This paper introduces the notion of open‐mindedness before proceeding to outline its value to the practical activity of nursing. An argument is constructed to point to the desirability of the development of a virtue of open‐mindedness in nurses in order to complement evidence‐based practice. Attention is drawn to two failures of open‐mindedness (the vices of closed‐mindedness and credulousness), which have the potential both to restrict autonomous practice and to cause harm.

Professional nursing -- Human vulnerability -- Practices and the practice of nursing -- Trust and trustworthiness -- Open-mindedness -- The place of the virtues in the education of nurses.

The values of nursing arise from a concern with human flourishing. If the desire to become a nurse is a reflection of an aspiration to care for others in need then we should anticipate that those who choose to nurse have a tendency towards the values we would normally associate with a caring profession (care, compassion, perhaps altruism, and so on). However, these values require a secure base if they are not to succumb to the corrupting pressures of the increasingly (...) instrumental nature of the values of the institutions in which healthcare in general and nursing in particular takes place. One way of securing a base for withstanding the corrupting influences of the institution is to understand nursing as a practice in the sense in which Alasdair MacIntyre uses that term. In this brief paper I will outline ways in which the managerial imperative of meeting targets is both distorting practice and undermining nursing’s values. I conclude that understanding nursing as a MacIntyrean practice provides a refuge from what might otherwise be overwhelming pressures for nurses to adopt instrumental values to the detriment of professional caring values. (shrink)

Few would argue with the idea that nursing research should be conducted ethically yet obtaining ethical approval is considered by many to have become unnecessarily burdensome. This brief article investigates the idea that there might be a relationship between the level of perceived burdensomeness of the research ethics application process on the one hand and the character of the nurse‐researcher on the other. Given that nurses are required to be other‐regarding, a nurse who undertakes research primarily for self‐regarding reasons would (...) seem to be acting in ways inconsistent with the aims of nursing as set out in nursing codes. It is suggested that the self‐regarding nurse‐researcher may find the ethics application process more burdensome than the other‐regarding nurse‐researcher who, it is further suggested, is engaged with nursing research as a practice in the technical sense in which that term has been developed by the philosopher Alasdair MacIntyre. (shrink)

In his attempt to explain and draw together disparate aspects of the tradition of the virtues MacIntyre develops a complex and specific concept that he terms a practice. By a practice he means to describe certain types of activities in which excellences can be pursued and that offer those engaged in a practice access to the goods internal to that practice.Sellman and Wainwright have both suggested that there are advantages to be had in understanding nursing as a practice in (...) this MacIntyrean sense. This paper suggests that nursing should be considered as a particular type of MacIntyrean practice, and I have used the term a professional practice to identify this species.This paper also considers some of the implications of such a perspective and suggests that one benefit of thinking of nursing as a professional practice is that it may offer a route by which the virtues necessary for nursing can be identified. (shrink)

The virtues have been a neglected aspect of morality; only recently has reference been made to their place in professional ethics. Unfashionable as Florence Nightingale is, it is nonetheless worth noting that she was instrumental in continuing the Aristotelian tradition of being concerned with the moral character of persons. Nurses who came under Nightingale’s sphere of influence were expected to develop certain exemplary habits of behaviour. A corollary can be drawn with the current UK professional body: nurses are expected to (...) behave in certain ways and to display particular kinds of disposition. The difference lies in the fact that, while Nightingale was clear about the need for moral education, current emphasis is placed on ethical theory and ethical decision-making. (shrink)

This book presents an exploration of concepts central to health care practice. In exploring such concepts as Subjectivity, Life, Personhood, and Death in deep philosophical terms, the book aims to draw out the ethical demands that arise when we encounter these phenomena, and also the moral resources of health care workers for meeting those demands. The series Values in Bioethics makes available original philosophical books in all areas of bioethics, including medical and nursing ethics, health care ethics, research ethics, environmental (...) ethics, and global bioethics. (shrink)

The idea that nurses should be trustworthy seems to be accepted as generally unproblematic. However, being trustworthy as a nurse is complicated because of the diverse range of expectations from patients, relatives, colleagues, managers, peers, professional bodies and the institutions within which nursing takes place. Nurses are often faced with competing demands and an action perceived by some as trustworthy can be seen by others as untrustworthy. In this article some of the reasons for the importance of being trustworthy are (...) offered together with a preliminary discussion about how being a trustworthy nurse is far from straightforward. (shrink)

The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the (...) literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier’s requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and ‘trust pretenders’ on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist. (shrink)

Many patients are subject to 'do not resuscitate' orders or are 'allowed to die'. The predominant moral position within health care seems to be that this is permissible, while voluntary euthanasia is not. This paper attempts to consider the logic of that position. It is not intended as a case for or against voluntary euthanasia; those cases are made elsewhere. Instead, this is an attempt to challenge implicit assumptions. It is the experience of many nurses that issues relating to matters (...) at the end of life are far from being resolved. This paper does not try to offer any practical solutions but aims at some clarification of the language used. This, it is hoped, will enable nurses to contribute to the debate. (shrink)

The following two letters were received in response to David Skidmore's article, 'Can nursing survive? A view through the keyhole', which was published in the December 1994 issue of Nursing Ethics.David Skidmore has been asked to reply; his comments follow. Both his and Janet Duberley's letters have been shortened with their consent.