How does a perioperative (operating room) nurse uphold provision 5 of the American Nurses Association (ANA) code of ethics?

How Perioperative Nurses Uphold ANA Code of Ethics Provision 5

Perioperative nurses uphold Provision 5 of the ANA Code of Ethics—which mandates nurses' duty to themselves, colleagues, and the profession—by maintaining their own professional competence through mandatory training on advance care planning and resuscitation policies, participating in quality improvement initiatives, and ensuring they can practice ethically even when facing institutional or team pressures. 1, 2

Professional Competence and Development

Maintain Current Knowledge and Skills

• Complete mandatory organizational training on advance care planning, resuscitation policies, and institutional documents to ensure competent practice 1
• Participate in quality improvement initiatives and audits to ensure compliance with best practices and identify areas for professional growth 2
• Develop expertise in recognizing and addressing ethical dilemmas specific to the perioperative setting, understanding that ethical decision-making is complex and requires ongoing education 3, 4

Understand Ethical Frameworks

• Use the ANA Code of Ethics not as a substitute for moral thinking but as an aid to guide ethical reasoning in perioperative situations 4
• Recognize that ethical awareness of everyday practice is a necessary precursor to moral agency—you must first understand the ethical nature of routine perioperative care before you can consistently act on behalf of patient interests 5

Duty to the Profession

Uphold Professional Standards

• Ensure processes are in place so healthcare teams are aware of patients' advance care planning documents and resuscitation wishes 1
• Advocate for standardized protocols and checklists to prevent inconsistent application of evidence-based practices 6
• Share nursing's unique perspective on ethics committees, leveraging prolonged patient contact, therapeutic communication skills, and goal-oriented approaches to facilitate ethical decision-making 7

Protect Professional Integrity

• Seek senior opinions and, when necessary, legal consultation when you cannot facilitate a patient-centered outcome that satisfies the patient's wishes 1
• Maintain patient confidentiality by sharing sensitive personal information only with the patient's consent and only when necessary for safe care 2
• Advocate for appropriate care and prevent disregard for patient dignity, which has been identified as a common issue in hospital care 2

Duty to Self

Maintain Personal Integrity

• Recognize when institutional pressures or team dynamics conflict with ethical practice and take appropriate action 3
• Consult with hospital legal representatives when uncertain about professional and legal obligations, particularly regarding end-of-life care 2
• Understand that you share in the moral responsibility of your institution to ensure the best ethical decision-making process is in place 7

Practical Application Across Perioperative Phases

Preoperative Phase

• Communicate all specific perioperative considerations during the surgical brief to ensure the team is aware of important patient factors 2
• Create processes for patients to safely disclose personal information relevant to their care during pre-operative assessment 2
• Ensure early discussions occur between patients and clinicians to establish shared understanding about appropriate perioperative treatments, including CPR 1

Intraoperative Phase

• Consider the patient's pre-operative priorities and goals of care when making clinical decisions, especially when conditions change unexpectedly 1, 2
• Apply the WHO Surgical Safety Checklist to ensure standardized safety protocols 6
• Implement appropriate care measures including age-appropriate anesthesia, proper fluid therapy, thermoregulation, and analgesia 2

Postoperative Phase

• Ensure comprehensive handover between care settings to prevent poor communication during care transitions 6, 2
• Continue identifying and reducing risks such as delirium, particularly in vulnerable populations 2
• Share information gathered preoperatively with ICU and postoperative teams when prognosis changes 1

Common Pitfalls and Prevention

Failing to Recognize Cognitive Impairment

• Use standardized screening tools to identify at-risk patients rather than assuming capacity 6, 2

Inadequate Pain Management

• Implement multimodal analgesia and regular pain assessments, particularly for patients who may not effectively communicate pain 6, 2

Poor Team Communication

• Ensure reciprocal information flow between patients, relatives/carers, and primary and secondary care services to maintain continuity of care 6

Inconsistent Ethical Practice

• Recognize that person-centered care requires respecting the patient as a unique individual and involving them in their own care throughout the entire perioperative process 8