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Nurses face ethical challenges on a daily basis, considering these within a social-ecological framework can assist in developing strategies and resolutions.

This commentary, based on the important contributions of this volume, is intended to summarize where we are with respect to the initial clinical trials of DC: 0 -3. On the one hand, the information we have can be regarded as disappointing. It is disappointing that there have not been a greater number of reported clinical trials since the classification system was introduced in 1994, especially with respect to trials in North America, where DC: 0 -3 was constructed. It is also disappointing that we have not been able to go further with information about its research related criteria of reliability and validity. On the other hand, we can temper our disappointment with gratitude, because we have learned a considerable amount about clinical usefulness from the work represented in these contributions. DC: 0 -3 is a new classification system, initiated by infant mental health clinicians to supplement DSM and ICD systems for more practical application in the early years, and so systematic information about usefulness is important. Thus, concerning clinical trials one can easily be swayed by our disappointments and say that the proverbial cup is half empty. As optimists, though, we prefer to take stock of where we are and say the cup is half full. Before moving to our summary of the trials that have taken place it seems appropriate to frame an overall perspective for diagnostic classification; this, in turn, will give us a basis for evaluating the trials and the other experiences reported in this issue with DC: 0 -3. It will also give us a basis for recommending a revision that can readily be implemented.