Applying the Ethics of Care to Your Nursing Practice
Applying the Ethics of Care to Nursing Practice
Introduction to the Ethics of Care
Author Information: Vicki D. Lachman, PhD, APRN, MBE, FAAN, is a Clinical Professor and Director of Innovation and Intra/Entrepreneurship in Advanced Practice Nursing at Drexel University, College of Nursing and Health Professions, Philadelphia, PA.
Core Idea: The capacity to care is what gives life its deepest significance, as stated by Pablo Casals (2000).
Purpose of the Article: To help nurses effectively apply the theory of care ethics in their practice by providing a basic definition of caring, outlining the evolution of care ethics theory, and illustrating it through a case study using Tronto's (1993) four phases and elements of caring.
Definition of Caring
Intertwined with Nursing: Caring and nursing are so closely linked that they always appear together in a Google search for 'caring'.
Standard Definition: Caring is defined as "a feeling and exhibiting concern and empathy for others; showing or having compassion" (The Free Dictionary, 2002, para. 2).
This definition highlights that caring is both an internal feeling and an external action.
Dr. Jean Watson's Caring Theory: A prominent theory in nursing, it comprises three major elements (Watson, 2001):
Carative Factors: These factors honor the human dimensions of nursing's work, the inner life world, and the subjective experiences of patients (Watson, 1997, p. 50).
Originally called carative factors, they were changed to caritas factors in 2001. Examples include:
Developing and sustaining a helping-trusting, authentic caring relationship.
Being present and supportive of expressing positive and negative feelings as a connection to the deeper spirit of self and the one-being-cared-for (Watson, 2001, p. 347).
This requires nurses to be self-aware to avoid judgmental feelings or crossing professional boundaries.
It necessitates a deep connection to the spirit within oneself and the patient.
Watson's model emphasizes the uniqueness of each individual and preserving the patient's dignity.
Transpersonal Caring Relationship: Describes the nurse's caring consciousness and moral commitment to intentionally connect with the patient.
Caring Occasion/Caring Moment: The specific space and time where the patient and nurse interact in a way that allows caring to occur.
Evolution of the Theory of the Ethics of Care
Edwards (2009) outlines three versions of the evolution of care ethics over the last 15 years:
First Version: Carol Gilligan (1982)
Initiated the discussion by emphasizing the context of the situation over impartial deliberation of ethical issues.
Distinction from Justice-Based Ethics: Impartial reflection, typical of justice-based moral deliberation, does not consider the level of caring or closeness in a relationship.
Shift in Moral Theorizing: Gilligan moved the perspective from independent selves to interconnected and interdependent selves.
Varying Levels of Care: Strangers do not receive the same level of care as those for whom we feel personal responsibility. For example, caring for a neighbor's cat differs significantly from caring for a sister in hospice at home. Caring exists on a continuum with different emotional involvement levels.
Second Version: Joan Tronto (1993)
Contributions: Primarily in political philosophy.
Radical Social Arrangements: Tronto argued that focusing on caring relationships and the interplay between power and caring practices (e.g., raising children, caring for the sick) would lead to fundamentally different social structures (Edwards, 2009, p. 233).
Obligation-Based vs. Responsibility-Based Ethics: Similar to Gilligan, Tronto distinguished between these approaches:
Obligation-Based Ethics: Rooted in theories like utilitarianism, deontology, or principalism (Beauchamp & Childress, 2009). The decision-maker determines their obligations and responds accordingly (e.g., "What obligation, if any, do I have for this person?").
Responsibility-Based Ethics: Starts with the relationship with others as its foundation.
"Habit of Care": Tronto (1993) described the ethic of care as developing "a habit of care" (p. 127). Nurses would ask how to best fulfill their caring responsibility.
Third Version: Chris Gastmans (2006) and Margaret Little (1998)
Central Question: "What is the best way to care for this patient at this time?"
Care as Moral Orientation: Unlike a full theory, they viewed the ethics of care as a moral orientation from which action emanates.
Limitations of Care as a Sole Tool: Critics believe care is essential for moral sensitivity and responses but requires additional tools for moral problem-solving (e.g., those found in Beauchamp and Childress (2009) or Tronto's (1993) four elements).
Moral Vision: Some individuals exhibit