What is the code of ethics for a perioperative nurse and anesthesiologist (ana)?

Perioperative Nursing and Code of Ethics

Perioperative nurses must uphold the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements, which emphasizes respect for patient autonomy, advocacy, dignity preservation, and confidentiality throughout all phases of surgical care. 1, 2

Core Ethical Principles for Perioperative Nurses

Patient Respect and Dignity

• Confirm and consistently use the patient's preferred name and pronouns at all times, particularly for transgender and gender-diverse patients, to show respect and decrease psychological distress 3
• Maintain patient privacy through appropriate draping, limiting unnecessary exposure, and providing single-sex waiting areas when patients change into theatre gowns 4
• Allow patients to retain personal items, clothing, and functional aids (glasses, hearing aids, dentures) until immediately necessary for surgery 4
• Enable patients to walk to theatre and transfer themselves onto the operating trolley when physically able 4
• Treat patients as individuals rather than procedures, allocating adequate time for interaction, especially with elderly patients who may require additional preparation time 4

Patient Advocacy Role

• Act as the patient's advocate by recognizing and resolving ethical dilemmas using systematic approaches based on the ANA Code of Ethics 2, 5
• Protect patients' rights by ensuring advance care plans and resuscitation wishes are respected and communicated to the entire surgical team 3
• Advocate for appropriate care and prevent disregard for patient dignity, which has been identified as a common issue in hospital care 3
• Intervene when witnessing potential ethical violations or threats to patient safety and dignity 5

Confidentiality and Information Sharing

• Share sensitive personal information only with the patient's consent and only when necessary for safe care 3
• Do not disclose the patient's personal information (including transgender status or other sensitive details) beyond those directly involved in their care 4
• Create processes for patients to privately and safely disclose personal information during pre-operative assessment 3, 4

Ethical Practice Across Perioperative Phases

Preoperative Responsibilities

• Participate in early assessment and optimization discussions, ensuring treatment plans based on senior doctor-patient discussions are clearly documented 6
• Communicate all specific perioperative considerations during the surgical brief to ensure the team is aware of important patient factors 3
• Screen for modifiable risk factors and implement multimodal intervention strategies, particularly for vulnerable populations at risk for postoperative delirium 7

Intraoperative Ethical Considerations

• Consider the patient's pre-operative priorities and goals of care when making clinical decisions, especially when conditions change unexpectedly 6, 3
• Implement appropriate care measures including proper fluid therapy, thermoregulation, and analgesia 3
• Maintain core temperature at ≥36°C through active warming for operations lasting longer than 30 minutes 7
• Apply the WHO Surgical Safety Checklist to ensure standardized safety protocols 7

Postoperative Ethical Obligations

• Ensure no patient is returned to the ward until control of postoperative nausea, vomiting, and pain is satisfactory 6
• Continue the process of identifying and reducing risks such as delirium, particularly in vulnerable populations 3
• Facilitate early oral feeding and mobilization to promote recovery while respecting patient comfort and independence 3

Managing Ethical Dilemmas

Decision-Making Framework

• Consult with hospital legal representatives when uncertain about professional and legal obligations, particularly regarding end-of-life care 6, 3
• Familiarize yourself with professional guidance about end-of-life care and advance care planning 6
• Use the ANA Code for Nurses and AORN Statements of Competency in Perioperative Nursing as primary resources when facing ethical dilemmas 5

Special Populations Requiring Enhanced Advocacy

• Assume elderly patients have mental capacity to make decisions about their treatment unless clearly demonstrated otherwise 7
• Provide specialized care for vulnerable populations such as elderly patients, who may require additional advocacy and protection 3
• Ensure appropriate care for transgender and gender-diverse patients by using inclusive language and respecting gender identity 3

Common Ethical Pitfalls and Prevention Strategies

• 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
• Avoid leaving patients exposed during transitions between care areas 4
• Minimize fasting times to reduce patient discomfort and maintain dignity 4

Professional Development Requirements

• Participate in quality improvement initiatives and audits to ensure compliance with best practices 3
• Reflect on previous ethical dilemmas and use them to assist with resolution of similar situations 5
• Remain knowledgeable of personal, departmental, institutional, and professional resources available when faced with ethical dilemmas 5