Ethics in Nursing: the Caring Relationship

A discussion of 'ethics relevant to nursing' or 'nursing ethics' should perhaps define the realms of nursing and ethics and so explain why a text on the subject is necessary. Tschudin relates the rise of nursing ethics to the new awareness of professional responsibilities among nurses. Individualised care and the nursing process has, she claims, made nurses much more involved with the feelings and rights of the patients they care for. They therefore require more knowledge and understanding of both the proper processes of decision-making and of ethical dilemmas which have to be tolerated. This book is proposing to help by providing information and guidance. Perhaps what is seen as most special to nursing by Tschudin is the caring nature of the work. The first chapter of the book is occupied by an explanation of a caring relationship. In one sense this is slightly puzzling as the reader searches for what is pertinent to ethical matters. However, subsequent chapters become more relevant and applied to the work of nurses with patients. After another abstract section on ethical theories the writer includes complete copies ofthe codes ofconduct for nurses issued by the United Kingdom Central Council for Nursing and the Royal College of Nursing, which should be useful to students or those who are unprofessional enough not to have studied them previously! It is really the last section of the book in which three chapters discuss ethical decisions, issues and dilemmas, that may seem most familiar to nurses ofany grade. Useful strategies for studying issues and making decisions are outlined and based on the classic ethical principles of 'value of life', 'goodness or rightness', 'justice or fairness', 'truth telling or honesty' and 'individual freedom'. This subject of ethics in nursing may be seen as so important for practitioners, as indeed the author believes, that it is difficult for a tiny book to do it justice, even as an introduction. Although Verena Tschudin has tried to integrate nursing and ethical issues, some sections seem slightly simplistic while others are rather sophisticated. For instance the contrast between the rather pseudophilosophical section on caring (at 'O' level standard) with the clear, academic, well-referenced style of subsequent sections on theories and values is startling. However, this is not a unique problem for nursing authors in seeking for an appropriate level and a reasonable price. Just as nursing is changing to expect a more scientific and rational basis for care so readers should deserve that level of material. Tschudin demonstrates how this can be done usefully for students and others in some later chapters. Students could benefit from this as an introduction to stimulate thought and interest in this area but of course the subject certainly deserves more advanced work.