Core Ethical Values and Principles Taught in Nursing Education

Caring as the Ethical Foundation of Nursing

The first principle instilled in nursing education is that caring is the ethical groundwork of the profession. Caring is an honorable disposition that extends beyond the technical performance of clinical functions. It is both a certified and a communal expectation: a nurse's occupation inherently entails caring — a genuine concern for the health and wellbeing of another person. Caring is felt rather than calculated, and its complexity resists a simple definition. As a theoretical foundation for nursing practice, caring continues to evolve, and our understanding of it deepens over time. It encompasses the concepts of self-confidence, similarity, capability, principles, connection, sympathy, obligation, cultural awareness, teamwork, and communication among all members of the healthcare team (Fowkes et al., 1990).

Nurses are also obligated to care for clients with respect for their individual needs and values. Factors such as a client's religion, gender, age, social position, ethnic background, or physical condition must never be permitted to compromise the nurse's commitment to that client's care. The expectations and normal life patterns of clients are to be acknowledged and honored (Fowkes et al., 1990).

Personalized plans of nursing care are designed to address the mental, emotional, social, intellectual, and spiritual needs of clients, in addition to their physical needs. The nurse should do more than simply react or respond to a client's expressed desires. By taking a proactive role, nurses assist clients in articulating their requirements and values within the framework of healthcare. Recognizing the client's family relationships and broader community ties, the nurse — with the client's permission — should work to involve significant people in the client's care (Fowkes et al., 1990).

Respect for Client Autonomy and Informed Consent

Grounded in respect for clients and recognition of their right to direct their own care, nursing practice must reflect the client's right to make choices about their treatment (Leininger, 1994). A capable client's informed consent is an essential prerequisite for the provision of healthcare. Nurses bear the primary responsibility for ensuring that clients are fully informed about the nursing care available to them.

Consent may be expressed in several different ways. Verbal consent or documented informed agreement are the most common forms by which clients agree to nursing care. In every case, however, valid consent represents the free and voluntary choice of a capable client to receive the available treatment. Properly understood, informed consent is the process through which a client becomes an active partner in their own care. Every client should be supported in becoming as active a participant in their treatment as their circumstances allow. Professional standards may sometimes demand actions by the nurse that exceed the minimum legal requirements of consent. For instance, even though a child may be legally incapable of giving formal consent, nurses must nonetheless strive to inform and engage the child in the healing process. Coercion and manipulation must never be used in obtaining consent (White, 1994).

Nurses are also taught to respond appropriately when illness or other factors affect a client's capacity for self-determination. Nurses have a continuing duty to support autonomy in these clients — for example, by creatively offering them opportunities to make choices within their capabilities, thereby helping them to preserve or regain some degree of independence. Whenever information is provided to a client, it should be delivered in an honest, clear, and sensitive manner, with full awareness of the client's needs, interests, wellbeing, and values. Nurses must respond openly to their clients' requests for information and explanation when they possess the knowledge needed to answer accurately. When a client's questions require information beyond the nurse's knowledge, the client must be told so and referred to a more appropriate healthcare professional (Andrews, 1992).

A nurse is obligated to maintain the confidentiality of all information concerning a client in the healthcare setting. The right of individuals to control how much personal information is disclosed must be exercised with particular care in healthcare contexts. It is, in most circumstances, the client's prerogative to decide who should be informed of their condition, how they should be informed, and how much they should be told (Mooneyhan, 1986).

Confidentiality and the Management of Client Information

When applying professional confidentiality, its limitations must also be acknowledged:

First, competent care requires that the entire team of healthcare workers have access to, or be provided with, the relevant details of a client's situation (Beardsley, 1994). Second, discussion of a client's care may be necessary for educational, research, or quality assurance purposes. In such circumstances, particular care should be taken to protect the client's anonymity (Beardsley, 1994). Additionally, the client should be informed of such requirements before treatment begins whenever it is practicable to do so (Beardsley, 1994). Nurses also have an affirmative duty to establish and maintain practices that protect client privacy (Beardsley, 1994).

A nurse is not ethically obligated to maintain confidentiality when disclosure of information is necessary to protect the client from serious harm. Similarly, legal requirements to disclose are generally ethically justifiable on the same grounds. In confronting such situations, the nurse's primary concern must be the wellbeing of the client. Care should be taken, however, to ensure that only the information strictly necessary is disclosed, only to those who absolutely need to know it, while the remainder of the information is kept confidential (Zorn, 1996).

Conclusion

Nursing has been a profession with a defined aim and objective. It has an exclusive association with the community, having been created by society to offer healthcare to those who need it. Nursing holds a distinct body of knowledge, its own sphere of autonomous practice, and is guided by a precise set of principles taught and reinforced throughout professional education and clinical training.