Caring has long been claimed as a concept at the heart of nursing, sometimes described as the thing that distinguishes nursing from other professions. Care is increasingly recognized as the moral foundation, ideal and imperative of nursing. What counts as caring at any particular historical moment is highly dependent on context; meanings of care are historically contingent and change over time. Caring is not just a subjective and material experience but one in which particular historical circumstances, ideologies and power relations create the conditions under which caring can occur, the forms it takes and the consequences it will have for those who undertake it.
Ethical selves are shaped by social discourses that situate care in relation to broader formations of gender, religion, class and ethnicity as well as factors such as age, nationality and physical location. Since 1900 no decade has passed without publication of at least one basic text in nursing ethics with one of the first discrete texts on nursing ethics being published as early as 1888 (Orr 2004). Since the inception of modern nursing in the last century, nurses globally have taken seriously their moral responsibilities as health care practitioners; they have also taken seriously the issues which have emerged as a consequence of their attempts to fulfill these responsibilities effectively.
As professionals working in the health care domain, very clear that nurses like other health care professionals cannot escape the tensions that are being caused by the radically opposing and competing moral viewpoints that are presently pulling the health care arena and indeed the world apart. An important question to arise here is: how can the nursing profession best respond to this predicament? There is, of course, no simple final answer to this question.
Nevertheless there is at least one crucial point that needs to be made, and it is this: it is vitally important that nurses learn to recognize the cyclical processes of social and cultural change, and realize that they themselves are participants in this change. Once realizing this, they also need to learn that, as participants in these cyclical transformations, they are positioned and have a stringent moral responsibility to sensitively and artfully advocate for the mediation of the extreme and multiple positions they might (and very often do) find themselves caught between. They also have a moral responsibility to facilitate this mediation by acting as mediators themselves.
Nursing ethics can be defined broadly as the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice which, in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health, healing, environment, and nursing itself (Narváez & Rest 1994). In this regard, then, contrary to popular belief, nursing ethics is not synonymous with (and indeed is much greater than) an ethic of care, although an ethic of care has an important place in the overall moral scheme of nursing. Nursing, like other health professionals, encounter many moral problems in the course of their everyday professional practice.
These problems range from the relatively simple to the extraordinarily complex, and can cause varying degrees of perplexity and distress in those who encounter them. For instance, some moral problems are relatively easy to resolve and may cause little if any distress to those involved; other problems, however, may be extremely difficult or even impossible to resolve, and may cause a great deal of moral stress and distress for those encountering them. In making an interpretation of the particular situation in which there is a moral problem, persons who have empathy and can take the perspective of others, and who care for others – even people who are quite different from themselves – are likely to exhibit high levels of moral sensitivity.
A person must be able to reason about a situation and make a judgment about which course of action is morally right, thus labeling one possible line of action as what ought morally to be done in that situation (Narváez & Rest 1994). Both a strong desire to do what is most morally defensible and a strong caring for other humans is necessary in order for a professional person to put aside a possible action that would serve self-interest in favor of the most ethical alternative action.
Nurses have as much independent moral responsibility for their actions (and omissions) as they have independent legal responsibility, and are just as accountable for their practice morally as they are legally. Nurses must be accorded the recognition and legitimated authority necessary to enable them to fulfill their many and complex responsibilities as professionals bound by agreed standards of care. It can be seen that the prospects of virtue ethics are indeed promising in nursing ethics.
The agreed ethical standards of nursing require nurses to promote the genuine welfare and wellbeing of people in need of help through nursing care, and to do so in a manner that is safe, competent, therapeutically effective, culturally relevant, and just. These standards also recognize that in the ultimate analysis nurses can never escape the reality that they literally hold human wellbeing in their, and accordingly must act responsively and responsibly to protect it (Bioethics for beginners). These requirements are demonstrably consistent with a virtue theory account of ethics.
The nursing profession worldwide has a rich and distinctive history of identifying and responding substantively to ethical issues in nursing and health care domains. In today’s highly technical health-care system, there seems to be general agreement that nurses must be rational, logical thinkers who can incorporate the tradition of justice that draws on long-established modes of moral reasoning. Nursing should be a relationship in which compassion, competence, confidence, justice, prudence, temperance, caring, honesty, responsibility and commitment are mobilized by the care-giver to promote the health and well-being of those in need of care.
The neglect or overemphasis of any one of these would cause for an imbalance in care. Hospital conditions are not those of ordinary life. Nursing deals with the unusual and the abnormal. Within the walls of the hospital nurses find that they must accept all people as they are, and devote themselves mainly to their physical betterment. However, an integrative theory of nursing ethics that synthesizes caring and justice has yet to be developed. Tensions in nursing among loyalty to patients, to physicians, to self, and to employing agencies provide a context for the development of ethics in nursing over the past century and nursing’s participation in health care reform today.
“Bioethics for beginners.” Available from: dttp://www.med.upenn.edu/~bioethic
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