Nursing Ethics in a Changing World

There are many reasons for the changes in the ways in which nursing ethics has been taught in recent decades. In the 1970s, the move of nursing education from hospital-based courses to tertiary courses at universities commenced in many developed countries such as the United Kingdom, the United States and Australia. The aim of the transfer of nurse education was to prepare nurses better for their changing roles in healthcare. They were no longer apprentices working in hospital wards under the supervision of more senior nurses. The technological advances in medicine in areas such as intensive care, neurosurgery and organ transplantation required nurses to have not only better clinical and technical skills but also the ability to think critically about the challenges posed by new technologies. In the previous decades it was considered enough to give nurses generalised hospital policy guidelines on how to act in encounters with patients and with doctors; unquestioning obedience and matters of etiquette were the limits of ethical considerations.

The old order in healthcare was equipped to provide basic care to all those who needed it; in the future, intensive care and other complex treatments could only be offered to the most deserving or needy patients. If this were the case, then the bases on which these determinations on who to give access to the new therapies would be made by health professionals using particular criteria that they were familiar with and that their patients could understand. These criteria could involve clinical considerations as before, but more often economic and other criteria would play a role in the deliberations of health professionals. If nurses were to be involved in the care of patients undergoing cardiac surgery or organ transplants, then they would need to develop an understanding of the ethical issues involved and also take part in trying to develop solutions to the problems they were confronted with.

With the development of technology nurses from the 1970s onwards were required to work as members of teams consisting of doctors and various kinds of technicians such as respiratory technicians; at the same time their relationships with the patients were changing. The rising consumer movement of the era meant that patients began to question the treatments and care that they were receiving; this questioning and an increased awareness of alternatives has increased exponentially since the birth of the worldwide web. BBC News last year reported that many doctors ‘are concerned that the huge quantity of information and advice (on the web) is at best unreliable, and in some cases even dangerous’ (BBC News Online 2010). If this is the case, then nurses must develop the skills to critically analyse the wealth of qualitatively variable information. They need to be able to answer patients’ questions related to this information in a way that corrects misleading advice and instead provides advice that is both reliable and accurate.