional growth and a commitment to lifelong learning. You must practice nursing that's evidence-based, be knowledgeable about the scope and standards of nursing practice, and have the necessary skills to perform nursing tasks effectively.

For example, consider the current evidence and skills required for professionally competent patient transfers. Research shows that best practices include having peer safety leaders on each shift to coach ergonomics and the use of lifts.

What does this have to do with ethics? To follow best practices for patient transfer, you must have the courage to demand lifts and the integrity to use them consistently. When nursing actions are in sync with the evidence, your practice environment supports integrity. See details for additional description. Skip to main content. About this product.

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