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The study investigated changes in care-based moral reasoning, in the context of justice development over the 2-year period among practical-nursing, bachelor-degree social-work and law-enforcement students (N = 59). Main measures were Skoe's Ethic of Care Interview and Colby et al.'s Moral Judgment Interview. Of the participants 34% progressed in care reasoning, and 48% in justice reasoning. Social-work and nursing students progressed in care reasoning, and all groups progressed in justice reasoning. One participant (1.7%) regressed in care reasoning. Care and justice reasoning were parallel in terms of internal consistency, and they were positively related to each other. Findings suggest that care reasoning follows a developmental sequence, involving three main and two transitional levels, as suggested by Gilligan (1982). Main levels include self-concern (Level 1), caring for others (Level 2), and balanced caring for self and others (Level 3).

While the ethic of care has generally been regarded as an appropriate attitude for nurses, it has not received equal attention as a mode of ethical problem solving. The primary nursing model is expected to be aligned with the ethic of care because it emphases the nurse–patient relationship and enables more independent role for nurses in decision-making. The aim of this study was to examine nurses’ ethical decision-making in the context of primary nursing. Participants were seven nurses, and one physiotherapist from a geriatric rehabilitation unit of a public hospital in Finland. Data were collected through focus group interviews and qualitatively analyzed through Lyons’ coding scheme for moral orientations. The results showed that primary nurses employ empathic understanding and particularistic thinking when building relationships with patients and their families, and when assessing their needs for coping at home after discharge. Most ethical conflicts were related to discharge and were solved through balancing the ethics of care and justice considerations. It is concluded that care and justice are integrated in nurses’ everyday ethical decision-making. The ethic of care nurtures good patient–nurse relationships, while the ethic of justice is needed to address the fair delivery of care in the context of an aging population and diminishing public resources. Both ethics should be acknowledged in clinical practices and included in ethics education.

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