Reframing covenant for nursing: From individual commitments to covenant with society.

Today's constrained healthcare environment can make it very difficult for nurses to provide compassionate, competent, and ethical care, and yet their continued commitment to care is viewed as requisite. Nurses' commitment to care of patients, enmeshed with professional identity, may be understood as heroic. A few nursing scholars have advanced the concept of a nurse-patient covenant to explain or inspire nurses' commitment to care. Covenant describes an enduring relationship characterised by mutual promises and generous responsiveness. However, recent critique has revealed a general misunderstanding and misuse of the term covenant in much of the nursing literature whereby individual nurses are improperly and impossibly idealised as holding sole responsibility in the commitment to care. Such an interpretation obscures society's responsibilities in caring for both patients and nurses and contributes to the idealisation of nurses' commitment to extend themselves to fill in healthcare system gaps. Yet, the concept of a covenant relationship, when reframed as occurring between society and the profession of nursing, may lead us toward solutions to the very problems the originally misused concept sustained. Evidence within healthcare systems globally suggests that nurses' commitments are fragile or fragmented under duress due to increasing pressure, demands, and even risks. A reframing of covenant has the common good for society and nursing at its core and, we argue, may lead to a more sustainable nursing identity. We present the results of an exploratory project, undertaken to examine the utility and suitability of covenant as a relational framework for nursing. We explore a reframing of a covenant of care as a relationship between nursing and society, which may provide a fruitful path toward a sustainable, shared commitment for healthcare. This covenant of care re-centres shared work-a joint responsibility between society and nursing-as necessary for the common good.

Rising to "The Highest Morals"-The Rich History of Nursing Ethics.

ABSTRACT: Modern nursing is supported by a rich ethical tradition dating back to the mid-19th century. Moving illustrations of nursing practice and "the highest morals" (McIsaac, 1901) relay the distinguished history and distinctives of nursing ethics from the 1860s to the present day. Of note is that nursing ethics is relationally focused, virtue-based, preventative, and central to the identity of nursing. A brief history of how bioethics emerged in the mid-20th century and an overview of the development of nursing ethics unveils differences between the two ethical paradigms.

Evangelism in Patient Care: An Ethical Analysis.

Evangelism has been present in modern nursing care from the days of Nightingale in the Crimea. Even so, there is little in the way of ethical analysis and guidance regarding evangelism in healthcare. This article examines Nightingale's concern about evangelism in nursing care; discusses the boundaries established by the 2015 American Nurses Association Code of Ethics for Nurses with Interpretive Statements; and analyzes ethical issues including vocation, power, vulnerability and voluntariness, religious diversity, spiritual care, harm, and the Great Commission. Within the context of ethical analysis, broad guidelines are provided for nurses in clinical practice.