Toward a Moral Horizon: Nursing Ethics for Leadership and Practice

This third edition of Toward a Moral Horizon: Nursing Ethics for Leadership and Practice will assist nurses and all health care providers to take up the challenge of embedding ethics in health care practice, education, research, and policy at all levels—from local to regional to global. In the current, complex health care environment, more nurses are engaging in graduate studies to enhance their knowledge and expertise in providing necessary leadership in all health care settings. As a result, there is a growing need for an advanced nursing ethics text, and so this book is targeted towards graduate-level and upper-level undergraduate nursing students, as well as nurses in leadership roles—providing a much-needed resource for these groups. This edition was written during a period when the COVID‑19 pandemic caused a health care crisis in Canada and around the world, provoking what the authors of one of the chapters called “a clarion call for change” in health care provision. The pandemic brought the fault lines of the Canadian health care system to the forefront of awareness, and profoundly affected patients, families, communities, as well as nurses and other health care providers. In addition to the influence of the pandemic, society is in the midst of rapid growth in science and technology. Now, more than ever, nurses need to use nursing ethics when developing their moral compasses for leadership. In this book, we focus on ethical knowledge for advanced practice nurse leaders to effect change and improve moral climates in nursing research, education, practice, and policy settings. We focus on social justice and equity as essential values of nursing ethics. Several chapter authors describe ways that nurses can press for improvements in the health care of vulnerable people who may be lacking access to quality health care: for example, Indigenous people, older adults, those who are coping with mental illness or substance use challenges, and those who have a disability. Social justice and equity issues are also explored in a chapter on global health. This book is structured in three sections, comprised of 22 chapters written by Canadian experts in ethics. In the book, we map the moral climate for health care and nursing ethics and describe the historical background of and theory related to nursing ethics. We illuminate the use of nursing ethics in diverse populations and with people at all stages of life; and we apply nursing ethics to new developments in health care issues and technologies. Instructors will be able to bring the content of this book alive with Ethics in Practice scenarios and reflective questions for students that are located in each chapter. Many chapters also include figures or appendices showing models and guidelines that can be used to assist with ethical decision making. This third edition includes several new chapters, including a chapter on nursing ethical theory as distinct from bioethics, as well as chapters related to people with disabilities, Indigenous health ethics, nursing leadership, and digital health technology. Many topics covered in previous editions are revised and updated. For example, the updated chapter about health care at the end of life now includes an in-depth discussion of medical assistance in dying (MAiD). Further updates are included in the areas of research ethics in nursing; the development of the Canadian health care system, and how the historical development has contributed to current deficiencies in health care delivery; nurses as moral agents, and the problem of moral distress; the application of nursing ethics in caring for patients at all stages of life; home health care ethics; ethical issues in biotechnology, and the broad areas of public health ethics and global health ethics. This edition is cutting-edge as the authors recognize the importance of inclusive language, since language affects attitudes towards people and the way they are treated. In particular, chapter authors in this text model the use of inclusive language in their writing as applied to gender diverse people and people with disabilities. This third edition is an open access, online publication, meaning that the book is accessible to all with no cost to the readers. This online publication also allows for new features, including two videos, with their accompanying transcripts, where listeners will gain a personal understanding of the contributors’ perspectives. In one video, Indigenous nurse scholars form a traditional circle online, as they discuss nursing ethics from their Indigenous perspectives. The other video showcases two nurses with expertise in digital health technologies in conversation with the book’s editors. Other features include access to additional resources on chapter topics and the inclusion of several chapters from the second edition of this textbook for readers’ reference. It is our hope that readers of this third edition will step boldly into shaping the future of health care by becoming more engaged in ethical practice, and becoming more confident in their leadership roles in health care. We believe that the content of this text can contribute to the knowledge needed for nurses to make ethical choices knowingly and wisely, so they can demonstrate moral imagination and moral courage in the face of challenges that confront them at all levels of the health care system.

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