professional±client relationships ,working in teams and with colleagues ,and wider
questions about institutional ,local or national policies. Although nursing involves
activities other than patient or client care ,such as health care research and man-
agement ,it seems reasonable to view care as central ,and to see the other activities
as supporting this central one. But care' is too broad a notion to be of much help in clarifying the aims of nursing; care is the focus ,but what are the aims of care? One example of the debate about nursing philosophy and the aims of nursing is what has been called the shiftfrom sick nursing to health nursing' [1]. The shift ±
which is dramatic in some areas of practice and incremental in others ± is from
doing thingstopatients towards workingwiththem; from an approach which is
disease based' and expert centred to one which is 'health based' and patient centred. This shift follows from and reflects many things including changing patterns of ill-health ,emerging professional roles ,an increase in consumerism , and developing ideas about health promotion. But at its heart is what might be called an ethical shift ,a shift in values which has two inter-related components. Firstly ,and rather crudely put ,there is a move from treating people as passive towards treating them with respect as equals. This is not only because individuals have an important role to play in their own care ,but also because individuals deserve' to be treated with respect ,whether or not to do so is useful to profes-
sionals. Secondly ,there is a move from equating the best interests of patients with
being disease free' towards an acceptance that there is much more to well-being. Quality of life ,peace of mind ,and self respect ,for example ,are legitimate concerns for a nurse ,as well as disease management. These two components are closely related because one aspect of well-being ,an aspect which many see as funda- mental ,is being able to make choices and have them treated with respect. These issues will be discussed more fully in the next section. This example of a cultural shift shows the importance of what can be called habitual ethics' [2 ,3]: the ethical judgements that individuals make as a matter of
course ,the values that are built into ways of working. Any shift in the philosophy
or culture of nursing ,which entails that normal practice and expectations are
changed ,has enormous impact. Practice can be enhanced 6or made worse) for
literally thousands of people. Generally speaking much less rests upon the
prolonged agonising about particular cases however difficult they are. Of course
these sorts of shifts in normal practice are difficult to implement: they involve
reform of policies ,institutions ,and so on. To reformers they might seem an
overwhelming task ,like trying to get the earth to spin on a different axis ,yet they
are the bedrock for any practical ethic.
2.1 Promoting welfare and well-being
Let us say ,to use a piece of shorthand ,that nursing is about the promotion of well-
being. This seems a useful phrase yet ,at the same time ,it throws up a lot of
questions. Many of the key ethical issues faced by nurses ,and other health care
workers ,can be identified and clarified by working through some of these
questions.
Is this formulation of the nurse's role not too broad? There are many aspects of
20 NursingLawandEthics