Ethical Theories and Principles in Healthcare: NCLEX-Focused Guide for BSN Students

Heather Murphy

Welcome to NSG4070, Legal and Ethics! I'm Professor Heather Murphy and this series will take you through key points we go over in class, as well as provide you some tips and tricks to prepare you for the NCLEX. I am joined today by three of my podcast colleagues who will share their expertise in this area.

Caitlin Hope

Hello everyone. I am Caitlin Hope and I have been a registered nurse for only 2 years so I can relate to you as future new RNs. We may not think that ethics and legal issues arise often, but you would be surprised. That is why we are here today to share some knowledge and examples so when you encounter them in practice, you'll be prepared to navigate those scenarios.

Karen Whitaker

You're right, Caitlin. I'm Karen Whitaker and I'm also a registered nurse. I can tell you that morals are about personal ideas of right and wrong—what YOU were raised to believe is good or bad. Moral philosophy is that deeper discussion of what’s good or bad, right or wrong. Ethics zooms out to the group level: it’s the study of social morality and reflection on society’s norms and practices. In nursing, ethics is: what should we do as professionals, given our codes and standards.

Derek Mendoza

Hello class! I am Derek Mendoza and I've been an RN for many years and also teach nursing. On the floor, you might feel a moral pull, like, “I’d never refuse this treatment for my family,” but ethically you still have to respect a patient’s decision to refuse it.

Heather Murphy

Exactly. And nurses are constantly making ethical decisions—delegating to assistive personnel, disciplining an unsafe peer, speaking up about how resources are distributed on the unit. It’s not just at end of life; it’s all day, every shift.

Caitlin Hope

And on the NCLEX, those “which action is best” questions often hide an ethics question. If you can spot the principle, the answer gets a lot clearer.

Karen Whitaker

Let’s hit the big ethical theories you’ll see underneath those questions. First up: utilitarianism. That’s the “greatest good for the greatest number” idea. An action is judged by its end result—does it increase overall happiness or benefit?

Derek Mendoza

In nursing, think triage during a mass casualty. As difficult as it may be to pass by the dying patient to save those who have a chance to survive may be, that is an example of utilitarianism. It is doing the greatest good for the greatest number.

Heather Murphy

Next is deontology, which is duty-based. The rightness or wrongness of an act depends on the nature of the act itself, not the outcome. You do something because it’s your duty, period.

Caitlin Hope

So, like, it’s my duty to advocate for a kid who needs blood to survive, even if the parents refuse. Deontologically, saving that life and honoring my professional duty to the child takes center stage, even though the situation is emotionally messy.

Karen Whitaker

Most professional codes of ethics borrow heavily from that duty-based thinking. Then we’ve got virtue ethics. Instead of rules or outcomes, this one focuses on character traits—compassion, discernment, trustworthiness, integrity. NCLEX tip here: if the question talks about outcomes for a group or allocation of resources, you’re probably in utilitarian territory. If it emphasizes duty, rules, or professional obligations, think deontology. If it highlights traits like compassion or integrity, that’s virtue ethics.

Heather Murphy

Let’s bring this down to the bedside and walk through the core ethical principles you’ll see over and over: autonomy, beneficence, nonmaleficence, justice, veracity, fidelity, and confidentiality. Do you remember learning those in your Intro class many semesters ago? We also touched on these during our mental health lab. And now they're BACK!

Caitlin Hope

I’ll grab autonomy. Autonomy is about self-governing, the right to self-determination. An autonomous person can set personal goals, decide on a plan, and act on that choice. Our job is to respect that.

Derek Mendoza

And autonomy gets threatened because patients are in a dependent role, and we’re in a power role. That imbalance can lead to us sliding into “I know best” mode without meaning to.

Heather Murphy

A classic NCLEX-style autonomy scenario: competent patient refuses a treatment, like a blood transfusion or surgery. The correct action is usually to respect the refusal, clarify understanding, notify the provider—NOT to pressure, threaten, or sneak in the treatment anyway.

Karen Whitaker

Related issues are informed consent, paternalism, advocacy, noncompliance, self-determination. If the stem mentions teaching before consent, clarifying understanding, or honoring refusal, your autonomy radar should go off.

Caitlin Hope

Okay, beneficence: to do good. We act in ways that benefit patients—promote good, prevent harm, remove harm. Think of choosing to spend more time with a high-acuity patient. You’re not ignoring the others, you’re balancing your time to do the most good where it’s needed most.

Derek Mendoza

Nonmaleficence is the flip side: avoid causing harm, even while you’re trying to do good. Weigh the risk of harm against expected benefits. A needlestick for an immunization—that’s short-term pain for long-term benefit. Opioids for terminal pain—relief, but risk of dependence or hastened death. Keeping a patient NPO longer than they’d like to protect them for a procedure.

Heather Murphy

Even reporting a colleague for unsafe practice is nonmaleficence. It might hurt feelings or relationships, but it protects patients from harm. Same with seeking legal input for life-saving treatments.

Karen Whitaker

Justice is about fair, equitable, appropriate treatment in light of what’s due to each person. Distributive justice asks how we divide limited goods—beds, staff, medications. You’ll see rules like “to each according to need” or “to each equally”.

Caitlin Hope

On an exam, if the stem is about who gets a resource first—like the homeless patient or the VIP patient who is CEO of a company—you’re looking at justice. Practicing justice would involve weighing which has higher acuity, not which is the person who can afford it best.

Derek Mendoza

Veracity is telling the truth. It builds respect, open communication, trust, and shared responsibility. Codes of nursing ethics promote veracity and treat it as a universal virtue.

Heather Murphy

And you might see tension between nursing and medical perspectives. Some physicians might avoid disclosure “for the patient’s good,” like not telling a mother in the ED that her children died, or not reminding a woman with dementia that her father is gone. As nurses, we still value honesty, but we also balance it with compassion and the patient’s condition.

Karen Whitaker

Fidelity is faithfulness and promise keeping—being trustworthy and competent. If you tell a patient, “I’ll be back in 15 minutes with your pain med,” fidelity means you actually follow through or explain the delay.

Caitlin Hope

And confidentiality: don’t disclose private, sensitive, or secret information. Privacy is the patient’s right to control their personal information. Respecting confidentiality supports autonomy and encourages people to seek care.

Derek Mendoza

But it’s not absolute. There are limits when we have a duty to protect others from harm. Foreseeability is key—you reasonably foresee harm, and that triggers duty to warn or mandated reporting, like for children, disabled adults, or seniors.

Heather Murphy

On NSG4070 or NCLEX-style items, if you see social media, technology, HIPAA, or “sharing information with coworkers,” think confidentiality. The safest answer usually keeps information on a strict need-to-know basis and avoids posting or casual sharing.

Karen Whitaker

NCLEX tip: match key words in the stem to principles. Patient chooses, refuses, decides—autonomy. Do good, promote comfort—beneficence. Prevent harm, report unsafe, weigh risks—nonmaleficence. Fair, equal, who first—justice. Truth, honesty, informing—veracity. Keep promises, follow through—fidelity. Privacy, HIPAA, social media—confidentiality. Then eliminate distractors that violate that primary principle.

Derek Mendoza

Let’s practice with a few quick vignettes and layer in some test strategy.

Caitlin Hope

Okay, end-of-life first. Your terminally ill patient with severe pain says, “I don’t care if this medicine shortens my life, I just don’t want to hurt like this.” The provider orders opioids that might hasten death a bit but will relieve pain. What’s the main ethical principle in your nursing actions?

Karen Whitaker

I’d say we have both beneficence—relieving suffering—and nonmaleficence—carefully weighing the risk of hastened death. On the test, if you have to pick one, look at the wording. If the options emphasize preventing or minimizing harm while treating pain, that’s nonmaleficence. If they emphasize promoting comfort and good, that leans beneficence.

Heather Murphy

And autonomy is in there too—the patient is clearly stating their goal. So a strong answer respects their informed choice while safely managing the medication.

Derek Mendoza

Next vignette: you observe a colleague repeatedly giving meds late and skipping independent double-checks on high-alert drugs. What principle drives your response?

Caitlin Hope

Nonmaleficence again—avoid causing harm. Reporting unsafe practice to protect patients is ethically justified, even if it feels uncomfortable. Fidelity shows up too because we’ve promised to safeguard patients.

Karen Whitaker

On an exam, the best answer usually involves following policy and escalating through the chain of command, not confronting in a hallway argument or ignoring it. Watch for words like “report,” “document,” “follow institutional policy.”

Heather Murphy

Third vignette: social media. A nurse posts a selfie at the nurses’ station with a patient in the background, even if the name isn’t visible. What’s the primary issue?

Derek Mendoza

Confidentiality and privacy. Technology and social media are specifically mentioned as contemporary confidentiality issues. Even without a name, you’re sharing identifiable health information.

Caitlin Hope

The safest NCLEX-style response would be something like: report the breach according to policy, reinforce education about social media and HIPAA, and avoid posting any patient-related content yourself.

Karen Whitaker

Now, quick refusal-of-treatment twist: A competent adult refuses a life-saving procedure. Family begs you to convince them. What’s your priority principle?

Heather Murphy

Respect for autonomy. You clarify understanding, make sure there’s no confusion or coercion, and then honor the patient’s decision—even when it clashes with what the family or staff wants.

Derek Mendoza

Let’s bring in ethics committees for a minute. When you’ve got conflicting principles—like autonomy versus beneficence—or every option feels “right” somehow, ethics committees can help.

Caitlin Hope

Their primary functions are consultation, education, and policy. They facilitate ethical analysis and support decision-making when the team’s stuck.

Karen Whitaker

Nurses play a key role there. We balance advocacy for the patient with cultural sensitivity and clinical guidelines. At the bedside, that might mean saying, “I think we need an ethics consult,” when goals of care are unclear or the family is divided.

Heather Murphy

Okay, let’s wrap with a few NCLEX strategy nuggets for ethical questions. Derek, you start.

Derek Mendoza

First, use “safety first.” If you’re torn, pick the option that best prevents immediate harm—nonmaleficence usually wins as a tiebreaker.

Caitlin Hope

Second, think “least restrictive, least invasive.” If several answers respect the same principle, choose the action that protects rights and autonomy with the least restriction—like teaching and clarifying before restraining or forcing treatment.

Karen Whitaker

Third, keep respect for autonomy in mind. If a competent patient’s clear choice is on the table, the correct answer usually honors that choice while ensuring they’re informed.

Heather Murphy

And keep matching language: choice, goals, consent—autonomy. Comfort, benefit—beneficence. Prevent harm, report unsafe—nonmaleficence. Fair distribution—justice. Tell the truth—veracity. Keep promises—fidelity. Protect information—confidentiality.

Derek Mendoza

If you can name the principle, you can usually spot the best answer—and be that nurse at the bedside who calmly says, “Here’s what’s ethically sound.”

Caitlin Hope

This stuff really does get easier the more cases you see. You start recognizing patterns instead of memorizing rules.

Karen Whitaker

Alright, we’re going to land the plane there. Ethics isn’t about being perfect; it’s about thinking carefully and consistently doing right by your patients and your profession.

Heather Murphy

Thanks for hanging out with us today. I’m Professor Murphy, and I love seeing students grow in this area—it really shapes your whole career. Thank you Caitlin, Derek, and Karen for joining me today!