The “do no harm” principle, formally known as Nonmaleficence, is the foundational pillar of safe and ethical patient care, translating the ancient Hippocratic tenet into nursing practice. It represents the primary duty to protect the patient from injury, danger, or negative outcomes. For nurses, this is an active commitment that informs every decision, from routine tasks to complex interventions. The principle establishes the expectation that a patient’s well-being will be safeguarded under a nurse’s professional care.
The Ethical Foundation of Nonmaleficence
The concept of “do no harm,” or Primum non nocere, is the formal ethical principle of Nonmaleficence. It is one of the four established principles of bioethics, which also include Beneficence, Autonomy, and Justice. Nonmaleficence requires professionals to avoid inflicting injury or harm, obligating nurses to consider the potential for adverse effects in all their actions.
This principle is often viewed in tension with Beneficence, which is the duty to act in a way that benefits the patient and promotes their well-being. For example, a nurse may administer a powerful chemotherapy drug to treat cancer, an act of Beneficence. However, this same drug causes severe side effects like nausea and immune suppression, which constitutes a form of temporary harm, requiring the nurse to manage these effects through Nonmaleficence.
The ethical framework requires nurses to weigh the potential benefits of an intervention against the associated risks and harms. When a treatment carries inherent risk, the nurse must ensure that the probability of harm is minimized and that the patient understands the nature of the risks involved. Nonmaleficence prioritizes safety; if an action’s potential for harm significantly outweighs its benefit, the nurse is ethically bound to abstain.
Preventing Direct Harm in Clinical Practice
Nurses prevent direct, physical harm through the consistent application of evidence-based safety protocols. A primary example is medication administration, which is strictly governed by the “five rights.” Modern nursing practice often expands this to include the right documentation and the right to refuse, formalizing the procedural checks necessary to prevent medication errors.
- Right patient
- Right drug
- Right dose
- Right route
- Right time
Infection control is a procedural defense against direct harm, with hand hygiene being the most effective tool. Nurses adhere to protocols, such as the World Health Organization’s five moments for hand hygiene, which specify when hand cleaning is required. The consistent use of alcohol-based rubs and soap prevents the transmission of healthcare-associated infections.
Fall prevention protocols are critical, as approximately one million patients experience a fall in hospitals each year. Nurses conduct immediate risk assessments upon admission and implement individualized care plans. These plans include ensuring the bed is in the lowest position, locked brakes, and non-slip footwear. Color-coded wristbands or signs communicate a patient’s elevated fall risk to all members of the care team.
Protecting Patients from Indirect or Systemic Harm
The principle of doing no harm extends beyond physical injury to include indirect, psychological, and systemic harm. Nurses function as patient advocates to protect individuals from failures within the healthcare system, such as inadequate staffing or miscommunication between providers. This advocacy involves speaking up to ensure that a patient’s care plan is not compromised by institutional or human errors.
Protecting patient dignity and autonomy is a core component of preventing psychological harm. Nurses safeguard confidentiality by ensuring personal health information is not improperly disclosed, which preserves trust and privacy. They also ensure that informed consent is truly understood, clarifying complex medical information about the purpose, risks, and alternatives of a procedure.
Nurses work to mitigate emotional harm by creating a psychologically safe environment. This includes upholding the patient’s right to refuse treatment and ensuring that all care respects cultural values and personal preferences. By mediating between the patient and the system, nurses ensure that systemic issues do not translate into a violation of the patient’s rights or emotional well-being.