The subject of this article is moral agency in nursing, studied by the use of an applied philosophical method. It draws upon nurses’ accounts of how they see intrinsic value in their work and believe that they make a difference to patients in terms that leave their patients feeling better. The analysis is based on the philosophy of Iris Murdoch to reveal how nurses’ accounts demonstrated that they hold a view of themselves and their professional practice that is intrinsically linked (...) to, and dependent upon, their capacity to see good in the work they do. (shrink)

In this paper I elaborate a notion of nurses’ professional self as one who is attracted towards intrinsic value. My previous work in 2003 has shown how nurses, who see intrinsic value in their work, experience self‐affirmation when they believe that they have made a difference to that which they see to have value. The aim of this work is to reveal a further aspect of nurses’ professional self. I argue that nurses’ desire towards that which they see to have (...) intrinsic value, is a necessary and self‐transcending aspect of a nurses’ professional self. I argue further that nurses’ desire towards intrinsic value inevitably involves their vulnerability. Nurses who see intrinsic value are shown to be vulnerable to self‐sacrifice in their inclination to work for the good of their patients, at the expense of themselves. Yet an ability to transcend their self in this way remains a necessary aspect of a nurse's professional self, which requires nurture and support through nurse education. (shrink)

This paper analyses a situation where a patient's suffering provoked feelings of compassion in a student nurse, and distress at her patient's circumstances. The reported behaviour of qualified nurses within the situation suggests that they lacked compassion, had inadequate knowledge, and that they failed to understand their patient's plight. An account of the situation is followed by an exploration of the nature of moral agency, and understanding in nursing. Nurses' capacity for moral imagination is shown to be of crucial importance (...) to the care that patients receive. The extent of nurses' responsibility for their behaviour is considered, and in particular, the extent of nurses' responsibility during times when they experience strain. Argument leads to the conclusion that we are justified in holding nurses responsible for their behaviour in situations of patient care, although we must not judge a nurse's behaviour too hastily. Attention is drawn to the need for a moral climate to sustain those nurses who struggle to give good patient care, despite the strain that is ever present within today's world of health care. (shrink)

Moral imagination has been described by Murdoch as ‘a way of seeing’. The focus of concern here is the influence of belief upon moral imagination and those attitudes that are needed if moral imagination is to be developed. The perspective adopted endorses a Humean recognition of the potent influence of personal experience upon those beliefs that are held, and therefore upon how we see the world. Kantian commitment to the power of the will, and to the ability of individuals to (...) choose who they wish to be, allows room for optimism, a view which is supported by the findings of Liaschenko. (shrink)

This paper considers the influence of guilt within nursing practice. The author draws on her experience as a nurse tutor to show how guilt has implications for the well-being of both nurses and patients. It is suggested that nurses' experience of guilt, and the fear that they may be considered guilty, are indicative of a moral climate that rests predominantly upon rules. While rules fulfil a requirement for professional and organizational accountability, they need not be perceived as statements about the (...) trustworthiness of nurses, or as a disciplinary threat. Nurses need to feel trusted to bring judgement to their practice. (shrink)