This essay will discuss the underpinning professional, ethical and legal principles of nursing using the standards of conduct outlined by the professional regulatory body; the Nursing and Midwifery Council in the code of conduct (NMC 2009). The policies which will be explored are confidentiality, informed consent and autonomy. Each will be discussed and their impact on the nursing profession and patients highlighted.
According to the NMC code of conduct (2009) every patient has the basic human right to confidentiality whilst being cared for by nursing professionals. Confidentiality is when one person gives information to another in situations where it is anticipated that the information will not be passed on (NMC 2009). This principle extends to include any details, written or spoken disclosed by a patient regarding their life and family and must not be used for any purpose other than what it was meant for or divulged to anyone outside the profession unless the patient consents as outlined in the Data Protection Act (1998). However, if the nurse deems any information to be significant to the patient’s wellbeing or treatment it can be passed on provided the patient is informed (Rumbold 2000). Adherence to this directive protects the patient and allows an open, honest and communicative nurse – patient relationship to develop which in turn enables the nurse to provide the best care based on the information the patient has provided As the nurse-patient rapport grows the nature of the information volunteered may change. On occasion the nurse may feel that the sharing of certain information may be crucial in preventing harm to others e.g. information detailing abuse or criminal activity (NMC 2009). In this instance the patients’ right to confidentiality may be overridden providing justification can be established, although inevitably it will be detrimental to the nurse patient bond of trust which has developed. However it is the Nurse’s moral and legal duty to ensure the information is passed on to the appropriate organisation, e.g. Police.
Maintaining confidentiality is a principle paramount to upholding the professionalism of nursing, this is true of all the guidelines detailed in the NMC code (2009) another being informed consent. It is the nurse’s responsibility to make sure a patient fully understands any information given to them regarding their care, illness or treatment before consenting to it. This can be achieved by explaining the information orally to the patient using terms they are familiar with, although at times it may be beneficial to give information in the form of leaflets or other written material to ensure that any implications or alternatives are fully understood before agreeing to the care proposed (Rumbold 2000). By abiding by this principle the patient can remain autonomous in their own healthcare. Failure to gain consent prior to any procedure is not considered lawful and the healthcare professional could be sued or liable to criminal prosecution even if no harm comes to the patient (Lloyd et al 2007). Consent can be given in various ways; written if concerning an invasive procedure or examination and verbal or implied for other forms of care, i.e. injections (Brooker & Waugh 2007). According to the NMC (2009) consent is only valid if it is given voluntarily and the patient has not been coerced or pressurised into granting permission. Exceptions to this guideline arises when the patient is a child and also in situations such as the administration of emergency treatment or if it is decided that the patient does not have the mental capacity required to fully understand or retain the information provided. In the last instance according to the Mental Health Act (2005) the lack of ability may be due to conditions such as brain injuries, unconsciousness or severe learning disabilities; temporary or permanent. In this case consent may be deferred to another adult such as the next of kin or ultimately the patients’ consultant, although any past or present wishes expressed by the patient should be taken into consideration (Adults with Incapacity Act Scotland 2000). While consent may be perceived as a one-off act it is essentially an ongoing process whereby it can be withdrawn or granted at any given time (Brooker & Waugh 2007) therefore continually granting the patient their right to autonomy.
Autonomy is the entitlement of the patient to exercise their freedom of choice with regards to their healthcare without the care provider influencing or making their decisions for them (Rumbold 2000). According to Feinberg (1982) and Seedhouse (1998) as cited in Rumbold (2000) in order for a person to be classified as autonomous they must be conscious, self aware, possess the ability to rationalise and plan ahead to choose freely and direct their own life. Respecting a patients decision even though it may not lie well with the Nurses view of beneficence is an important part of the care process and may help to ease the anxiety felt concerning their illness or surroundings. Creating and respecting a person’s autonomy is an integral part of the nursing process for both the healthcare professional and the patient. In order for the patient to be granted autonomy the nurse must also be allowed to exercise her autonomy when providing care. According to Heath (1995) nurses’ autonomy was suppressed as they were seen to be sub-servant to other professionals such as Doctors and therefore unable to make decisions themselves. In modern day times nurses are regarded as self governing professionals who are accountable for their actions and should act with beneficence for their patient at all times (NMC 2009). A significant element in respecting the patients’ autonomy is to always tell the truth about their illness, diagnosis and prognosis. If the patient isn’t fully aware of their condition they are not able to make an informed decision, hence their autonomy has been compromised (Alexander et al 2006). When caring for the patient the ultimate goal is to enable greater independence therefore creating and respecting their autonomy is essential to the nursing process (Seedhouse 1998) cited in Rumbold (2000). The underpinning of the nurse patient relationship requires honesty and trust; these values must be upheld by the healthcare professional as part of the code of conduct which must be adhered to. It is seen to be beneficial to the patient as their health care may be one of the few ways they have left to employ their independence due to illness or disability (Heath 1995). However according to Heath (1995) at times beneficence might override the patient autonomy and the health professional will make the decision based on the patients’ best interests.