Visiting Nurses’ Situated Ethics: beyond ‘care versus justice’

Abstract

This article discusses Dutch visiting (district) nurses' moral considerations of their daily work. It is based on an empirical study using extensive semistructured interviews. The study is informed by the theoretical debate on the 'ethics of care' and the 'ethics of justice'. It is argued that this debate easily turns into an unfruitful contest between these two perspectives: which one is best? The results suggest that visiting nurses' moral considerations of their day-to-day work can be described well in terms of an ethic of care. At the same time, however, concepts and issues central to an ethic of justice are also of crucial importance to their considerations. Nurses' ways of managing to combine both perspectives, even in situations of apparent conflict between them, are described. Thus, clues are provided on how the debate on the ethics of care and the ethics of justice may be carried out in a more fruitful way apart from through hierarchically opposing both perspectives.

Nurses as Guests or Professionals in Home Health Care

“…Sometimes the metaphor 'guest' is used to describe a nurse practicing in patients' homes, 32 although most studies have not explicitly explored nurses' position as guests. 33,34 How then, do nurses describe themselves and the care given to patients at home?…”

Dementia Care Work Situated Between Professional and Regulatory Codes of Ethics

“…The provided analysis has presented some ethically challenging care work situations, as well as practices for addressing them, in the context of professional care for people with dementia. Such situations are not unique to the cases studied here; rather they represent common challenges reported in care services across care settings and countries (see examples in Gremmen 1999;Oberle and Tenove 2000;Tønnessen, Nortvedt, and Førde 2011;Choe, Kim, and Lee 2015). Providing safety for people with dementia while maintaining their dignity and not overruling their autonomy is a demanding (and at times impossible) task.…”

“…Gremmen 1999; Barnes and Brannelly 2008;Weinberg 2010;Brannelly 2011;Banks 2014). Scholars have found differences in care work practices between the 'ethics of care' and the 'ethics of justice' (Gremmen 1999) or between 'situated' and 'regulatory codes of ethics' (Banks 2014). Regulatory codes of ethics are organizational rules that provide detailed guidance of what carers should do in particular situations.…”

A Case Study: The Nurse Researcher in the Home Setting

“…The owner of the home is considered to be the authority in that home (Gremmen, 1999). In the American culture, guests are expected to defer to the home owner and abide by the rules of conduct of the home owner (United States Bureau of Education and Cultural Affairs, 2011).…”

“…Other principles of ethics of care are promoting trust, attentiveness, openness and communication. These two perspectives, justice and care, are frequently viewed as opposites or at odds (Gremmen, 1999). Ethics of care is often viewed as a feminine perspective with lesser status and ethics of justice is regarded as having a masculine viewpoint and a higher position (Clement, 1996).…”