Philosophical Perspectives on Trustworthiness and Open-mindedness as Professional Virtues for the Practice of Nursing: Implications for he Moral Education of Nurses



Nursing as a Response to Human Vulnerability

needs, or the capacity of that person to make auton-
omous choices. While a generous account of paternal-
ism would note that paternalists are motivated from
a desire to protect a patient from unnecessary harm,
worry, distress and so on, it remains the case that
paternalism is by its very nature an external and pro-
fessional standard of reference. Protection of patients
from avoidable harm does not require paternalism.

If it is the case that one of the functions of nursing
in general and of individual nurses in particular is to
protect patients from harm, then any action which
restricts the flourishing of more-than-ordinarily vul-
nerable persons is inconsistent with the practice of
nursing. This seems an obvious point and an oft-
stated intention. Yet while there seems to be a high
level of public trust in nurses the fact is that not only
do some nurses sometimes act in ways that result in
harm to individual patients but also that the UK reg-
ulatory body for nurses believes it necessary to pub-
lish guidance on protecting patients from harm
(NMC, 2002a). Moreover, this guidance is primarily
aimed at the protection of patients from the activities
of abuse of nurses.

In a publication entitled Practitioner-Client Rela-
tionships and the Prevention of Abuse
the Nursing and
Midwifery Council (NMC) stated that
‘Registered
nurses... have a responsibility to protect clients from
all forms of abuse’
(emphasis in the original) (NMC,
2002a, p. 7). While it may be reassuring for the public
to know that the regulatory body for nurses takes the
protection of more-than-ordinarily vulnerable people
seriously, it may at the same time raise questions in
the public domain about the general trustworthiness
of nurses. This issue cannot be pursued here but it is
worth noting that there is professional recognition of
the necessity for nurses to be ready and willing to
adapt their practice to ensure that more-than-
Ordinarily vulnerable patients are protected from
abuse. This‘protective’ function of nursing is essential
for human flourishing for without it the ability of a
more-than-ordinarily vulnerable person to flourish is
compromised.

The guidance expects nurses to act in certain sorts
of ways (i.e. in professional rather than unprofes-
sional ways) in order to protect patients. Nurses in
the UK are accountable to the NMC and are
required to practise ways consistent with the tenets
of the Code of Professional Conduct (NMC, 2002b).
But it would be an impoverished account of nursing
if it were assumed that nurses act in protective and
professional ways only because the NMC requires it.
It is true that a nurse’s actions are required to be
generally protective but it is also assumed that a
nurse should be generally disposed to act in protec-
tive ways. It is also true that the nurse who is dis-
posed to act in protective ways is to be preferred to
the nurse for whom acting in a professional way
requires a conscious decision to act against inclina-
tion. Nevertheless, merely being disposed to act in a
protective way is insufficient to ensure patients are
protected from harm. What is required is that these
‘protective’ dispositions are cultivated in formal and
informal ways during both pre- and postregistration
practice.

Conclusion: nurses and
human flourishing

One consequence of providing protection is that it
enables human flourishing. Hence, human flourish-
ing is a legitimate end of nursing. For while ordi-
narily vulnerable people are able to flourish despite
the risks of harm to which we are all subject there
are additional obstacles to flourishing for more-than-
ordinarily vulnerable people. In providing protection
from the additional risks of harm that being more-
than-ordinarily vulnerable brings nurses are helping
to remove or at least reduce those obstacles that
restrict the capacity for human flourishing among
patients. It should be clear, then, that those in
receipt of nursing care, the more-than-ordinarily
vulnerable, are vulnerable to obstacles that get in
their way of flourishing precisely because they are
patients. If this is true then whatever else is taken
into account when decisions about care and/or treat-
ment are made it is important that a nurse attempts
to ensure that it contributes to, rather than detracts
from, that patient’s capacity to flourish. Of course
the detail on this does depend on what is understood
by human flourishing but in principle the force of
this position is strong. To put this another way, one
legitimate role of the nurse is to ensure that their

© Blackwell Publishing Ltd 2005 Nursing Philosophy, 6, pp. 2-Ю

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