Running head: NURSING THEORY AND PRINCIPLES
Ethical Theory and Principles in Nursing
Kayla McDonald
Dixie State University
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NURSING THEORY AND PRINCIPLES
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Ethical Theory and Principles in Nursing
Ethical theories and principles provide the foundation for quality nursing practice. It is
important for nurses to recognize and develop ethical theories and principles relating to their own
values and morals in order to guide clinical judgment when faced with ethical situations in their
nursing practice. One of the most important ethical theories in nursing is virtue ethics, the
process of following virtuous instinct to do what is best for the patient. Like virtue ethics, the
ethical principle beneficence is also very important to nursing practice. Beneficence is
commonly summarized as “the doing of good,” it encompasses the nurse’s moral desire to help
others and act in the patient’s best interest (Black, 2014). Another ethical principle that holds
importance in nursing practice is fidelity. Fidelity is defined in nursing as honoring promises,
obligations, and commitments; both stated and implied (Blackwell, 2009). Information shared
between the patient and the nurse in most circumstances would remain confidential, honoring the
commitment made by the nurse and upholding ethical principle of fidelity. Although, in certain
situations confidentiality must be broken, and the ethical principle of fidelity would be in
conflict. Virtue ethics, beneficence, and fidelity are fundamental ethical traits that nurses must
learn to implement into their nursing practice to improve clinical and ethical judgment.
Begley explains that “the Greek word arête (virtue) means excellence in relation to a skill
or trait of character.” Professional virtuous traits or attributes include compassion, justice,
understanding, integrity, courtesy, kindness, patients, and courage (Begley, 2005). Virtue ethics is
an important ethical theory in nursing because it guides nurses to have a holistic approach of care
and work toward the best outcome for the patient and their family. It means to follow instinct do
what is right, and avoid what is wrong. Virtue ethics provides the framework for the nurse to
advocate for his or her patient. Ewashen provides two questions to help guide a nurse using the
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virtue ethics approach, “What should and must I do?” and “What kind of practitioner should I
be?” These questions from a virtue ethics perspective help to develop the internal good of
practice and a just action (Ewashen, 2013). While it is important for nurses to understand their
own morals and beliefs, it is of equal importance for the practicing virtue ethics nurse to connect
with their patients and their families to understand what it means to them to live a virtuous life.
Krishna discusses the use of Nasogastric (NG) feeding in patients approaching the end of
life, despite the clinical evidence suggesting that NG feeding in the terminally ill has been found
to have no benefit. Data suggests that NG feedings do not have a life preserving effect, but even
if it did, the wishes of a dying patient is not always to prolong the dying process. Many families
fear their loved one may be suffering from hunger pains and feel obligated to provide them with
a form of nutrition. Even though early satiety and decreased metabolic demand in the dying
patient supports NG feedings to be unnecessary, implementing NG feedings may bring peace and
acceptance to family members of the dying patient. It is important for the nurse to understand
patient and family morals, views, beliefs, and virtues to be able to act in the patient’s best interest
when ethical dilemmas occur. In the example of NG feedings in the dying patient, the virtuous
nurse would incorporate all facts and opinions of the patient and family to ensure that clinical
evidence is not the prime consideration in determining the use of NG feedings in the dying
patient (Krishna, 2011).
Kennedy describes the ethical principle of beneficence as the “moral obligation to act for
the benefit of others” (Kennedy, 2004). Beneficence may also be commonly defined as “the
doing of good” and is known as one of the primary critical ethical principles in health care
(Black, 2014). It is important for nurses to practice the principle of beneficence to aid in quality
patient centered care, prevent harm, build a trusting nurse-patient relationship, and to promote
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excellence. Kennedy claims that the principle of beneficence can be seen in the foundation of a
caring nurse. The caring nurse practices through moral desire to help others and act in the
patient’s best interest. In addition to doing good acts, the acts being performed should be
performed out of good motive and show respect for patient autonomy (Kennedy, 2004).
According to Denny, “the ethical principle of beneficence is integral to the nursing
profession’s mission to alleviate pain and suffering” (Denny, 2012). Denny outlines three
principles of beneficence as a framework for nurses to assess and treat pain in the elderly patient.
The three principles of beneficence are to: “prevent harm or pain”, “remove harm or pain”, and
“do or promote good or pain relief.” Elderly patients seem to be the group at highest risk for the
under treatment of pain. Nurses hold an ethical responsibility to practice beneficence in doing
their best to provide pain relief, prevent pain, and remove pain in all patients. Practicing
beneficence guides nurses to prevent the harm created by effects from uncontrolled pain by
effectively assessing pain in a timely manner and promotes pain relief by then applying
intervention as quickly as possible. It is important for the nurse to anticipate patient’s pain,
especially in the elderly because they are less likely to initiate complaints of pain. In order for
nurses to act in the patient’s best interest, the nurse must also provide education about the
patient’s options of pain management, answer questions and clearly answer any misconceptions
of pain and pain relief to support patient autonomy (Denny, 2012).
Fidelity is an important ethical principle that refers to honoring promises, obligations, and
commitments; both stated and implied. Loyalty and honesty are key concepts central to fidelity
(Blackwell, 2009). Black teaches that when nurses pass their licensing exam, they are granted the
privilege to practice as a nurse. A nurse’s license comes with great responsibility and requires
commitments to uphold the nurses code of ethics, be faithful in keeping promises and respecting
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all individuals, practicing only within the scope of practice, staying current on skills and
knowledge, be an advocate for patients and protect the privacy of patients. Fidelity entails
meeting expectations in all these commitments made (Black, 2014). Within the nurse-patient
relationship, the nurse has a clear implied commitment to be honest, to keep the patient properly
informed, and to maintain patient confidentiality. According to Blackwell, a very important part
for the integrity of the nurse-patient relationship is to explain to the patient certain situations
under which confidentiality must be broken (Blackwell, 2009). For example, if a patient
expressed thoughts to harm themselves or to harm others, the nurse’s commitment to maintain
patient-nurse confidentiality would then need to be broken to ensure the patient remains safe and
receives the proper care. Fidelity in this example, would then be in conflict when confidentiality
was broken. Black explains an important consideration of the ethical principle fidelity, stating
“the harmful consequences of the promised action must be weighed against the benefits of
promise keeping” (Black, 2014). The nurse has the more important commitment to keep the
patient safe, and therefore patient confidentiality regarding self-harm must be broken but can be
justified because of the harmful consequence outweighing the benefit of promise keeping.
In conclusion, ethical theories and ethical principles both play a large role in creating
different types of nurses. The implementation of virtue ethics, beneficence, and fidelity into
nursing practice is important to guide in decision making when faced with ethical dilemmas. All
nurses must create a foundation strong in ethical theories and ethical principles to base their
motive and provide direction in order to succeed as a nurse in the healthcare world today.
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References
Begley, A. M. (2005). Practicing virtue: A challenge to the view that a virtue centered approach
to ethics lacks practical content.Nursing Ethics, 12(6), 622-37.
Black, B. (2014). Ethics: Basic Concepts for Nursing Practice. In Professional nursing: Concepts
& challenges (7th ed., pp. 96-97). St. Louis, Mo.: Elsevier.
Blackwell, T. L., Case, J. C., Barros-Bailey, M., & Waldmann, A. K. (2009). Special issues in
rehabilitation counselor ethics in disasters. Journal of Applied Rehabilitation
Counseling, 40(1), 14-26.
Denny, D. L., & Guido, G. W. (2012). Undertreatment of pain in older adults: An application of
beneficence. Nursing Ethics, 19(6), 800-9.
Ewashen, C., McInnis-Perry, G., & Murphy, N. (2013). Interprofessional collaboration-inpractice: The contested place of ethics.Nursing Ethics, 20(3), 325-35.
Kennedy, W. (2004). Beneficence and autonomy in nursing. British Journal of Perioperative
Nursing, 14(11), 500-506.
Krishna, L. (2011). Nasogastric feeding at the end of life: A virtue ethics approach. Nursing
Ethics, 18(4), 485-94.
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Melissa Baldw in
Show Assessment By:
Nursing Theory Essay Rubric
Criteria
Introduction
Ratings
Pts
The student provides a
The student provides an
The student does not
reasonable description of
unreasonable description
describe any major
the major topic areas in
of the major topic areas
topic areas in an
the introductory
in an introductory
introductory paragraph
paragraph
paragraph
10 pts
0 pts
6 pts
The student provides a
The student provides a
The student does not
credible and well-
plausible justification
justify or provides an
of Ethical
supported justification of
of the importance of
implausible justification
theory to
the importance of ethical
ethical theory to
of the importance of
nursing
theory to nursing
nursing
ethical theory to nursing.
Importance
25 pts
6 / 10 pts
15 pts
25 / 25 pts
5 pts
Importance
The student provides
The student provides a
The student does not
credible and well-
plausible justification
justify or provides an
principle
supported justification of
of the importance of
implausible justification
and
the importance of ethical
ethical principle to
of the importance of
importance
principle to nursing.
nursing. 15 pts
ethical principle to
of an ethical
to nursing
Ethical
principle in
25 pts
nursing. 5 pts
The student provides a
The student provides a
The student provides an
precise summary of an
reasonable summary of
imprecise summary or no
ethical principle that
an ethical principle that
summary at all of an
would be in conflict if
would be in conflict if
ethical principle that
conflict
with broken
25 / 25 pts
would be in conflict if
25 / 25 pts
NURSING THEORY AND PRINCIPLES
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Nursing Theory Essay Rubric
Criteria
Ratings
Pts
confidential
confidentiality were
confidentiality were
confidentiality were
ity
broken. 25 pts
broken. 15 pts
broken. 5 pts
Professional
The student cites more
The student cites 3-5
The student cites less
than 5 professional,
professional, scholarly
than 3 professional,
scholarly sources in the
sources in the paper
scholarly sources or
paper that are less than
that are less than 10
sources that are older
10 years old. 10 pts
years old. 6 pts
than 10 years old in the
, Scholarly
Sources
10 / 10 pts
paper 0 pts
Overall
Exemplary
Meets Standards
Unacceptable
5 pts
3 pts
0 pts
holistic
Total Points: 96
5 / 5 pts