1. Applying Care Ethics to Performance Measures
Leakie Bell-Wilson

2. Abstract
Use of the theory of care ethics is discussed to demonstrate to nurses how applying this theory can be useful in improving patient’s performance measures outcomes, thus valorizing nursing practice. After a basic definition of performance measures and an overview on the progression of the theory of ethics of care, a case will be used to illustrate Tronto’s (1993) four phases of caring and her four elements of care. Thus, bridging the relational side of nursing with the reasoning side to offer an argument of those who might feel nursing is to feminine of a profession.

3. Theoretical Framework
Joan Tronto (1993)
Four elements of care (caring about, taking care of, caregiving and care receiving)
Four elements (attentive, responsibility, competence, and responsiveness)
Political component

4. Case Study
Mr. Anderson, 73yrs old male, has his routine outpatient primary care visit today. He has a long history of congestive heart failure, hypertension, uncontrolled diabetes and smoking. He has been a widow for 1yr after 30 years of marriage with his second wife. He reports that since his wife’s death he has trouble sleeping, loss of appetite, reduced interest in activities that he once enjoyed, such as golfing. During the visit he reports that he just returned from visiting his daughter in Singapore 2 weeks ago. He was hoping the visit with his daughter would lift his spirits, but he still feels the same. During this visit he is scheduled to have a depression, tobacco and diabetes performance measures screenings completed. Having taken care of Mr. Anderson before you notice he is quieter, scoring on depression screen is higher, bruises are present on his arms, and he appears more disheveled than on previous visits. As a response to this change in his depression screen score (performance measure), appearance and mood you notify the Provider for follow-up on the positive depression screen as well as the other changes noted with Mr. Anderson. The Provider conducts the required follow-up depression screen, but due to short staffing on the mental health team he is hesitant on referring Mr. Anderson for a mental health evaluation. However, you advocate for Mr. Anderson because you recognize that his performance measures results and the symptoms he is exhibiting are vastly different from previous visits and might indicate that he is in medical trouble. This advocacy results in the mental health team discovering that Mr. Anderson was planning suicide and his trip to Singapore was a goodbye trip to his daughter. The Mental health team is able to assist Mr. Anderson with the proper mental health treatment he needs. As the nurse leaves Mr. Anderson with the mental health team, he reaches out to squeeze her hand and mouths “thank you”.

5. Application of Tronto Four Phases and Elements of Care
Phases of care (4)
Nurses Application of
Phases of Care
Elements of Care (4)
Elements Care of
1. Caring about (assume responsibility of care)
Nurse Recognize change in condition
1. Attentiveness (recognizing another person’s needs)
Used past experiences and interaction to note changes
2. Taking care of (provide the needed care)
Took responsibility in ensure performance measures were complete
2. Responsibility (caring enough to want to provider care either as obligation or responsibility)
Cared enough about him to keep probing
3. Caregiving (meeting the needs of another)
Advocate for patient despite hesitancy from Provider
3. Competence (provide appropriate care)
The completion of the performance measures identified depression
4. Care receiving (recipient of care)
Patient received necessary treatment
4. Responsiveness of care receiver (re-assessing effectiveness of actions)
Patient expressed gratitude

6. Argument for Use
Promotes fusion of traditional nursing values like morality and caring with reasoning through the use of evidenced-based data.
Gives female nurses a stronger voice in decision-making without having to take on a masculine persona
To the delight of feminist like Kristin Coyle's (2002) makes profession more appealing to more males and those with keen interest in research by altering the perception that the profession is woman’s work. Thereby improving opportunities to close the gendered, race and class gaps in the profession.

7. Suggested Future Use
Using Tronto Care Ethics theory as a way to integrate teaching performance measures into nursing curriculums