Three Key ANA Code of Ethics Provisions for Perioperative Nurses
Perioperative nurses can uphold three critical provisions of the ANA Code of Ethics: (1) respect for patient dignity and autonomy, (2) patient advocacy, and (3) protection of patient rights and confidentiality. These provisions are directly applicable to the unique ethical challenges encountered in the operating room environment.
Provision 1: Respect for Patient Dignity and Autonomy
The first provision emphasizes treating every patient with inherent worth and respect, which is fundamental to perioperative nursing practice. 1
Practical Applications in the OR:
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
Maintain patient dignity during vulnerable moments such as during anesthesia induction, positioning, and exposure, as disregard for patient dignity has been identified as a common issue in hospital care 2
Allow functional aids (glasses, hearing aids, dentures) to remain in place until just before induction of anesthesia, particularly for elderly patients who require additional time to prepare for surgery 3
Ensure informed consent is obtained and documented before procedures, with discussions taking place in the absence of factors that could unduly influence the patient's decision 4
Common Pitfalls to Avoid:
Failing to recognize when patients lack decision-making capacity—all personnel involved in perioperative care should be aware of their duties under mental capacity laws 3
Proceeding without verifying the patient's understanding of risks and benefits discussed during the consent process 4
Provision 3: Patient Advocacy
The third provision positions nurses as advocates who protect patients' rights and ensure their wishes are respected throughout the perioperative period. 5
Practical Applications in the OR:
Protect patients' rights by ensuring their advance care plans and resuscitation wishes are respected and communicated to the entire surgical team 2
Communicate all specific perioperative considerations during the surgical brief to ensure the team is aware of important patient factors 2
Consider the patient's pre-operative priorities and goals of care when making intraoperative clinical decisions, especially when conditions change unexpectedly 6, 2
Advocate for appropriate care measures including age-appropriate anesthesia, proper fluid therapy, thermoregulation, and analgesia 2
Advocacy During Critical Moments:
When surgical findings change intraoperatively and prognosis becomes poor, the pre-operative understanding of the patient's priorities should guide clinical decision-making by the entire surgical team 6
Consult with hospital legal representatives when uncertain about professional and legal obligations, particularly regarding end-of-life care 2
Ensure experienced personnel are available at all times and that high-risk surgery is not performed without a preoperative commitment to adequate postoperative care 3
Provision 3 (Confidentiality Component): Protection of Patient Rights and Confidentiality
Nurses must maintain patient confidentiality by sharing sensitive personal information only with the patient's consent and only when necessary for safe care. 2
Practical Applications in the OR:
Create processes for patients to safely disclose personal information relevant to their care during pre-operative assessment 2
Share sensitive information only with team members who require it for safe perioperative care, not with unnecessary personnel 2
Document the patient's specific preferences when they qualify their general consent to treatment by refusing specific aspects for religious or other personal reasons 4
Report transgender status to the hospital's blood transfusion service only with the patient's consent to ensure appropriate blood products are administered 4
Documentation Requirements:
The consent process must be clearly documented, including the patient's agreement to the intervention and the discussions that led to that agreement 4
Documentation should include the patient's questions and the responses given, recorded on a standard consent form, on the anesthetic record, or separately in the patient's notes 4
Special Considerations for Vulnerable Populations
Provide specialized care for vulnerable populations such as elderly patients, who may require additional advocacy and protection. 2
Implement regular pain assessments, particularly for patients who may not effectively communicate pain effectively 2
Use standardized screening tools to identify at-risk patients and avoid failing to recognize cognitive impairment 2
Facilitate early oral feeding and mobilization to promote recovery while respecting patient comfort and independence 2
Continue the process of identifying and reducing risks such as delirium, particularly in vulnerable populations 2