Striking a Balance: Nonmaleficence and Beneficence in Nursing

picture of a nurse with hands in air doesn't know how to balance
Written by
Crystal Shoaie
Reviewed by
Miranda Kay, RN
May 31, 2023

Table of Contents

In the ever-evolving world of healthcare, nurses are entrusted with the fundamental principle of Nonmaleficence – doing no harm. Yet, navigating moral dilemmas that intertwine the closely related principles of Nonmaleficence and beneficence can be a tightrope walk. 

As healthcare becomes increasingly diverse, cultural competency emerges as a critical capacity to uphold this principle. In this article, you will recognize some thought-provoking scenarios where ethical choices blur the lines and get a glimpse of how cultural competency plays a pivotal role in ensuring that nurses provide compassionate care while preserving the sacred duty of Nonmaleficence.

What are the Standard Ethical Principles that Guide Nursing?

The Code of Ethics for Nurses establishes ethical parameters for nursing practice, including four underlying principles

  1. Nonmaleficence - The duty to ensure patient safety 
  2. Beneficence - Compassionate care
  3. Autonomy - The patient's right to make well-informed  healthcare decisions
  4. Justice - Fair and equitable treatment

Nurses are advocates for patients and must find a balance among these principles while delivering patient care.

Read The Code of Ethics for Nurses: Your Guide on the Job

What is the Origin and Definition of Nonmaleficence?

The principle of Nonmaleficence, rooted in the ancient medical maxim "primum nonnocere," means "first do no harm." The historical Greek Hippocratic oath does not actually include this wording, but it does state that the physician will "abstain from whatever is deleterious." 

What Does Nonmaleficence Mean in Nursing?

Today in nursing, Nonmaleficence means:

  • Avoiding or preventing all harm, whether intentional or due to negligence, 
  • Ensuring a safe environment,
  • Minimizing any adverse effects of imperative treatments, or  
  • Identifying early signs of adverse reactions to medication and taking action, such as alerting the doctor.

In some cases, it implies abstaining from certain interventions or treatments when the risks outweigh the benefits. This involves balancing the principle of beneficence with Nonmaleficence which can be sensitive and complex.

Nonmaleficence versus Beneficence 

Don't beneficence and nonmaleficence sound like the same thing, two sides of the same token? Well, they actually can be quite different and sometimes even come into conflict.

Beneficence is the ethical principle of promoting good, while Nonmaleficence is to avoid harm. One example of beneficence is when a nurse provides emotional support to a patient who is going through a difficult time, whereas nonmaleficence calls for not mentioning to the patient some issue that might cause unnecessary stress. Another example is helping a patient get out of bed (beneficence) or, if necessary, putting up the guardrail on the bed to safeguard the patient from falling even if the patient does not feel they need the extra protection (Nonmaleficence). 

Moral Dilemmas

Assessing and comparing beneficence and Nonmaleficence is one of the more common ethical challenges. Weighing the benefits and risks of treatment is crucial to almost all medical decisions, whether to order a certain test, which medication to prescribe, if it is safe to perform surgery and when, or what procedure or treatment to recommend.

In the process of securing informed consent, nurses and physicians help patients understand a procedure's potential pitfalls as well as its advantages. The possible relief or healing effects of any action must be greater than the risks for the action to be ethical. 

Some examples of moral dilemmas contemplating beneficence and Nonmaleficence have to do with everyday nursing responsibilities, and others are not so common and can be quite complex.

  • Administration of Medications: Nurses may find themselves dealing with uncertainty when administering medications with potential adverse effects or complications. They must balance the therapeutic advantages (beneficence) of the medication against the adverse secondary effects it may cause (Nonmaleficence), considering the patient's condition, preferences, and informed consent.
  • Resource Allocation: In situations of limited resources, such as organ transplantation or critical care beds, nurses may find themselves in frustrating and disconcerting situations when determining how to distribute resources fairly. They must consider the principle of Nonmaleficence in making decisions that minimize harm and suffering and maximize beneficial impact for the greatest number of patients.
  • Pain Management: For patients experiencing severe pain with a terminal illness, opioids may be the only effective option to relieve extreme pain. On the other hand, opioids can also result in addiction and even death. The healthcare team has to carefully ponder the relief and the risks and explain them clearly to the patient. Nonmaleficence Nursing - NurseStudy.Net

Nurses face many cases in their daily practice where the line is blurred, either because the harm and the benefit are close to equaling each other, because the outcome of treatment cannot be guaranteed, or because of opposing views and beliefs. 

Intercultural misunderstandings, involving some of the most perplexing dilemmas, can harness deeper understanding and broader perspectives from consideration of both beneficence and Nonmaleficence, as well as patient autonomy.  

A True Story

A prize-winning true story narrative, "The Spirit Catches You, and You Fall Down" by Anne Fadiman, vividly portrays the suffering of an epileptic Hmong child and her family and the baffling situation for the American healthcare team due to clashing ways of thinking regarding epilepsy, accentuated by the lack of cross-cultural understanding and communication. The doctors and nurses earnestly tried to provide the very highest standard of care (beneficence) but did not understand the family's traditions and point of view, and despite many efforts, the cultural barriers were not successfully addressed, ending up in non-compliance in the treatment, as well as the anguish of forced separation of the child from her family. This harmful experience might have been avoided or lessened with the application of the principle of Nonmaleficence in the form of cultural competence. This book made a breakthrough in the development and awareness of cultural competence in multicultural contexts.

The case highlights the need for healthcare professionals to approach patients with empathy, cultural humility, and a willingness to engage in meaningful dialogue. By understanding and respecting the cultural beliefs and practices of their patients, healthcare providers can better navigate the complexities of Nonmaleficence and deliver care that is truly patient-centered and ethically sound.

Read our article about the ban on noncompetes, which frees up healthcare professionals to take control of their careers and ultimately, destinies.

Crystal Shoaie
Blog published on:
May 31, 2023

Meet Crystal, a contributing copywriter for Nursa who specializes in writing topics that help nursing professionals navigate the world of finances, education, licensing, compliance, equality, and ideal locations for per diem jobs.

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