This reflection paper explores the ethical foundations of nursing practice through a personal lens. The author examines how spiritual beliefs, cultural values, and formative life experiences — including childhood observations of elder care — have shaped a personal nursing philosophy. Key ethical challenges discussed include conflicting loyalties between patients, colleagues, and administrators; end-of-life decision-making; the therapeutic role of spirituality in patient care; and contentious issues such as medical cannabis and treatment refusal on religious grounds. Drawing on Winslow & Wehtje-Winslow (2007) and Trevizan et al. (2004), the paper argues that a strong, flexible moral compass — rooted in patient advocacy and whole-person care — is essential to ethical nursing.
A strong ethical component undergirds the nursing profession. Nurses have an express duty to care, and we are driven by the desire to help others. When completing the "My Nursing Ethic" questionnaire, I was asked to search for the roots of my passion and motivation. I was also asked to consider who or what inspires me, and to whom I am loyal. It is this latter question that becomes the most challenging, because nurses will often discover they have conflicting loyalties. Most of the ethical challenges I have encountered as a nurse stem from grappling with conflicting roles, duties, and responsibilities.
Although we may try to cultivate objectivity, our backgrounds, beliefs, and worldviews prevent nurses from being completely unbiased in our approach. We are human beings, not robots. The personal, cultural, and spiritual values that have contributed to my worldview — and continue to do so — shape my philosophy of nursing. I believe that religion and spirituality are deeply personal, and I rarely share my beliefs with others. I was raised in a non-denominational household but nevertheless developed a strong spiritual identity. Drawn to prayer and meditation naturally, I have always respected the religions of others.
When I work with religious patients from all backgrounds, I am more than happy to encourage them to explore the spiritual dimensions of their suffering and their goals in healing. Because religion and culture are closely connected, I have always found that patients respond better when they are surrounded by family members who provide emotional support in culturally relevant ways. As Winslow & Wehtje-Winslow (2007) point out, there is "mounting evidence that spirituality can be significant in patients' recovery from illness and the evidence that most patients want to have attention to their spirituality included in their health care" (p. 1). Thus, nurses have a responsibility to recognize the importance of spirituality by actively seeking patient input on the matter.
Spirituality is "invaluable" also in the construction of a core nursing ethic, providing the underpinnings for sound decision-making (Trevizan et al., 2004, p. 791). Decisions should be made consistently, and yet with sensitivity to the nuances and uniqueness of each patient and each caregiving situation. While my moral compass does include some absolute cardinal points, there is room for flux and flexibility.
Some of the toughest ethical dilemmas actually arise in my relationships with coworkers and administrators, as opposed to working directly with patients. I frequently clash with a supervisor or coworker over views toward visible displays of patient faith, even when evidence does support the inclusion of faith within a whole-person system of care (Winslow & Wehtje-Winslow, 2007). Moreover, there are broader ethical conundrums that indirectly impact quality of care. I have often disagreed with structural issues in American healthcare and hope that in the future I can work more extensively in the area of patient advocacy.
"Childhood experience inspiring elder care advocacy"
"End-of-life, medical cannabis, and treatment refusal ethics"
Inspired to action by nurses who are devoted to promoting patient health and well-being, I know that any ethical dilemmas that arise may be resolved reasonably with the best interests of the patient in mind. Money should never come before patient rights. One's preference for a certain religion or worldview should likewise never interfere with a nurse's ability to deliver care. When we consider the diversity of our communities, it is our responsibility to learn more about what patients need for their healing. When my personal values converge with the core goals and objectives of the patients and their families, I know my work has been completed with aplomb.
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