The nurse, in all professional relationships, practices
with compassion and respect for the inherent dignity,
worth, and uniqueness of every individual, unrestricted
by considerations of social or economic status, personal
attributes, or the nature of health problems
1.1 Respect for human dignity
1.2 Relationships to patients
1.3 The nature of health problems
1.4 The right to self-determination
1.5 Relationships with colleagues and others
1.1 Respect for human dignity
A fundamental principle that underlies all nursing practice is respect for the inherent
worth, dignity, and human rights of every individual. Nurses take into account
the needs and values of all persons in all professional relationships.
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1.2 Relationships to patients
The need for health care is universal, transcending all individual differences.
The nurse establishes relationships and delivers nursing services with respect for
human needs and values, and without prejudice. An individual’s lifestyle, value
system and religious beliefs should be considered in planning health care with and
for each patient. Such consideration does not suggest that the nurse necessarily
agrees with or condones certain individual choices, but that the nurse respects
the patient as a person.
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1.3 The nature of health problems
The nurse respects the worth, dignity and rights of all human beings irrespective
of the nature of the health problem. The worth of the person is not affected by
disease, disability, functional status, or proximity to death. This respect extends to
all who require the services of the nurse for the promotion of health, the prevention
of illness, the restoration of health, the alleviation of suffering, and the provision
of supportive care to those who are dying.
The measures nurses take to care for the patient enable the patient to live with
as much physical, emotional, social, and spiritual well-being as possible. Nursing
care aims to maximize the values that the patient has treasured in life and extends
supportive care to the family and significant others. Nursing care is directed toward
meeting the comprehensive needs of patients and their families across the continuum
of care. This is particularly vital in the care of patients and their families
at the end of life to prevent and relieve the cascade of symptoms and suffering that
are commonly associated with dying.
Nurses are leaders and vigilant advocates for the delivery of dignified and
humane care. Nurses actively participate in assessing and assuring the responsible
and appropriate use of interventions in order to minimize unwarranted or
unwanted treatment and patient suffering. The acceptability and importance of
carefully considered decisions regarding resuscitation status, withholding and
withdrawing life-sustaining therapies, forgoing medically provided nutrition and
hydration, aggressive pain and symptom management and advance directives are
increasingly evident. The nurse should provide interventions to relieve pain and
other symptoms in the dying patient even when those interventions entail risks
of hastening death. However, nurses may not act with the sole intent of ending a
patient’s life even though such action may be motivated by compassion, respect for
patient autonomy and quality of life considerations. Nurses have invaluable experience,
knowledge, and insight into care at the end of life and should be actively
involved in related research, education, practice, and policy development.
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1.4 The right to self-determination
Respect for human dignity requires the recognition of specific patient rights,
particularly, the right of self-determination. Self-determination, also known as
autonomy, is the philosophical basis for informed consent in health care. Patients
have the moral and legal right to determine what will be done with their own person;
to be given accurate, complete, and understandable information in a manner
that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment;
to accept, refuse, or terminate treatment without deceit, undue influence,
duress, coercion, or penalty; and to be given necessary support throughout the
decision-making and treatment process. Such support would include the opportunity
to make decisions with family and significant others and the provision of
advice and support from knowledgeable nurses and other health professionals.
Patients should be involved in planning their own health care to the extent they
are able and choose to participate.
Each nurse has an obligation to be knowledgeable about the moral and legal
rights of all patients to self-determination. The nurse preserves, protects, and
supports those interests by assessing the patient’s comprehension of both the
information presented and the implications of decisions. In situations in which
the patient lacks the capacity to make a decision, a designated surrogate decisionmaker
should be consulted. The role of the surrogate is to make decisions as the
patient would, based upon the patient’s previously expressed wishes and known
values. In the absence of a designated surrogate decision-maker, decisions should be
made in the best interests of the patient, considering the patient’s personal values
to the extent that they are known. The nurse supports patient self-determination
by participating in discussions with surrogates, providing guidance and referral
to other resources as necessary, and identifying and addressing problems in the
decision-making process. Support of autonomy in the broadest sense also includes
recognition that people of some cultures place less weight on individualism and
choose to defer to family or community values in decision-making. Respect not
just for the specific decision, but also for the patient’s method of decision-making,
is consistent with the principle of autonomy.
Individuals are interdependent members of the community. The nurse recognizes
that there are situations in which the right to individual self-determination
may be outweighed or limited by the rights, health and welfare of others, particularly
in relation to public health considerations. Nonetheless, limitation of individual
rights must always be considered a serious deviation from the standard of
care, justified only when there are no less restrictive means available to preserve
the rights of others and the demands of justice.
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1.5 Relationships with colleagues and others
The principle of respect for persons extends to all individuals with whom the
nurse interacts. The nurse maintains compassionate and caring relationships with
colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise, and to resolving conflict. Nurses function in
many roles, including direct care provider, administrator, educator, researcher, and
consultant. In each of these roles, the nurse treats colleagues, employees, assistants,
and students with respect and compassion. This standard of conduct precludes
any and all prejudicial actions, any form of harassment or threatening behavior, or
disregard for the effect of one’s actions on others. The nurse values the distinctive
contribution of individuals or groups, and collaborates to meet the shared goal of
providing quality health services.
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