Oral Presentation The 26th International Nursing Philosophy Conference 2023

Challenging existing ideals for an ethic of care: From individual commitments to societal covenant (#17)

Dorolen Wolfs 1 , Darlaine Jantzen 1 , Lynn Musto 1 , Sheryl Reimer-Kirkham 1 , Marsha Fowler 2
  1. Trinity Western University, Langley, British Columbia, Canada
  2. Azusa Pacific University, Azusa, California, USA

Nurses shoulder remarkable social responsibility to provide compassionate, competent, and ethical care, even with unprecedented strain on healthcare systems. Their continued commitment to care is viewed as requisite and, at times, heroic. We challenge this professional identity, shaped by early religious and Victorian ideals, and later biomedical ethics. For decades, a few nursing scholars have proposed that this ethic of care is covenantal. Covenant has roots in Judeo-Christian theology and describes an enduring relationship characterized by mutual promises and benevolent responsiveness to each other’s needs. We observe misapplication of covenant in the nursing literature, whereby the nurse is positioned as solely responsible for maintaining the covenant relationship with each patient. The literature focuses on the nurse’s faithfulness and obligation to embody nursing’s professional ideals in all situations. This framing ignores the mutual responsibility that is inherent in covenantal relationships and contributes to the idealization of nurses as both savior and servant-like figures. There is evidence within healthcare systems globally that nurses’ commitments are fragile or fragmented under increasing pressure, specifically where neoliberal managerialism and care as commodity hold dominance. At a time when nurses are struggling to provide dignified, person-centred care and are poised to leave healthcare in increasing numbers, we are challenging the status quo understanding of covenant. Informed by a knowledge synthesis, we engaged in a yearlong exploratory project using consultative dialogues with diverse interdisciplinary scholars to explore the usefulness and suitability of the concept of covenant as an ethic of nursing care. We have also critically considered related themes, such as ethical comportment, a feminist ethic of care, and relational practice. We present a re-framing 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.