NR 703 Advanced Practice Leadership from an Ethic of Care

NR 703 Advanced Practice Leadership from an Ethic of Care

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Chamberlain University

NR-703: Applied Organizational & Leadership Concepts

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Advanced Practice Leadership from an Ethic of Care

The aim of this paper is to critically examine advanced practice leadership through the perspective of the ethic of care. This analysis also incorporates a comparison between the ethic of care and the ethic of justice, as well as an evaluation of interprofessional collaboration and the challenges posed by ethical dilemmas in healthcare leadership. Leadership actions grounded in ethical principles are vital, as they assist in addressing moral conflicts, reducing distress among providers, and fostering high-quality healthcare delivery.

Description of Ethic of Care versus Ethic of Justice Perspectives

Advanced practice leaders frequently rely on guiding ethical perspectives when making decisions. Two primary frameworks that shape ethical reasoning are the ethic of justice and the ethic of care.

• Ethic of Justice emphasizes principles of fairness, equity, and adherence to standardized rules. It focuses on providing impartial treatment, ensuring equitable distribution of resources, and upholding patient autonomy (Botes, 2000).
• Ethic of Care highlights empathy, attentiveness, and maintaining relationships. It focuses on connectedness, compassion, and holistic patient care, where the individual is seen as a whole rather than a set of medical needs (Van Hooft, 2011).

While both approaches are necessary, conflicts may arise if they are applied in isolation. Thus, leaders must skillfully integrate these perspectives to promote ethical clarity and avoid misunderstandings in clinical decision-making.

Ethic of Care

Carol Gilligan’s model of the ethic of care describes moral development in three progressive stages, transitioning from self-focused perspectives to relational and principle-driven orientations.

Stage	Goal	Transition
Pre-conventional	Survival and self-interest	Movement from self-centeredness to responsibility
Conventional	Goodness through self-sacrifice	Shift toward balancing self with others’ needs
Post-conventional	Non-violence and avoidance of harm	Transition from goodness to truth

The ethic of care underscores the significance of harmony, compromise, and a holistic orientation in patient care. Nurses are expected to extend their responsibilities beyond medical needs to encompass emotional, psychological, and social well-being (Nordhaug & Nortvedt, 2011).

According to Lachman (2012), four critical elements define the ethic of care:

1. Moral attention – attentiveness to the needs of others.
2. Sympathetic understanding – the ability to empathize with patient circumstances.
3. Relationship awareness – recognition of interdependence in care.
4. Harmony – fostering balance between the needs of individuals and the community.

Nurse leaders guided by this ethic focus on authentic engagement, empathy, and holistic commitment. Unlike transactional care, which is reciprocal, the ethic of care involves supporting patients regardless of whether the care is returned.

Ethic of Justice

The ethic of justice, in contrast, centers on fairness, autonomy, equality, and beneficence.

• Fairness ensures unbiased treatment for all patients.
• Autonomy promotes respect for patients’ rights to self-determination.
• Beneficence guides healthcare providers to prioritize patient well-being, though it can be complex in application when resources or values conflict.

This approach is rooted in integrity and universality, holding that certain rules (e.g., “stealing is wrong”) must be upheld regardless of context (Nordhaug & Nortvedt, 2011). However, when merged with the ethic of care, the ethic of justice allows a balance between fairness and compassion, strengthening patient-centered care.

Reflection on the Application from an Ethic of Care Perspective

Question: What is the difference between caring for and caring about?

• Caring for refers to the provision of clinical, emotional, and supportive services. It involves technical skills, competence, and responsibility in addressing patient needs.
• Caring about represents an empathetic stance, emphasizing compassion, concern, and a willingness to advocate for the patient.

From the ethic of care perspective, both aspects are interconnected. Nurses must not only provide direct care but also embody empathy, attentiveness, and responsibility in practice (Lachman, 2012).

Nurse leaders can support ethical practice through initiatives such as:

• Ensuring adequate access to medical and supportive resources.
• Promoting collaborative environments, such as family-centered discussion rooms.
• Establishing ethics committees or involving ethicists to aid in decision-making (Simola, Barling, & Turner, 2012).

These measures enhance interprofessional collaboration while embedding both justice and care principles in organizational practices.

Case Reflections from Intensive Care Practice

Ethical dilemmas in intensive care units (ICUs) are often complex.

• Case 1: A 28-year-old Jehovah’s Witness awaiting a heart transplant declined blood products, sparking controversy. The surgeon agreed to proceed without transfusion, but some nurses opposed, citing compromised safety. This response reflected a failure to fully respect the patient’s beliefs, contrary to the Code of Ethics for Nurses, which stresses dignity and autonomy (ANA, 2001).
• Case 2: A 58-year-old male with severe heart failure declined a transplant after thoughtful reflection. The nurse demonstrated the ethic of care by offering emotional support, guidance, and presence, enabling the patient to make an informed decision. This case exemplifies how therapeutic nursing care extends beyond medical interventions to embrace dignity and respect for patient choice.

These examples demonstrate how the ethic of care elevates practice from procedural duties to meaningful commitments, emphasizing respect for autonomy and holistic well-being (Edwards, 2011).

Conclusion

Ethical leadership in advanced nursing requires balancing justice with care. By integrating these frameworks, nurse leaders can reduce moral distress, resolve dilemmas, and strengthen collaboration across disciplines. Care is a foundational human value, and when combined with principles of justice, it creates a comprehensive framework for ethical decision-making. The DNP-prepared leader plays a crucial role in applying this dual perspective to ensure patient-centered, holistic, and ethically sound healthcare delivery.

References

American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author.

Botes, A. (2000). A comparison between the ethics of justice and the ethics of care. Journal of Advanced Nursing, 32(5), 1071–1075.

Edwards, S. D. (2011). Three versions of an ethics of care. Nursing Philosophy, 10(4), 231–240. https://doi.org/10.1111/j.1466-769X.2009.00415.x

Lachman, V. (2012). Applying the ethics of care to your nursing practice. MedSurg Nursing, 21(2), 112–116.

NR 703 Advanced Practice Leadership from an Ethic of Care

Nordhaug, M., & Nortvedt, P. (2011). Justice and proximity: Problems for an ethics of care. Health Care Analysis, 19(1), 3–14. https://doi.org/10.1007/s10728-010-0159-3

Simola, S., Barling, J., & Turner, N. (2012). Transformational leadership and leaders’ mode of care reasoning. Journal of Business Ethics, 108(2), 229–237. https://doi.org/10.1007/s10551-011-1080-x

Van Hooft, S. (2011). Caring, objectivity and justice: An integrative view. Nursing Ethics, 18(2), 149–160. https://doi.org/10.1177/0969733010388927