Care and justice reasoning in nurses' everyday ethics.

Abstract

Background: The ethics of care and justice represent two modes of moral reasoning that nurses use in solving real-life ethical dilemmas. Research aim: The present study investigated what types of dilemmas nurses encounter in everyday work and to what extent they use care versus justice reasoning to solve them. Research design: The study used a cross-sectional survey design. Participants reported a real-life ethical dilemma and its resolution through an online survey. Open-ended data were analysed with an adjusted taxonomy of real-life moral dilemmas and moral orientations. Quantified data were analysed with statistical methods (χ²-test, analysis of variance). Participants and research context: Participants were 334 registered nurses and 177 practical nurses from four health and social care organisations in Finland. Ethical considerations: The study was approved by the Research Ethics Committee of Finnish Institute for Health and Welfare. Findings: Nurses reported six types of ethical dilemmas. Nurses used more care reasoning on the needs of others and conflicting demands dilemmas than on applying rules, social pressure and reacting to transgression dilemmas. Applying rules and needs of others dilemmas were the most common types of ethical dilemmas in both occupations. Practical nurses reported more non-ethical dilemmas than registered nurses did. Discussion: Ethical dilemmas of nurses are diverse, and the use of care and justice reasoning is differentiated according to the type of dilemma. Care reasoning dominates nurses' ethical decision-making when responding to the needs of patients. Nurses use justice reasoning when they apply regimens, rules and procedures. In everyday ethics, care and justice reasoning complement each other. Conclusions: Highly regulated healthcare environments prefer rule-oriented justice reasoning that may supersede care reasoning in addressing patients' situations. Focus on technical-professional expertise may further hamper nurses' ethical decision-making. Nursing education and management should encourage nurses to use ethical concepts and values in their work.