A nurse is preparing to witness the informed consent for a patient scheduled for elective surgery. Which of the following actions should the nurse take? (Select all that apply)

Rationale:

A. Utilitarianism is incorrect because this principle evaluates actions based on the greatest good for the greatest number of people. While useful in public health or policy decisions, it does not directly address ethical dilemmas focused on the well-being or potential harm to a single patient. Applying utilitarianism in this context would prioritize outcomes broadly rather than considering the individual’s suffering and the potential for harm.

B. Fidelity is incorrect because fidelity involves being faithful to commitments, promises, and professional responsibilities. While maintaining trust and honoring the patient’s wishes are important, fidelity alone does not directly guide the ethical consideration regarding potential harm from opioid administration at the end of life.

C. Veracity is incorrect because veracity emphasizes truth-telling and honesty in communication with patients and families. While veracity is crucial in discussing prognosis, treatment options, and expectations, it does not provide guidance for decisions about actions that might unintentionally harm the patient.

D. Nonmaleficence is correct because this principle focuses on the ethical obligation to do no harm. The nurse’s concern that administering an opioid might hasten death reflects the application of nonmaleficence in clinical decision-making. In palliative care, nurses balance nonmaleficence with beneficence, the principle of promoting good, in this case, relief of suffering. The principle of double effect is often applied: if the primary intention is to relieve severe pain and suffering, the potential secondary effect of hastening death is ethically permissible, provided it is not the intended outcome.

Rationale:

• Review mandatory nursing skills and competencies: This is relevant for the entire unit to ensure compliance with skill competency requirements and to promote safe client care.
• Review central line infections rates and causes: Unit-wide education is important to prevent infections, reinforce proper central line care, and improve patient outcomes.
• Review the incident of disruptive behavior: Discussing civility, teamwork, and professional communication benefits the whole team and helps prevent future conflicts.
• Meet to talk about mislabeling of laboratory specimen: This is specific to the AP who repeatedly mislabeled specimens. Addressing individually allows focused corrective action and policy review.
• Review near miss fall: This involves a specific incident with an AP; individualized coaching ensures understanding of fall precautions, proper bed/chair use, and safety protocols.