How does a perioperative (nurse who cares for patients before, during, and after surgery) nurse follow the code of ethics for nurses?

How Perioperative Nurses Follow the Code of Ethics for Nurses

Perioperative nurses must act as patient advocates who recognize and resolve ethical dilemmas by protecting patient autonomy, dignity, confidentiality, and human rights throughout all phases of surgical care. 1

Core Ethical Responsibilities in Perioperative Care

Patient Respect and Dignity

• Confirm and use the patient's preferred name and pronouns at all times to show respect and decrease the risk of distress, particularly important for transgender and gender-diverse patients 2
• Protect patient dignity by advocating for appropriate care and preventing disregard for patient dignity, which has been identified as a common issue in hospital care 2
• Maintain patient confidentiality by sharing sensitive personal information only with the patient's consent and only when necessary for safe care 2

Patient Advocacy

• Act as a patient advocate in the vulnerable surgical environment where patients need surgical teams to act on their behalf 1
• Recognize and address ethical dilemmas that occur during all phases of perioperative care and in every practice setting 1
• Protect patients' rights by ensuring their advance care plans and resuscitation wishes are respected and communicated to the entire surgical team 2

Informed Decision-Making

• Ensure patients have the opportunity to make informed decisions about their care by providing appropriate education in multiple formats (oral, written, pictorial) 3
• Assume patients have the mental capacity to make decisions about their treatment unless clearly demonstrated otherwise, particularly important for elderly patients 3
• Create processes for patients to safely disclose personal information relevant to their care during pre-operative assessment 2

Ethical Practice During Different Perioperative Phases

Preoperative Phase

• Conduct early assessment and optimization of the patient's condition, tailoring the approach based on available time before surgery 3
• Screen for modifiable risk factors that could affect surgical outcomes, including smoking, alcohol use, undiagnosed conditions, and nutritional status 3
• Communicate all specific perioperative considerations during the surgical brief to ensure the team is aware of important patient factors 2

Intraoperative Phase

• Apply standardized safety protocols such as the WHO Surgical Safety Checklist to prevent errors and complications 3
• Consider the patient's pre-operative priorities and goals of care when making intraoperative clinical decisions, especially when conditions change unexpectedly 2
• Implement appropriate care measures including age-appropriate anesthesia, proper fluid therapy, thermoregulation, and analgesia 2

Postoperative Phase

• Facilitate early oral feeding and mobilization to promote recovery while respecting patient comfort and independence 2, 3
• Implement multimodal opioid-sparing analgesia techniques to reduce complications while effectively managing pain 3
• Continue the process of identifying and reducing risks such as delirium, particularly in vulnerable populations 2

Ethical Challenges and Solutions

Managing Ethical Dilemmas

• Use a systematic approach to analyze and resolve ethical dilemmas when they arise 1
• Refer to professional resources such as the ANA Code of Ethics for Nurses and the AORN Statements of Competency in Perioperative Nursing 1
• Consult with hospital legal representatives when uncertain about professional and legal obligations, particularly regarding end-of-life care 2

Special Populations Considerations

• Provide specialized care for vulnerable populations such as elderly patients, who may require additional advocacy and protection 2
• Ensure appropriate care for transgender and gender-diverse patients by using inclusive language and respecting gender identity 2
• Maintain continuity of care through effective information flow between patients, families, and healthcare providers 3

Professional Development

• Participate in quality improvement initiatives and audits to ensure compliance with best practices 2
• Develop ethical skills to enhance patient advocacy and protection of human rights 1
• Reflect on previous ethical dilemmas to improve resolution of similar situations in the future 1

Common Pitfalls and Prevention

• Avoid failing to recognize cognitive impairment by using standardized screening tools to identify at-risk patients 3
• Prevent inadequate pain management by implementing regular assessments, particularly for patients who may not effectively communicate pain 3
• Address poor communication during care transitions by ensuring comprehensive handover between care settings 3