The four ethical principles of the nursing profession covered by the American Nurses Association’s Code of Ethics include autonomy, justice, nonmaleficence, and one 11-letter word with a simple definition: beneficence. So, what exactly is beneficence in nursing?
Cynda Rushton, PhD, RN, FAAN, the Anne and George Bunting Professor of Clinical Ethics and Nursing at Johns Hopkins University in Baltimore, Maryland, describes it this way: “Beneficence is a big word that only ethics folks use in a sentence,” she joked.
The true definition of beneficence in nursing is something nurses achieve regularly but may not notice. “It’s doing good or benefiting the people we serve,” Rushton continued. “I think nurses are doing it every day.”
Nurses may not realize that through their daily work, beneficence is front and center. Rushton says nurses should take stock of just how much this principle plays a role in the care they provide.
“Nurses use their expertise, their judgment, and their skill to create a sort of safe passage for their patients through the healthcare system,” she said. “Claiming that contribution is really important because nurses spend more time than anyone else with patients. They’re instrumental in being able to help patients realize the benefits that are possible for them.”
In a March 2023 study published in the journal BMC Nursing, nurse researchers from Tabriz University of Medical Sciences in Iran concluded that clarifying beneficence among nurses can lead to increased well-being in patients, reduction in their mortality rate, increased patient satisfaction, and the respect and human dignity of patients.
The intertwined principles
To better understand the role of beneficence in nursing, understanding nonmaleficence is imperative. The ANA defines nonmaleficence as the avoidance or minimization of harm.
For nurses, these two principles are often intertwined. Rushton explains the connection as the relationship between burdens and benefits.
One example is patients undergoing chemotherapy treatments under the guidance of oncology nurses. “We give chemotherapy, and in the short term it makes them very ill,” she said. “But the goal, ultimately, is to eliminate the cancer cells.”
For labor and delivery nurses, this can involve giving medication to induce labor. “You give Pitocin to cause more intense contractions with the goal of a safe (vaginal) delivery, rather than a C-section,” Rushton said. “It’s kind of a dance of being able to hold both of those realities at the same time.”
The tradeoff of benefits versus burdens sometimes is very clear. Other times, it’s not.
“You start down a path of treatment and you realize, ‘Wow, this is not what we thought was going to happen.’ Is it still an ultimate benefit to this person or not?” she said. “I think that’s where nurses struggle a lot.”
When benefits fall short
Watching patients suffer from the burdens of a disease can be overwhelming and make them question whether beneficence is something they are actually exhibiting.
The result can be what some call compassion fatigue. Rushton, however, suggests that term is misnamed. “It’s actually empathy fatigue,” she said. “Scientists have shown that different parts of the brain light up when we experience empathy and when we experience compassion.”
Watching a patient suffer or seeing their body disintegrate can cause a powerless feeling for nurses. “It’s intensified when we’re already depleted and exhausted,” Rushton said.
Managing those feelings should involve understanding the boundaries of a nurse’s responsibilities.
“It’s helpful for nurses to recognize that our effort matters whether or not we’re able to bring about the ultimate outcome that we’re intending,” she said. “Sometimes taking on more than is ours to carry becomes a habitual pattern that begins to erode our commitment to our profession and our ability to stay in our role.”
Regardless of the outcome, Rushton encourages patients and families to share notes and messages with nurses and other clinicians who exhibited beneficence to remind them of why their efforts matter. She also says nurses should do more to recognize their contributions and honor them.
“We’ve really got to keep things in perspective about what we actually are responsible for and how we can recalibrate what we expect of ourselves in the midst of very complex situations,” she said. “Honor the effort of everyone.”
An exercise in beneficence
How can nurses notice the beneficence in their daily work? Rushton has a simple exercise to practice after every shift. “First, the idea of taking a breath” is an important way to start, she said. Breathing deeply calms and stabilizes the nervous system.
“Then, remember why you’re doing this important work,” Rushton said. “Why am I here? What is it that I want to bring about for this person in this moment? What can I do right now that will be a benefit?” This can include simply being present and listening or acknowledging other skills that nurses offer to improve a patient’s situation.
Next, reflect on the moments that made a difference for a patient and begin to notice them more intentionally. That can involve listening to a patient, having their attention, noticing their appreciation, or realizing that they understood the knowledge that was passed along.
“Take stock of those moments and decide how you will remember them at the end of the day, instead of the laundry list of, ‘Oh, I forgot this. I didn’t do that,’” Rushton said. “Have a process at the end of a shift and say, ‘I did the best I could with the resources I had.’”
From there, examine the responsibilities of the job and ask, “What part of this day is mine to carry, and what part isn’t?” she said. “What part could I let go of?” Having a formal practice to write down and let go of the residual from the day can reinforce letting go.
Avoid the sense of “over-responsibility,” Rushton said. “We can’t change the entire healthcare system,” she said. “We do have control of how we are in the moment.”
The exercise can help nurses achieve closure to each day and understand how much they exhibited beneficence.
“Every nurse wants to be a benefit,” she said. “We have to also notice that we are a benefit.”
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