Introduction
The nursing profession requires strong moral values and personal beliefs. The development of a worldview has had a significant impact on a nurse’s moral ways of seeing, believing, and acting. The more pluralistic the world has become, the more value systems there have been available to nurses and the more complex their ideas about what constitutes the moral life and how best to achieve it.
There is increasing recognition that our moral standards are not absolute, but are “ever-changing social creations” (Sullivan & Decker 2005, p. 4). Such skills include the ability: to read the world, which means not the only question but to call into question things as they are; to anticipate moral problems and take the necessary action to prevent them from occurring in the first place, otherwise known as preventive ethics.
The task of a nurse is to develop and follow moral philosophy that is concerned with establishing a standard of correctness by the prescription of certain rules and principles. Ethics inquiry is not so much concerned with how the world is, but with how it ought to be. In other words, it is not concerned with merely describing the world (although, of course, a description of the world is necessary as a starting point for an evaluative inquiry.
Worldview
The worldview is explained as the way a person or group understands the world about them and their perspective about life and the world (Tomey & Alligood, 2002). The worldview helps every person (and nurse) to think critically and reflectively about emergent and emerging moral issues; to discern a range of possible solutions to moral problems identified; to communicate effectively with others; to respect, listen to, understand, and be compassionate toward others; to be tolerant, flexible, creative and imaginative when dealing with and attempting to resolve moral problems; to act as a moral negotiator and mediator when confronted by competing moral viewpoints (Daniels, 2004).
My worldview is based on ideas of morality, ethics, and humaneness. The agreed end of the profession and practice of nursing is the promotion of health, healing, and wellbeing, together with the alleviation of suffering, in individuals, groups, and communities for whom nurses care.
This end is moral, and one that carries with it a strong moral action-guiding force for nurses insofar as it requires nurses to engage in the behaviors necessary to promote health, healing, and wellbeing in people, and, when manifest, to alleviate their suffering (Potter & Perry, 2005). The agreed ethical standards of nursing require nurses to promote the genuine welfare and wellbeing of people in need of help through nursing care and to do so in a manner that is safe, competent, therapeutically effective, culturally relevant, and just. My philosophy is to take care of the patient, to the best of my ability. Take care of the person as a whole. For me, it means taking patients and their environment as a single whole (Daniels, 2004).
Metaparadigm
Another important concept which helps to define my values is the metaparadigm. It can be explained as a phenomenon of central interest to the discipline (Fawcett 2000, p. 4). Metaparadigm concepts of Nursing involve health, person, environment, nursing, and caring. I suppose that moral diversity supports these issues and helps to ensure that no one moral point of view dominates; in short, it helps to prevent what might otherwise be termed “moral fascism” (Potter & Perry 2005, p. 76).
Meanwhile, its emphasis on understanding difference rather than striving for uniformity will help to ensure the moral system nurses end up in (Potter & Perry, 2005). Metaparadigm is the sub-domain of a worldview that is concerned with the nature, logical form, and language of the world structure and functions. Today, adopting a transcultural approach to nursing can be beneficial in a range of ways. Among other things, at a global level, it can enable cross-cultural interactions that ‘build bridges of understanding between persons and cultures that make cooperation possible and conquest unnecessary’ (Potter & Perry 2005, p. 6).
It can also help to avoid the perils of ‘moral suprematism’ such as those which have been amply exemplified during wartime. The goal of a nurse is ‘to reach a common set of moral ideals which everyone can follow’ or, rather, to ”seek principles of conduct which everyone can live by “ (Leininger & McFarland 2002, p. 34). Moral principles are needed to regulate our moral decisions and to help settle competing alternatives. Moral principles remind us of our overriding duties to others and the merits of morally principled action. Principles of morality also lend people ‘tools’ which can be used to deal appropriately and effectively with moral crises and dilemmas in both everyday and special (e.g. professional) worlds) (Leininger & McFarland, 2002).
Metaparadigm Concepts of Nursing
Health
I perceive health as a dying process at the slowest possible rate. The task of a nurse is to help the patient find ways and methods to prologue his well-being. Other important practical issues concern the moral imperatives of the professional, client relationship (including mutuality, therapeutic alliance, safety, security, trust, compassion, and empathy); the moral dimensions and unacceptable consequences of stigma and discrimination; and the moral imperatives of transcultural mental health nursing, to name some (Potter & Perry, 2005).
Health involves a holistic concept of wellbeing; this is in contrast with traditional medicocentric notions of health being merely the absence of disease or as something that can only be measured physiologically. Health care, in turn, can be provided by a range of people, not just members of the medical profession. Many people do not seek professional medical care; often they seek and receive help for their health problems from other people (Potter & Perry, 2005).
Person
The concept of ‘person’ means the one receiving care. In terms of meta paradigm, it could be one or a million. The nursing profession is fundamentally concerned with the promotion and protection of people’s genuine wellbeing and welfare, and in achieving these ends, responding justly to the genuine needs and significant interests of different people (Daniels, 2004). The nursing profession is, therefore, fundamentally concerned with ‘moral problems’ as well as other kinds of problems (for example, technical, clinical, legal, and so forth).
Mataparadigm involves multifaceted and complex human beings who have very real feelings and moral interests, and who are more often than not faced with very real and significant threats to these moral interests and, ultimately, their wellbeing. Dealing effectively with moral problems in nursing care domains is thus not an easy task and, among other things, requires a deep and informed understanding of the complexities and ‘messiness’ of human life. Nurses are not immune from the many and complex moral problems that plague health care domains (Potter & Perry, 2005). As in the case of other professional (client relationships, no nurse) patient relationship occurs in a moral vacuum or is free of moral risk.
Nurses have the capacity (whether by act or omission) to harm as well as benefit their patients. Nurses, therefore, need to be especially vigilant regarding both their capacity to harm the significant moral interests and wellbeing of patients, and to take appropriate action to prevent such harms from occurring, even those which might be deemed ‘inadvertent’ and ‘accidental’. To be effective in preventing harm occurring in nursing care domains, nurses must have an informed knowledge and understanding of the nature of problems and the various forms in which they can manifest (Sullivan & Decker, 2005).
Environment
The concept of environment evolves the patients’ surroundings: external and internal. It is quite probable that a nurse’s responsibilities do not just begin and end with an individual patient (Sullivan & Decker, 2005). If the whole notion of moral obligation is taken seriously from a professional point of view, then there is considerable room to suggest that the moral responsibilities of nurses extend far beyond their immediate one-to-one professional, client relationships to include other things such as professional and political activism aimed at improving the plight of those who suffer from mental health problems (Fawcett, 2002).
The activism of this kind could be aimed at securing such things as the demystification and destigmatization of mental health disorders, mental illness and other mental health problems, better mental health care services (to be distinguished here from psychiatric services) for the community, and other general mechanisms which will assist those with mental health problems to be spared the devastating consequences of stigma and discrimination which many continue to suffer (Daniels, 2004; Sullivan & Decker, 2005).
Nursing
Nursing means caring and medical help, support, and psychological help. When dealing with moral problems nurses need to remember, meanwhile, that sometimes it may be difficult to take the ‘morally correct’ action because of various institutional and legal constraints (Sullivan & Decker, 2005). As has already been discussed and demonstrated in this text, nurses can suffer enormously if they take a firm moral position about a clinical nursing or controversial medical matter. Life can be made torture for nurses if they do not conform to the status quo, and in many instances, they have no choice but to ‘voluntarily’ resign (Fawcett, 2002).
Nursing knowledge does not exist independently of medical knowledge; similarly, neither should overlap in medical and nursing care be taken as implying that nursing ethics is at best only vicarious to or a subcategory of medical ethics. Nursing ethics can be defined broadly as the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice which, in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health, healing, environment, and nursing itself all of which have been comprehensively articulated in the nursing literature (Fawcett, 2002).
Caring
Caring could be explained as an internal feeling or described as a feeling. My definition of caring is taking pride in meeting the patient’s needs, and aiding the patient and his/her body on the road to healing (Fawcett, 2002). Following Daniels (2004), my worldview is based on the idea of virtuous caring which is integral to ‘good’ (moral) nursing practice (and, by implication, nursing ethics) in at least two important ways.
First, virtuous caring or right attitudes (which include the behavioral orientations of compassion, empathy, concern, genuineness, warmth, trust, kindness, gentleness, nurturance, enablement, respect, mutuality, giving presence (being there), attentive responsiveness, providing comfort, providing a sense of safety and security, and others) have all been thoroughly implicated as effective nursing healing behaviors in the alleviation of human suffering (Sullivan & Decker, 2005).
Caring for patients and caring for people is not just a task; it is itself a virtuous moral ideal of nursing. If nurses are to uphold this ideal and uphold it well they must include a sound and experientially based moral point of view in their clinical nursing practice. As well as this, they must be able to function as competent moral problem-solvers and decision-makers, and truly make a difference in terms of promoting and protecting the welfare and genuine moral interests of all those for whom they care (Leininger & McFarland, 2002).
Conclusion
Nurses, like other health professionals, encounter many moral problems in the course of their everyday professional practice. These problems range from the relatively ‘simple’ to the extraordinarily complex and can cause varying degrees of perplexity and distress in those who encounter them.
For instance, some moral problems are relatively easy to resolve and may cause little if any distress to those involved; other problems, however, may be extremely difficult or even impossible to resolve, and may cause a great deal of moral stress and distress for those encountering them. Nurses, like other health care professionals, have a fundamental and unavoidable moral responsibility to be able to identify and respond effectively to the moral problems they encounter, and, where able, to employ strategies to prevent them from occurring in the first place.
References
- Daniels, R. (2004). Nursing Fundamentals: Caring and Clinical Decision Making, Thomas Learning, Oregon.
- Fawcett, J. (2002). The Nurse Theorists: 21st-Century Updates—Madeleine M. Leininger. Nursing Science Quarterly, 15 (2): 131-136.
- Leininger, M. M., & McFarland, M. (2002). Transcultural nursing: Concepts, theories, research, and practices. 3rd edn. McGraw-Hill.
- Potter, P. & Perry, A. (2005). Fundamentals of Nursing. Elsevier PTE LTD, Singapore.
- Sullivan, E.J., Decker, Ph. J. (2005). Effective leadership & Management in Nursing 6th ed. Pearson Hall.
- Tomey, A. M., Alligood, M. R. (2005). Nursing Theorists and Their Work. Mosby;.