Non-maleficence in Nursing: 4 points to understand

Non-maleficence in nursing is the act of avoiding harm to others. It is commonly referred to as an ethical obligation for healthcare providers to avoid harming their patients physically or psychologically.

The principle of non-maleficence became established around the time of Hippocrates, with his belief that it was highly unethical not to do everything in one’s power to save a life. The principle is therefore also referred to as the “Hippocratic oath.”

“First, do no harm” (or the Latin phrase “primum non nocere”) is a medical ethical principle that a physician should first try not to harm a patient, even if that means the physician cannot also achieve the desired outcome of helping that patient.

What does Non-maleficence in nursing mean in healthcare?

The concept is attributed to Hippocrates, who was asked what ‘the most important thing’ a person should consider regarding medical treatment. He replied “Not to harm” or “primum non nocere”, sometimes translated as “first, do no harm.”

Hippocrates appears to have meant that a physician should do nothing to a patient which might damage the relationship between them, and is thus considered a precursor of modern clinical ethics.

Priority Non-Maleficence in Nursing

Priority Non-Maleficence in nursing can be defined as “one cannot stand by when doing something that may cause harm to a patient and not address the situation in some way. Priority Non-Maleficence is an ethical obligation and moral commitment of nurses.”

Priority non-maleficence can be further divided into priority non-maleficence and priority non-malfeasance. Priority non-maleficence is only harming the patient and is not giving any treatment or medication that may harm them. Priority non-malfeasance is only allowing the patient to be harmed by someone else’s actions, neglecting care they are responsible for, or leaving them in a situation where they could potentially cause self-harm.

What is the difference between beneficence and Nonmaleficence in nursing?

Non-maleficence has been a part of medical ethics since the 18th century when Scottish physician Thomas Percival introduced it as a concept through his publication “Medical Ethics”.

Percival drew up a document to facilitate discussion between physicians and patients. This document discussed confidentiality, relations with other physicians and surgeons, various details about the patient’s life, and the physician’s duties to the patient. In one section of this document, Percival states that a physician must do all they can to help their patients. This is where the principle of non-maleficence comes from.

During the 18th century, priority non-maleficence was discussed by Michel Foucault in his publication “The Birth of the Clinic”. He argues that the patient should be isolated because they are seen as diseased. The sick were separated from the healthy to avoid their illnesses spreading, but also because it would allow for physicians to focus on one patient at a time rather than treating several people who had different needs. However, Foucault argues that this separation was not around the whole of society but rather only the inner circle of physicians and scientists. This is because physicians believed that they were smarter than everyone else, and thus, they needed to be separated from the general population to prevent their mistakes from affecting others.

During the 18th and 19th centuries, priority non-maleficence was discussed by many other writers, including Emily Curren, who wrote “Clearing the Smoke: Using Priority Non-Malfeasance as a Necessary Ethical Standard” and “Nursing Ethics“, “The Rights of Patients”, and the Agency for Healthcare Research and Quality.

Non maleficence in healthcare

Priority Non-Maleficence is the guiding principle of Nursing and is one of six core professional values defined by the American Nurses Association (ANA). It states that “the nurse practices with compassion and respect for patient’s dignity and uniqueness, as well as for the nurse herself or himself. Priority non-maleficence is a moral commitment to care for oneself and others by protecting them from harm. In nursing, priority non-maleficence is often tied to the five elements of respect for persons: beneficence, human rights, justice, autonomy, and dignity. Nurses strive to benefit patients while respecting their right not to be harmed or exposed to unnecessary risk. Priority non-maleficence means a nurse cannot stand by when doing something that may cause harm to a patient and not address the situation in some way.

Priority Non-Maleficence is an ethical obligation and moral commitment of nurses.”

It can be applied across various contexts, including clinical practice, policymaking, education, and research.

Priority Non-Maleficence can be applied in different nursing contexts and situations, such as notifying appropriate healthcare team members (i.e., the patient’s doctor, an advocate, or a nurse specialist), creating mutually agreed upon plans of care with patients and families to manage pain and symptoms at end-of-life and complying with the wishes of patients and families regarding end-of-life treatment decisions. As such, nurses must prioritize patients’ well-being and respect their autonomy by working collaboratively to achieve justice that respects human rights.

What is an example of non-maleficence?

Non-maleficence can be applied in different ways, including asking for help from colleagues when you are unsure of the correct course of action, discussing the plan of care with patients and families to minimize harm, disclosing benefits and harms related to treatment options using an informed consent approach, seeking consultation from clinicians with specialized expertise if necessary, or seeking medical advice for complex cases that require it.

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