Title: Legal and ethical issues
Description: Publisher's description of articles.

---- Trust, Power, and Vulnerability: A Discourse on Helping in Nursing / Michele A. Carter, PhD :This article uses philosophical inquiry to present the relationship between the helping role in nursing and the concept of trust essential to it. It characterizes helping as the moral center of the nurse-patient relationship and discusses how patients' expectations of help and caring create obligations of trustworthiness on the part of the nurse. It uses literature from various disciplines to examine different theoretical accounts of trust, each presenting important features of trust relationships that apply to health care professionals, patients, and families. Exploring the concept of trust, and the key leverage points that elicit it, develops a thesis that nurses can improve their understanding of the principal attributes and the conditions that foster or impede trust. The article concludes that trust is the core moral ingredient of helping relationships. Trust as a moral value is even more basic than duties of beneficence, respect, veracity, and autonomy. Trust is the confident expectation that others can be relied upon to act with good will and to secure what is best for the person seeking help.

---- Personal Conscience and the Problem of Moral Certitude / Cheryl Ellis Vaiani, PhD : The moral practice of nursing requires the difficult work of discerning the best response to an ethical quandary. Determining the right course of action can rarely be discovered by assuming that one value, one theory, one point of view will always and reliably identify the morality of an action. Thus, the role of a nurse is an inherently moral activity that is at the heart and soul of health care. Practitioners who move too quickly to a state of moral certainty about a decision may be missing essential components of the enactment of moral agency. Personal integrity and professional integrity, patient interests, society's expectation of a profession, the balance between rights and obligations within the nurse-patient relationship, acting according to one's conscience, power, control, and moral certainty are a few of the topics that enrich thinking about the moral richness of nursing practice, and will encourage readers to know, to reason, and to act in ways that demonstrate reflective moral judgment.

---- Art, Science, or Both? Keeping the Care in Nursing / Tayray Jasmine, PhD, MSN, RN : Nursing is widely considered as an art and a science, wherein caring forms the theoretical framework of nursing. Nursing and caring are grounded in a relational understanding, unity, and connection between the professional nurse and the patient. Task-oriented approaches challenge nurses in keeping care in nursing. This challenge is ongoing as professional nurses strive to maintain the concept, art, and act of caring as the moral center of the nursing profession. Keeping the care in nursing involves the application of art and science through theoretical concepts, scientific research, conscious commitment to the art of caring as an identity of nursing, and purposeful efforts to include caring behaviors during each nurse-patient interaction. This article discusses the profession of nursing as an art and a science, and it explores the challenges associated with keeping the care in nursing.

---- Moral Accountability and Integrity in Nursing Practice / Cynthia Ann LaSala, MS, RN : The therapeutic nature of the nurse-patient relationship is grounded in an ethic of caring. Florence Nightingale envisioned nursing as an art and a science <U+2026> a blending of humanistic, caring presence with evidence-based knowledge and exquisite skill. In this article, the author explores the caring practice of nursing as a framework for understanding moral accountability and integrity in practice. Being morally accountable and responsible for one's judgment and actions is central to the nurse's role as a moral agent. Nurses who practice with moral integrity possess a strong sense of themselves and act in ways consistent with what they understand is the right thing to do. A review of the literature related to caring theory, the concepts of moral accountability and integrity, and the documents that speak of these values and concepts in professional practice (eg, Code of Ethics for Nurses with Interpretive Statements, Nursing's Social Policy Statement) are presented in this article.

---- Nursing Advocacy in a Postgenomic Age / Rebekah Hamilton, PhD, RN : The Human Genome Project will change how health is defined and how disease is prevented, diagnosed, and treated. As the largest group of health care providers in contact with patients, nurses need to be competent in the science of genetics. Beyond this, nurses need to understand the complexities that arise in genomic health care. Ethical, legal, and social issues are integral to the delivery of genomic health care, and nurses must have an astute understanding of such complexities. What it means to know, to reason, and to act in this postgenomic age is explored.

---- Thoughtful Nursing Practice: Reflections on Nurse Delegation Decision-Making / Leigh Ann McInnis, PhD, RN, FNP-BC, Lynn C. Parsons, DSN, RN, CNA-BC : This article discusses delegation challenges and legal and regulatory oversight associated with delegation in the clinical practice setting. The authors address moral and legal attributes of the roles and responsibilities of health care providers regarding delegating health care interventions. The article also explores guiding principles and rules of delegation within professional standards, national practice guidelines, and state nurse practice acts. Nurse experts provide thoughtful reflection on nursing models and the role of delegation, emphasizing the critical role of delegation in extending the role of the health care professional in patient care services.

---- Science, Technology, and Innovation: Nursing Responsibilities in Clinical Research / Christine Grady, RN, PhD, Maureen Edgerly, RN, MAb : Clinical research is a systematic investigation of human biology, health, or illness involving human beings. It builds on laboratory and animal studies and often involves clinical trials, which are specifically designed to test the safety and efficacy of interventions in humans. Nurses are critical to the conduct of ethical clinical research and face clinical, ethical, and regulatory challenges in research in many diverse roles. Understanding and addressing the ethical challenges that complicate clinical research is integral to upholding the moral commitment that nurses make to patients, including protecting their rights and ensuring their safety as patients and as research participants.

---- Care and Meaning in War Zone Nursing / Ernestine (Tina) Cuellar, RN, PhD : During the past century, nurses have served as caregivers for United States military personnel in every major theater of war. Military nurses in the war zone deliver patient care while working in austere conditions, and are under constant threat of personal danger. This article gives a historical overview of the role of nurses in war zones, followed by a review from the perspectives of environment, safety, the nature of injuries, and treatment of military personnel and civilians.

---- Perspectives on Transcultural Care / Dana Bjarnason, PhD, RN, NE-BC, JoAnn Mick, PhD, RN, AOCN, NEA-BCb, Julia A. Thompson, PhD, RN, CIPc, Elizabeth Cloyd, MBA, RN, NEA-BC, FACHEd : Culture has been defined as the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. A culture of nursing refers to the learned and transmitted lifeways, values, symbols, patterns, and normative practices of members of the nursing profession of a particular society. To serve the unique and diverse needs of patients in the United States, it is imperative that nurses understand the importance of cultural differences by valuing, incorporating, and examining their own health-related values and beliefs and those of their health care organizations, for only then can they support the principle of respect for persons and the ideal of transcultural care.

---- From Means to Ends: Artificial Nutrition and Hydration / Cheryl Monturo, PhD, MBE, CRNPa, Kevin Hook, MA, MSN, CRNPb : The withdrawal, withholding, or implementation of life-sustaining treatments such as artificial nutrition and hydration challenge nurses on a daily basis. To meet these challenges, nurses need the composite skills of moral and ethical discernment, practical wisdom and a knowledge base that justifies reasoning and actions that support patient and family decision making. Nurses' moral knowledge develops through experiential learning, didactic learning, and deliberation of ethical principles that merge with moral intuition, ethical codes, and moral theories. Only when a nurse becomes skilled and confident in gathering empiric and ethical knowledge can he or she fully act as a moral agent in assisting families faced with making highly emotional decisions regarding the provision, withholding, or withdrawal of artificial nutrition and hydration.

---- Nursing, Religiosity, and End-of-Life Care: Interconnections and Implications / Dana Bjarnason, PhD, RN, NE-BCab : The influence of religion, religious beliefs and practices at the end of life is underinvestigated. Given nursing's advocacy role and the intimate and personal nature of the dimensions of religiosity and the end of life, exploring the multidimensional interplay of religiosity and end-of-life care is a significant aspect of the nurse-patient relationship and must be better understood. The question that must be faced is whether nurses' own belief systems impinge on or influence patient care, especially for patients who are at the end of life. When nurses understand their own beliefs and respect the religious practices and needs of patients and their families, it deepens the humanistic dimensions of the nurse-patient relationship.
Subjects: Nursing ethics, Law and legislation, Nursing Ethics, Nursing, Nursing, law and legislation