The relational narrative: implications for nurse practice and education

Nurses frequently encounter situations in which they are compelled to make ethical decisions about what is good and right to do in their day-to-day practice. Often existing moral edicts prove to be inadequate in light of the patient's particular circumstances. To what, then, can the nurse turn? In response to this question, Gadow (1999) proposes a dialectical framework comprised of three ethical approaches: subjective immersion (ethical immediacy), objective detachment (ethical universalism), and intersubjective engagement (relational narrative). In this paper, the dialectic framework proposed by Gadow (1999) is examined with respect to some of its potential implications for nursing practice and education. This endeavour is undertaken in the spirit of extending the dialogue that Gadow has so eloquently initiated. Questions related to whether it is possible (or necessary) to reconcile the contradictory tenets of these ethical approaches or the potential disjunction between the knowledge embedded in the relational narrative and ensuing action on the part of the nurse are discussed. In addition, some of the potential implications of this dialectical framework for nurse education are explored, including the question of how nurses learn to enter into a relational narrative with another and the relevance of relational narratives to teacher–student relationships.