It is not unusual for the adjective ‘vulnerable’ to be applied to those in receipt of nursing practice without making clear what it is that persons thus described are actually vulnerable to. In this paper I argue that the way nursing has adopted the idea of vulnerability tends to imply that some people are in some way invulnerable. This is conceptually unsustainable and renders the idea of the vulnerable patient meaningless. The paper explores the meaning of vulnerability both in general (...) terms and in the context of nursing practice. It is argued that to be in receipt of nursing is to become, to a greater or lesser extent, more‐than‐ordinary vulnerable. Thus all patients are more‐than‐ordinarily vulnerable and this restricts their potential to flourish. Nurses are well placed to contribute to the flourishing of more‐than‐ordinarily vulnerable persons and my substantive claim is that this ‘protective’ function is indeed a legitimate and fundamental part of the role of nurses. (shrink)

This article explores the experience of death from the perspective of existential philosophy, for the purpose of finding ways to humanize end‐of‐life nursing care. A person in his or her final days is seen by the caregiver as a being seeking the continual creation of his human becoming, from the experience of sickness to death. From the moment the torment of suffering begins, a person needs a presence of humanistic professionalism that embraces the values of the nursing profession.

This analysis presents an epistemological and moral examination of suffering. It addresses the specific questions: (1) What is suffering? (2) Can one's suffering be assessed by another? and (3) What is the moral significance of suffering? The epistemological analysis is orientated by Peter Hacker's framework for the investigation of emotions, demonstrating that suffering is an emotion. This leads to a discussion of whether suffering is a phenomenon that can be evaluated objectively by another person who is not experiencing the suffering, (...) questioning the validity of some decisional models for limiting life-sustaining therapies with the aim of preventing suffering. This analysis highlights that understandings of suffering are value laden. It is conventionally implied that suffering is `bad' and that it should be eliminated. Suffering is commonly regarded as a moral wrong that needs to be made right by health care. This article concludes with a recommendation for a paradigm shift in how suffering can be better understood, through the practice of empathic attunement. (shrink)

Nursing, or caring science, is mainly concerned with developing knowledge of what constitutes ideal, good health care for patients as whole persons, and how to achieve this. The aim of this study was to find clinical empirical indications of good ethical care and to investigate the substance of ideal nursing care in praxis. A hermeneutic method was employed in this clinical study, assuming the theoretical perspective of caritative caring and ethics of the understanding of life. The data consisted of two (...) Socratic dialogues: one with nurses and one with nursing students, and interviews with two former patients. The empirical data are first described from a phenomenological approach. Observations of caregivers offering `the little extra' were taken to confirm that patients were `being seen', not from the perspective of an ideal nursing model, but from that of interaction as a fellow human being. The study provides clinical evidence that, as an ontological response to suffering, 'symbolic acts' such as giving the `little extra' may work to bridge gaps in human interaction. The fact that `little things' have the power to preserve dignity and make patients feel they are valued offers hope. Witnessing benevolent acts also paves the way for both patients and caregivers to increase their understanding of life. (shrink)

The aim of this study was to explore neonatal nurses’and mothers of preterm infants’experiences of daily challenges. Interviews took place asking for good, bad and challenging experiences. Data were analysed using qualitative content analysis and findings were clustered in two categories: good and challenging experiences, each containing three themes. The good experiences were: managing with success as a nurse, small things matter for mothers, and a good day anyhow for mothers and nurses. The challenging experiences were: mothering in public, being (...) pulled between responsibilities, and adverse things stick under the nurses’skin. The study shows that small daily clinical matters become big issues and could lead to moral distress, and that nurses integrate ethics of justice and ethics of care while mothers are concerned about health and well-being of their specific infant only. The challenge for nursing to integrate fairness and sensitive care in family-oriented neonatal care is discussed. (shrink)

The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants’ examples of (...) ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians’ ‘doings’ and tensions in expressing moral awareness. A main theme was formulated as caring about - caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing. (shrink)