The ethics of care and justice in primary nursing of older patients

Abstract

While the ethic of care has generally been regarded as an appropriate attitude for nurses, it has not received equal attention as a mode of ethical problem solving. The primary nursing model is expected to be aligned with the ethic of care because it emphases the nurse–patient relationship and enables more independent role for nurses in decision-making. The aim of this study was to examine nurses’ ethical decision-making in the context of primary nursing. Participants were seven nurses, and one physiotherapist from a geriatric rehabilitation unit of a public hospital in Finland. Data were collected through focus group interviews and qualitatively analyzed through Lyons’ coding scheme for moral orientations. The results showed that primary nurses employ empathic understanding and particularistic thinking when building relationships with patients and their families, and when assessing their needs for coping at home after discharge. Most ethical conflicts were related to discharge and were solved through balancing the ethics of care and justice considerations. It is concluded that care and justice are integrated in nurses’ everyday ethical decision-making. The ethic of care nurtures good patient–nurse relationships, while the ethic of justice is needed to address the fair delivery of care in the context of an aging population and diminishing public resources. Both ethics should be acknowledged in clinical practices and included in ethics education.