Case Study: The Application of Nursing as Caring Theory to Ethical Decision-making

In nursing, the willingness to empathetically and benevolently meet the needs of clients forms the foundation of nursing ethics. Yet, conflict can occur when the personal values of a nurse practitioner conflict with the personal values of a patient. This case considers a scenario where a nurse must consider working in an abortion facility, even though it is against her own personal ethics. Through the application of nursing as caring theory and humanistic nursing theory, the nursing as caring framework will be utilized to demonstrate that nursing ethics requires the practitioner to identify where her values are in conflict with the values of the patient, to explore methods of overcoming those gaps, and to refrain from entering into a caregiving relationship when those values are found to be irreconcilable.

Assessment of the Situation

This case study considers the scenario of a nurse who is opposed to assisting with abortion procedures on moral grounds. Yet, the hospital where the nurse works is short-handed and the nurse receives a request from her supervisor urging her to work in the gynecological department despite her reservations. The primary ethical issue identified in this case is that the nurse’s moral opposition to assisting with abortion procedures might undermine her ability to effectively care for patients. As the College of Nurses of Ontario (2009) publication on ethical standards assesses, providing for client well being forms the foundation of nursing ethics. In their guidelines, CNO states, “Providing client well-being means facilitating the client’s health and welfare, and preventing or removing harm” (2009, p. 5). Further, CNO asserts that a nurse must withdraw from a situation where his or her own values conflict with the interests of the patient (2009, p. 6). The importance of avoiding scenarios that present conflict in values can be understood from the perspective of nursing as a caring framework.

Application of a Nursing as Caring Framework

Nursing as caring is applicable to this case because it examines the dynamics of the relationship between a nurse and patient. As Boykin and Shoenhofer establish (2010), nursing as caring theory asserts that the nursing relationship with a client involves the recognition of value and connectedness that is shared between the nurse and patient (p. 372). The theory emphasizes that the nurse and patient are involved in a voluntary relationship where the care of the nurse is essential in affirming the dignity of the patient (2010, p. 372). As a form of nursing as caring theory, humanistic nursing theory elaborates on the bond that is formed in an ethical nursing relationship. In order for nurses to provide proper care, they must consider the Gestalt technique, or the set of values and social considerations, that impact the way in which both the patient and the caregiver view the caregiving relationship (Kleiman, 2010, p. 341). Humanistic theory requires nurses to engage in the practice of transcending barriers between the patient’s gestalt and the caregiver’s gestalt in order to form a truly altruistic relationship between patient and client. The main concern in this case study is that the nurse’s opposition to abortion might prevent her from entering a caring relationship with the client. If the nurse is judgmental towards a patient seeking abortion services, this judgment might undermine her ability to truly empathize with and affirm the human dignity of the patient.

To apply nursing as a caring theory to this case, one must first consider the stakeholders involved. The first stakeholder is the nurse practitioner. Her primary objective is to provide care to her patients in a manner that she considers ethical. The second stakeholder is the hospital administrator who holds the objective of providing adequate staffing in the hospital facilities so that patients will receive care in an efficient manner. The final stakeholder is the patient whose primary objective is to receive treatment in a nonjudgmental and caring setting.

In recognition of these objectives, the nurse practitioner has three choices. First, she can attempt to overcome her objection to assisting patients with abortion procedures by developing empathy for the patient’s need for care. Second, the nurse practitioner can compromise with administration by agreeing to assist in the department if she is provided with supporting staff to assist with all manners concerning abortions. Through this option, the nurse can help the hospital staff the department while receiving assistance in caring for patients whose needs conflict with their own values. Finally, the third option is to refrain from assisting in the gynecological unit despite the reservations of management. If the nurse practitioner cannot successfully pursue the first two options, then she must pursue the third. The framework of nursing as caring requires the nurse to refrain from actions that might undermine her ability to fully empathize with the needs of patients.

Conclusion

Nursing as a caring framework establishes that ethical care requires a nurse to enter a co-relationship with the client. Further, humanistic nursing theory elaborates on nursing as a caring theory because it identifies methods that a nurse must undertake in order to eliminate the barriers that prevent him or her from being able to develop a shared experience with the client. If the nurse determines after the careful assessment that her values will undermine the level of service she provides to the patient, she must remove herself from the situation and decline the request of her supervisor that she provides care to patients seeking elective abortions.

References

Boykin, A., Schoenhofer, S.O., & Linden, D. (2010). Ann Boykin and Savina O. Shoenhofer’s nursing as caring theory. In M. Parker & M.C. Smith (Eds.), Nursing theories and nursing practices (3rd ed.) (pp. 370-385). Philadelphia, PA: F.A. Davis Company.

College of Nurses of Ontario. (2009). Practice standard: Ethics. Toronto, ON: College of Nurses of Ontario.

Kleiman, S. (2010). Josephine Paterson and Loretta Zderad’s humanistic nursing theory. In M.E. Parker & M.C. Smith (Eds.), Nursing theories and practice (3rd ed.) (pp. 337-350). Philadelphia, PA: F.A. Davis Company.