Foreword for the 2nd edition:
Nurses make decisions all the time in their work with patients and their families. Some decisions may be relatively straightforward, while others will prove more testing. It is not always easy to know what to do for the best. This book, written clearly and succinctly by Peter Ellis and his team, helps a student nurse build an understanding and a framework, based on ethical principles and concepts, for considering and taking difficult decisions. It is a guide useful not only for the student nurse but also for those who have qualified. This framework is an essential part of nursing today.
As a manager for many years in different health and social care settings, I recognise the importance of nurses becoming aware both of their own values and those of the profession in which they are working. Congruence between these is important. As Peter Ellis rightly points out, if there are major conflicts between what you value as a person and what you value as a nurse, these need to be carefully thought through.
Values guide the way we behave. It is our behaviours, potentially more than our skills, that make a profound difference to people and their families who are so vulnerable when they use healthcare services. I have often talked to my staff about the fact that ‘how’ we do our work is as important as ‘what’ we do. Careful listening, understanding of and response to individual needs, being honest and respectful – all these make a significant difference to well-being of those who are ill and anxious. It is notable that so much of the positive feedback from patients and their families reflects the importance of behaviour: “even when he was unconscious you showed him such respect in your care”; “thank you for the help you gave us enabling us to come to our own decisions”; “you helped us so much by giving us the understanding of what a dying person’s needs are and, by so doing, allowing us to care for him too”.
Nurses will encounter dilemmas daily in their work – how best to communicate; when to provide care or support independence; how to allocate their time; how to respond most effectively to someone from a different culture. The complexities of disease, of human lives and of the conditions in which nurses work also often make decisions difficult to take. It is possible, too, that other hard judgements may be required, for example the reporting of potential abuse or speaking out about concerns relating to work practices. When taking action, it is important not only for patients but also for themselves that nurses can feel assured that their decisions and actions are justified, by being able to articulate the values that underlie the decision they make. The responsibility of nurses is great and their views, strengthened in this way, can be influential and beneficial.
This book provides the essential ethical, reflective approach that is needed in nursing, offering a framework which helps guide and develop an individual’s own thoughts, and encouraging decision-making that is based on a sound ethical understanding. It strengthens the ability of nurses to develop the values that will underpin their work and enable them to offer ethical services and leadership in the years to come.