"

5.2 Ethical Principles

The American Nurses Association (ANA) designates “Ethics” as the first Standard of Professional Performance in the publication Nursing: Scope and Standards of Practice, stating, “The registered nurse integrates ethics in all aspects of practice.”[1] See the following box for nursing actions associated with the Ethics Standard of Professional Performance.

Ethics Standard of Professional Performance[2]

The registered nurse:

  • Uses the Code of Ethics for Nurses  as a moral foundation to guide nursing practice and decision-making.
  • Demonstrates that every person is worthy of nursing care through the provision of respectful, person-centered, compassionate care, regardless of personal history or characteristics (Beneficence).
  • Advocates for health care consumer perspectives, preferences, and rights to informed decision-making and self-determination (Respect for autonomy).
  • Demonstrates a primary commitment to the recipients of nursing and health care services in all settings and situations (Fidelity).
  • Maintains therapeutic relationships and professional boundaries.
  • Safeguards sensitive information within ethical, legal, and regulatory parameters (Nonmaleficence).
  • Identifies ethics resources within the practice setting to assist and collaborate in addressing ethical issues.
  • Integrates principles of social justice in all aspects of nursing practice (Justice).
  • Refines ethical competence through continued professional education and personal self-development activities.
  • Depicts one’s professional nursing identity through demonstrated values and ethics, knowledge, leadership, and professional comportment.
  • Engages in self-care and self-reflection practices to support and preserve personal health, well-being, and integrity.
  • Contributes to the establishment and maintenance of an ethical environment that is conducive to safe, quality health care.
  • Collaborates with other health professionals and the public to protect human rights, promote health diplomacy, enhance cultural sensitivity and congruence, and reduce health disparities.
  • Represents the nursing perspective in clinic, institutional, community, or professional association ethics discussions.

American Nurse Association Code of Ethics

The ANA Code of Ethics establishes the ethical standard for the nursing profession. It contains ten provisions that provide a guide for nurses to use in ethical practice and decision-making in all practice settings. The Code of Ethics for Nurses states that it stands as both a normative framework and an aspirational guide, with the 2025 edition containing updated provisions based on the current health care environment and a new  tenth provision that envisions the role of nursing in creating a healthier society and a healthier world. Read a summary of the ten provisions in the following box.[3]

Ten Provisions of the ANA’s Code of Ethics for Nurses[4]

Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

Provision 2: The nurse’s primary commitment is to the recipient(s) of nursing care, whether an individual, family, group, community, or population.

Provision 3: The nurse establishes a trusting relationship and advocates for the rights, health, and safety of the recipient(s) of nursing care.

Provision 4: Nurses have authority over nursing practice and are responsible and accountable for their practice consistent with their obligations to promote health, prevent illness, and to provide optimal care.

Provision 5: The nurse has moral duties to self as person of inherent dignity and worth including an expectation of a safe place to work that fosters flourishing, authenticity of self at work, and self-respect through integrity and professional competency.

Provision 6: Nurses through individual and collective effort, establish, maintain, and improve the ethical environment of the work setting that affects nursing care and the well-being of nurses.

Provision 7: Nurses advance the profession through multiple approaches to knowledge development, professional standards, and the generation of policies for nursing, health, and social concerns.

Provision 8: Nurses build collaborative relationships and networks with nurses, other healthcare and non-health care disciplines, and the public to achieve greater ends.

Provision 9: Nurses and their professional organizations work to enact and resource practices, policies, and legislation to promote social justice, eliminate health inequities, and facilitate human flourishing.

Provision 10: Nursing, through organizations and associations, participates in the global nursing and health community to promote human and environmental health, well-being, and flourishing.

 

Read the full descriptions of the ten provisions in the online 2025 ANA Code of Ethics for Nurses.

Ethical Principles

Ethical principles are used to define right from wrong actions. They are used to help define nurses’ moral duties and aid in ethical analysis and decision making. Although there are many ethical principles that guide nursing practice, foundational ethical principles include respect for autonomy and self-determination, beneficence (do good), nonmaleficence (do no harm), justice (fairness), fidelity (keep promises), and veracity (tell the truth).

Autonomy and Self Determination

The ANA Ethics Standard of Professional Performance states that nurses respect a client’s autonomy by advocating for their perspectives, preferences, and rights to informed decision-making and self determination.[5]

Provision 1, Section 1.4 of the ANA Code of Ethics for Nurses states, “Respect for human dignity requires the recognition of specific patient rights, in particular, the right to self-determination. Recipients of care have the moral and legal right to determine what will be done with and to their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed decision; and to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment. They also have the right to accept, refuse, or terminate treatment without undue influence, duress, deception, manipulation, coercion, or prejudice, and to be given necessary support throughout the decision-making and treatment process. Such support includes the opportunity to make decisions with family and persons of their choosing, and to partner with nurses and other healthcare professionals.”[6] See examples of nurses implementing interventions based on the ethical principles of  autonomy and self-determination in the following box.

Case Applications of Autonomy and Self Determination

Medical Example: Sarah, an experienced registered nurse, is caring for Mr. Thompson, a 68-year-old man recently diagnosed with early-stage lung cancer. His oncologist has recommended surgery followed by chemotherapy, explaining that this approach offers the best chance of remission. However, after discussing the options with Sarah and his family, Mr. Thompson decides to decline aggressive treatment in favor of palliative care, prioritizing his quality of life over prolonged treatment. Although Sarah personally believes that pursuing treatment might extend his life, she respects Mr. Thompson’s decision. She ensures that he fully understands the risks and benefits of his choice, answers his questions, and advocates for his wishes with the healthcare team. She arranges for a palliative care consultation and works to provide comfort-focused care, demonstrating her commitment to the ethical principle of autonomy.

Mental Health Care Example: A nurse  is providing care for a client diagnosed with severe, treatment-resistant depression whose health care provider has recommended electroconvulsive therapy (ECT). The client tells the nurse they feel unsure about proceeding with ECT. The nurse provides health teaching about the ECT procedure and the potential side effects in a clear, compassionate manner and provides time for the client to ask questions and voice concerns. This action upholds the client’s rights to self determination and autonomy and  by respecting their right to make informed choices about their mental health treatment.

Beneficence and Respect for Human Dignity

The ethical principle of beneficence is described in the ANA Ethics Standard of Professional Performance as the nurse “demonstrates that every person is worthy of nursing care through the provision of respectful, person-centered, compassionate care, regardless of personal history or characteristics.[7]

Provision 1, Section 1.1 of the ANA Code of Ethics for Nurses states, “A fundamental principle that underlies all nursing practice is respect for the inherent dignity, worth, unique attributes, and human rights of all individuals; therefore, ethical nursing practice requires compassion for all humans as deserving of dignity and respect. Nurses maintain caring relationships and are committed to fair treatment, transparency, integrity-preserving compromise, building trust, and the best resolution of conflicts. The nurse is additionally committed to creating and sustaining an ethical environment where the nurse-patient relationship can flourish.”[8]

Section 1.3 of Provision 1 of the ANA Code of Ethics for Nurses further described beneficence as, “Optimal nursing care enables recipients to live with as much physical, emotional, social, religious, and/or spiritual well-being as possible, aligning with their preferences, values, and determination of quality of life. Nurses lead the implementation of responsible and appropriate evidence-based interventions across the lifespan to optimize the health and well-being of those in their care. When a recipient of care no longer sees a proportional benefit from the burdens of interventions, nurses are attentive and practice shared decision-making to arrive at medically achievable goals that reflect patient values. All human beings should have access to what they recognize as a good quality of life, which is subjective. Nurses appreciate that what is right for one person may not be right for another. The nurse balances respect for values with harm mitigation and recognizes that every decision for each person is unique and situational.”[9]

When caring for clients with mental health disorders, nurses implement beneficence by actively advocating for evidence-based treatments that promote the best possible outcomes. For instance, if a client with schizophrenia is not responding well to their current medication regimen and is experiencing distressing side effects, the nurse collaborate with the healthcare team to recommend a more effective and better-tolerated alternative. By staying informed about current research and clinical guidelines, the nurse ensures the client receives the most appropriate care, demonstrating a commitment to the client’s well-being and overall mental health recovery. See an example of nurse implementing interventions based on the ethical principles of beneficence respect for human dignity in the following box.

Beneficence Case Application

A nurse is caring for Jake, a 25-year-old client admitted for severe depression and suicidal ideation. After assessing Jake’s condition, the nurse notices that he is hesitant to engage in psychotherapy and has refused to take his prescribed antidepressant medication due to side effects he experienced in the past. The nurse provides health teaching to Jake about the prescribed antidepressants, psychotherapy, and lifestyle modifications to help treat depression, and also contacts his psychiatrist to share Jake’s concerns and sets up an appointment to discuss adjusting his treatment plan to better suit his preferences. The nurse also continues to encourage Jake to participate in his scheduled cognitive behavioral therapy sessions, recognizing its proven effectiveness in treating depression. By proactively seeking the best care for Jake and ensuring he receives appropriate, individualized treatment, the nurse exemplifies the ethical principle of beneficence.

Nonmaleficence

The ethical principle of nonmaleficence is commonly defined as a duty to do no harm and balancing avoidable harm with benefits of good achieved. Non-maleficence is further described in the ANA Ethics Standard of Professional Performance as the nurse “safeguards sensitive information within ethical, legal, and regulatory parameters.”[10]

Provision 1, Section 1.3 of the ANA Code of Ethics for Nurses further describes nonmaleficence related to health as, “Nurses promote health and wellness, address problems, and respect patient decisions. Respect for a patient’s decisions does not require that the nurse agrees with or supports all choices made by a recipient of care. When patient choices are assessed to be dangerous, risky, or self-destructive, nurses have a moral obligation to take appropriate actions to address the behavior, and provide accurate, evidence-based education and resources. In immediately dangerous situations, the nurse focuses on modifying the harmful behavior to either mitigate or eliminate the risk.”[11]

A classic example of doing no harm in nursing practice is reflected by nurses checking medication rights three times before administering medications. In this manner, medication errors can be avoided, and the duty to do no harm is met.  Furthermore, nurses continually assess for side effects of medications and promptly report them to the health care provider.  See an additional example of nursing implementing interventions based on the nonmaleficence ethical principle in the following box.

Nonmaleficence Case Application

A nurse is caring for Lisa, a client diagnosed with bipolar disorder who has been taking lithium for mood stabilization. During the routine nursing assessment, the nurses notices that Lisa is experiencing potential signs of lithium toxicity, including symptoms of nausea, hand tremors, and mild confusion. Recognizing these cues, the nurse immediately reviews Lisa’s most recent lab results and finds that her lithium level is approaching a toxic range. Acting quickly, the nurse notifies the prescribing provider and advocates for dosage adjustment to prevent further harm. The nurse educates Lisa about the importance of staying hydrated and recognizing and reporting early signs of lithium toxicity. By proactively identifying and addressing a potential medication-related harm, the nurse demonstrate the ethical principle of nonmaleficence, ensuring that Lisa’s treatment remains both safe and effective.

Justice

Justice is described in the ANA Ethics Standard of Professional Performance as the nurse “integrates principles of social justice in all aspects of nursing practice.”[12]

Provision 1, Section 1.2 of the ANA Code of Ethics for Nurses further describes justice as, “Nurses establish relationships of trust and provide nursing services according to need. Nurses engage in self-reflection to identify and mitigate bias or prejudice that interferes with or harms the nurse-patient relationship. The nurse recognizes that biases can exist both explicitly and unconsciously. Attributes such as the patient’s culture, value systems, religious and/or spiritual beliefs, lifestyle, social support system, preferred language, and sexual identity are to be considered when planning individual, family, and population-centered care. Nurses promote health and wellness, address problems, and respect patient decisions. Respect for a patient’s decisions does not require that the nurse agrees with or supports all choices made by a recipient of care.”[13]

Nurses have a social contract to “provide compassionate care that addresses the individual’s needs for protection, advocacy, empowerment, optimization of health, prevention of illness and injury, alleviation of suffering, comfort, and well-being.”[14] An example of a nurse upholding the principle of justice in all settings is ensuring that quality care is provided to all clients, even for those who do not have the cognitive ability to communicate their needs. See an additional example of nursing implementing interventions based on the justice ethical principle in the following box.

Justice Case Application

A nurse working in a busy emergency department is caring for two clients who arrived at the same time. One client is a well-dressed business professional with private insurance who is experiencing a panic attack, and the other is an unhoused individual with no health insurance who is experiencing a mental health crisis. Despite their differing backgrounds, the nurse treats both clients with the same level of care, professionalism, and respect.

The business professional can clearly articulate his concerns and symptoms. The unhoused client is disoriented and unable to clearly communicate his needs. The nurse takes time to thoroughly assess both clients, advocating for  psychiatric evaluations and appropriate mental health care. For the unhoused individual, the nurse also implements interventions based on the client’s physiological needs by making a referral to social work support services to advocate for food and housing resources. The nurse provides individualized health teaching to both clients and ensures they have follow-up care in place before discharge.

By providing equitable and compassionate care to both clients—regardless of their socioeconomic status— the nurse upholds the ethical principle of justice, ensuring that healthcare is delivered fairly and without bias.

Fidelity

Fidelity is described in the ANA Ethics Standard of Professional Performance as the nurse “demonstrates a primary commitment to the recipients of nursing and healthcare services in all settings and services.”[15]

Provision 2, Section 2.1 of the ANA Code of Ethics for Nurses further describes fidelity as, “Within the context of nursing practice, the nurse prioritizes recipients of nursing care, placing them over institutions. Every clinical encounter and plan of care reflects the fundamental commitment of nursing to the inherent dignity, worth, unique attributes, and human rights of the patient. Nurses provide patients with opportunities to participate in …planning and implementing their plan of care, and deciding what supportive services are acceptable to them.”[16]

Fidelity also means nurses must remain up-to-date with evidence-based practice in order to plan and implement effective nursing interventions. For example, a nurse is upholding the ethical standard of fidelity by staying informed about current cognitive-behavioral therapy (CBT) techniques and appropriately integrating them into nursing care plans for clients with mental health disorders.

Fidelity Case Application

A nurse on a medical-surgical unit is caring for Mr. Thompson, a 70 year-old postoperative client recovering from orthopedic surgery.  During the assessment, the nurse notices non-verbal cues of pain, including wincing and guarding of the affected area, even though Mr. Thompson reports his pain level as a “1.” The nurses states this observation and incongruency in verbal and nonverbal pain indicators. Mr. Thompson confides in the nurse that he is in more pain than he has been reporting to the health care provider and nurses, but asks the nurse to not document it because he’s afraid it might delay his planned discharge to go home today.

The nurse listens carefully and empathetically to Mr. Thompson’s concerns. The nurse asks Mr. Thompson about his desire for discharge today and discovers he is mostly concerned about his cat, who is alone at home and needs to be fed. The nurse explains the importance of appropriate pain management for his recovery process and offers to contact the health care provider regarding the pain management plan offers. The nurse also offers to assist Mr. Thompson to use the phone in the room to call a trusted neighbor to feed the cat. The nurse documents the client’s verbal and nonverbal indicators of pain as well as his preferences for discharge today in the electronic medical record.

The nurse upholds the ethical principle of fidelity by maintaining honest, empathetic communication, honoring professional responsibilities, and maintaining trust in the nurse-client relationship.

Veracity

Veracity means telling the truth. An example of veracity in health care is informed consent. Nurses ensure that clients have a good understanding of the benefits and risks of a prescribed procedure or psychotropic medication. By providing honest, clear, and complete information, nurses support clients in making informed decisions about their mental health treatment, fostering trust and ethical care.

Veracity Case Application

A nurse is providing preoperative care while preparing Mr. Jackson for an elective colonoscopy. The nurse reviews the client’s chart and notices that he has not yet signed the informed consent form. When asking Mr. Jackson if he has any questions about the procedure or post-operative care, he admits he doesn’t understand the risks and benefits of the procedure. The nurse waits to administer preoperative sedative medications and notifies the health care provider about Mr. Jackson’s concerns. After the health care provider visits the client, answers his questions, and addresses his concerns, Mr. Jackson signs the informed consent form. The nurses witnesses the signature then administers the prescribed sedative medication. By ensuring that the client receives complete information before signing the informed consent form and ensuring the form is signed before preoperative medications are administered, the nurse upholds the ethical principle of veracity.

Role of Caring

Nurses use a client-centered, care-based, ethical approach to nursing care that focuses on the specific circumstances of each situation. This approach aligns with the foundational nursing concepts of holism and caring in a nurse-client relationship rooted in dignity, respect, kindness, and compassion.[17]It is grounded in dignity, respect, kindness, and compassion, ensuring that care is both ethically sound and deeply humanistic.

Role of Caring Case Application

Elena, a nurse on an oncology unit, is caring for Mrs. Rivera, a client undergoing chemotherapy who is experiencing significant fatigue, hair loss, and emotional distress. During morning rounds, Elena notices that Mrs. Rivera is unusually quiet and tearful.

Instead of simply focusing on clinical tasks, Elena pulls up a chair, holds Mrs. Rivera’s hand, and asks how she’s truly feeling. Mrs. Rivera opens up about her fears, body image concerns, and feelings of isolation. Elena listens with empathy, validates her emotions, and offers support by involving the hospital counselor and arranging a visit from a volunteer who also underwent cancer treatment.

Later that day, Elena brings in a soft headscarf gifted by a local support group and helps Mrs. Rivera feel more comfortable and cared for. She checks in regularly—not just to assess physical symptoms, but to ensure emotional and spiritual needs are met.

By going beyond physical care to foster connection, compassion, and comfort, Elena exemplifies the role of caring in nursing, nurturing a healing environment that supports the whole person, not just the illness.

  1. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  2. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  3. American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/provisions ↵
  4. American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/provisions ↵
  5. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  6. American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/provisions ↵
  7. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  8. American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/provisions ↵
  9. American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/provisions ↵
  10. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  11. American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/provisions ↵
  12. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  13. American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/provisions ↵
  14. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  15. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
  16. American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org/provisions ↵
  17. Legal Information Institute. (n.d.). Welcome to LII. Cornell Law School. https://www.law.cornell.edu ↵
definition

License

Icon for the Creative Commons Attribution 4.0 International License

Nursing: Mental Health and Community Concepts - 2e Copyright © 2025 by WisTech Open is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

Share This Book