Past research on the ethical decision making of nurses has used Kohlberg's model of moral reasoning, which does not adequately ad-dress issues of caring. The present study builds on the work of Gilligan, Brown, and colleagues to describe issues of moral concern, including justice, care, and integrated concerns. Nurses in the present study articulated justice concerns for fairness, patients' rights, and autonomy. They also stated care concerns for a patient's needs, pain, emotional support, and relationship. Beyond these, nurses expressed concerns that integrated a principled approach (justice) to caring for patients (care) in dealing with issues of deceit and trust, advocacy, and patient dignity in dying. Whereas many earlier studies reported low moral reasoning scores for nurses, the present analysis shows nurses involved in complex and sophisticated ethical considerations and decisions. The analysis also reveals professional constraints on those ethical decisions.
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