The key leadership capability of advanced nursing practice dynamics is the provision of patient-centered care. The advanced practice nurses (APRNs) are expected to have sophisticated knowledge regarding their field and strong decision-making skills. The practice shows that many leaders encounter ethical dilemmas while advocating for their patients’ needs, which can be addressed via the ethic-of-care approach. This paper aims to examine the perspectives of ethics-of-care and ethic-of-justice in the context of nursing leadership and reflect on the application of the former from the point of the modern healthcare environment.
Description of Ethic-of-Care Versus Ethic-of-Justice Perspectives
Patient safety and improved health outcomes are the key priorities of APRNs. The evidence shows that interprofessional collaboration plays a paramount role in ensuring the mentioned goals. The ethical dilemmas occurring in the nursing context may be resolved by applying ethic-of-care or ethic-of-justice perspectives (Schuchter & Heller, 2018). According to the founder of these approaches, Carol Gilligan, norms, values, and rules compose the classical ethic-of-justice paradigm (Schuchter & Heller, 2018).
The rule of law and order is put based on this approach. On the contrary, ethics-of-care considers patients’ stories and relationships as the foundation for decision-making. The intensification of empathy and responsiveness towards patients is regarded as critical.
To better understand the difference between the identified ethical perspectives, it seems appropriate to focus on several examples. For instance, a woman with a knife wound was hospitalized, and the dilemma is whether to report to the police or keep silent as it is asked by this patient. The woman states that it was her husband who injured her, and she is afraid that in case of reporting, he can do even more harm to her. This is the case of mandatory reporting threat when the state law requires providing information about such events, but the patient’s life may be jeopardized (Othman, Goddard, & Piterman, 2014).
It should be stressed that some states require mandatory reporting, while others do not identify reporting specifics. The leader nurse should contact the police in terms of ethic-of-justice, yet ethic-of-care may be more suitable to communicate with the woman and find a common solution to enhance her safety.
Elaborating on the above example, it is possible to consider misconduct in the team. When the APRN decided to pay more attention to ensuring the patient’s safety, some team members rudely convinced her in being unprofessional and violating rules, mobbing, and bullying this leader. It may be challenging to overcome such inappropriate behaviors due to the group thinking phenomenon that implies the collective following of common ideas (Othman, et al., 2014).
However, the open discussion of the problem, strengths, and weaknesses of both solutions options is likely to show the team members that the situation is complicated, and common efforts are needed to find the most suitable decision. Instead of applying ethic-of-justice and setting punitive measures, the ethic-of-care and beneficence seem to be more effective concerning the discussed case.
The potential impact and strength of ethic-of-justice is the standard vision of one or another situation that is to be resolved inconsistency with the existing laws, policies, and other regulations. The main weakness of this approach is that nurse leaders have little room for a more detailed exploration of their patients’ needs and backgrounds. The effect of ethics-of-care is more advantageous related to the nursing context and ethical practice. Schuchter and Heller (2018) state that by using evidence-based interventions, they have the opportunity to properly understand what exactly their patients need and how to approach them in the best way possible. As for the weakness of this perspective, one may note that it can be misused by some specialists in their interests, which is a violation of the very idea of ethics.
Reflection on the Application from an Ethic-of-Care Perspective
The need for the creation of empathetic involvement, evidence-based interventions, and patient-centered care are the factors that point to the ethic-of-care approach as a way to improve care quality. A nursing leader is a person who can enable others to work in collaboration to achieve all of the mentioned needs (Lamb, Martin‐Misener, Bryant‐Lukosius, & Latimer, 2018). Advanced practice leader nurses are the paramount motivators of ongoing change to facilitate quality, safety, and a focus on individualized care practices. In this connection, current leaders are to be empathetic and transformative to help colleagues’ to adopt the ethic-of-care perspective.
Today’s environment is characteristic of the rapid pace of life, various ethical dilemmas, and the growing population morbidity. To cope with these issues, patients need more attention and understanding from caregivers, while the role of the cooperation between the interprofessional team cannot be overestimated (Lamb et al., 2018). For example, a patient who was under the long-term care of a nursing leader is hospitalized due to severe depression after her husband’s death.
She also has chronic back pain after the car accident two years ago and asks for more analgesia compared to other patients with similar health problems. Following the principle of ethic-of-care and interprofessional collaboration, the nurse addressed the physician who seems to be hesitant to increase morphine. To advocate for the patient’s concern, the nurse explains that she used to ask for more medication and pain relievers during previous hospitalizations, and the physician agrees.
This example demonstrates that the nursing leader applied such essential qualities as competence, responsibility, and attentiveness, and attentiveness to the patient’s needs. The mentioned qualities belong to Tronto’s theory of phases of care, which reflect the importance of ethical care (Scott, 2017). At the same time, the argumentative consultation between two professionals improved their relationships and teamwork. Thus, the key strategy for improving interprofessional collaboration is to build trust, mutual respect, and transparency in the team. Another example is a Heinz dilemma, in which the husband stole drugs necessary for his dying wife since the druggist refused to sell it at a lower price (Scott, 2017).
The salvation of human life, in this case, maybe regarded as a primary goal, but Heinz cannot be justified as he violated the law. The perspective of ethics-of-care is beneficial to discuss the above example from the point of humanism, empathy, and relationships between people.
Summary
Ethical dilemmas in nursing practice are common, and they can be addressed according to ethic-of-care and ethic-of-justice perspectives. Several examples were provided to better represent the benefits and application of each of them. It was revealed that the ethic-of-justice approach focuses on decision-making that is proposed by policies and standards, which narrows nursing leaders’ capabilities concerning patient-centered care.
The ethic-of-care approach allows adopting a more sophisticated view of patients’ problems, doubts, expectations, and needs to apply evidence-based strategies. The key benefits of this perspective are the empathetic atmosphere, trustful and respectful relationships between care providers and patients, the opportunity to establish proper team cooperation, and more effective solutions related to health outcomes of the latter.
References
Lamb, A., Martin‐Misener, R., Bryant‐Lukosius, D., & Latimer, M. (2018). Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nursing Open, 5(3), 400-413.
Othman, S., Goddard, C., & Piterman, L. (2014). Victims’ barriers to discussing domestic violence in clinical consultations: A qualitative enquiry. Journal of Interpersonal Violence, 29(8), 1497-1513.
Schuchter, P., & Heller, A. (2018). The care dialog: The “ethics of care” approach and its importance for clinical ethics consultation. Medicine, Health Care and Philosophy, 21(1), 51-62.
Scott, P. A. (2017). Key concepts and issues in nursing ethics. Cham, Switzerland: Springer.