A theoretical basis and its problems in nursing ethics: A text analysis of Notes on Nursing

Abstract

This study aims to identify normative principles and related ethics issues intrinsic to traditional nursing science, and explore suggestions from this to choose an appropriate ethics theory, which could assist in developing a responsible nursing ethics. Eight basic norms, based on Florence Nightingale’s understanding of nursing, were derived from a text analysis of Notes on Nursing, where we identified passages with ‘ought’ as ethics index items. The eight norms may be classified into two groups: behavioral and cognitive. The behavioral norms concern nursing activities, including some bioethics principles. The cognitive norms are concerned with nursing as a specialty related to scientific and managerial issues in nursing. Cognitive norms can provide nurses with a basis for common nursing practices. However, neither provide a basis for ethical thinking about morally responsible behaviors. Further, the relations between norms and laws in the text suggest that other than relying on the laws of God, nurses should be autonomous in managerial activities to improve patient health. Virtue ethics is unsuitable for forensic psychiatric nursing practice. Owing to its universalizability, the most suitable ethics theory to supplement moral principles in nursing needs to be utilitarian and thus one that includes deontology.