Professional Practice, Ethics, and Safety
Ethical principles and decision-making
Apply autonomy, beneficence, nonmaleficence, justice, and veracity to nephrology scenarios. Support informed consent for dialysis, access procedures, and transplantation. Respect refusal of treatment and advance directives, and distinguish withholding from withdrawing therapy, which are ethically equivalent when goals align. Consider resource allocation and equity in access to transplantation and home therapies. Protect privacy and confidentiality.
Safety and quality
Understand patient identification, medication reconciliation, and high-alert medication safety in dialysis. Recognize the importance of machine checks, water quality, dialysate composition verification, and infection control audits. Report adverse events and near misses without blame. Know scope of practice and when to escalate. Address workplace safety including needlestick prevention and safe handling of hazardous drugs.
Traps
Do not assume a family member's wishes override a competent patient's decision. Do not treat a do-not-resuscitate order as a do-not-treat order. Do not accept a verbal order for a high-alert medication without verification per policy. Do not hide an error; disclosure and reporting are expected. Do not assume a patient lacks decision-making capacity because they disagree with the team.
Worked example and rule of thumb
A competent patient on hemodialysis decides to stop treatment. Explore the reasons, treat depression or reversible barriers, ensure informed refusal, and involve palliative care; honor the decision. Rule of thumb: capacity plus information plus voluntariness equals valid consent or refusal, and every safety event gets reported and disclosed.