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Nursing is one of the most complex and multidimensional professions today. It requires strong personal values and medical knowledge, good practical skills, and excellent communication skills. Like other organizations, health care depends upon the social, cultural, and political impact of the modern environment and events. For this reason, a nurse should be flexible in order to meet changing cultural and social conditions. Nursing is defined as “a profession whose focus is to help the client to prevent, solve, alleviate or cope with problems associated with the activities he or she carries out in order to live” (Roper, Logan, and Tierney, 1990 cited Mckenna 1997, p. 4). Nurses like other health care professionals cannot escape the tensions that are being caused by the radically opposing and competing for moral viewpoints that are presently pulling the health care arena and indeed the world apart.
The older definition states that nursing is: “A socially valued service whose goal is to promote a positive adaptation to the stimuli and stresses encountered by the client (Roy, 1971 cited Mckenna 1997, p. 4). An important question to arise here is: how can the nursing profession best respond to this predicament? There is, of course, no simple ‘final answer’ to this question. Nevertheless, there is at least one crucial point that needs to be made, and it is this: it is vitally important that nurses learn to recognize the cyclical processes of social and cultural change and realize that they themselves are participants in this change (Anderson, 1983). Once realizing this, they also need to learn that, as participants in these cyclical transformations, they are positioned and have a stringent moral responsibility to sensitively and artfully advocate for the mediation of the extreme and multiple positions they might (and very often do) find themselves caught between.
The core of these definitions is that nursing means to care about patients and promotion of well-being. Newer definitions state that where able, they also have a moral responsibility to facilitate this mediation by acting as mediators themselves (Kozier et al 2004). However, the additional point needs to be made that fulfilling these responsibilities requires much more than ordinary commonsense and intuition. The ramifications of these ‘new’ moral responsibilities for the nursing profession, and not least for nursing education and research, are obviously enormous. They are not, however, insurmountable (Mckenna, 1997). So long as the nursing profession can keep its collective mind even and not become unbalanced by the ‘vertigo of relativity, can view the present moral crisis of the world as a crucial stage or ‘turning point’ rather than as destructive chaos, and can approach the future with vision, informed knowledge and skill, it will be able to correctly anticipate the challenges ahead in its practice, and in its education and research programs (Daniels, 2004).
Special attention is given to the cultural and social context of modern healthcare. Dreher and Macnaughton (2005) underline that cultural competency is at the heart of nursing. By achieving these things, nurses will be enabled and empowered to honor their long-held historical, cultural, and moral commitment to promoting and protecting human welfare and wellbeing. Deciding and acting morally in a conflicted world, dealing constructively with moral controversy, finding satisfactory solutions to moral disagreements, and coping effectively with moral distress are all complex, perplexing, and demanding tasks. Garrison et al (2004) underline the importance of professional knowledge and skills which help nurses to accept the right decision in complex situations. Compounding the problems associated with their achievement is the additional problem of the demise of traditional moral certainty and a concomitant rise in moral fanaticism which has seen acts of violence committed in the name of morality. It is, among other things, this increase in violence associated with moral fanaticism that underscores the need to find tenable solutions to moral disagreements and the controversies that have emerged as a result of them; that is before they are transformed into acts of violence (Daniels, 2004).
Personally, I suppose that nursing can be defined as a healthcare profession that helps patients to prevent and cope with illness despite cultural or social background. Today, nurses have as much independent moral responsibility for their actions (as they have independent legal responsibility, and are just as accountable for their practice morally as they are legal. This, in turn, places at unacceptable risk the welfare interests and wellbeing of patients who may, in some circumstances, be dependent on nurses to protect their welfare interests. Nurses must be accorded the recognition and legitimated authority necessary to enable them to fulfill their many and complex responsibilities as professionals bound by agreed standards of care.
It is important for members of the medical profession to realize that nurses do have independent moral responsibilities (and, it should be added, legal responsibilities) when caring for patients and, indeed, can be (and have been) held independently accountable for their actions. It is neither reasonable nor fair to expect nurses to ignore or violate their demonstrable responsibilities to patients and to practice below an acceptable standard of care. The medical profession has been even less supportive of the idea and has rejected outright any thought that nurses are capable of and indeed make independent moral judgments and decisions when caring for patients, believing instead that only members of the medical profession are capable of these things which, in their view, are not always readily distinguishable from simply ‘good medical judgments and decisions’ being made. Patient relationships and the ethical concerns of nurses are the core of modern nursing.
References
Anderson, M.L. (1983). Nursing interventions: What did you do that helped? Perspectives in Psychiatric Care, 21(1), 4-8.
Daniels, R. (2004). Nursing Fundamentals: Caring and Clinical Decision Making, Thomas Learning, Oregon.
Dreher, N., Macnaughton, N. (2002). Cultural competency in nursing: foundation or fallacy? Nursing Outlook, Sep-Oct; 50 (5):181-6.
Garrison, D.R., Morgan, D.H., Johnson, J.G. (2004). Thriving in chaos: Educating the nurse leaders of the future. Nursing Leadership Forum. Fall; 9 (1), 23-27.
Kozier B., Erb G., Berman A. & Snyder S. (2004). Fundamentals of Nursing: Concepts, Process and Practice, New Jersey, Pearson Education Inc.
Mckenna, H. (1997). Nursing Theories and Models. Routledge.
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