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Ethics in perioperative practice—promoting health, welfare, and safety

AORN Journal, Nov, 2002 by Cecil A. King

Editor's note: This is the eighth 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 deals 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.

More Articles of Interest: Ethics in perioperative practiceÂprinciples and applications; Ethics in perioperative practiceÂduty to self; Ethics in perioperative practiceÂadvancing the profession; Code of Ethics For Nurses With Interpretive Statements; Ethics in perioperative practiceÂvalues, integrity, and social policy

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 problem of the patient undergoing treatment. 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 code expresses the moral commitment to uphold the goals, values, and distinct ethical obligations of all nurses. The ANA code and AORN's explications for perioperative nurses provide a framework in which perioperative nurses can make ethical decisions. (3) The code articulates statements about the moral obligation of members of the nursing profession and addresses duties beyond individual nurse-patient relationships. In this way, professional standards are distinguished from standards imposed by external agencies (eg, regulatory agencies).

MEETING HEALTH CARE NEEDS

Provision eight of the ANA code states that "The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs." (4) Social justice is the core ethical principle inherent in this statement. Nursing has a history of exercising social justice, which was demonstrated by Florence Nightingale and Lillian Wald. "Nightingale shaped the profession as a social movement intent on (health care) reform," (5) and Wald brought the relationship between the nurse and the public to the foreground. Nurses have an ethical obligation to promote the health, welfare, and safety of all people.

HEALTH AND WELFARE

Nurses as responsible professionals are concerned not only with providing care to individual patients, but they also are committed to promoting the health and well-being of all people. Nurses must be knowledgeable about broader health concerns, such as poverty, access, quality and cost of health care, violation of human rights, health care rationing, health maintenance organizations, disease prevention, and activities that threaten the welfare of the community and the environment.

Perioperative nurses recognize that interdependence and collaborative practice implies information sharing with other health care providers and consumers, as well as a respect for other people's skills and knowledge, so quality health care can be provided for all people. Nurses have an obligation to be knowledgeable about consumer health care needs, fully aware of their ability to meet these needs, and informed about economic implications and effects on society. Nurses must be involved enthusiastically in collaborating with other health care providers and consumers to define what is quality health care and in promoting national health care policy and reform. Perioperative nurses' individual and collective responsibility for promoting the health and welfare of society is articulated further in AORN's "Standards of perioperative professional performance." The standard on collaboration states, "The perioperative nurse collaborates with the patient, significant others, health care providers, and others in providing care." (6)

Perioperative nurses also must demonstrate their commitment to social justice through their actions. This requires that they maintain an ecological view of health and actively participate in public health promotion and policy development locally through practice-related and research activities that focus on the effect specific policies have on the health and welfare of society. Perioperative nurses also need to develop political competency. They have an opportunity and an obligation to be at the forefront in eliminating disparities in health care and society.

Various reports have demonstrated that there are reduced rates of negative outcomes and patient injury when there is a higher ratio of RNs to patients. The Perioperative Nursing Data Set defines and correlates various nursing interventions and patient outcomes that can be used to measure perioperative nursing contributions to quality care in the perioperative arena. (7)

Health Care Industry

Ethics in perioperative practice—promoting health, welfare, and safety

AORN Journal, Nov, 2002 by Cecil A. King

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