Introduction 1. Woman's Place in Man's Life Cycle 2. Images of Relationship 3. Concepts of Self and Morality 4. Crisis and Transition 5. Women's Rights and Women's Judgment 6. Visions of Maturity References Index of Study Participants General Index

In a Different Voice. Psychological Theory and Women’s Development. Cambridge, MA (Harvard University Press) 1982.

How to ... be a reflective practitioner.

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Narrative Methods for the Human Sciences

Theory in Practice: Increasing Professional Effectiveness

Symposium Review: 25th Anniversary of Moral Boundaries by Joan Tronto

The physical nearness, or proximity, inherent in the nurse-patient relationship has been central in the discipline as definitive of the nature of nursing and its moral ideals. Clearly, this nearness is in service to those in need of care. This proximity, however, is not unproblematic because it contributes to two of the most prolonged difficulties, both for individual nurses and the discipline of nursing--moral distress and moral ambiguity. In this paper we explore proximity using both a moral and geographical lens and offer some insights regarding this practice reality. We examine the effect of proximity to patients on nurses' moral responsiveness, particularly as it affects nurses' moral distress. Proximity is paradoxical in this regard because, while it propels nurses to act, it can also propel nurses to ignore or abandon. Likewise, we argue that nursing's tendency to define itself in relation to the closeness of the nurse-patient relationship leads to problems of moral ambiguity. Our recommendations include moving others closer to the bedside and thus to the work of nursing in the literal and theoretical sense.

Perils of proximity: a spatiotemporal analysis of moral distress and moral ambiguity.

One result of the historical division of labor between nurses and physicians is that nurses became the eyes and ears of the physician, extending their perceptual capabilities across space and time. This “gaze of medicine” has evolved with the rise of technology, hospitals, and the medical profession

The moral geography of home care.

Background Collaboration between nurses and physicians is linked to positive outcomes for patients, especially in the intensive care unit. However, effective collaboration poses challenges because of traditional barriers such as sex and class differences, hierarchical organizational structures in health-care, and physicians' belief that they are the final arbiter of clinical decisions. Objective To further analyze the results of an investigation on how intensive care unit culture, expressed through everyday practices, affected the care of patients who became confused. Methods A model of the types of knowledge (case, patient, and person) used in clinical work was used to analyze the breakdown in collaboration detected in the original study. Results Breakdown of collaboration occurred because of the types of knowledge used by physicians and nurses. Certain types of knowledge were privileged even when not applicable to the clinical problem, whereas other types were dismissed even when applicable. Conclusion Viewing collaboration through the conceptual lens of knowledge use reveals new insights. Collaboration broke down in the specific context of caring for patients with confusion because the use of case knowledge, rather than patient knowledge, was prominent in the intensive care unit culture.

Understanding Collaboration Between Nurses and Physicians as Knowledge at Work

Background. Nursing has been understood as a calling, vocation, profession, and most recently, a practice. Each of these conceptualizations has associated with it an ethics that has emphasized particular aspects of nursing reflecting the social position of nursing in a given historical period. The ethics associated with current understandings of nursing as a profession and a practice are, we believe, no longer adequate to address the social realities and moral challenges of health care work.

Aim.  The aim of this paper is to discuss the limitations of the ethics associated with profession and practice and to show why the concept of work can contribute to a nursing ethics.

Discussion.  The characteristics that have socially defined professionals, among them the possession of a unique body of knowledge, provision of an altruistic service to society, and autonomy in the sense of control over their work and work conditions, only partially reflect the realities of contemporary health care work. This is true even for physicians, an exemplar of a professional group. The ethics associated with the professions has tended to limit what counts as a moral concern and who is authorized to label them as such. More recently, the idea of a practice has been used to argue for an ethics in which professional activities of a certain kind and understood in a specific way are inherently moral. However, this approach is limited for similar reasons. Because morality cannot be separated from the social organization of health care, we argue that considering nursing primarily as work, in contrast to a profession or a practice, offers the possibility of an ethics that more completely reflects the complexity of contemporary health care.

Conclusion.  Beyond the obvious conclusion that nursing is work, conceptualizing nursing as work points to changing social realities that are raising significant ethical issues. As a concept, work inherently conveys value, connects intellectual and manual labour, and recognizes social divisions of labour. At the moment an ethics of work is merely an idea, but we believe that such an ethics would lead nurses to ask different questions and propose different answers to the moral challenges of the present and near future.

Nursing ethics and conceptualizations of nursing: profession, practice and work

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life.

Joan Liaschenko

Papers

Perils of proximity: a spatiotemporal analysis of moral distress and moral ambiguity.

The moral geography of home care.

Understanding Collaboration Between Nurses and Physicians as Knowledge at Work

Nursing ethics and conceptualizations of nursing: profession, practice and work

Moral Distress Reexamined: A Feminist Interpretation of Nurses’ Identities, Relationships, and Responsibilites