Recent work in clinical nursing ethics has been influenced by two main areas of insight associated with the challenge levelled by the women's movement to traditional thinking about morality and ethics. Broadly speaking these two realms have been distinguished as articulating ‘feminist’ socio‐political and ‘feminine’ ethic of care concerns. Often these two impulses are seen as pulling against each other, or worse, the ‘feminine’ emphasis on the ethics of care is seen as reinforcing the dynamics that elicit the ‘feminist’ concern. (...) In this paper I suggest how an expanded understanding of an ethic of care in clinical settings can provide resources for dealing with both concerns. A discussion of the way institutional relations can ride rough‐shod over the ‘feminist’ insights of ethical care, in the second part of the paper, provides evidence for my conclusion that ethical nursing care depends on recognizing that both areas of insight are imperative for its success. (shrink)

In an age where previous frames of reference lose their certainty nurses are finding themselves rethinking their relations to the ‘real’. In this paper I interrogate an empirical ‘text’ of a local nursing cultural practice through a poststructural critique of the ways in which language, discourses, representation and experience intersect to construct ‘reality’ for us with specific consequences. I do this in an attempt to disclose the micro‐politics at work in the processes of signifying and thus representing nursing to a (...) world of potential students. The discourses of science and caring find themselves exposed in particular representational technologies and practices that mark nursing's collusion with the ‘truths’ of science at the expense of those we loosely name ‘caring’. This cultural theoretical work constitutes a provisional and historical fragment of analysis designed to trouble the relations we often unwittingly sustain with dominant ‘regimes of truth’. (shrink)

Nurse educators, like many of their health care professional colleagues, frequently face moral dilemmas when they identify a student as presenting an unacceptable risk to public safety. In this situation, the statutory requirement of nurse educators to protect the public, under the Health Practitioners Competence Assurance Act , competes with the rights of the student to receive education under the Education Act . Using the different moral voices of justice and care, identified by Gilligan , this moral dilemma is examined (...) within the context of one school of nursing in a New Zealand tertiary education organisation. Overall, the justice voice dominated within the tertiary education organisation. Academic committees, and appeal panels, operating within the educational statutory framework, used democratic processes to reach decisions. The individual committee members, acting as autonomous moral agents, made decisions using universal principles and abstract moral reasoning. The focus was on individual rights, natural justice and due process. Nurse educators articulated both justice and care moral voices. Those with care voices described how they agonised between their duty to protect the public, and their wish to facilitate students, with whom they had built relationships, to succeed. The education management process did not acknowledge the statutory obligations of nurse educators, as registered nurses, or the implications of this within the education context. The moral dilemmas were either ignored, or rendered invisible. As a result of this, nurse educators engaged in various survival strategies, and the broader educational context remained intact and unchallenged. (shrink)

This paper forms part of a wider study examining the history and sociology of nursing education in England between 1860 and 1948. It argues that the question of whether nursing was an art, science and/or social science has been at die ‘heart’ of a wider debate on die occupational status and disciplinary identity of nursing. The view that nursing was essentially an art and a ‘calling’, was championed by Florence Nightingale. Ethel Bedford Fenwick and her allies insisted that nursing, like (...) other professions, was a ‘scientific’ and technical enterprise. Social scientists later came to challenge nursing's claim to professionalism by analysing nursing work first within die context of industrial psychology. But they also advocated a rapprochement between nursing, health services and social science research, a challenge which we are in nursing, still striving to meet This paper argues for a strong coalition of nursing with its former nineteenth century ally, social science, in die continuing struggle for change within nursing and health care policy. Rather than searching for some rarified and purified essence of nursing knowledge, it argues that nurses need to join forces with sociologists and economists in striving to shape die agenda for health services research and provide die evidential basis for health policy transformation more generally. (shrink)

The claim that, in some nontrivial sense, nursing can be identified with caring has prompted a search for the philosophical foundations of care in the nursing literature. Although the ethics of care was initially associated with Gilligan's ‘different voice’, there has more recently been an attempt – led principally by Benner – to displace the gender perspective with a Heideggerian one, even if Kant is the figure to whom both Gilligan and Benner appear most irretrievably opposed. This paper represents the (...) first half of a double-edged project: initially, to point out that Heidegger explicitly disowns any ethical implications for his ontological thinking, and to argue that no ethical theory (including an ethics of care) can be derived from Being and Time; and then to argue that Kant's categorical imperative is not only compatible with the ethics of care but actively entails it. In this, Heideggerian, part of the argument, I consider three attempts to wrest an ethics from Being and Time– those of Benner, Olafson and Guignon – suggesting that, for different reasons, they all fail. Benner systematically confuses the ontological with the ontic, not recognizing that care, concern and solicitude have ‘deficient’ modes as well as positive ones, and that Heidegger's ontology retrieves the possibility of an ethics-in-general without at any point implying an ethics-in-particular (whether of care or justice). Olafson does recognize this, and to that extent admits his failure, but his efforts to amplify Heidegger's thought in such a way as to generate an ethical theory involve both the importing of Kantian premises, and an appeal to some rather doubtful empirical observations. Guignon resorts to Heidegger's discussion of authenticity, and the idea that authentic Dasein ‘may choose its hero’, suggesting a morally reassuring list of heroes who might fit the bill. However, there is nothing in Heidegger's account of this choice that justifies his confidence, and I conclude by proposing that we should take Heidegger at his word when he says that ontology has ‘no result, no effect’. (shrink)

Working in and around the ‘chain of command’: power relations among nursing staff in an urban nursing homeBy most accounts, the discipline of nursing enjoys considerable hegemony in US nursing homes. Not surprisingly, the ethos of this setting is influenced, in large part, by nursing’s value system. This ethos powerfully impacts both the residents who live in nursing homes and the staff who work there. Using ethnographic methods, this project explored power relations among nursing assistants and nurses in an urban (...) nursing home in the United States. Factors contributing to tensions among nursing staff were the stigma attached to nursing homes and those who work in them, as well as the long history of class conflict and power struggles within the discipline of nursing. The latter struggles, in turn, reflected nursing’s quest for professional status in the face of medicine’s hegemony over health‐care. Ultimately, these factors coalesced to produce a local work environment characterized by conflict — and by aides’ resistance to nurses’ domination. (shrink)