Ethical Principles, Boundaries, and Patient Care in Nursing Practice

This essay examines the ethical principles that underpin nursing practice, emphasizing the importance of maintaining professional boundaries and adhering to guidelines established by the Singapore Nursing Board. It discusses the significance of therapeutic communication, cultural competence, and the need to respect patient autonomy and privacy. The essay outlines four key ethical and regulatory provisions: nurses/midwives and people, nurses/midwives and their practice, nurses/midwives and their professions, and nurses/midwives and co-workers, highlighting the principles of respecting people, promoting autonomy, safeguarding confidentiality, and advocating for patient interests. It further explores ethical theories like deontology, consequentialism, and virtue ethics, along with the core ethical principles of non-maleficence, beneficence, autonomy, and justice. The essay also references relevant legislation, such as the Vulnerable Adults Act and the Healthcare Services Act, to underscore the commitment to patient safety and welfare. Overall, the paper provides a comprehensive overview of ethical considerations in nursing, aiming to protect the public and ensure high-quality patient care.

Running Head: ETHICAL PRINCIPLES
ETHICAL PRINCIPLES
Name of the Student
Name of the University
Author’s Note

1ETHICAL PRINCIPLES
Introduction
Nurses and midwives have to follow several principles and guidelines in their nursing
practice as it is a part of their professional development. They have to maintain professional
boundaries as well as work for the welfare of the patients by following the ethical principles. It is
extremely necessary to perform according to the professional boundaries because it affects the
growth of nurse in the career aspect. The professional boundary of a nurse includes the patient’s
vulnerability and the nurse’s power, which has to be in a balance and both should not enter into
each other’s space. The protocol and guidelines have to be followed to maintain this boundary as
it can be crossed if the ethical principles are not utilized in their daily interactions and
communication (Ingham-Broomfield, 2017). Therapeutic communication is a usual routine that
is followed by the nurses, which helps them to express themselves in an appropriate manner and
it also explores the preferences of a person, which increases their customer satisfaction. The care
setting has to be maintained involving people of different health professionals without crossing
the boundaries of professionalism (Kowitlawakul et al., 2014). The cultural competence of
patients has to be respected so that it does not violate their ethical principles, which has to be
used at all times. The Singapore Nursing Board has implemented several laws and ethics that has
to be maintained by the nurses as a professional etiquette, which will be discussed in this paper.
Discussion
The codes have been implemented by the Singapore Nursing Board for the nurses and the
midwives as it helps them to set out a professional conduct with ethical values and practice
standards that has to be acted upon. Proper decision making and therapeutic communication are
all a part of maintaining professional boundaries. The regulation of nursing practice has a

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framework that is provided by the Code and if the nurses are found to do any misconduct then
they have to face disciplinary actions against them. The Code has four key ethical and regulatory
provisions that includes Nurses/midwives and people, nurses/midwives and their practice,
nurses/midwives and their professions, nurses/midwives and co-workers. All these four
principles has to be followed to maintain professional boundaries (Ayre & Bee, 2014). The first
principle focus on respecting people because that is the foundation of their profession. Nurses
have to respect the patient’s values, needs and rights that includes providing care for them
without any prejudice or unfair treatment irrespective of their gender, religion, ethnicity,
economic or social status, and any other preference or attribute (Bowrey & Thompson, 2014).
They have to treat people with compassion, kindness and respect, be considerable towards their
cultural rights and sensitivities when planning care and health needs for them. The priority
towards a person’s values, feelings and wishes has to be thought about when the person is being
dealt with. Coming up with an appropriate care plan during palliative care so that people in their
death bed can go through dignified and supportive care during their end of life. The second
principle is to promote and respect the autonomy and right to self-determination in people that
includes taking the permission of patients before making any decisions or planning treatment
procedures. The determination of their treatment plan is dependent on the patient’s choice, which
has to be respected (World Health Organization, 2017). They have to be informed about the care
options that are available to them, help other health professionals to find reliable data from
official sources, wait for an individual with impaired decision making capabilities to regain their
capacity in the future so that their decision is given importance, guiding and encouraging a
patient to participate for improving his or her ability in decision making and most importantly to
take part in acts that is affecting their wellbeing. Nurses have to also seek consent of patients or

3ETHICAL PRINCIPLES
their legally authorized representative where applicable when the patient is not in the capacity to
make decisions (Yun & Kim, 2014). People with no mental capacity to take decisions should be
considered so that their rights and best interests are maintained, be in clinical or non-clinical.
This also includes saving them from harm and exploitation as they are vulnerable. The third
principle is about saving people’s right to confidentiality and privacy as it plays a major role in
patient safety (Singapore Nursing Board. 2018). The privacy of a patient has to be safeguarded
because it is right that makes them control other people’s access to themselves. Their personal
information and data should be disclosed to people who are not connected to them or are not
related to their welfare. They have the right the withhold information for the time and to the
extent they want to. The act of confidentiality is the maintenance of secrecy that allows them to
not disclose their clinical information. It is a nurse’s duty to protect people’s information who are
under their care but they can share it with people who are directly involved in their treatment and
is included in the provision of care (Kerridge, Lowe & Stewart, 2013). This can be achieved if
nurses respect the rights of people and maintain the privacy and dignity that they deserve,
safeguarding clinical information and data to maintain confidentiality but revealing the same
information without the patient’s consent when there is law and patient safety from risks and
harm is involved, and the respect for patient confidentiality and privacy has to be maintained
after death as well. The fourth principle is about advocating for the interest of people that
includes speaking for the betterment and welfare of a patient’s rights, wishes and feelings (Koon
& Krishna, 2014). This will be maintained by safeguarding a patient’s opinion by not trying to
influence them to change their mind if they do not want to do it voluntarily. It is necessary for
the nurses to be alert in their work so that they can take appropriate actions when the rights and
safety of a patient is under threat, and nurses should report any incident to higher authorities if

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they feel it is unsafe and can affect a person’s wellbeing (Tapper & Millett, 2014). Nurses have
to work according to the correct procedures and methods that is under an accountable manner,
which shows that they are responsible because any misconduct can affect their professional
development and also become dangerous for the patient’s safety. They have to be accountable
for the decisions they make and the actions they take because it can reflect on the safety of the
patient.
There are certain ethical theories involved in a patient’s wellbeing that includes
deontology, which means doing one’s duty that is inherent in the quality or in the action,
consequentialist, which is also known as utilitarianism that means the action is judged as right or
wrong according to the outcome and it is done for the greater good of majority of the people
(Centre for Biomedical Ethics, 2017). Virtue is a form of moral value that allows people to judge
a person’s moral perspective if it is done for the betterment of other people or not, feminist moral
philosophy and ethics of care focuses on recognizing the sacrifices done by women in the field
of care including the ethics of interpersonal relationship and ethics of care, which has love,
personal responsibility, care and trust. Communitarianism is the influence of communal values
and the ethics that are necessary for community health, social relationships and wellbeing (Heale
& Shorten, 2017).
The underlying ethical principles for the welfare of patients include autonomy, non-
maleficence, beneficence and justice. The first principle is non-maleficence that means doing no
harm to other people and it is a nurse’s duty to protect the safety of the patient. No patient should
be vulnerable to harms or risk under the care of a nurse or a midwife. The harm includes physical
as well as emotional because any type of risk or unsafety to the patient that can affect their
wellbeing is harmful for them (Tan, Lopez & Cleary, 2016). It is necessary to have a better

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communication so that no misconduct happens. All types of treatment are tried on patient after
taking their consent so that the measures taken for them are appropriate. It is essential to remove
all forms of hurdles and obstructions that comes between patient safety because it is the utmost
priority of the healthcare sectors to look after them (Kangasniemi, Pakkanen & Korhonen, 2015).
The patients should be made aware about their condition and any risks they are vulnerable
towards so that they will refrain from things that can negatively affect them (Salminen et al.,
2016). The second principle is Beneficence, which is the ethical consideration of only promoting
good in nursing profession. The nurses have to take measures and interventions that will be
beneficial for the patients and it will help them in promoting good. It is the responsibility of the
nurses to understand what is beneficial for the patient and it should not come in between logical
reasoning because sometimes what the nurse thinks is needed for the patient is different from
what is actually needed for the patient (Tan, Zhou & Kelly, 2017). The use of clinical reasoning
should be applied so that nurses can achieve beneficence for the patients. It is also said that a
patient’s good comes before the organization but it is still conflicted because the good for patient
is interconnected to the good for the healthcare team and the organization. Beneficence has a
central place in the concept of morality because it is for the betterment and welfare of people
including patients and the medical sector (McCarthy & Gastmans, 2015). It is an essential
principle of ethics that is being followed and accepted by people all around the world. The third
principle is autonomy, which is the right of the patient to make decisions according to their
understanding and wellbeing. They have the right to self-determination and to give their opinion
as per their choice without being influenced by other people or organizations. Patients have been
given the legal right of autonomy, which should not be violated under any circumstances. The
power of autonomy gives the right to authority so that patients can make their own decisions

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without being forced to opt for some other solution and not what they want to do. In the same
way, even the nurses should be aware about the power of autonomy so that they can take charge
of the situation where they are responsible (Anderson & Anderson, 2015, April). The patient
should also be given every detail and education about their condition and treatment so that they
can make decisions for their best interest. The fourth principle is justice that means people
should be given the privileges and rights according to what they deserve. What people should be
given will be decided with the parameter of fairness, equality, and any other criteria that is
needed for justice. This is widely based on the accessibility of healthcare facilities based on
equality without discriminations. The nurses and patients should be given rights, responsibilities
and facilities through fair practice that is included in the principle of justice (Teven & Gottlieb,
2018)
There are several acts that are implemented for the welfare of patients and nurses such as
the vulnerable adults act no. 27, which is for all the vulnerable adults who do not have the
capacity to make decisions so they should be protected from harm, abuse and self-neglect.
Another act known as healthcare services act (HCSA) is made for the safety of patients in
premises of hospitals, medical centers and clinical laboratories (Ministry of Health, 2020).
Conclusion
In conclusion, this paper attempts to focus on the importance of maintaining professional
boundaries in nursing practice and the underlying ethical principles that are needed to protect the
public. It discusses the guidelines given to nurses and midwifes for efficient practice and
prioritizing over patient safety, which is an essential requirement in nursing practice. The
Singapore Nursing Board has been a guiding body for the nurses so that their professional
development is enhanced. It also looks after patient safety, which is the most important feature in

7ETHICAL PRINCIPLES
a medical sector. There are few ethical principles that has to be followed for the wellbeing of
patients such as non-maleficence, beneficence, autonomy and justice. All these factors come
together for the welfare of the patients as well as the healthcare professionals.
References
Anderson, M., & Anderson, S. L. (2015, April). Toward ensuring ethical behavior from
autonomous systems: a case-supported principle-based paradigm. In Workshops at the
Twenty-Ninth AAAI Conference on Artificial Intelligence.
Ayre, T. C., & Bee, T. S. (2014). Advanced practice nursing in Singapore.
Bowrey, S., & Thompson, J. P. (2014). Nursing research: ethics, consent and good
practice. Nursing times, 110(1-3), 20-23.
Centre for Biomedical Ethics (2017). Caring for older people in an ageing society. CBmE.
http://www.bioethicscasebook.sg/
Heale, R., & Shorten, A. (2017). Ethical context of nursing research. Evidence-based
nursing, 20(1), 7-7.
Ingham-Broomfield, R. (2017). A nurses' guide to ethical considerations and the process for
ethical approval of nursing research. Australian Journal of Advanced Nursing,
The, 35(1), 40.
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an
integrative review. Journal of advanced nursing, 71(8), 1744-1757.
Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professions (4th ed.).
Annandale, NSW: The Federation Press.

8ETHICAL PRINCIPLES
Koon, O. E., & Krishna, L. K. (2014). Perspective from singapore. Asian Bioethics Review, 6(4),
420-427.
Kowitlawakul, Y., Ignacio, J., Lahiri, M., Khoo, S. M., Zhou, W., & Soon, D. (2014). Exploring
new healthcare professionals’ roles through interprofessional education. Journal of
interprofessional care, 28(3), 267-269.
McCarthy, J., & Gastmans, C. (2015). Moral distress: a review of the argument-based nursing
ethics literature. Nursing ethics, 22(1), 131-152.
Ministry of Health (MOH). (2020, January 28). Healthcare Services Act. MOH.
https://www.moh.gov.sg/hcsa/about-hcsa
Salminen, L., Stolt, M., Metsämäki, R., Rinne, J., Kasen, A., & Leino-Kilpi, H. (2016). Ethical
principles in the work of nurse educator—a cross-sectional study. Nurse education
today, 36, 18-22.
Singapore Nursing Board (SNB). (2018). Code for nurses and midwives. SNB.
https://www.healthprofessionals.gov.sg/docs/librariesprovider4/publications/code-for-
nurses-and-midwives-april-2018.pdf
Tan, T. C., Zhou, H., & Kelly, M. (2017). Nurse–physician communication–An integrated
review. Journal of Clinical Nursing, 26(23-24), 3974-3989.
Tan, X. W., Lopez, V., & Cleary, M. (2016). Views of recent Singapore nursing graduates:
factors influencing nurse–patient interaction in hospital settings. Contemporary
nurse, 52(5), 602-611.

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Tapper, A., & Millett, S. (2014). Is professional ethics grounded in general ethical
principles?. Theoretical & Applied Ethics, 3(1), 61-80.
Teven, C. M., & Gottlieb, L. J. (2018). The 4-quadrant approach to ethical issues in burn care.
AMA Journal of Ethics, 20(6), 595-601.
https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-06/
vwpt1-1806.pdf
World Health Organization. (2017). Patient safety: making health care safer (No.
WHO/HIS/SDS/2017.11). World Health Organization.
Yun, S. Y., & Kim, M. (2014). A study on the relevance among self efficacy, major satisfaction,
nursing ethics values in nursing students before clinical practice. Journal of Digital
Convergence, 12(2), 363-372.