Care Ethics and Nursing Values: A Clinical Case Study Analysis

This report delves into the application of care ethics within a nursing context, using a clinical case study to illustrate ethical dilemmas and decision-making processes. The assignment begins by defining care ethics and its significance in nursing practice, emphasizing its role in promoting patient well-being and incorporating patient autonomy. It then presents a detailed scenario involving a 70-year-old patient in palliative care, highlighting conflicts of interest and ethical challenges faced by the healthcare team. The report analyzes the actions and perspectives of various actors in the scenario, including nurses and the ward manager, using virtue ethics as a framework for ethical evaluation. It explores the impact of individual values, emotions, and professional responsibilities on decision-making, particularly concerning the patient's pain management and care interventions. The report concludes by emphasizing the crucial role of care ethics in providing safe, responsive, and patient-centered care, and it reflects on the author's learning and the importance of ethical sensitivity in nursing practice.

Running head: CARE ETHICS
Name of the Student
Name of the University
Author Note

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Introduction:
In general, the ethics are defined as principles, values, and care which enable a person to
live a morally good life. The term care ethics refer to the idea concerning both the nature of
mortality and normative ethical theory (Vryonides et al. 2016). As discussed by Mill et al.
(2016), it is a feminist philosophical perspective that uses a relationship as well as context bound
approach toward morality along with decision making. The care ethics in the nursing practice
is highlighted as one of the crucial parts of the standard practice which share many principles
with the medical ethics such as respect for autonomy and dignity, autonomy, beneficence, non-
maleficence (Peter 2016). The case study represents a terminal stage of metastasis cancer of a
70-year-old single lady, Betty who was admitted to the palliative care unit for elderly care.
However, during the care process, various conflict of interest and an ethical dilemma arises
which affected her treatment process. The purpose of the paper is to demonstrate care ethics and
nursing values with the assistance of a scenario. This paper will discuss the approach to care
ethics in clinical practice, description of scenario, and ethical round of the scenario in the
following paragraphs.
Discussion:
The moral theory is known as care ethics which indicted that care following
professional ethics are fundamental components of a relationship and human life (Peter 2016).
As discuses by Sundean, and Polifroni (2016) care ethics seek to maintain a therapeutic
relationship by promoting the wellbeing of the caregiver and patients in society. It is the most
crucial component of practice since it involves the meeting of the needs of others and ourselves
by incorporating patient in the decision making, respecting the autonomy of the patient (Bliss et

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al. 2017). Considering the clinical practice, there are several ethical issues arises in the clinical
setting which affected the treatment of the patient and wellbeing of the patient. Taking an
insight of the situation, as discussed by Aydin, ehiralti and Akpinar (2017), care ethics is
highlighted as better approach compared to other principles since it is situational based approach
since it is taken into consideration the key factors that lead to the situation and provide care
considering these factors without breaching the ethics for promoting the wellbeing of the patient.
The care ethics influenced patient differently than other approaches because it allows the health
professionals to prioritize the patient by incorporating five component of care such as care,
compassion, competence, communication, courage and commitment (Bliss et al. 2017). Besides,
it allows to design best possible care for promoting the wellbeing of the patient since they feel
comfortable, empowered and safe. For this essay virtue ethics is chosen since it allows
individuals to focus on the honest, braveness and moral character by providing justice (Leget,
Nistelrooij and Visse 2019). This principle is better than deontological ethics is which based on
the fact that whether the action is the wrong or right under a serious of rules rather than
considering the consequences of the actions.
Case scenario:
Betty (pseudonym) is a 70-year-old single lady admitted to the palliative care unit on my
placement of elderly care. She is in the terminal stages of metastatic cancer and as a result she
needs assistance with her activities of daily living. Her admission notes ordered she was to be
kept comfortable with medication. A special mattress was ordered to prevent skin breakdown,
but the staff still need to turn her every two hours to prevent bedsores and change bed linens.
Betty cried out from the pain to the extent that staff wondered if their interventions were
working. Finally; The Multidisciplinary team (MDT) including me, met to decide what they

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should do. The ward manager suggested that Betty should be turned two-hourly for linen
changes and to observe her skin. Noleen; a nurse on the unit for almost 15 years and
acquaintance of Betty’s stated that she could not bear to hear her cry every time she was turned
and suggested her sedation to be increased to reduce her pain and facilitate linen changes. Stella,
a recent graduate, voiced her opinion that the patient should have some say regarding her care.
Olga another nurse thought that Betty’s consultant was the one who should make the decision
whether Betty should be turned; the nurses would follow his orders which the rest of the nurses
objected. They argued that turning a patient, changing linen, and observing for skin breakdown
are nursing measures.
Actors and actions:
Taking an insight into the situation, the actors of the scenario involve ward manager who
suggested that Betty should be turned two-hourly for linen changes and to observe her skin.
Noleen; a nurse on the unit for almost 15 years and acquaintance of Betty’s stated that she could
not bear to hear her cry every time she was turned and suggested her sedation to be increased to
reduce her pain and facilitate linen changes. Stella, a recent graduate, voiced her opinion that the
patient should have some say regarding her care. Olga, another nurse thought that Betty’s
consultant was the one who should make the decision whether Betty should be turned; the nurses
would follow his orders. Other nurses who objected this situation.
Ethical round of the scenario:
Considering the situation, in order to prevent skin breakdown, a special mattress was
ordered to prevent where nurses were required to turn her every two hours to prevent bedsores

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and change bed linens. Here conflict of opinion observed in the situation regarding what
should be the best interventions for Betty to reduce her suffering. As discussed by Gallagher et
al. (2015), conflict of opinion is serious disagreement in the clinical practice which is quite
common in health care. The conflict of opinion is the difficulty in utilitarian ethics which think
of what makes people happy and what is good for people (Ling et al. 2017). The first priority of
every actor in this situation was Betty and her wellbeing which reflected through their
suggestions and to promote the wellbeing of Betty every actor of the situation use their own
values along with ethics. Considering myself in this situation, I follow the virtue ethics since I
believe that being a person my honesty, respect towards the patient, forgiving nature an empathy
will influence the care receiver. Initially, while I met them for the discussion regarding decision
making since Betty cried out from the pain, it broke my heart to see her in pain and I empathize
with the patient and felt that I should involve myself in the decision making which would
promote the wellbeing of the patient. I believe it is an unethical way of treating service users
where they are not receiving accurate care for their wellbeing. In this case, I feel ethical
sensitivity comes into play regarding the care of Betty. Considering the staff manager, he
suggested that Betty should be turned two-hourly for linen changes and to observe her skin. The
prime reason behind it is that maybe he thought that betty required a change of interventions for
her wellbeing to which he suggested the continuous monitoring of betty to check the status of her
skin. He taken into consideration the professional responsibility and accountability for the
wellbeing of Betty and suggested evidence-based practice, highlighting the fact that he believed
in justice (Campbell and McCarthy 2017). However, he believed in utilitarian ethics as care
ethics which focuses on what makes people happy which led to the decision of observing skin,
highlighting the focus on the consequences of the action. Noleen was working almost 15 years

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and acquaintance of Betty unable to bear her pain, highlighting that she had a lack of emotional
control. As discussed by De Natalz and Waltz (2015) a nurse should be empathetic towards
patients and compassionate with experience of the patient to provide accurate care but a nurse
should be confident enough to take the best decision for the patient, ensuring that her emotions
and personal values should not influence her decision. In the current context, Noleen was feeling
helpless and emotional experiencing the suffering of Betty which made her provides the
suggestion that her sedation to be increased to reduce her pain and facilitate linen changes. This
decision reflected her nursing values such as altruism and justice. As discussed by () altruism in
nursing practice defined as a selfless concern for the well-being of others. Since Noleen
encountered with Betty during her care process she showed selfless concern for Betty so that
her suffering can be reduced. However, as discussed by Traynor et al. (2017), while working
with the patients, nurse exposed psychological distress because of their lived experience with the
patients they counters which sometimes influence their decision and maybe give rise to ethical
issues. In the current context, her inability to hear Betty suffering led to the decision of the
increasing her sedation to be increased to reduce her pain because she wanted to see the lady
have some happiness in the final period of her life. Although she thought about the wellbeing of
the patient it is also influenced by her emotions and values that may give rise to an ethical
dilemma (Traynor et al. 2017). Stella, a recent graduate suggested that patients should be
incorporated in her practice, highlighting the fact that a patient-centered approach should be
integrated into the nursing practice. As discussed by Slatyer et al. (2016), person-centered
approach is one of the crucial attributes of the care of ethics which enable nurses to incorporate
patients in the treatment, providing patients an opportunity to share their concern and participate
in the decision making. Considering the situation, it is the responsibility of the nurse to

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incorporate Betty as a part of care ethics which would promote empowerment and comfort and
shows the respect for autonomy, these values reflected through the decision of Stella when she
suggested patient to incorporate in the treatment procedure (Traynor et al. 2017). Considering
Ogla, who believed that Betty’s consultant should be the one who takes the best decision of her,
highlighting the dependency of that nurse. She believed that Betty’s consultant knew best
about her health conditions which further highlighted the dependency nature. Although a consult
knew better about the patient it is the responsibility of the nurse to participate in the decision
making to design best interventions for the patients (Baillie 2017). Since she believed that the
consultant knew better and should take the decision alone, it may give rise to an ethical dilemma.
Because of her decision rest of the nurses objected because they want to stick to their nursing
values and ethics which are providing accurate and comprehensive assessment to provide
comprehensive care. The incident also highlighted virtue ethics rather than utilitarian ethics that
led to the conflicts. Because of the difference in values the argument existed between health
professionals and it should be resolved by considering each component of care ethics and
designing what should be best for the patient.
Conclusion:
Thus it can be the conclusion, the care ethics are extremely important attributes of
nursing practice which provide a nurse to provide safe and responsive care. The exercise helped
me understand that ethical nursing care crucial for providing safe and responsive care to the
patient which is the prime goal of nursing. The exercise allowed me to gain an understanding of
the ethics of care in clinical practice and how it should be incorporated. The paper was allowed
me to reform my values and nursing practice by incorporating care ethics. The case study
represents the health condition of Betty who was admitted to the palliative care department. The

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argument took place regarding the nursing measures such as linen and observing for skin
breakdown where different health professionals reflected their values. This exercise affected my
learning since I went through an ethical dilemma regarding patient care and which ethics we
follow virtue, deontology or Utilitarianism. After experiencing the incident that I realized that to
provide care nurses should incorporate patient in the care process and take decision what is best
for the patient and I will incorporate this in my future practice.

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References:
Ackelsberg, M. A., & Shanley, M. L. 2018. Privacy, publicity, and power: A feminist rethinking
of the public-private distinction. In Revisioning the political (pp. 213-233). Routledge.
Aydin Er, R., Sehiralti, M. and Akpinar, A., 2017. Attributes of a good nurse: the opinions of
nursing students. Nursing Ethics, 24(2), pp.238-250.
Baillie, L., 2017. An exploration of the 6Cs as a set of values for nursing practice. British
Journal of Nursing, 26(10), pp.558-563.
Bliss, S., Baltzly, D., Bull, R., Dalton, L. and Jones, J., 2017. A role for virtue in unifying the
‘knowledge’and ‘caring’discourses in nursing theory. Nursing inquiry, 24(4), p.e12191.
Campbell, L. and McCarthy, J., 2017. A decision-making tool for building clinical ethics
capacity among Irish health professionals. Clinical Ethics, 12(4), pp.189-196.
De Natale, M.L. and Waltz, C.L., 2015. Reflections of nursing students travel abroad
experiences in Ireland: a global nursing perspective. Nursing Education Perspectives, 36(3),
pp.188-189.
Gallagher, A., Bousso, R.S., McCarthy, J., Kohlen, H., Andrews, T., Paganini, M.C., Abu-El-
Noor, N.I., Cox, A., Haas, M., Arber, A. and Abu-El-Noor, M.K., 2015. Negotiated reorienting:
a grounded theory of nurses’ end-of-life decision-making in the intensive care unit. International
Journal of Nursing Studies, 52(4), pp.794-803.
Leget, C., van Nistelrooij, I. and Visse, M., 2019. Beyond demarcation: Care ethics as an
interdisciplinary field of inquiry. Nursing ethics, 26(1), pp.17-25.

9CARE ETHICS
Ling, D.L., Yu, H.J. and Guo, H.L., 2017. Truth-telling, decision-making, and ethics among
cancer patients in nursing practice in China. Nursing ethics, p.0969733017739783.
Mill, J. E., Allen, M. N., and Morrow, R. A. 2016. Critical theory: Critical methodology to
disciplinary foundations in nursing. Canadian Journal of Nursing Research Archive, 33(2).
Peter, E. 2016. The politicization of ethical knowledge: feminist ethics as a basis for home care
nursing research. Canadian Journal of Nursing Research Archive, 32(2).
Peter, E., 2016. The politicization of ethical knowledge: feminist ethics as a basis for home care
nursing research. Canadian Journal of Nursing Research Archive, 32(2).
Slatyer, S., Coventry, L.L., Twigg, D. and Davis, S., 2016. Professional practice models for
nursing: A review of the literature and synthesis of key components. Journal of Nursing
Management, 24(2), pp.139-150.
Sundean, L.J. and Polifroni, E.C., 2016. A feminist framework for nurses on boards. Journal of
Professional Nursing, 32(6), pp.396-400.
Traynor, M., Galanouli, D., Roberts, M., Leonard, L. and Gale, T., 2017. Identifying applicants
suitable to a career in nursing: a value‐based approach to undergraduate selection. Journal of
advanced nursing, 73(6), pp.1443-1454.
Vryonides, S., Papastavrou, E., Charalambous, A., Andreou, P., & Merkouris, A. 2015. The
ethical dimension of nursing care rationing: A thematic synthesis of qualitative studies. Nursing
ethics, 22(8), 881-900.