Ethical Awareness: What It Is and Why It Matters

Aimee Milliken, PhD, RN


Online J Issues Nurs. 2018;23(1) 

In This Article


Many scholars have addressed the ethical nature of nursing practice (Austin, 2007; Erlen, 1997; Milliken & Grace, 2015; Truog et al., 2015; Ulrich et al., 2010). Though nursing ethics education often focuses on dilemmas and challenging situations (Truog et al., 2015; Zizzo, Bell, & Racine, 2016), ethical awareness involves recognizing that every nursing action has the potential to impact the patient, even routine daily actions (Grace & Milliken, 2016; Milliken, 2016; Milliken, 2017a; Milliken & Grace, 2015). Recent work suggests that this awareness may be lacking, and that nurses do not often recognize daily activities (e.g., taking vital signs, administering medications, or starting an intravenous line) as having ethical implications (Krautscheid, 2015; Milliken, 2017a; Truog et al., 2015). This trend is problematic, and may put patients at risk for harm.

Nursing goals encompass the "the protection, promotion, and restoration of health and well-being; the prevention of illness and injury; and the alleviation of suffering, in the care of individuals, families, groups, communities, and populations" (American Nurses Association ANA, 2015, p. vii). For a nursing action to be considered ethical, it should be aimed at promoting the goals of nursing in conjunction with the patient's wishes. Using the language of ethics, the goals of nursing can be broadly categorized into actions aimed at promoting the four major ethical principles. These principles are autonomy (the right to self-determination); beneficence (promotion of good); maleficence (avoidance/minimization of harm); and justice (fairness/equal distribution of benefits and burdens) (ANA, 2015; Beauchamp & Childress, 2009).

If an action is in conflict with a nursing goal or one of these principles, or if it ignores a patient's preferences, the nurse risks acting unethically. Ethical awareness involves recognizing the risk that nursing actions could fail to adhere to the goals of nursing, thereby violating an ethical principle. Awareness ideally leads the nurse to take action to practice in the most ethically acceptable way (Milliken, 2016; Milliken, 2017a; Milliken & Grace, 2015).

Research has suggested that nurses often feel unprepared to manage ethical challenges they face in practice (Austin, 2016; Rodney, 2017; Woods, 2005), resulting in possible moral distress and burnout. Ensuring that nurses have the tools to manage difficult situations is one way to mitigate this concern (Jurchak et al., 2017). Ethical awareness is important for nurses to develop as part of the larger skill set of ethical competence (Grace & Milliken, 2016; Kulju, Stolt, Suhonen, & Leino-Kilpi, 2016; Lechasseur, Legault, & Caux, 2016). The following everyday scenarios highlight the importance of ethical awareness, and focus on the role it plays in day-to-day nursing care. In the interest of confidentiality, these cases are not actual occurrences, but constructed scenarios that represent common challenges.