Ethics in perioperative practice—duty to self

AORN Journal,  August, 2002  by Patricia C. Seifert

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Editor's note: This is the fifth in a nine-part series that explores the effect the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements has on perioperative nurses. Each article in this series will deal with one of the nine provisions outlined in the ANA code, along with interpretations and examples for perioperative nurses. At the conclusion of this series, perioperative explications of the ANA code will be included in AORN's 2003 Standards, Recommended Practices, and Guidelines.

Perioperative nurses often find ethical decisions difficult to make but necessary when caring for surgical patients in practice. Perioperative nurses need to be able to recognize ethical dilemmas and take appropriate action as warranted. They are responsible for nursing decisions that are not only clinically and technically sound but also morally appropriate and suitable for the specific problems of the particular patient being treated. The technical or medical aspects of nursing practice answer the question, "What can be done for the patient?" The moral component involves the patient's wishes and answers the question, "What ought to be done for the patient?" (1)

AORN's Ethics Task Force has detailed specific perioperative nursing explications that correspond to the nine provisions in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. (2) The ANA's code of ethics expresses the moral commitment to uphold the goals, values, and distinct ethical obligations of all nurses. Nursing is practiced in a changing social context, so this code of ethics has become a dynamic document.

The ANA code and AORN's explications for perioperative nurses provide the framework in which perioperative nurses can make ethical decisions. (3) The code establishes a nonnegotiable ethical standard for the nursing profession. It demonstrates accountability and responsibility to the public, other members of the health care team, and the profession overall. This series of articles will help perioperative nurses relate the ANA code to their own area of practice and provide examples of behaviors that reflect the ethical obligations of perioperative nurses.

DUTY TO SELF

Provision 5 in the Code of Ethics for Nurses with Interpretive Statements says "The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth." (4) This provision addresses the duty to self, lifelong learning, competence, personal and professional values, and maintenance of integrity. This new provision in the code of ethics emphasizes the personhood of nurses and nurses' role as moral agents. (5)

One of the first duties people have to themselves is to be honest with themselves and candid about their strengths and weaknesses. It is difficult for individuals to behave morally (ie, do the right thing) if they are not truthful with themselves or others about their abilities--or lack thereof--their values, and their actions. If nurses ascribe moral worth to every patient, it logically is consistent that they would grant moral worth to themselves as well. Why would a patient have confidence in a nurse who describes himself or herself as "just a nurse"? It would be inconsistent intellectually and practically for nurses to consider themselves as less worthy and others as more worthy.

RESPECTING MORAL GROWTH AND DEVELOPMENT

A nurse's duty to self is demonstrated by ongoing personal and professional growth, which includes engaging in lifelong learning activities and maintaining professional competence. The continual refinement and expansion of intellectual and technical skills serves both nurses and patients. Too often, nurses or individuals in positions of authority emphasize nurses' moral duty to others, but they deemphasize nurses' duty to self. The 1985 ANA Code for Nurses with Interpretive Statements addresses the duty to self only in the interpretive statements and not as a provision. The 2001 code clearly articulates in the fifth provision that nurses have a right to protect their moral integrity and a responsibility to nurture and strengthen their duty to self as well as to others. (6)

The 2001 ANA code interprets duty to self not as a purely egocentric or selfish behavioral phenomenon but as a requirement for achieving a level of professional practice that enables nurses to collaborate effectively with others to provide patient care. Such collaboration occurs between and among equals; when nurses are not considered equals, collaboration, by definition, cannot exist. The consequences of professional imbalances affect not only nurses, but also patients. If a professional imbalance exists, patients will not receive the benefits--which are documented and in the literature--from a collaborative and collegial working environment. (7)

In addition, collegial relationships benefit physicians and other professionals. (8) One physician has identified three reasons why collaborative working relationships--where nurses are equal parmers--can enhance patient care.