Professional Practice, Ethics and Patient Safety
What to master
Ethical principles: autonomy (the patient's informed choice, even if you disagree), beneficence (do good), non-maleficence (avoid harm), justice (fair allocation), veracity (truthfulness), fidelity (keep promises, be loyal), and accountability.
Informed consent requires capacity, disclosure, comprehension and voluntariness; the provider obtains it, the nurse witnesses and advocates, and a patient may withdraw consent at any time. Know advance directives, durable power of attorney for healthcare, and what happens when a patient and family disagree - the patient's previously expressed wishes prevail.
Safety science: incident reporting (including near misses) is non-punitive and exists to fix systems, not blame individuals; root-cause analysis addresses systems; just culture separates human error from reckless behaviour. Know SBAR for handover, speak-up/escalation tools, and mandatory reporting duties (suspected abuse or neglect of children, older adults, or vulnerable persons; impaired colleagues; certain communicable diseases).
Confidentiality under data-protection law: share only with those who need to know for care.
Traps in questions
- Choosing "ask the family to decide" when the patient has capacity - autonomy wins.
- "Document the refusal and move on" when the correct answer also includes informing the provider and educating the patient.
- Reporting a near miss only when harm occurred - near misses are always reportable.
- Confusing the nurse's role (witness, advocate, verify) with obtaining consent (provider's role).
Worked example
A competent adult with a treatable infection refuses antibiotics after full explanation. Options: give the medication covertly, ask the family to persuade, document the refusal, inform the provider and continue to monitor and support. Choose document the refusal, inform the provider, and continue care - autonomy permits refusal of treatment, but duty of care and education continue.
Rule of thumb
A capable patient's informed refusal is legally and ethically binding - your job is to inform, document, and remain available.