1. Mikos-Schild, Sophia EdD, MSN, RN, CNOR, Column Editor

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Nurses face ethical issues in their daily working lives when caring for patients and providing education to staff. The issues are more complex because of today's increasingly complex world in which technology has made information available at the touch of a keystroke or provided high-tech machines to extend the lives of those who are ill. The technological influence has placed nurses in a positive position to influence staff in learning and making informed ethical decisions. Whether teaching, caring for patients, or becoming involved in policy making, nurses need to know basic ethical theories and principles to help navigate in a world in which rational, responsible, effective, and self-reliant nurses meet their daily responsibilities (Burkhardt Nathaniel, 2008). Additionally, nursing educators are seen as a model of professional and academic values in which respect, honesty and integrity, standards of excellence, and fairness and justice are important components of daily interactions (Poliforoni, 2007).


In this two-part article, definition, history, and ethical theories of utilitarianism, deontology, virtue ethics, moral particularism, and the American Nurses Association (ANA, 2003) code of ethics will be examined. Finally, ethical principles of autonomy, beneficence, nonmaleficence, veracity, justice, and fidelity will be defined, with application to nursing staff development.



According to the Merriam-Webster Online Dictionary (2008), ethics is defined as a set of moral principles, values, and principles of conduct governing an individual or a group. For the healthcare professional, this means a conscious decision to follow a moral philosophy, which guides practice. Practice, which is concerned with what is morally right and wrong whether it be clinical or educational, may form the basis of a personal philosophy that guides professional practice. Professional ethics help educators deal with issues in the classroom, at work, and within student and faculty interactions. For us as educators in healthcare settings, educating staff regarding ethical issues means that we incorporate ethical standards when developing programs, orienting, or interacting with staff and others on a daily basis.



The Greek philosopher Socrates believed that evil arises out of ignorance because humans are by nature good. Socrates believed that happiness can be attained by being virtuous and that virtue can be taught to people. Virtue as a means to be like God was also espoused by Plato, who took it one step further in believing that "justice, temperance, and fortitude constitute proper harmony of man's activities" (Society, 2008). Finally, Artistotle stated that what was needed is a melding of pleasure, friendship, virtue, honor, and wealth which becomes a part of the person. Aristotle's philosophy included the belief that good habits and upbringing are import parts of a person's life. These habits can be achieved not be learning but by practicing them throughout one's life (Kraut, 2007). Other philosophers who rejected the Greek's moral law proposed hedonism, cynicism, stoicism, and skepticism. The rejection of moral law continued to be popular until the Christian philosophy took hold. Christianity gave rise to beliefs that God had instilled moral law in the hearts of humans, and as such, each person must follow his or her conscience to do what is morally correct. The church's influence was felt even when less attention was paid to moral issues during the Middle Ages.


In the late 1700s, Immanuel Kant saw reason as internal and autonomous and to be accepted without regard to if it is useful and pleasurable. However, others including John Stuart Mill viewed moral conduct to be that which human practices for the common good of humankind as an accepted criterion for ethical behavior. One hundred years later, Herbert Spencer believed that human beings had not adapted to life and cannot be perfectly ethical, so compromises are made to achieve enlightenment. Although this meant that humans were seen as mere brutes who needed to evolve, economic situations and beliefs that men affected morality contributed to though evolution of ethics. Marx and Engels were proponents who valued economics and incorporated it into their philosophy.


"Do the thing that is good, whether it is 'suitable for a woman' or not" was the belief of Florence Nightingale when writing, administering to the ill, or teaching nurses (Nightingale, 1859, as cited in Burkhardt & Nathaniel, 2008). Nursing ethics has evolved over the years, and today, the ANA provides nurses with guidelines regarding moral duties and standards (Glassberg, 2007). These include a code of ethics applicable to nurses practicing in varied settings including "direct patient care, administrators, educators, and researchers" (ANA, 2003).

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