A nurse notes that a diabetic patient has not received insulin as prescribed due to a missed dose. Which ethical principle has been most violated?

Appeared in: GMCH Nursing Officer-2025

Explanation

Fidelity is the ethical principle requiring nurses to be faithful to their professional commitments, responsibilities, and promises to patients.
This duty includes adhering to the prescribed plan of care, which involves administering medications like insulin at the correct time and dose.
The failure to administer the insulin is a direct breach of the nurse's professional duty and commitment to the patient, making fidelity the most directly violated principle.

Option A: This principle concerns the patient's right to make their own decisions. The scenario describes a nurse's error, not a patient's choice.
Option C: This principle ('do no harm') relates to the potential consequence (harm from hyperglycemia) of the missed dose. The primary violation is the failure in the duty itself, which is governed by fidelity.
Option D: This principle is about truthfulness. The error itself is not a lie.

Visual 1: Table: A comparative chart of core ethical principles in nursing (Autonomy, Beneficence, Nonmaleficence, Justice, Fidelity, Veracity) with definitions and clinical examples to differentiate them.

Clinical Relevance

Nursing practice connection: Use the key finding related to Ethical Principles in Nursing to guide bedside assessment, documentation, and the next nursing action.
Upholding fidelity is crucial for building trust in the nurse-patient relationship. Patients rely on nurses to follow through on the agreed-upon plan of care.
The 'Five Rights of Medication Administration' (Right Patient, Right Drug, Right Dose, Right Route, Right Time) is a practical framework that helps nurses uphold the principles of both fidelity and nonmaleficence.
What if the nurse was unable to administer the insulin due to a system issue, like the medication not being available from the pharmacy? The nurse's fidelity would then be demonstrated by actively following up, documenting the issue, and communicating with the prescriber to find a solution, rather than simply omitting the dose.

How to Approach the Question

First, identify the core action or inaction in the question: A nurse failed to give a prescribed medication.
Next, recall the definitions of the ethical principles listed in the options.
Analyze the action itself. Is it primarily a failure of duty, an act of causing harm, a disregard for patient choice, or an act of dishonesty?
The failure to perform a required task (giving medication) is a direct breach of professional duty and commitment. This aligns most closely with the definition of Fidelity.
Differentiate between the action and its consequence. The action is the breach of duty (Fidelity), while the potential for harm is the consequence (related to Nonmaleficence). In 'most violated' questions, the principle related to the action itself is often the best answer.

Concept Tested & Keywords

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