Introduction
The field of nursing and midwifery is underpinned by a strong commitment to ethical principles and legal frameworks that ensure patient safety, dignity, and well-being. As a nursing student, reflecting on the values that shape professional practice is essential to understanding how these principles guide decision-making in complex healthcare environments. This essay explores the core values of nursing and midwifery as outlined by the Nursing and Midwifery Council (NMC) Code, focusing on their relevance to legal and ethical practices. The discussion will examine key values such as respect, compassion, and accountability, while considering their application in real-world scenarios. Furthermore, it will address the challenges nurses and midwives face in balancing these values with legal obligations and organisational policies. By critically engaging with these themes, this essay aims to highlight the importance of reflective practice in fostering ethical competence and ensuring compliance with professional standards.
The Core Values of Nursing and Midwifery
Central to the practice of nursing and midwifery are the values enshrined in the NMC Code (2018), which serves as a benchmark for professional conduct in the UK. The Code identifies four key themes: prioritising people, practising effectively, preserving safety, and promoting professionalism and trust (NMC, 2018). These values are not just aspirational but are deeply intertwined with ethical and legal expectations. For instance, prioritising people requires nurses to respect patient autonomy by ensuring informed consent before any procedure. Legally, this aligns with the Mental Capacity Act 2005, which mandates that healthcare professionals assume capacity unless proven otherwise and provide information in an accessible manner (Department of Health, 2005). Reflecting on this value, I recognise that respecting autonomy is not always straightforward, especially when patients refuse treatment due to cultural or personal beliefs. This tension highlights the need for cultural competence and empathy in practice.
Compassion, another fundamental value, underpins the therapeutic relationship between healthcare professionals and patients. Compassionate care is not only an ethical imperative but also a legal one, as failure to provide care with dignity can result in breaches of the Human Rights Act 1998, particularly Article 3, which protects individuals from degrading treatment (Legislation.gov.uk, 1998). Reflecting on my clinical placements, I recall instances where time constraints challenged my ability to provide compassionate care. Such experiences underscore the importance of self-awareness and advocacy to ensure that patient needs are prioritised over systemic pressures.
Legal Frameworks and Ethical Dilemmas
The interplay between legal obligations and ethical values often presents dilemmas for nurses and midwives. One prominent example is the duty of confidentiality, which is both a legal requirement under the Data Protection Act 2018 and an ethical principle within the NMC Code (NMC, 2018; Legislation.gov.uk, 2018). Confidentiality ensures trust in healthcare relationships, yet there are circumstances where it must be breached, such as in cases of safeguarding concerns or public safety risks. Reflecting on this, I find that navigating such dilemmas requires a nuanced understanding of both legal precedents and ethical guidelines. For instance, the case law of Gillick v West Norfolk and Wisbech Area Health Authority (1986) established the principle of Gillick competence, allowing minors to consent to treatment if they demonstrate sufficient understanding. This legal ruling has ethical implications, as it challenges nurses to assess capacity objectively while respecting the young person’s rights (House of Lords, 1986).
Moreover, accountability is a value that binds nurses to both legal and ethical standards. The NMC Code mandates that professionals take responsibility for their actions and omissions (NMC, 2018). Reflecting on this, I have come to appreciate the importance of accurate record-keeping, not only as a legal requirement but as a means of ensuring transparency and continuity of care. However, accountability can be complicated by systemic issues, such as understaffing, which may lead to errors. In such cases, nurses must balance self-advocacy with the duty to report unsafe conditions, as outlined in the NMC’s guidance on raising concerns (NMC, 2018). This reflection has deepened my understanding of the courage required to uphold accountability in challenging environments.
Challenges in Applying Values to Practice
While the values of nursing and midwifery provide a clear framework for ethical and legal practice, their application is often tested by real-world constraints. Organisational policies, resource limitations, and interprofessional conflicts can create barriers to embodying these values fully. For example, during my placement, I observed instances where workload pressures led to delays in care, raising ethical concerns about fairness and equity. Research suggests that such systemic issues contribute to moral distress among healthcare professionals, where they know the right course of action but are unable to pursue it due to external factors (Morley et al., 2019). Reflecting on this, I recognise the importance of resilience and problem-solving skills in addressing such challenges. Engaging in debriefing sessions with colleagues and seeking mentorship are practical strategies that I plan to adopt to mitigate moral distress.
Another challenge lies in balancing individual patient needs with broader legal and ethical obligations. For instance, in end-of-life care, nurses must navigate complex decisions about withholding or withdrawing treatment, guided by legal frameworks such as advance directives and ethical principles of beneficence and non-maleficence. Reflecting on this, I am aware that such situations require not only technical competence but also emotional intelligence to support patients and families through difficult conversations. Indeed, the ability to communicate effectively is a critical skill that bridges the gap between legal mandates and ethical care (Silverman et al., 2016).
Conclusion
In conclusion, reflecting on nursing and midwifery values reveals their profound connection to legal and ethical practices. Values such as compassion, respect, and accountability, as articulated in the NMC Code, serve as a compass for navigating the complexities of healthcare delivery. However, as this essay has discussed, applying these values in practice is often fraught with challenges, including systemic constraints and ethical dilemmas. Through critical reflection, I have gained a deeper appreciation for the importance of balancing legal obligations with patient-centred care, as well as the need for resilience and advocacy in upholding professional standards. The implications of this reflection extend beyond personal growth, highlighting the broader need for supportive environments that enable nurses and midwives to embody these values consistently. Ultimately, by engaging in continuous reflection and drawing on evidence-based resources, I aim to develop the competence required to address complex problems and contribute to safe, ethical, and compassionate care.
References
- Department of Health. (2005) Mental Capacity Act 2005. London: The Stationery Office.
- House of Lords. (1986) Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112. London: House of Lords.
- Legislation.gov.uk. (1998) Human Rights Act 1998. UK Government.
- Legislation.gov.uk. (2018) Data Protection Act 2018. UK Government.
- Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2019) What is ‘moral distress’? A narrative synthesis of the literature. Nursing Ethics, 26(3), 646-662.
- Nursing and Midwifery Council (NMC). (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC.
- Silverman, J., Kurtz, S., & Draper, J. (2016) Skills for Communicating with Patients (3rd ed.). London: CRC Press.
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