Glossary

Accountability. To be answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard such as that established by the Code of Ethics for Nurses.

Advocacy. The act or process of pleading for, supporting, or recommending a cause or course of action. Advocacy may be for persons (whether as an individual, group, population, or society) or for an issue.

Allyship. An ethical duty through intentional interventions, advocacy, and support to eliminate harmful acts, words, and deeds and creating space to amplify voices that are not traditionally heard, recognized, or welcomed.

Anti-racism. Involves examining systems and structures as well as intentionally preserving the dignity of others, managing perceptions, maximizing curiosity, and minimizing certainty.

Alternate decision-maker. Any person participating in decision-making for a patient, regardless of whether they are appointed through default surrogate statutes, appointed by a court, or specified in an advance directive.

Artificial intelligence (AI). A broad category that involves using algorithms to drive the behavior of agents such as software programs, machines, robotics, games, and other hardware devices. Encompasses a wide range of existing, emerging, and future technologies intended to assist nurses in caring for their patients.

Augmented intelligence. Augmented intelligence refers to the effective use of emergent technologies that extend the human capacity to process, analyze, and synthesize data.

Autonomy. For Kant, autonomy refers to rational self-legislation and self-determination that is grounded in informedness, voluntariness, consent, and rationality. In other systems of ethics, it also includes the person’s subjective interpretation, situation, preferences, and relational network.

Bias. A natural tendency to favor or disfavor individuals, groups, or concepts over others. Bias may be conscious or unconscious and may advantage or disadvantage specific individuals or groups. Negative biases may be dehumanizing.

Capacity. Functional determination of whether an individual is capable or incapable of decision-making within a particular healthcare context. Differs from a legal competency determination.

Civic engagement and Civic professionalism. Civic engagement refers to the exercise of one’s moral agency, individually or with others, in issues of public importance or concern. Nursing civic engagement, also called civic professionalism, may involve engagement with formal legislative or regulatory requirements, or political structures.

Coercion. Coercion refers to external forces of restraint or compulsion. Coercion may include undue influence, threat, fraud, deceit, manipulation, force, or situational requirements.

Community-based participatory approach. A process of systematic inquiry that encompasses all aspects of the research process (design, method, framework) and engages those affected by an issue, irrespective of their research acumen, in direct collaboration to study that issue with the intention of impacting change.

Conflicts of commitment. Conflicts of commitment refer to competing commitments of time, attention, or loyalties that interfere with the nurse’s ability or willingness to perform the full range of responsibilities associated with their position.

Conflicts of interest. Conflicts of interest exist when the primacy of the patient is secondary to, or conflicts with, a personal self-interest of the nurse.

Conscience-based objection. The conscience-based refusal (conscientious objection) to participate in a lawfully permitted process within one's scope of practice. This refusal is customarily based upon the nature of a particular intervention in all cases (as a category). Conscience-based objection, when not categorical, is based upon the appropriateness of the intervention for a particular patient or on the patient’s known objection to the intervention.

Culturally concordant care. The recognition that patients who share the same race, ethnicity, culture, gender, and/or language as their healthcare providers can have positive outcomes based on a shared identity.

Dehumanization. Dehumanization is a spectrum of disrespect that, at one end, treats persons or groups as underserving of respect for their inherent worth and dignity (i.e., microaggressions). At the other end of the spectrum, dehumanization denies the persons or groups their full humanity, moral worth, and agency (i.e., macroaggressions).

Discernment. Discernment is a moral evaluative ability to weigh the moral obligations and values of a given circumstance, event, or issue. In some instances, moral discernment may also involve weighting competing obligations or values.

Discipline. A discipline is a distinct domain of research and scholarship with specialized or subspecialized content, methodologies, and body of knowledge.

Disinformation. Disinformation is intentionally misleading, erroneous, or inadequate information, disseminated to further a particular agenda.

Environmental justice. A form of justice whose concerns include degradation of agricultural land and food sufficiency; aridification, desertification, water takings, and potable water; ozone layer degradation, deforestation, climate change, and air pollution; habitat loss and ecosystem destruction; industrial waste, sanitation, and nonbiodegradables; and choices of nonreplenishable over replenishable resources. It is also concerned with how various forms of environmental damage in the pursuit of economic self-interest places the heaviest burden upon the poor, forcing them to bear the highest social, environmental, economic, and health costs.

Ethics. The branch of philosophy or moral theology in which one reflects upon morality; the formal study of morality from a wide range of perspectives including semantic, logical, analytic, epistemological, normative, and applied.

Ethical judgment. Ethical judgment follows from moral discernment and analysis, based upon the particular aspects of the ever-evolving patient condition and context or, more largely, upon the features and context of an ethical issue.

Fidelity. The ethical principle that requires faithfulness to a formal or implied agreement. This would include loyalty, fairness, truthfulness, promise-keeping, and dedication in relationships.

Greater ends. The goals and values that nursing seeks, synonymous with the Greek term telos (teloi, plural).

Health. "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Health disparity. "Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations."

Health equity. "Equity is the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically, or by other dimensions of inequality (sex, gender, ethnicity, disability, or sexual orientation [identity]). Health equity is achieved when everyone can attain their full potential for health and well-being."

Impaired practice. Functioning poorly or with diminished competence, as evident in changes in work habits, job performance, appearance, or other behaviors that may occur in any role or any setting. This impairment can be due to myriad factors including substance use disorder (SUD) or other mental or physical conditions.

Instantiated. To instantiate is to internalize and enact the moral identity of the nurse as defined by the moral values and norms of the tradition, narrative, and community of practice. Instantiation is a process from novice to expert and involves interiorizing and demonstrating the values and virtues of nursing.

Integrity. Integrity manifests outwardly as honesty, constancy, and consistency with shared moral norms. This is the other-regarding form of integrity. The self-regarding form of integrity is an interior norm of faithfulness to one’s own moral values, virtues, and norms; and constancy in adhering to them.

Interprofessional. Characterized by practicing professionals from two or more disciplines working, learning, or taking action together.

Intersectionality. Intersectionality stems from a group of critical theories that examine social constructs such as race, gender, class, religion, ability, caste, physical attributes, and so on. Intersectional theories recognize the complexity of interacting constructs, (for example race with gender with religion), as potentiating social disadvantage or advantage, and giving greater nuance to understanding social and structural oppressions.

Intraprofessional. Characterized by practicing professionals from the same discipline working, learning, or taking action together.

Justice. Justice is a central concept in ethics, one of great complexity and depth with an extensive literature. In bioethics, justice is deployed as a principle, largely to examine the allocation and cost of health care. More recently, bioethics has taken note of justice in relation to social and structural issues, particularly in the nursing ethical literature.

Knowledge of a discipline (nursing). “Knowledge of a discipline consists of the ideas that have been expressed in writing, and these writings have been collectively judged by standards shared by members of the disciplinary community so that the ideas can be taken to be a valid and accurate understanding of elements and features that comprise the discipline.”

Misinformation. Misinformation is information that is factually erroneous, flawed, or incomplete that may be disseminated mistakenly, without ill intent.

Moral agency. Moral agency refers to the exercise of moral autonomy. Moral agency, to be autonomous, must be free of internal constraints (such as exhaustion) or external constraints (such as institutional policy) to moral action.

Moral distress. The experience of a) believing one knows a correct ethical action to take or professional obligation to meet and b) being unable to act due to constraints beyond their immediate or individual control. This threatens their sense of moral agency and integrity as healthcare professionals. There is debate in the literature about whether the definition ought to incorporate other morally troubling situations with one suggestion being that moral distress is the psychological distress that is causally related to a moral event.

Moral disposition. The moral tendency, grounded in the values and virtues of a community, to behave in ways that are consistent with moral values, virtues, obligations, norms, and ideals of that community (nursing) and its tradition and practice.

Moral equality. All persons have equal moral dignity and worth and are deserving of respect.

Moral fortitude. Strength of character in the pursuit of goodness; virtue demonstrated by the ability to stand firm on values, moral principles, and moral convictions; grit

Moral identity in nursing. One’s moral identity in nursing is formed through education and practice within the community, tradition, and practice of nursing. That formation involves the immersion and internalization in, and increasing enactment of, the moral virtues, values, ideals, and obligations of nursing’s community of practice. The ability to enact these values increases with experience as the nurse moves from novice to expert.

Moral milieu. An environment that supports the practice of morally good nursing.

Nursing organizations. Groups and associations who affiliate to promote nursing practice, unity, and political advocacy, disseminate professional knowledge, and facilitate professional development.

Planetary health. “A solutions-oriented transdisciplinary field and social movement focused on analyzing and addressing the impacts of human disruptions to Earth’s natural systems on human health and all life on Earth.”

Prejudice. A preconceived notion or stereotype, deeply held, whether aware or unaware, that results in ascribing unfounded attributes to a group or individuals. Prejudice generally operates negatively to the disadvantage of groups or individuals in the form of bias and prejudicial discrimination.

Professional nursing organizations. An organization that includes a member body of professional nurses and elected association leadership that is responsive to its members’ needs and the needs of the profession.

Racism. Assaults on the human spirit in the form of actions, biases, prejudices, and an ideology of superiority based on race that persistently cause moral suffering and physical harm of individuals and perpetuate systemic injustices and inequities.

Recipient(s) of care. Intentionally used to identify those who receive nursing care, including those left outside the established healthcare systems (e.g., persons who are undocumented, unsheltered, un- or under-insured) used interchangeably with recipients of nursing care and patients. Recipients implies reciprocity in the relationship.

Responsibility (for nursing action). Responsibility is tied to moral agency and accountability. Nurses are answerable for judgments and actions under their control. They are considered morally praiseworthy or morally blameworthy in proportion both to the degree of their control of their action, and its conformity with standards of practice.

Rights, human. Human rights are fundamental freedoms to which all are entitled by virtue of their humanity. Rights include both positive rights (a right to...) and negative rights (a right to be free from...).

Scholarly inquiry. Scholarly inquiry, also scholarly research, originally referred to research that took place within the walls of the scholus (school) itself, that is, in the archives and libraries of the school’s collections. It referred to nonscientific, nonempirical, research that included for example, philosophy, theology, and history. Scholarly inquiry refers broadly to research in the humanities that employ humanistic methodologies, including but are limited to, classical languages, linguistics, literature, history, philosophy, theology, religion, ethics, art theory and criticism, as well as the humanistic methods or content of aspects of the social sciences such, as critical theories.

Self-regarding duty. Duties to self are based on the moral understanding that duties and values, such as dignity and worth, are universally applied, including to the nurse. That is, nurses are a part of the universal. Duties to self is an aggregate duty (hence duties) that is self-regarding. It includes several duties in one principle such as maintaining one’s integrity, being fully who one is, maintaining competence, and more.

Social and structural determinants of health. Social determinants of health are both structural and nonstructural aspects of society that advantage or disadvantage individuals or groups. Social and structural elements that disadvantage individuals or groups are also referred to as oppressions. Additionally, political and environmental determinants of health, although social and structural in nature, are used, at times, to emphasize the effects that sociopolitical and environmental factors have on health.

Social justice. A form of justice that engages in social criticism and social change. Its focus is the analysis, critique, and change of social structures, policies, laws, customs, power, and privilege. It examines the way in which these disadvantage or harm vulnerable social groups through marginalization, exclusion, exploitation, and voicelessness. Among its ends are: a more equitable distribution of social and economic benefits and burdens; greater personal, social, and political dignity; and a deeper moral vision for society. It may refer to a theory, process, or end.

Trauma-informed. “An intentional patient-centered approach to healthcare that is used to prevent re-traumatization of patients” and recipients of care who have a history of trauma.

Values. Values are the goods intrinsic to nursing, such as compassion and caring, as well as the ends that nursing seeks, such as health, dignity, and well-being. Some values are intrinsic goods, meaning that they are an end for their own sake. Other values are instrumental goods such as health as an end to personal satisfaction and life enjoyment. Nursing seeks both intrinsic and instrumental goods.

Virtue. Virtues are attributes of moral character that are habituated so that they may be enacted. However, in the ancient understanding they were static attributes possessed by the individual. Contemporary understanding sees virtues as the possession, not of the individual, but of the community that embraces them as normative. Thus, virtues are fluid in the sense that they require moral attunement and responsiveness, and different virtues emerge as morally required, when required. Virtues are not to be confused with traits of personality.

Weathering. The wearing down, breaking, disintegration, and/or alteration of the human spirit over time based on the continued impact of external factors.