Ethical frameworks are a critical aspect of nursing practice in any area, and they provide for principles that apply across every potential phenomenon. The key framework for ethics in nursing is the code of ethics provided by the authority for the practicing body, and this provides expectations as they relate to that state’s framework for nursing. Various organizations and bodies, however, contain additional ethical frameworks which reflect the ideals and commitment of nurses and nursing to patients and the community.
The ethical framework is often encoded in the regulatory structure for nurses on a state by state basis. The American Nurses Association (ANA) also has a Code of Ethics which applies to their membership across America. The ANA Code of Ethics describes these principles in terms of the “values, obligations, and duties of every individual who enters the nursing profession” (ANA, 2016). These values, obligations and duties are non-negotiable and expressed as nine provisions. These provisions, and the ideals and spirit behind them have specific and direct application for the phenomenon of interest of nutrition in the NICU.

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Three ethical principles stand out when discussing the phenomenon of nutrition in the NICU. For example, a narrow focus on the neonate’s primary reason for being in NICU, without regard for the nutritional needs of a newborn, can have long term detrimental effects on a newborn (Thureen, 2012). Further, moral distress in nursing can be an outcome of a lack of understanding or implementation of ethical principles or a lack of skill in communicating ethical dilemmas (Burston & Tuckett, 2013). This can be prevented or avoided by adhering to the principles of the ANA ethical framework, in particular the provisions with regard to the interdependent relationships of a patient, the need for collaboration with other professionals to ensure the best care of the patient and the need to protect patients from impaired practice. All nine provisions of the ANA Code of Ethics also have specific application in terms of the specialty area of the Nurse Practitioner (NP) who specializes in the neonatal context, but these three principles stand out with regard to the neonatal environment and the duties of the NP. This can be seen by comparison of the previous focus of neonatal care which did not recognize the importance of nutrition in the NICU, which had long term negative impacts and therefore represents an impairment of the profession which has since been corrected; the collaborative nature of expertise which has been required in order to implement that correction, from investigation of proper breast milk storage to nutrition research; and the need to include parents, particularly the mother, in the feeding of even fragile newborns. One can imagine that prior to the implementation of this new approach, many nurses were faced with moral dilemmas in regard to the nutrition of neonate patients.

The ANA framework was chosen because of its broad reach as well as its application across the nation and state regulatory frameworks. This has significant relevance for nurses, as this is a very mobile profession where demand and supply often dictate where (and therefore how) nursing is practiced. For advanced nursing practice, the understanding and implementation of personal, professional and regulatory frameworks is of even greater importance give the leadership role in the healthcare context.

Ethical frameworks are at the heart of nursing, because they support the intent and spirit of nursing to care for and support the health of patients. No patient is more fragile and helpless than the newborn child in NICU, and the nutritional needs of such a patient must remain a focus of care in additional to the primary cause of health issue.

  • ANA (American Nurses Association). (2016). “Code of Ethics for Nurses with Interpretive Statements”. Retrieved from:
  • Burston, A. S., & Tuckett, A. G. (2013). Moral distress in nursing Contributing factors, outcomes and interventions. Nursing Ethics, 20(3), 312-324.
  • Thureen, P. J. (2012). Neonatal nutrition and metabolism. Cambridge University Press.