The core principle of "do no harm," known as non-maleficence, is a foundational pillar of nursing practice, deeply embedded in professional oaths and codes of ethics. While there isn't one single, universally mandated "Oath to Do No Harm" that all nurses recite globally, the spirit of this commitment is enshrined in historical pledges and modern ethical guidelines.
The most widely recognized historical pledge that embodies this principle is the Florence Nightingale Pledge, often taken by new nursing graduates. This pledge, developed in 1893, reflects the profound ethical commitment expected of nurses. It includes a solemn promise to avoid causing injury or harm, echoing the very essence of non-maleficence. Specifically, early nursing commitments stipulated: "I shall abstain from anything that is harmful or injurious, and I shall not take or give any substance or product that is harmful to health." This vow underpins the enduring dedication of nurses to patient well-being and safety.
Evolution of Nursing Ethics
While the Florence Nightingale Pledge laid the groundwork, modern nursing ethics are guided by comprehensive professional codes established by organizations like the International Council of Nurses (ICN) and the American Nurses Association (ANA). These codes articulate the nurse's responsibilities to the public, practice, profession, and colleagues, always prioritizing patient safety and advocating for beneficial outcomes.
Key aspects of the nurse's commitment to "do no harm" include:
- Protecting Patient Safety: Preventing errors, infections, and adverse events.
- Maintaining Competence: Staying current with knowledge and skills to provide effective care.
- Advocating for Patients: Speaking up when patient well-being is at risk.
- Upholding Ethical Standards: Adhering to professional boundaries and respecting patient rights.
Core Ethical Principles Guiding Nursing Practice
The commitment to "do no harm" is intricately linked with several other ethical principles that guide nursing care. These principles provide a framework for making sound clinical and ethical decisions.
| Ethical Principle | Definition | Application in Nursing |
|---|---|---|
| Non-Maleficence | The duty to avoid causing harm to patients. | Ensuring patient safety, preventing errors, avoiding neglect. |
| Beneficence | The duty to act in the best interest of the patient; doing good. | Providing competent care, advocating for patient needs, promoting health. |
| Autonomy | Respecting the patient's right to make decisions about their own healthcare. | Obtaining informed consent, respecting refusal of treatment, ensuring privacy. |
| Justice | Treating all patients fairly and equitably, without prejudice. | Fair allocation of resources, non-discriminatory care, advocating for vulnerable populations. |
| Fidelity | Remaining loyal and committed to professional duties and responsibilities. | Keeping promises, maintaining confidentiality, upholding professional standards. |
Practical Application in Nursing
Nurses uphold the principle of "do no harm" in their daily practice through various actions:
- Medication Administration: Double-checking dosages, routes, and patient identification to prevent medication errors.
- Infection Control: Adhering strictly to hand hygiene protocols and sterile techniques.
- Patient Education: Providing clear and accurate information to patients and families to prevent misunderstandings and promote self-care.
- Advocacy: Intervening when a patient's care plan might lead to adverse outcomes or when a patient's rights are not being respected.
- Continuous Learning: Engaging in ongoing education and training to ensure practice is based on the latest evidence.
- Reporting Errors: Documenting and reporting near misses or actual errors to learn from them and prevent future occurrences, fostering a culture of safety.
By integrating these principles into their practice, nurses ensure that their actions consistently aim to protect and enhance the well-being of those under their care, embodying the enduring commitment to "do no harm."
