Ethics in perioperative practice—values, integrity, and social policy

AORN Journal, Dec, 2002 by Cecil A. King, Catherine Broom

Editor's note: This is the final article 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 an perioperotive nurses. Each article in this series deals with one of the nine provisions outlined in the ANA code, along with interpretations end 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 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. The code of ethics establishes a nonnegotiable ethical standard for the nursing profession. It demonstrates accountability and responsibility to the public, other members of the surgical team, and the profession overall. This series of articles will help perioperative nurses relate the ANA code to their area of practice and provide examples of behaviors that reflect their ethical obligations. (3)

PROFESSIONAL RESPONSIBILITIES

The ninth provision of the ANA code states,

   The profession of nursing, as represented by associations and their
   members, is responsible for articulating nursing values, for maintaining
   the integrity of the profession and its practice, and for shaping social
   policy. (4)

Provision nine addresses the ethical responsibility professional nursing organizations and their individual members have to articulate professional nursing values, maintain the moral principles of the profession, and use professional knowledge and expertise to effect social change for the welfare of society. This provision stresses that both individual nurses and nursing organizations have an obligation to act as responsible moral agents because they are representatives of the profession itself. Representative's actions reflect upon the entire profession. As the professional organization of perioperative RNs representing more than 40,000 perioperative RNs in the United States and abroad,

   AORN is dedicated to enhancing the professionalism of perioperative nurses,
   promoting standards of perioperative nursing practice to better serve the
   needs of society, and providing a forum for interaction and exchange of
   ideas related to perioperative health care. (5)

VALUES

Values are beliefs and considerations that are held to be true and significant. Values guide an individual's assertions and actions. At the core of professional nursing is the value that nursing practice serves to act in the best interest of the patient. For AORN and its members, this core value focuses on meeting the perioperative health care needs of individual patients and society as a whole. As a professional association, AORN works to support its members so they can uphold this fundamental professional value.

To sustain practice that reflects and confirms these values, professional organizations work to articulate values and communicate them to members. In addition, values are explained to the public in a way that clarifies professional obligations to society at large. An organization establishes its mission according to its values; it then formulates goals and aligns priorities according to those values. AORN's mission statement says that "AORN supports registered nurses in achieving optimal outcomes for patients undergoing operative and other invasive procedures." (6) AORN's organizational values statement articulates the functions and elements that help members manifest the Association's values in practice. These values include

* educational services that are

* cost effective,

* accessible,

* driven by member needs,

* current and timely,

* approved for contact hours, and

* convenient;

* representation that is

* effective,

* comprehensive,

* visible,

* current and timely,

* present in diverse health care arenas,

* cost effective, and

* collaborative; and

* standards that are

* research based,

* current and timely,

* comprehensive,