Nonmaleficence in Nursing: Nursing Ethics Breakdown

• In the next installment of Nursing Ethics Breakdown examine the role of nonmaleficence in nursing as the principle of preventing harm towards other humans. 
• Summarize the six other nursing ethics: accountability, justice, autonomy, beneficence, fidelity, and veracity, as well as the history of their development. 
• Recognize the importance of nonmaleficence through practical examples in nursing and examples of consequences if nonmaleficence is not followed. 

When one thinks of nursing ethics, the first principle that comes to mind is the principle of nonmaleficence. You may be less familiar with this terminology and more familiar with the phrase “do no harm.” This is what nonmaleficence means.  

Nurses have an obligation to ensure all actions they take during nursing care are non-maleficent. Practicing nonmaleficence means always having the best interests of the patient in mind. Nonmaleficence is an essential part of providing high-quality nursing care.  

This article will discuss nonmaleficence further, and examples of nonmaleficence in nursing will be provided.  

What is Nonmaleficence?

Nonmaleficence is the principle of refraining from causing intentional harm toward another human being. Maleficence is the deliberate infliction of a negative act or effect on another individual or group. Nonmaleficence indicates that a person genuinely works for a positive outcome for those with whom they come in contact. This principle especially applies to healthcare, particularly in the field of nursing.  

Nonmaleficence has the following four key components: 

• An action must not be intrinsically wrong. 
• A good effect must be intended by the action. 
• The good outcome must not be a byproduct of a bad effect. 
• If there are negative outcomes of an action, the good outcomes of the action must outweigh the bad. 

Emergence of Nonmaleficence

The concept of nursing ethics started in the nineteenth century. These ethics refer to character traits that a nurse should be able to demonstrate as a medical professional. These ethics help ensure that nurses are providing appropriate care to the patients they care for.

Nonmaleficence is one of the seven nursing ethics. The seven ethical principles of nursing are as follows: 

1. Accountability: accountability is one of the most important ethical principles in nursing. Each nurse must be responsible for his or her own choices and actions during patient care. Nurses who hold themselves accountable often provide higher-quality patient care. 
2. Justice: every nurse has a responsibility to make care decisions that are based only on the facts, not on other factors such as the patient’s age, ethnicity, religion, socioeconomic status, or sexual orientation. To uphold this principle, nurses should act as fairly and objectively as possible to help patients feel more valued. Fairly treating each patient regardless of their circumstances is essential for helping patients accept and participate in their health care. 
3. Nonmaleficence: this means to do no harm. Nurses have a critical responsibility to prevent further harm from coming to all of their patients. Each nurse must take action to prevent harm. This is essential to provide safe, effective patient care that is delivered to the best of a nurse’s ability. 
4. Autonomy: nurses should be able to perform their duties using their knowledge and professional judgment appropriate for each patient. Nurses must act within their scope of practice yet continue to provide high-quality nursing care. Autonomy is an essential part of nursing practice and helps nurses to make appropriate decisions based on critical thinking. This principle goes hand in hand with accountability. 
5. Beneficence: actions that are performed with the intention of benefiting other people. An example of this is a nurse caring for a patient and putting the patient’s needs above their own in the best interests of the patient.  
6. Fidelity: this means keeping your word to your patients. Nurses should be honest and loyal to each patient. Without fidelity, more trusting relationships cannot be formed, which leads to less positive patient outcomes and distrust. 
7. Veracity: working in healthcare is challenging for many reasons, and in some cases, nurses must communicate unpleasant information to a patient. Veracity in nursing is the ethical principle of being completely open and honest with patients, even if the truth causes distress. Veracity helps patients become more autonomous when making decisions for their care based on all relevant and factual information. 

Nonmaleficence in Nursing

Nonmaleficence means to “do no harm.” Therefore, in nursing practice, it is essential that nurses provide care in the best interests of their patients. The benefits should always outweigh the potential negative effects of treatment.  

Importance of Nonmaleficence in Nursing 

The principle of nonmaleficence is an essential part of delivering safe, effective, high-quality nursing care. Every possible effort must be made to protect patient safety and improve patient outcomes.  

Examples of Nonmaleficence in Nursing 

Following are some examples of how nonmaleficence directs the actions of nurses when they make decisions regarding patient care: 

• Choosing whether to resuscitate a patient – this can result in the death or continued life of a patient but may also result in prolonging the pain of the patient and the mental and emotional suffering of their loved ones. In some instances, choosing not to resuscitate an individual can be a non-maleficent action. 
• Administering medications with potential side effects – the use of certain medications can lead to negative effects. However, the positive outcome of the medication is potentially much greater than any negative consequences. In the case that a nurse decides to administer medications that pose risks, a proposal for treatment for the negative effects and a full explanation are given to the patient.   
• Reporting seemingly insignificant changes on a patient’s chart – the inclusion of the smallest changes on a chart, such as an abnormal and brief rise in blood pressure can lead to tremendous insight in the event of an unforeseen emergency. Nonmaleficence requires diligent attention to all aspects of the patient’s health. 

Consequences of Nonmaleficence in Nursing

• Increased risk to patient safety – failure to practice nonmaleficence increases the risk of medication errors and other patient safety risks. 
• Loss of Job/License – failure to practice nonmaleficence in every nursing action can result in patient harm, causing severe consequences for the nurse, including loss of job or loss of nursing license if the harm is severe.

The Bottom Line

Nursing ethics are essential to your professional and personal life. Among these ethics, nonmaleficence refers to engaging in actions that avoid harm to others. Nonmaleficence is the backbone of healthcare.  

As nurses, you are expected to provide care that is beneficial to the patient and avoid harm or injury. Failure to practice nonmaleficence must be avoided in order to deliver high quality healthcare and to achieve positive patient outcomes.  

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