The moral context of oncology nursing.
Current work environments in health care are hierarchical social systems built around disease-oriented medical goals and procedures. Expansion of biomedical technologies and cost-containment policies have increased the ethical concerns and problems of nurses and other providers. Yet, nurses often are not included as major contributors in deliberations about solutions to these ethical problems. A patriarchal pattern of decision making reflects the paternalistic organization of patient care settings and discounts the reality that multiple providers from many disciplines and specialties provide patient care. To foster ethical practice as a shared activity, ways are needed to build work environments that foster interdependent practice and facilitate moral discourse among all participants. Actions to promote the development of work environments as moral contexts require systematic attention to conceptual, structural, process, and leadership issues that foster collaboration, open communication, and person-centered care.