It is common to encounter ethical dilemmas in nursing practice. Fidelity is a moral principle integrally tied to nursing professional practice due to the importance of maintaining trust and integrity in the nursing profession. Nurses must be familiar with the ethical principles that guide the nursing profession. When ethical dilemmas arise, ethical principles established by nursing professional organizations can guide nurses to make the best decision possible in challenging scenarios. These ethical guidelines outline established norms and expectations for the nursing profession regardless of the nurse’s personal beliefs.
In this article:
- Principle of Fidelity in Ethics: Definition
- What is Fidelity in Nursing?
- Nursing Ethical Principles
- Beneficence vs Nonmaleficence in Nursing
- Examples of Fidelity in Nursing
- Veracity vs Fidelity
Principle of Fidelity in Ethics: Definition
Fidelity is an ethical principle that pertains to trustworthiness. Practicing fidelity includes creating and maintaining trust in relationships.1 Fidelity also means that commitments and promises are fulfilled. Fidelity requires integrity and honesty, but fidelity goes one step further than just honesty in that practicing the principle of fidelity requires one also to fulfill commitments.
What is Fidelity in Nursing?
The ethical principle of fidelity in nursing includes the basic definition of acting with integrity and trustworthiness but also, in a professional context, nurses are expected to act in the best interest of their patients or clients. This is consistent with fulfilling the expectation that nurses will fulfill their professional obligations to provide safe, ethical, and competent care.
Practicing fidelity as a nurse means that the nurse keeps both explicit promises made to their patients, “I’ll be back in 10 minutes with your pain medication,” and implicit promises that are expected from nurses. Some of the implicit promises that are expected from nurses include that the nurse will maintain confidentiality and will orient care toward the patient’s needs. When nurses fulfill these commitments, they are acting in alignment with the ethical principle of fidelity.
Overall, to practice with respect for fidelity, nurses must act in a way that increases the public’s trust that the nurse will provide safe, ethical, and competent care. Fidelity directs nurses to provide care that is delivered with loyalty, caring and honesty. 2
Nursing Ethical Principles
Fidelity is just one of the ethical principles that guide nursing practice. Other ethical principles commonly used in nursing include the bioethical principles of autonomy, beneficence, and justice. Here are some short definitions of each of the principles1:
- Autonomy: Self-determination that is informed, voluntary and rational. Is the person being supported in their wants and preferences?
- Beneficence: May include prevention of harm or acting in a way that actively benefits someone
- Nonmaleficence: Acting in a way that is not harmful.
- Justice: There are different domains of justice, but nurses tend to be more focused on distributive justice—meaning there should be an equitable distribution of burdens and benefits for all people in society. At the minimum nurses promote justice by treating all patients with respect and fairness.
Additionally, there are nine provisions of the American Nurses Association (ANA’s) code of ethics.3 Listed here is a short summary of the provisions. For exact definitions and expanded statements, please see the official website of the ANA. Additionally, different nursing professional associations may differ on the interpretation and ethical guidelines. Therefore, nurses should be familiar with the code of ethics where they practice.
- Provision 1: Nurses treat all patients and clients equally and with dignity and respect.
- Provision 2: The priority of the nurse should be the patient. The “patient” may include an individual, family, or community.
- Provision 3: The nurse acts as an advocate for the rights and safety of the patient.
- Provision 4: The nurse acts in a way that is consistent with agreed-upon standards and expectations of the nursing profession.
- Provision 5: The nurse is responsible for maintaining their own health, including personal and professional growth.
- Provision 6: The nurse promotes ethical environments both as an individual and in the collective.
- Provision 7: The nurse engages in advancing the nursing profession, including in scholarship, professional practice, and health policy.
- Provision 8: The nurse collaborates with other members of the health team to promote human rights, health diplomacy and improve equity.
- Provision 9: The nurse promotes social justice and nursing values in professional organizations and health policy.
Beneficence vs Nonmaleficence in Nursing
Beneficence and nonmaleficence are two ethical principles that are often confused with one another. The best way to remember the difference between the two principles is to think about the root words. Beneficence is very similar to the word benefit, which should help nurses remember that beneficence is the ethical principle of doing good. Beneficence requires that action be taken, and that action is to the benefit of the patient.
To remember the meaning of nonmaleficence, nurses can use the word root “mal” which means bad or wrong. Think of other words such as maladaptive, malpractice or malady. So to practice nonmaleficence means to not do harm or “first do no harm,” as the Hippocratic oath states. Nonmaleficence may require that the nurse does not act or acts in a manner to minimize harm to the patient.4 This principle recognizes that sometimes medical interventions, even if intended to benefit, have the potential to harm.
Examples of Fidelity in Nursing
Fidelity is an overarching ethical principle that interacts with other ethical principles. Here are two common examples of how nurses can uphold the ethical principle of fidelity in their practice.
Example 1: Commitment to fulfilling a promise
A nurse is caring for a patient who recently underwent a below-knee amputation (BKA) related to diabetes. The patient’s pain has been unmanageable despite the nurse providing the maximum doses of the PRN pain medication. During the morning assessment, the nurse discusses potential options to control the pain with the patient. In this discussion, the nurse mentions that the patient might benefit from a consultation from a pain specialty doctor. The nurse tells the patient they will bring up this suggestion during rounds. The surgery team is busy and initially dismisses the need for the patient to see a pain specialist, however, the nurse advocates for the patient and the surgical team decides to go ahead with the referral. This is an example of fidelity because the nurse is fulfilling both their explicit promise to the patient to bring up this suggestion at rounds and the implicit promise that the nurse will act as an advocate on behalf of their patient.
Example 2: Protecting patient confidentiality
Protecting confidentiality is more of an implicit expectation in practice. One principle of confidentiality is that information should be shared about a patient on a “need-to-know basis.”1 This means that if the information does not need to be shared to provide necessary care, this information should not be discussed or shared with others. For example, a nurse is collaborating with a physiotherapy assistant to help ambulate a patient that was admitted after a surgery for her ankle. In the patient’s chart, there is mention of a previous admission for psychiatric care four years ago. The physio assistant in report with the nurse, starts asking questions about the nature of the past psychiatric visit. Since this history is not relevant to the role of the physio assistant, the nurse directs the report back to discussing the plan for ambulation. Even when talking to other health team members, it is important that only necessary information about the patient be shared. This is an example of fidelity as the nurse was maintaining the confidentiality of privileged information in the patient’s best interest.
Veracity vs Fidelity
While veracity and fidelity are similar concepts, they should not be confused. Veracity means telling the truth or the opposite of deceiving or misleading. Veracity also includes being transparent and not holding back important information. One common place where veracity is encountered in nursing is when informed consent is needed. For the nurse to practice in alignment with veracity, they need to present all necessary information to the patient in a truthful manner that allows the patient to make an informed choice. Veracity means that there has been full and honest disclosure.
While being truthful and honest are also necessary components of fidelity, fidelity is more concerned with one’s commitment to professional obligations. Fidelity encompasses more than veracity. While veracity is necessary for fidelity, it is not sufficient for fidelity. For instance, a nurse could be truthful but not provide the care required of them by professional and patient expectations, therefore not practicing fidelity. Both veracity and fidelity are related to the trust awarded to nurses, but they are not interchangeable principles.
- Code of Ethics for Registered Nurses. 2017 edition. Canadian Nurses Association; 2017.
- Ethical decision-making. Nurs Made Incred Easy. 2018;16(2):4-5. doi:10.1097/01.NME.0000529954.89032.f2
- Code of Ethics for Nurses. Published online 2015. Accessed February 23, 2023. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
- Haddad L, Geiger R. Nursing Ethical Considerations. StatPearls. Accessed February 23, 2023. https://www-ncbi-nlm-nih-gov.ezproxy.library.ubc.ca/books/NBK526054/