Understanding the ethical, legal, and spiritual principles of nursing practice

by John
nursing practice

Nurses care for the most important aspect of our lives – our health. They are required to make decisions on the go, and some situations they face are not clear-cut. In some cases, they must make choices that fly in the face of their moral and ethical convictions.

Fortunately for them, and all of us, they are guided by a strict set of ethical guidelines. Whether they are dealing with an everyday patient or have encountered an unusual situation, they can refer to these guidelines to help them come to a decision. 

Nursing students are required to be familiar with these ethical principles. If you enroll in an online accelerated BSN at Baylor University, for example, you will study an introduction to nursing practice, and within it, you’ll cover the ethical principles of nursing. The course can be completed in two years and is especially ideal for those who want to transition to nursing and do not necessarily have a healthcare background. 

Why do nurses need to be guided by a code of ethics?

Ethical debates in healthcare are not unusual and sometimes can consume not just doctors and nurses, but the population at large. The Terri Schiavo case is a good example; in the end, the moral dilemma spanned the country, went as far as the Vatican, and engrossed people across the world.

Although that is an extreme case, nursing professionals have to make decisions that may seem controversial to the rest of us. Ethical principles of nursing practice ensure that they adhere to what is morally and ethically acceptable for healthcare providers.

Not only do these ethics guide doctors and nurses in healthcare practice, but they also prevent malpractice. In areas like research and drug testing, they allow physicians and nurses to understand how far they can go to advance science. 

What are the ethical principles of nursing practice?

  • Autonomy

There are two interpretations of this principle. The first is for patients and the other for nurses. 

Patients have the right to make medical decisions. Based on their beliefs and values, they can refuse medications and treatments, surgery, blood transfusions, and any other treatment a nurse may want to administer. 

So long as the patient states their wishes, the nurse must respect their choice. For example, if a patient chooses home remedies instead of conventional medicine, the nurse must respect their wishes.

Autonomy for nurses means that nurses must act using their professional judgment, knowledge, and assessment of the situation. They must adhere to their scope of practice while providing the best patient care they can. 

This principle is supposed to allow nurses to make the best decisions based on critical thinking.

  • Beneficence

This means acting with compassion at all times. Nurses encounter dozens of opportunities to be beneficent each day. 

Doing something as simple as stopping to have a conversation with a lonely patient, combing their hair, or helping them into the shower, is following one of the most important principles of nursing practice.

  • Nonmaleficence

This can be described as “do no harm” for nurse practitioners. They must always select a course of action or treatment that results in the most benefit without causing harm. Essentially, everything a nurse does must be safe for the patient. 

  • Justice

Patients must receive fair and impartial treatment. It is an especially important ethical principle when dealing with patients who may not have insurance or the funds to cover treatment and a hospital stay.

  • Accountability

Nurses are responsible for their choices when providing treatment and care. This principle ensures that nurses provide the best care they can at all times. Should they fail to, they can be held responsible for the consequences. 

  • Fidelity

This guiding principle is possibly the reason nurses are regarded as figures of authority. It means that they must always remain true to their word, honest, and loyal to patients. The information that patients get from nurses must be accurate and candid.

It allows them to form trust-based relationships. Patients know they can trust their nurses, which gives them the confidence to open up and discuss their illnesses and symptoms. 

  • Veracity

This means being completely open and honest when delivering information. In nursing, it is especially important because they often have to break the bad news to patients. 

If a test comes back positive for cancer or any other terminal illness, for example, the nurse must be direct and honest as they discuss the diagnosis with the patient.

  • Confidentiality

Nurses cannot disclose information about those under their care. This guideline also states that all patient cases must be kept confidential. They also cannot discuss patient cases within earshot of others who are not privy to the information. 

Patient Advocacy

It is the nurse’s job to make sure that patient needs (as far as their treatment is concerned) are met. If patients are not strong enough or stable enough to make decisions, it is the nurse’s job to help them without interference or undue influence. 

What happens when ethical conflicts arise?

The parents of a child who desperately needs a blood transfusion arrive in the ER only for them to decline the prescribed treatment because of their religious beliefs. 

Alternatively, imagine a scenario where a convicted murderer must receive certain treatments at the expense of another patient who hasn’t broken the law. 

What should a nurse do? There are no hard and fast answers. The nurse should escalate the matter to the hospital administration. They can take the necessary steps to ensure the matter is handled properly.

In some cases, the court has to step in to make medical decisions. 

As a nurse, it is important to recognize the point at which you should escalate issues to superiors. 


The principles of nursing practice guide nurses as they carry out their duties. They tell them how they should handle those within their care and help prevent mistakes that can lead to loss of life. 

As a student in an online accelerated BSN, you will come across these guiding principles. Internalize and understand them because you will refer to them every day as a qualified, practicing nurse.

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