01.01 What Guides Nurses Practice

In this lesson, we’re going to talk about some of the core principles of what guides our practice as nurses
When we first look at what we call “the overall guiding forces of nursing practice,” we need to look at several main principles. These are ethics, legal implications (so what laws we follow), nursing prioritization and safety. These all function like the four outside walls of the house, working together to provide a foundation for the rest of the house.
Today, I’m just hitting the high points, but check out the other lessons to get more details on safety, legal stuff and nursing prioritization, but in the meantime, let’s dive in.
When we look at ethics in nursing, what does that mean? Well the American Nurses Association currently houses the Code of Ethics, which is a pretty solid outline of guiding principles regarding ethics. Look them up and there’s a pretty nifty resource for it. There are 7 foundational principles in nursing ethics, which we will go over here.

The first one is justice is always being fair to the patients that you care for. Every patient should receive the same, high quality care that you would deliver to someone like your grandma, despite any factors. That includes race, sexual orientation, gender, culture, religion, political views, or anything that would personally skew your view of them. Our responsibility is to the patient and to the profession, so we want to make sure that we continually deliver the same care to every patient. For example, the first patient that I had as an inmate was a convicted sex offender. But because I didn’t know it at the time, I continued to provide the same quality of care for him as I did for the little meemaw in the next room.

The next one is beneficence. Beneficence is doing good. But not just doing good things - it’s doing the most good for the patient. For example, clustering care for a patient in pain is doing the most good, because you’re examining them on the whole. The goal here is “if I do all of their care at once, then I’m minimizing the amount of time they’re in pain.” So, you’re doing the most good and what’s good for the patient.

Which leads me to my next point - nonmaleficence (I know it’s a mouthful). On every talk show, podcast, tv series or what have you, they always say “do no harm.” This is different than Beneficence. Being nonmaleficent means that you’ll do what’s in your power to not harm the patient or to avoid harm at all cost. Let’s go back to our patient in pain. If you need to turn them, as their nurse you could possibly consider giving them their pain medications 30 minutes prior to turning them, that way, the process of turning them doesn’t hurt them, or is at least minimized by the medication.

Another thing we want to consider as nurses is being accountable. It simply means that you need to “own it.” Be confident in your care, but also know that when bad things happen or things don’t go as planned, be responsible and accountable for whatever mistake you did and not pass that blame to someone else. If you accidentally give your patient the wrong dose of medication, own that responsibility. You are in charge of the care you give, in both the good and bad times.

The next one is fidelity. Fidelity is being faithful to your practice and your patients. For example, imagine your patient has HIV and they’ve asked you not to share the information with their family, and you agree. That’s fidelity. The point here is that the patient entrusts information to you that you promise not to share - that’s fidelity.

Autonomy is the idea that every patient is unique and individual. They may have their own cultural or religious practices that are personal, and you must do what you can to honor those. More importantly, patients have every right to refuse any aspect of care. Not only is it their right, it’s also important that you tell them that they CAN refuse care.

Veracity is being honest. Do you have to deliver the heartbreaking news of a cancer diagnosis to a patient? No. That’s the doctor’s responsibility. But what veracity means is that you shouldn’t lie to patients or their family members. Sometimes these situations are tough, but being honest with them is important. For example, if your patient is not likely going to walk again after suffering a spinal injury, it’s important (and more importantly it’s ok) to tell them that, but in a supportive and caring way.

Now let’s look at some legal principles. Forewarning, some of this stuff is extremely boring, but as nurses, we need to know some general principles about the legal system and how it impacts what we do.

There are different state and federal laws which impact you as a nurse, so be sure to be find out what those are where you live. There are also facility policies, so in other words, the rules at the place you work. Check with your management or leaders for the ins and outs of those. There are also some aspects to criminal and civil law and even patients rights, which are covered in other lessons so be sure to check those out.

Quickly, I want to hit on one important note. Patient’s have the right to refuse care. Any aspect of care. So educate your patients so that they know that they can do that, especially in situations where there’s confusion and they seem uneasy. Be your patient’s advocate and make sure they know that they can go “full stop” until they’re comfortable. For example, if a patient tells you that they’re uncomfortable with the doctor performing a procedure or they don’t know why the doctor needs to do it, let them know that it’s ok to say “hold on” until they better understand.

As nurses we have to prioritize the care for our patients and one way we do that is through the nursing process. We use the acronym ADPIE, which stands for Assessment, Diagnosis, Planning, Implementation, and Evaluation which helps us remember what we need to do for our patients.
This is a circular principle. Once you get done with the last thing, then you’ll start back over. There are multiple lessons for the nursing process, so be sure to check those out.

For now, let me just show you what I mean.
Assessment - My mouth is dry.
Diagnosis - I’m thirsty.
Planning - I’m going to get a glass of water.
Implementation - I drink the glass of water.
Evaluation - Am I still thirsty?
Nope? I’m good.

What are some other aspects to nursing prioritization?
Critical thinking is one. I’m not going to lie, but this is a big challenge for nursing students. This idea that you just “study” critical thinking is just not logical. It’s a development of the several key principles. First, it’s gained with experience. You need time to develop the skills necessary to practice prudently and safely. Second, it’s built with knowledge. The more you learn throughout nursing school, you’ll put in your nursing toolbox and then you’ll be able to pull from it to apply those principles.

And lastly is competency. Being competent shows that you’ve shown that you can recognize, evaluate, process and deliver care with accuracy and confidence.
There are two lessons that you should check out. One is critical thinking and the other is “thinking like a nurse.” This will help you guys out.
The last important principle is safety.
I’m going to touch briefly on this, but this is a foundational principle of nursing.
The one question you should ask yourself every single time you touch a patient is “Am I being safe?” or “Is what I’m about to do a safe thing for the patient?”
Safety is a crucial factor for nursing care. So, if you aren’t being safe, then you should re-evaluate either what you’re doing or how you’re doing it.
One other key thing to think about - is what you’re doing safe for YOU? Examples of this are transfers or moving patients up in bed. If you’re going to injury yourself or put yourself at risk for the sake of time or being rushed, then you should pause. Because if you can’t give a patient care because you hurt yourself, what happens to the care of the patient? It suffers, and you don’t do yourself or your patient any favors because you’ve injured yourself, or put yourself in harms way.
A good example of this are the oxygen masks on a plane. The instructions are always to put on your oxygen mask first, because if you pass out, you can’t help anybody else.
There are multiple lessons on safety, so be sure to check those out.

So we’ve gone throughout some of the guiding principles of nursing care and we’ve touched on ethical and legal practice, so essentially what laws you should follow and what ethical principles should guide your practice. We covered some nursing prioritization, so that’s how we should think about the care we deliver, and safety. We should always be safe nurses, both for our patient and ourselves.

So now to recap:
Ethics are the things that we do based on 7 principles. Justice, beneficence, nonmaleficence, autonomy, veracity, fidelity and accountability for your practice. Treat every patient as if they’re your grandmother.
Follow the laws in both your state and federally. Refer to your state practice act for details and follow your facility policy when giving care.
As a nurse, always use the nursing process, this will help you to prioritize your patient’s care.
ALWAYS be safe - safe for your patient and safe for you
The last thing to remember is that patients are human - they have the right to refuse any aspect of care and you should respect them and their wishes.

I cared for a convicted sex offender the same way I cared for an elderly lady in the next room as an example of justice.