ETHICS AND PRINCIPLES OF NURSES DISCUSSION 2022

Running head: ETHICS AND PRINCIPLES
Rights and ethics of nurses
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ETHICS AND PRINCIPLES 1
Introduction
Health care professionals are increasingly experiencing violence while treating their patients.
It is reported that above 75% of the health care staff are abused physically or mentally by
their patients in their clinical practices. These violent practices are common in the critical
care units while administrating analgesics to the patients (Kapoor, 2017). Regular reports of
HCPs being bullied, threatened, abused or even killed are evidence of the increasing danger
on the healthcare personnel. As a response, in some cases, the HCPs refuse to treat patients
with violent behaviour as a threat to their personal safety and the fundamental rights of
humans (Bordignon & Monteiro, 2016). This conduct of a health care professional is
subjected to reviews and assessments of aligning one’s conducts with codes of ethics. Ethics
are the standards of practice that guide the professional actions of individuals. There are four
fundamental ethics guiding the professional practices of an HCP, namely non-maleficence,
beneficence, autonomy and justice (ANCI Council, 2002). These ethical considerations and
the fundamental right of a nurse as an individual raise the controversy of allowing the HCPs
the right to refuse treatment to violent patients. This essay is in agreement with the side that
the HCPs experiencing violence from their patients in their professional practice can refuse
treatment of the patient.
Discussion
The first argument supporting the rights of HCPs facing violence from their patients to refuse
treatment is that it is a threat to their safety. Nursing professionals often report incidents of
being kicked, bitten, beaten or even killed by the patients. This form of physical abuse poses
a serious risk to the life of the health care professionals. Beneficence and non-maleficence are
integral ethical considerations under the Code of Ethics outlines for professional practices of

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HCPs, by which the health care workforce is obligated to act in the best interest of the patient
and avoid causing suffering to the patients. These ethical obligations of the HCPs are
justifiable if the patient suffers from a critical mental health disorder and the violence is part
of the clinical representation of the disease or in cases of children (Kerridge, Lowe &
Stewart, 2013). However, these ethical considerations are not legitimate in cases where the
patients exhibit sound mental capacities and the violence is intentional. A survey revealed
that over 30% of nurses experienced sexual assault by their patients with serious mental
diseases such as Alzheimer’s and on heavy medications (Niu et al., 2019). In these cases, the
nurses must refuse treatment as it is a violation of their privacy and personal safety. The
professional practices of health care personnel do not require them to tolerate any kind of
physical or sexual assault and are intolerable as being assaulted is not a part of their duties.
Besides, the HCPs also have the right to deny treatment to patients with deteriorating mental
conditions in some cases where the patients sexually assault the nurses. Physical violence can
often cost the health care personnel their lives or leave long-lasting scars. The increasing
trends of physical and sexual assaults have also resulted in a decrease in the retention of
health care workers, particularly the young nurses in the profession. The ethical
considerations outline for guiding professional health practices cannot be placed above the
safety of health care professionals (Concannon, Gillibrand & Jones, 2019).
The second argument supporting the rights of HCPs to refuse treatment against violent
patients is a risk to their mental well-being. Health care personnel are subjected to verbal
abuse which has a long-lasting impact on their mental capacities. A survey reported that
psychological violence accounted for 82.1% among health care professionals (Lima & de
Sousa, 2015). In addition to the physical injuries caused by the physical or sexual assaults, it
also affects the mental and emotional stability of nurses and causes mental stress. This may
be displayed as nightmares, loss of sleep and flashbacks of the incident. After repeated

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mental stress, nurses are required to treat the same patients and face mental stress every day.
In many cases, the emotional instability of the nursing professionals affects their professional
practices, communication skills and a feeling of retreat from their professional duties (Itzhaki
et al., 2018). This raises ethical issues of benefice and autonomy. As the principle of
beneficence requires health care professionals to provide care that benefits the patient.
However, the degrading mental capacity of the nurses cannot be caused by violence by the
patients often fails to deliver optimum care to those particular patients. This persistent
violence in the form of physical and verbal abuses also developed anger, frustration,
irritability, apathy and helplessness. This deteriorating mental stability of the nurses also
raises the ethical issue of autonomy. As the principle of autonomy states the rights of the
patient in knowing the treatment plan and being actively involved in the decision-making, the
nurses do not consider the opinions of the patients and apply their plan of care if forced to
work with patients violent towards the nurses. The health care professionals’ right to refuse
treatment against violence is an act of protecting their psychological stability and giving
peace to their minds. This is essential as exposure to prolonged stress among nurses led to
adverse symptoms such as post-traumatic stress disorder, role stress, job dissatisfaction,
reduced feelings of safety and the constant fear of future assaults. These injuries of the mind
sustained even in the absence of physical bruises (Liberman, 2017).
The third argument to support the argument and agree with the denial of the HCPs for the
treatment of violent patients is under their fundamental human rights. Physical, verbal and
sexual assaults are violations of an individual’s fundamental human rights. The professional
practices of the nurses must follow the Code of Ethics, under which they are required to
inculcate the ethical principles of justice and non-maleficence in their professional
interactions with the patients. However, these ethical considerations can be fulfilled if the
environment for professional nursing practices ensures personal safety, mental well-being,

4ETHICS AND PRINCIPLES
freedom from violence, intimidation, threats and reprisals (Östman et al., 2019). Personal
safety and mental well-being are the fundamental human rights of any individual, which are
of a higher priority compared to the professional duties of the nurses. These rights also allow
the nurses to form associations or unions and report against their violation of human rights,
without prioritizing their duties of nurses to adhere to the ethical considerations. The nurses
cannot do justice in addressing the needs of a patient if they face injustice towards their
human rights. Nursing professionals experience human rights issues regularly. They are
forced to apply their skills and knowledge to care for the patients, even if it violates their
fundamental individual rights. The health care professionals must be allowed to choose
whether they are willing to accept the risk to their physical and mental health. This decision
must be of the health care professionals and not be forced on them (Nytimes.com, 2020). Just
like every other individual, health care professionals also possess the rights to protect
themselves from harm and ensure their safety. Majority of the violence is observed due to
drunken behaviour of the patients and the denial to such treatments must not involve ethical
implications (the Guardian, 2020). Along with the ethical principles of beneficence, non-
maleficence, justice and autonomy expected in the nursing practices, the health care
professionals also have rights to work without the fear of violence in their workplace.
Conclusion
In conclusion, it is observed that the violence towards health care professionals is increasing
exponentially and is a significant threat to their physical and psychological well-being.
However, many health care professionals continue to tolerate such inhumane behaviour
considering it as a part of their job and the ethical principles of justice, autonomy, non-
maleficence and beneficence associated with professional nursing practices. The rights of the
health care professionals and the ethical implications involved in delivering treatment to

5ETHICS AND PRINCIPLES
patients as their right to health are contradictory and are presented with different arguments.
This paper agrees with the rights of HCPs to refuse treatment to patients if they experience
any form of violence, physical, mental or sexual, from the patients. It can be argued as an act
of ensuring personal safety. Physical violence in the form scratching, grabbing, biting, or
even killing the professionals pose a severe threat to the lives of the health care professionals
or leave long-lasting bruises and scars. Moreover, another argument to support the HCPs
rights’ to refusal is that some forms of violence such as verbal and sexual might not leave
marks but pose serious harm to the mental well-being of the professionals. It results in
disturbed minds, job dissatisfaction, irregular sleep, frustration, cognitive inability, anxiety
and reduces the overall quality of treatment of the professionals. Violence has also led to
continued absenteeism or poor retention of health care professionals, particularly the young
workforce. Lastly, it can be argued that forcing the HCPs to treat violent and abusive patients
is a violation of their fundamental human rights of life and freedom.

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References
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