Simply stated, fidelity is the keeping of promises. For nurses, that means remaining true to the professional promises made to provide quality, competent care to their patients.
What Are Ethics?
Ethics are moral principles that are concerned with the good of individuals and the good of society. Ethics govern our rights and responsibilities and guide moral decision-making. Throughout the centuries, philosophies, religions and cultures have shaped ethics so that, throughout the world, different peoples may hold different beliefs. Professional organizations, such as those governing health care providers, have established ethical guidelines for all practitioners, regardless of their personal beliefs.
Why Is a Code of Ethics Necessary?
A code of ethics takes the emotion out of decision-making. Health care providers often see patients and their families in difficult situations. Witnessing the pain of others is difficult. There can be the temptation to "go with one's gut" and make a care decision based on a feeling rather than on experience, training and a professional code of conduct. When it comes to patient care, decisions are not always black and white. There can be a lot of gray areas. A code of ethics helps nurses navigate those gray areas to provide safe and competent care to their patients.
American Nurses Association Code of Ethics
What's the definition of ethics in nursing? This is best explained by the professional code of ethics that has been set forth for practitioners. The code of ethics is crafted to provide guidance for the varied and complex situations in which health care providers can find themselves in the course of their work with patients.
Nurses are held to seven ethical principles put forth in the American Nurses Association Code of Ethics: accountability, autonomy and patient self-determination, beneficence, fidelity, justice, nonmaleficence and veracity.
Accountability means taking responsibility for one's actions. Nurses must accept the professional and personal consequences associated with the decisions they make regarding patient care.
Autonomy and Patient Self-Determination
Nurses must respect the right of patients to make decisions on their own behalf. Every individual has a unique perspective and is entitled to hold beliefs, opinions and values. The nurse might not agree but must respect the individual's right to them. Nurses must allow patients to make decisions without judgment or coercion. Nurses must respect a patient's right to accept or reject any or all courses of treatment.
This one is simple: Do the right thing for the patient. The other ethical principles in nursing are a guide for this.
Fidelity in nursing means that nurses must be faithful to the promises they made as professionals to provide competent, quality care to their patients.
Justice means fairness. When nurses care for a group of patients, care must be given equitably, fairly and justly to each individual. A nurse cannot play favorites or compromise care because of personal opinions or beliefs.
As stated in the Hippocratic oath, the first principle of patient care is to do no harm. It does not matter whether the harm is intentional or unintentional.
Veracity is truth. Nurses must not withhold the whole truth from patients, even if they believe the truth will cause distress. A patient always has the right to know about diagnoses and care options.
The Importance of Fidelity in Nursing Ethics
In health care, fidelity is the most important of the ethical principles because it governs the other six. Nurses promise to provide competent care to patients and to do so in a way that is honest, responsible and fair.
Fidelity is considered by many nurses to be the most common source of ethical conflict. Health care professionals may find themselves caught between what they believe is right, what the patient wants, what other members of the health care team expect, and what is required by organizational policy and the law.
Fidelity requires that nurses treat all patients with respect. It's not always easy, especially if a patient is disagreeable, uncooperative or rude. Nurses need to put aside any negative feelings they might have about such patients and adhere to the standard of care. Nurses should talk with their team members if they believe their feelings toward a patient could compromise care.
Common Dilemmas in Nursing Ethics
Health care professionals are often faced with ethical dilemmas. They are called upon to make decisions about and on behalf of their patients. They may be charged with acting under legal guidelines but in ways that may feel morally questionable. Here are some examples:
Disclosing Medical Conditions
John is a 54-year-old man with terminal cancer. The doctors believe he has just a few months to live. It is painful for the family to listen to John talk about all the things he wants to do when he gets out of the hospital. They believe it's best for John to maintain his positive attitude, so they ask the nurse not to tell John the whole truth about his condition. However, failure to talk honestly with John violates the nurse's ethical principle of fidelity. The nurse has an obligation to a patient's right to know.
In some cases, a family may say that a patient didn't want to know about a terminal diagnosis. The nurse has no way of knowing if this is true. The family may want a nurse to keep a secret from a patient for reasons known only to them. It may be difficult to go against a family's wishes, but the patient's rights come first. What if the situation is reversed, and the patient does not want to disclose a diagnosis, even a terminal one, to the family? It is the patient's right to keep that information confidential. The nurse's responsibility is to the patient, and the patient's wishes must be honored.
Mary is a quiet, shy young woman. She does not understand her doctor's explanation about her diagnosis and treatment options. The doctor reminds Mary of a stern professor she had in college, and she does not feel comfortable asking him many questions. She would rather ask the nurse for clarification. The nurse should not assume individual responsibility in interpreting the doctor's oral and written statements. Nurses should rely on interdisciplinary teams for ethical decision-making.
Incompetence Among Colleagues
Eric and Susan are nurses who work together. They also see each other socially because Eric and Susan's husband are good friends. Eric has seen, on several occasions, examples of Susan's incompetence in certain situations. He is not sure what to do. He has an obligation to patients to ensure that they receive safe, competent care. At the same time, he is hesitant to say anything because he knows Susan needs the job, and he doesn't want to do anything that might get her fired. He values his friendship with Susan's husband. Besides, if Susan loses her job, her absence creates a staffing shortage for the unit.
Eric's first obligation is to the patients. He should talk with Susan, who might not realize she has done anything wrong. If additional training or education can rectify the situation, Eric should encourage Susan to take the proper steps. If Susan is unable or unwilling to make the necessary changes to the ways she makes decisions and provides care, Eric must report what he has seen to his superior.
Learning to Handle Ethical Conflicts
To earn a nursing degree, candidates typically take foundational classes in life sciences, social sciences and the humanities. They also take classes that introduce them to clinical skills. In the final months of training, students complete clinical rotations that afford them the opportunity to begin practicing those skills in a supervised setting. Students may witness ethical dilemmas but may not get any practice in navigating them.
Hospitals and nursing schools are increasingly using patient simulation as a learning tool. Just as student pilots first "take flight" in a simulator, nursing students can use high-fidelity patient simulation (HPS) in the form of computerized mannequins. The HPS mannequins, originally used primarily in medical schools and the military, simulate real-life scenarios. Student nurses gain practice with complex situations without the potentially dire real-life consequences. Studies have shown that using the mannequins promotes more than the acquisition of skills. They also help nurses develop clinical judgment. Nurses get practice in the kinds of decision-making they will be called upon to perform in their professional lives.
Abiding by the Nurses' Code of Ethics
As a nurse, adhering to the professional code of ethics is not a matter of choice. It is an integral part of the profession, and it governs everything that nurses do. A nurse cannot pick and choose patients based on personal likes or dislikes. Nurses cannot show bias based on a patient's race, religion, ethnicity, gender or sexual orientation. A nurse cannot coerce a patient to accept or deny a course of treatment. The decision to accept or refuse any treatment is always a patient's own. A nurse cannot give advice based on personal rather than professional opinion.
Nurses are required by their code of ethics to be wholly truthful with their patients. It is not the nurse's right to keep information from a patient, even if the nurse feels the patient will be upset. When the wishes of the family conflict with the wishes of a patient still capable of self-determination, the nurse must always honor the wishes of the patient.
Upon entering the nursing profession, nurses make promises governing the care of patients and the respect of their rights. Upholding these promises is a serious responsibility. Patients must be able to count on the fidelity of nurses. They must have assurances of their rights and entitlements when under a nurse's care. Nurses are custodians of the public trust. They have a responsibility for their own actions and those of their colleagues. As one professional put it, "It's not about you, it's about the patient." Nurses must always act first in the best interest of their patients and not themselves.