Term Paper: Nursing Definitions Autonomy

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[. . .] Nursing negligence claims have been increasing for several years and there is no sign of a slowdown on the horizon. Because of health insurance limitations more responsibilities are being delegated to assistants who do not have proper training and patients are being discharged earlier than before without proper referrals. There is also a nursing shortage in the country which contributes to overworked nurses unable to fully focus their attention on individual patients. Patients are also better informed about malpractice and expanded definitions of negligence further erode the nurse's legal protection (Croke, 2003, p.54).

A nurse treating a diabetic patient could fall victim to negligence claims. Many times, especially in hospitals, there are many patients in the same area requiring similar doses of the same medication and insulin is a popular one. It is not inconceivable that the incorrect dosage could be administered to a patient by a nurse dealing with several different patients. Under normal circumstances, the blood sugar would be checked. If this is routine task is not performed, the patient could become severely hypoglycemic and coma and death could result, opening the nurse to charges of negligence. However, if the blood test is performed and the low blood sugar levels caught, the nurse could follow regular hospital protocol and notify the attending physician while following the standards of care for hypoglycemia, including medication if necessary. Should the blood sugar levels return to normal, there would be no injury or damage and, therefore, no negligence as the problem has been resolved properly.

Negligence is one of the most pressing concerns in the nursing profession today. With the rise of medical malpractice claims and an increasingly litigious society, it is imperative that nurses do all they can to protect themselves from negligence claims, spurious and otherwise. The best protection against these claims, of course, is to always follow regular nursing protocol or specific hospital regulations. But, in the heat of the moment when fatigue has set in and understaffed nurses are stretched thin, it is often difficult to maintain proper protocol. In these cases, it sometimes behooves the affected nurse to admit a mistake and do everything in his or her power to remedy the situation. Regardless of legal outcomes, a patient's life may hang in the balance.


Beneficence in nursing is the promotion of the welfare of other people, in this case patients assigned to a nurse (Butts & Rich, 2005, p.13). This can sometimes conflict with the idea of autonomy for the patient when a patient resists treatment which may be in his best interest. Many times a nurse may be required to perform a task which the patient is not inclined to allow but which is necessary for his general well-being. The nurse must then make a determination about whether the patient's wishes supersede the recommended medical procedure.

Beneficence would seem like common sense when viewed in terms of the nursing profession. A nurse is obligated to engage in behavior which is in the best interest of the patient at all times. But a nurse is also obligated to take into consideration the wishes of the patient and these two ideas often conflict with one another. This can be difficult to reconcile when the patient is not capable of rendering his own determination about his care. But if the patient is capable of making decisions about his own care, then it is imperative that the medical professionals acquiesce to the patient's wishes.

Beneficent care should be the norm when nurses are engaging in everyday patient care. Most everything a nurse does for a patient could be interpreted as beneficent, The most simple actions of a nurse, such as practicing sterile techniques and helping patients with pneumonia to cough and breathe, are prime examples of beneficence. Beneficence can also be seen when nurses override patients' wishes, like when a physician orders oxygen to be administered to a confused patient (Butts & Rich, 2005, p.13).

In general, nurses practice beneficence every day. It is part of their defined job, providing care for all their patients and tending to their general welfare. Even the simple act of brining someone an extra blanket can count as an act of beneficence. Many nurses go above and beyond the call of duty by performing such other beneficent actions as making phone calls for older debilitated patients or speaking to family members on behalf of the patient (Masters, p.93). Manu of these seemingly charitable acts are all part of the job in nursing and occur with great frequency.

However, there are occasions as discussed earlier when the concepts of beneficence and autonomy may interfere with one another. In these instances nurses act in the best interest of patients who they feel cannot decide for themselves. This is known as paternalism, since it refers to a type of parenting of the patient in which they override the autonomy of the patient (Masters, 2009, p. 93). This can be a tricky proposition for any nurse, since autonomy of a patient is also an important concept in nursing. The question could be asked whether the simple act of overriding autonomy itself does not have the patient's best interests at heart. After all, it is the patient who must make the decisions about what is best for his own health. A paternalistic action should only be taken when the patient's imminent health is at risk and their personal safety jeopardized. Mental capacity of the patient should also be taken into account.

Beneficence is the most obvious motivation for any nurse. Every nurse maintains that they entered the profession to help people and that is the very definition of beneficence. This does not always have to be accomplished in overly demonstrative, life-saving examples. It can be the everyday kindness and charity that a nurse provides during the course of the job. Many patients find these acts to be the most comforting of all the help they receive when hospitalized.


Many people have argued that the principle of nonmaleficence is not a principle that stands on its own, but can only be understood when discussed in context with beneficence. Simply stated, nonmaleficence means that nurses have a duty to not harm their patients, "First, do no harm" as the popular saying states (Rumbold, 1999, p.220). Along with beneficence, this is the overriding principle of nursing care in general and should be considered the underlying premise of all nursing actions.

Like beneficence, nonmaleficence is a way that nurses can ensure that they are not being negligent in their practices (Butts & Rich, 2005, p.13). But many insist that the theory of nonmaleficence actually is more important than beneficence because before one can promote a patient's well-being, a nurse must be assured that the patient is not being harmed by any procedure. A good example of nonmaleficence coming before beneficence would be a nurse deciding whether or not to keep the HIV status of a patient confidential. Before acquiescing to the patient's wish, the nurse must first ensure that doing so would not pose a risk to other clients or the community at large (Hitchcock & Schubert & Thomas, 2003, p.143).

The definition of actual harm may not be the same for all people involved, including the nurse, patient, or doctor. For instance, a patient may see the simple act of drawing blood as causing harm since it is uncomfortable and even sometimes painful to him. But the nurse and doctor would view this as necessary and perhaps even beneficent behavior since the ensuing blood test would help reveal potential medical problems and aid in diagnosis. It becomes increasingly more difficult to avoid harm as nurses are becoming more overburdened and the acute nursing shortage continues to take its toll. A nurse who is feeling under the weather may consider the act of showing up to work to be detrimental to her patients' health and might view any patient interaction as potentially harmful. However, if the nurse is capable of providing beneficent care even while feeling ill then the determination may be made that this care overrides the potential harm. Care must always be taken to weigh the potential for harm against the beneficent care that can be provided. In this way it is easy to see how closely related beneficence and nonmaleficence are.

Another important example of nonmaleficence would be the introduction of care that does the patient no discernible good. For example, a terminally ill cancer patient who has opted to undergo chemotherapy even though he has been informed that there is no hope of remission or success should be dissuaded from pursuing this course of action. When the potential for harm exists, there must be a compelling medical benefit to perform any procedure. It is understood that all procedures carry with them some form of risk and this must be weighed carefully against the possible benefits. Ultimately, if a patient exercises his autonomy and demands… [END OF PREVIEW]

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