Chapter 10 focuses on the nurse through a discussion of issues of professional self-respect, with a special focus on reporting mistakes and clinical incidents, but also in a consideration of the place of self-forgiveness after making a mistake. It looks at factors that influence nurses’ decisions about reporting, and explains the importance of dealing effectively and ethically with clinical errors and incidents – for the sake of both patients and nurses. Admitting to mistakes has a number of important moral and practical effects for nurses, including restoring their self-respect and putting the patient back at the centre of care. The chapter also explains the open disclosure process for dealing with mistakes in a way that restores trust and justice to the clinical relationship.Finding the courage and the words to admit mistakes can be facilitated in the workplace by employing specific approaches. This chapter discusses an approach developed in the United States, and adopted worldwide, known as ‘Giving Voice to Values’. This is a structured practical approach that helps individuals to develop the skills they need to speak out when they know they should.

This book has been written specifically for nurses training and practising within Australia, to assist and encourage them to develop a strong and well-defined sense of professional and moral identity. It endeavours to provide an integrated, practical framework for understanding the ethical and legal dimensions of nursing practice in Australia by referencing Australian law and reflecting the Australian clinical context and cultural norms.

Chapter 6 takes a detailed look at the concept of negligence as it applies to health care, and how it is tied to the nurse’s duty of care towards their patients. It explains how a failure to meet that duty of care can lead to a legal finding of negligence against a nurse. It describes how a nurse’s required standard of care is determined in law, and how negligence is proven (or defended). It also explains a nurse’s legal liability and professional indemnity, as well as the employer’s vicarious liability for the actions of nurses. Finally, it discusses the role of apology and when an apology to a patient is appropriate. It also introduces the related concept of a ‘statutory duty of candour’, recently introduced into law in Victoria.

Chapter 7 looks at the cultural and ethical considerations that are relevant to nursing people from diverse cultures, with a focus on nursing Aboriginal and Torres Strait Islander people, and describes nursing practice that is culturally safe. It is important to remember that Aboriginal and Torres Strait Islander peoples are diverse groups who live a variety of lifestyles, from highly traditional to highly modern, on tropical islands, in remote deserts and in cities. Indigenous culture encompasses elements from ancient practices to contemporary technology. Appreciating the complexity of Indigenous Australian culture and its historical context is fundamental to providing ethical and therapeutic care.

Chapter 9 takes up the issues of trust and hope in the care provided by nurses – including trust in machines and colleagues – and revisits themes of power, autonomy and advocacy in decision-making about care. Trust is central to negotiating treatment in the nurse–patient relationship because the patient does not choose to enter into a relationship with the nurse. In considering the nature and scope of trust, and the extent to which nurses can be expected to accommodate patients’ wishes, the chapter also discusses the importance of hope and of avoiding both unrealistic hope and hopelessness.

Chapter 1 describes how we each become persons over time and through our relations with other people. This makes personhood fundamentally relational and interpersonal: we become who we are – with our tastes, talents and abilities – as a result of our interactions with the environment around us and the people in it. Moreover, this is a lifelong process. The idea that we are always in formative relations with the environment and other people is part of the concept of human vulnerability. Vulnerability can be understood as an expression of our belonging to the world with other people, and it is this belonging together in the human world that drives our capacities to care for one another. This is why skills in managing interpersonal relations and communication are central to the nursing role.

Chapter 11 looks at some of the legal and ethical dimensions of two high-profile situations: abortion and voluntary assisted dying. These situations are often discussed together because they concern the limit of human vulnerability (in death) and the limit of human freedom and autonomy (in determining who can legitimately kill). This chapter considers some of the main ethical arguments for and against abortion and voluntary assisted dying, and sets out the relevant legal frameworks for nurses. In recent years, voluntary assisted dying laws have been introduced in all Australian states and the Australian Capital Territory, but not yet the Northern Territory, although legislation is being prepared. While nurses often have a special interest in the morality of abortion and voluntary assisted dying, the nurse’s role is clearly prescribed by law, and failure to act within the law can result in criminal charges of assault or even manslaughter.

Chapter 4 addresses the legal framework for valid consent to treatment and refusal of treatment, which is based on the right to autonomy (as discussed in Chapter 3). It considers situations where a person cannot give valid consent – for example, where the person is a young child or is unconscious – as well as situations where consent is not needed, such as in a medical emergency, where there is serious mental illness or where a patient needs to be restrained for their own safety. The chapter also explains the place of guardianship and advocacy, and the use of advance care directives in protecting a person’s autonomous decision-making.

Chapter 5 examines ‘restrictive practices’ and their legal and ethical implications for nurses. Restrictive practices are actions that restrict a person’s freedom of movement, such as locking the person in a room, secluding them by confining them to a physical space, putting them in manacles or straps, medicating them or directly holding them to restrict their movement. These practices can only be carried out as a last resort to protect the patient or another person, and must be authorised by a medical practitioner. A patient subject to restrictive practices must be observed closely at all times. In years past, the use of physical restraints in a clinical setting was not uncommon and included tying a person to a chair with a sheet, or tying the hands of a bed-bound person to the side of the bed. Besides any obvious cruelty, these practices were known to result in death by strangulation, falls, head injuries, lacerations and tissue necrosis. Nurses who use unauthorised restrictive practices may be liable for charges of kidnapping, assault and battery and, in the worst case, manslaughter.

Chapter 2 provides an overview of the Australian legal system, its structure, function and philosophical underpinnings. It explains what counts as law in Australia and who can set the rules, and it sets out the differences between legislation, common law, criminal law and civil law. It illustrates how the law is relevant to nurses and the profession, especially the concept of ‘scope of practice’. This edition of the book also raises some new concepts, such as the ‘stabilising’ and ‘disburdening’ effects of law, both of which smooth the way for people who are essentially strangers to each other to interact in everyday life.

Chapter 8 continues the focus on the nurse–patient relationship by examining legal and moral requirements around patient privacy and confidentiality, and mandatory reporting. It explains requirements in relation to the management of patient information, including reporting of child abuse, family violence and professional misconduct.

Chapter 3 focuses on of the nurse–patient relationship. This relationship is called a therapeutic relationship because its function is to have a beneficial effect on the patient. This chapter has a focus on power within the therapeutic relationship: what it is, how it is related to vulnerability and how the Nursing and Midwifery Board of Australia’s Code of Conduct for Nurses places constraints on nurses’ use of their power. The chapter explores different models of professional relationship, and explains how nursing fits into a model of the fiduciary relationship. It then discusses how the therapeutic relationship embodies the moral principles of non-maleficence, beneficence, autonomy and justice. It also describes the regulation of nursing practice in Australia and explains why this is a necessary part of ensuring the safety and quality of clinical care. It sets out the roles of the Australian Health Practitioner Regulation Agency (AHPRA) and the Nursing and Midwifery Board of Australia (NMBA) in setting the training and practice standards for nurses and midwives, and handling complaints, investigations and disciplinary hearings.

Chapter 12 discusses ethics and aged care, with a special focus on how nurses can support the autonomy of elderly people. Although it is often believed that an older person’s autonomy begins to deteriorate as the processes of biological decline affects their mobility and mental acuity, it is more often the negative attitudes of other people that show up early and that initially constrain an older person’s freedom. This chapter begins with an alarmingly commonly reported experience of being treated as senile or invisible simply by virtue of looking older. It is usually much later that physical and/or mental decline manifests. While ethical issues such as assisted dying (previously called ‘euthanasia’) tend to capture the public imagination, it is at the level of everyday living that nurses can often have the most profound impact on the lives of older people experiencing physical and/or mental decline. It is at this level too that the dangers (and complexities) of elder abuse typically manifest. The role of artificial intelligence (AI) in providing companionship, engagement and even care for people living in aged care facilities is also touched upon.

This chapter uses creative, narrative nonfiction writing to portray a deathbed conversation or confession of sorts between a dying person and their healthcare providers. While literary in style, it is based on seven years of the author’s immersive field research in post-Apartheid South Africa in long-term and frail care homes. After providing background on long-term care and the history of racial segregation in that country, the chapter depicts a scene where white and Black nursing staff provide palliative care for and converse with a dying white woman whose character is composed from life history interviews with multiple residents of the home. As a contribution to the anthropology of death, the chapter shows how humanistic and literary approaches can be used to represent voices of dying people, as well as the ways histories of racial violence and inequality can be highlighted in research on long-term and palliative care.

Throughout U.S. history, women have served and participated in war efforts in both official and unofficial capacities, playing central roles in furthering U.S. war aims and achieving the mission at hand. At times, military authorities have acknowledged women’s unofficial contributions by offering payment for services and access to postwar benefits. Military leaders have also recognized the value of servicewomen when personnel needs required them. Since the end of the Vietnam War-era draft in 1973, the U.S. armed forces have gradually opened military occupation specialties, including combat positions, to women. Yet in the civilian world and within the military ranks, resistance to women’s service remained steady over the decades. Critics have cited unit cohesion and readiness as reasons to keep women out of the forces, and they have also made cultural arguments grounded in the links between gender, power, and military service to oppose the mobilization of women. Although U.S. military leaders have opened opportunities for women due to pragmatic needs for personnel, Americans have held on to the notion that soldiers are men, and women belong on the homefront.

Between October 1990 and May 1996 cultural safety was a major and extraordinarily contentious issue. The Nursing Council of New Zealand’s resolution that cultural safety would be part of the requirements for nursing and midwifery education programs might be considered as one of the greatest challenges to face the nursing profession in New Zealand. This chapter provides analysis of why cultural safety was almost lost from the language of nursing. It begins with brief historical perspective on nursing and cultural safety in New Zealand. The important differences between transcultural nursing and cultural safety are discussed, as well as the ensuing public debate that followed cultural safety’s early development.