Project MUSE®: Narrative Inquiry in Bioethics - Latest Articles
https://muse.jhu.edu/journal/521
Project MUSE®: Latest articles in Narrative Inquiry in Bioethics.daily12026-05-12T00:00:00-05:00text/htmlen-USVol. 1 (2011) through current issueLatest Articles: Narrative Inquiry in BioethicsTWOProject MUSE®Narrative Inquiry in Bioethics2157-17402157-1732Latest articles in Narrative Inquiry in Bioethics. Feed provided by Project MUSE®Editors' Note
https://muse.jhu.edu/article/989480
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In the early 1900s New York City had a significant problem: thousands of children were absent from school each day due to health-related issues that were often common and not that alarming, such as lice and ringworm (Houlahan, 2018; Kueter, 2019). Lina Rogers Struthers became the first school nurse in the United States when she was hired for a one-month experiment to see if having a nurse in schools could boost attendance (Hawkins et al., 1994; Schumacher, 2002). The experiment was so successful in reducing absenteeism that after one month, the NYC Board of Health hired 12 nurses to serve the city's schools (Schumacher, 2002).Over time, the role of school nurses has expanded, though school nurses face many of the
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallEditors' Note2026-05-08text/htmlen-USEditors' Note2026-05-082026TWOProject MUSE®129722026-05-12T00:00:00-05:002026-05-08Ethical Dilemmas in School Nursing
https://muse.jhu.edu/article/989481
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Conflicts of Interest. The author reports no conflicts of interestIn 1902, Lillian Wald, one of the founders of Henry Street Settlement in lower Manhattan, was approached by the Chairman of the Board of Education and Health Commissioner of NYC (Houlahan, 2018). Nearly one-fifth of the school population were absent each day because of contagious diseases, although many children remained in school if the teacher did not recognize the child's illness (Houlahan, 2018, p. 205). When teachers did send a child home, they were rarely seen by a physician, resulting in prolonged absences.Wald proposed a one-month experiment of having a nurse in schools (Kennedy, 2003). She hired Lina Rogers Struthers, an experienced
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallEthical Dilemmas in School Nursing2026-05-08text/htmlen-USEthical Dilemmas in School Nursing2026-05-082026TWOProject MUSE®295502026-05-12T00:00:00-05:002026-05-08Beyond the Band-Aids: A School Nurse's Journey from Discovery to Heartbreak
https://muse.jhu.edu/article/989482
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School nursing did not call my name. Extraneous factors and the need for a schedule that mirrored that of my children influenced my decision to practice nursing in the school setting. I began my school nurse career in inner-city schools. My training consisted of the meager suggestion, "Keep your admin happy." Where does the health and well-being of the students rank, I wondered. I was a mother of four, which proved invaluable due to the lack of training. Each day, I donned my proverbial motherly hat and spent my days tending to elementary-aged children, middle-school teens, and high-school adolescents. Some days, I made a difference in the life of a student. Most days, I kept my admins happy. One day, I found
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallBeyond the Band-Aids: A School Nurse's Journey from Discovery to Heartbreak2026-05-08text/htmlen-USBeyond the Band-Aids: A School Nurse's Journey from Discovery to Heartbreak2026-05-082026TWOProject MUSE®83782026-05-12T00:00:00-05:002026-05-08K–12 Independent School Sees Entire Team of Nurses Leave After Nurses Endure Years of Understaffing: Ethical Implications and Lessons Learned
https://muse.jhu.edu/article/989483
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I worked as a school nurse at an independent school with 1,000 students for almost fifteen years; however, last year, ongoing staffing issues in the nursing department became a significant safety concern, ultimately leading me to feel pressured to resign. By the end of the year, the School had lost both of its full-time nurses and its permanent nurse substitute related to staffing decisions.As is often the case in schools, administrators—who are not medical professionals—may lack a full understanding of the healthcare industry. This can leave school nurses isolated, working alongside well-intentioned educators who may not fully grasp the risks nurses face. I would like to believe this was the situation at my former
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallK–12 Independent School Sees Entire Team of Nurses Leave After Nurses Endure Years of Understaffing: Ethical Implications and Lessons Learned2026-05-08text/htmlen-USK–12 Independent School Sees Entire Team of Nurses Leave After Nurses Endure Years of Understaffing: Ethical Implications and Lessons Learned2026-05-082026TWOProject MUSE®107762026-05-12T00:00:00-05:002026-05-08Keep Calm, I am a School Nurse
https://muse.jhu.edu/article/989484
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A school nurse is a compassionate and skilled healthcare professional. They work as an integral part of an entire community. They rarely look at things in isolation but rather as part of a larger system. A school nurse's trained eye allows them to search for deeper reasons and explanations when a situation arises. I have always loved that part of my practice and likened it to that of a "Columbo" mentality1. Asking questions and gaining connections with children, parents, or staff make the work of school nursing rewarding.When a school nurse is in practice for many years, there will undoubtedly be countless times when they are placed in situations where people need help, but the constraints of our "systems" make it
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallKeep Calm, I am a School Nurse2026-05-08text/htmlen-USKeep Calm, I am a School Nurse2026-05-082026TWOProject MUSE®135132026-05-12T00:00:00-05:002026-05-08Ethical Dilemmas in School Nursing: Advocating for a Student in Crisis
https://muse.jhu.edu/article/989485
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As a Latina-certified school nurse and educator, advocating for vulnerable students is both a professional responsibility and a deeply personal mission. I have always believed that school nurses do more than manage physical ailments; we are often the first responders to students' unseen mental health struggles. One case that impacted me occurred in the wake of the COVID-19 pandemic, highlighting the ethical tensions between confidentiality, cultural sensitivity, and ensuring student safety.The student, whom I will refer to as "Sofia" to protect her privacy, was a bright yet withdrawn 10th grade student who frequently visited the health office. At first, her complaints seemed minor—headaches, nausea, and fatigue.
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallEthical Dilemmas in School Nursing: Advocating for a Student in Crisis2026-05-08text/htmlen-USEthical Dilemmas in School Nursing: Advocating for a Student in Crisis2026-05-082026TWOProject MUSE®82122026-05-12T00:00:00-05:002026-05-08"How Can I Not!?"
https://muse.jhu.edu/article/989486
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Should I? How can I not? It's illegal … but how can I not? This is a child.Before I elaborate on these professional yet personal, ethical, and moral questions … Let me introduce my professional self. I was employed at a large metro middle school for 23 years as the Certified School Nurse with a Nationally Certified School Nurse (NCSN) credential and an Illinois Professional Educator License (PEL) up to my recent retirement. This Illinois middle school taught almost 1,200 5th through 8th-grade students with diverse racial and ethnic backgrounds. Of the students, 99% were from low-income households, 23% were English learners, and 16% had Individualized Education Plans (IEPs). I was one of the two full-time nurses who
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmall"How Can I Not!?"2026-05-08text/htmlen-US"How Can I Not!?"2026-05-082026TWOProject MUSE®77282026-05-12T00:00:00-05:002026-05-08Caring Against the Odds: Ethical Challenges as a School Nurse in a Title 1 District
https://muse.jhu.edu/article/989487
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I served as the sole credentialed school nurse in a K–12 public school district in the San Francisco Bay Area, covering approximately 11,000 students across multiple campuses. Our district was designated as Title 1, meaning that a significant portion of our students came from low-income families. Many faced housing instability, food insecurity, and limited access to healthcare. This role taught me that school nursing was not just about scraped knees and vaccine records—it was about navigating ethical gray zones, systemic failures, and the heartbreak of not being able to do enough.One of the most ethically distressing situations I encountered involved a young elementary student with uncontrolled asthma. Within a
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallCaring Against the Odds: Ethical Challenges as a School Nurse in a Title 1 District2026-05-08text/htmlen-USCaring Against the Odds: Ethical Challenges as a School Nurse in a Title 1 District2026-05-082026TWOProject MUSE®128092026-05-12T00:00:00-05:002026-05-08Where Do I Start?
https://muse.jhu.edu/article/989488
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When asked to consider the ethical dilemmas experienced in school nursing, my initial thought was: "Where do I start?" As a School Nurse who worked through the COVID-19 pandemic and a polarizing election, I felt heat on all sides of my seat from parents, administrators, students, teachers, and friends. To complicate matters, I also worked in the same district that I lived in, and where my children went to school. I now know that this is a rule many educators have for themselves: "Always work one town over."There are three themes I can identify for when I felt the most conflicted, restricted, or frustrated in my role as a School Nurse. The first was planning, preparing, and implementing a safe "return to school"
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallWhere Do I Start?2026-05-08text/htmlen-USWhere Do I Start?2026-05-082026TWOProject MUSE®150632026-05-12T00:00:00-05:002026-05-08A Nurse Practitioner's Unique Perspective in School Nursing: Ethical Challenges Encountered in Providing Primary Care in a School-Based Clinic
https://muse.jhu.edu/article/989489
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In rural South Carolina in 2012, I was employed by a Federally Qualified Healthcare Center (FQHC) as a nurse practitioner with a Doctorate in Nursing Practice. The FQHC had 24 offices scattered about the Midlands of South Carolina, and I managed one of the most rural areas in the state. The area was large, remote, and poor. Transportation to the nearest town proved challenging for many patients and their families.A federal grant provided funding for the family practice office site and the newly constructed building where I practiced. The grant for the project stipulated that funding included the establishment of a school-based clinic in the community. There was one local elementary school that served kindergarten
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallA Nurse Practitioner's Unique Perspective in School Nursing: Ethical Challenges Encountered in Providing Primary Care in a School-Based Clinic2026-05-08text/htmlen-USA Nurse Practitioner's Unique Perspective in School Nursing: Ethical Challenges Encountered in Providing Primary Care in a School-Based Clinic2026-05-082026TWOProject MUSE®111052026-05-12T00:00:00-05:002026-05-08Ethical Dilemmas in School Nursing during the COVID-19 Pandemic
https://muse.jhu.edu/article/989490
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I have long been interested in the role of ethics in school nursing practice. During my combined 28 years as a school nurse and school health services leader, I believe that when a school nurse asks, "What should I do?" they are usually struggling with an ethical dilemma. Helping school nurses parse ethical challenges in school health has been one of the most rewarding parts of my leadership career. Little did I know how much I also would experience significant ethical dilemmas in my leadership role during the COVID-19 pandemic.The K-12 response to the COVID-19 pandemic provided me with many challenging ethical dilemmas. As the nation and public health authorities struggled with "What should we do?", so were
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallEthical Dilemmas in School Nursing during the COVID-19 Pandemic2026-05-08text/htmlen-USEthical Dilemmas in School Nursing during the COVID-19 Pandemic2026-05-082026TWOProject MUSE®108652026-05-12T00:00:00-05:002026-05-08The Cost of Inaction: An Ethical Dilemma of Delayed Treatment
https://muse.jhu.edu/article/989491
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In the educational environment, school nurses often cope with ethical predicaments that concern student well-being and parental rights. I found myself in such a situation on a Thursday afternoon when a student came to my office holding her wrist and visibly upset. The student told me that she had been at a gymnastics class the day before and that her wrist had been hurting since then.When I evaluated her wrist, it was observed to be slightly swollen, exhibited some bruising and had some tenderness with some limited range of motion. The student had confided to me that she had told her parents when it happened but they did not take her to the doctor. She stated that she was afraid she would be forced to mow the lawn
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallThe Cost of Inaction: An Ethical Dilemma of Delayed Treatment2026-05-08text/htmlen-USThe Cost of Inaction: An Ethical Dilemma of Delayed Treatment2026-05-082026TWOProject MUSE®91822026-05-12T00:00:00-05:002026-05-08One Breath Away
https://muse.jhu.edu/article/989492
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He's here again, the larger-than-life red-headed, freckle-faced teenage boy—not yet a man but eager to be one someday. He has fire-red cheeks and is clawing at his football pads, trying to suck in air while I run cool water over a towel to put on his neck. I know he has asthma and that the combination of the heavy pads, the pollen in the fall air, and the soaring temperatures is wreaking havoc on his airways. He's already been in a few times this week. My mind races to one conclusion. I should call 911. His mother has taken him to a doctor for a proper diagnosis, but she has not had the time or money to get his prescription inhaler. We do not have an unassigned inhaler in this district. But, if I call 911, the
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallOne Breath Away2026-05-08text/htmlen-USOne Breath Away2026-05-082026TWOProject MUSE®73912026-05-12T00:00:00-05:002026-05-08The Moral Burden of Inaction: A School Nurse's Perspective on Secure Firearm Storage Education
https://muse.jhu.edu/article/989493
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Walking through the halls of my school, I often feel the weight of what isn't being said and what isn't being done. Every day, I see the faces of students who trust us to keep them safe, yet I know we're falling short in a critical way. As a school nurse, a family member of gun violence survivors and victims, and an advocate for gun violence prevention, I carry a deep sense of moral injury because my school district refuses to take action on secure firearm storage education. This inaction is more than frustrating—it's heartbreaking.Gun violence has been the leading cause of death for children and teens in the United States since 2021. Let that sink in. It's not car accidents or illnesses; it's gun violence. That
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallThe Moral Burden of Inaction: A School Nurse's Perspective on Secure Firearm Storage Education2026-05-08text/htmlen-USThe Moral Burden of Inaction: A School Nurse's Perspective on Secure Firearm Storage Education2026-05-082026TWOProject MUSE®85912026-05-12T00:00:00-05:002026-05-08Walking the Ethical Tightrope: Protecting Students with Seizures in School Settings
https://muse.jhu.edu/article/989494
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School nursing is a multifaceted role that requires a balance between ethical considerations, legal requirements, and the well-being of students. It encompasses chronic disease management, emergency preparedness, mental health support, and advocacy for students with medical needs. Ethical dilemmas arise when these responsibilities intersect with legal limitations, parental rights, and institutional constraints. One of the primary ethical principles in nursing is beneficence, which dictates that nurses must act in the best interests of their patients. However, when parental decisions conflict with what medical professionals consider best for the child, nurses find themselves in morally distressing situations.My
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallWalking the Ethical Tightrope: Protecting Students with Seizures in School Settings2026-05-08text/htmlen-USWalking the Ethical Tightrope: Protecting Students with Seizures in School Settings2026-05-082026TWOProject MUSE®96452026-05-12T00:00:00-05:002026-05-08School Nurses as Navigators, Translators, and Advocates
https://muse.jhu.edu/article/989495
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Conflicts of Interest. The author reports no conflicts of interest.Nurses are entrusted as witnesses to the unfiltered messiness of being human, including the vulnerabilities that arise from threats to health and wellbeing, including in the schoolhouse. They are usually proximate to and present with the recipient of care and work alongside other practitioners, institutions, and systems. In this light, the long-standing traditions in nursing that emphasize the multidimensional nature of health, the role of relationships and systems on health, and the nurse's advocacy obligations make perfect sense. At their best, nurses are observers, translators, navigators, partners, and especially, advocates for those in their
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallSchool Nurses as Navigators, Translators, and Advocates2026-05-08text/htmlen-USSchool Nurses as Navigators, Translators, and Advocates2026-05-082026TWOProject MUSE®385672026-05-12T00:00:00-05:002026-05-08Parents' Perspectives on the Role and Value of School Nurses
https://muse.jhu.edu/article/989496
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Conflicts of Interest. The authors report no conflicts of interest.Nurses, in general, are highly regarded as professionals," Elizabeth Blanton writes, but school nurses often "fall into a different category." Blanton continues that school nurses are sometimes "viewed as irrelevant and expendable" or simply "unnoticed." As Rachel Torres suggests, people in the field are often described as "'just' a school nurse," as though they are somehow second-class professionals, not real nurses, like those who work within clinics and hospitals. As contributors to this collection make clear, however, treating school nurses as "second-class" professionals reveals a misunderstanding—and a lack of appreciation—for the essential
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallParents' Perspectives on the Role and Value of School Nurses2026-05-08text/htmlen-USParents' Perspectives on the Role and Value of School Nurses2026-05-082026TWOProject MUSE®264292026-05-12T00:00:00-05:002026-05-08Unsung Healthcare Heroes for Children
https://muse.jhu.edu/article/989497
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Conflicts of Interest. Dr. Newland received funding related to school-based COVID-19 testing from the National Institutes of Health.Schools are central to all communities as they focus on the health, well-being, and development of our children. This commentary takes the perspective from school nurses, the unsung heroes of schools and our communities, due to their fierce dedication to children and their families. Often, these healthcare workers are the only medical professionals responsible for the health of hundreds to thousands of children and adolescents at one or more schools geographically separate. They are relied upon to not only keep the school safe but also to provide compassionate, supportive care for each
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallUnsung Healthcare Heroes for Children2026-05-08text/htmlen-USUnsung Healthcare Heroes for Children2026-05-082026TWOProject MUSE®336792026-05-12T00:00:00-05:002026-05-08Ethical Dilemmas in School Nursing: A Virtue-Centered Reading of Care, Courage, and Character
https://muse.jhu.edu/article/989498
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Conflicts of Interest. The author reports no conflicts of interest.School nurses face many challenges, including understaffing, ethical dilemmas, and advocating for students' medical needs when resources are limited. The 13 narrative symposium authors in this issue of NIB—all of whom have worked as school nurses—recount their experiences addressing students' physical and mental health issues, navigating systemic limitations, and demonstrating the importance of compassion and resilience in providing holistic care. Many of the authors' stories highlight instances where they faced difficult decisions in which the ethical need to provide the best possible care clashed with the reality of limited resources or
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallEthical Dilemmas in School Nursing: A Virtue-Centered Reading of Care, Courage, and Character2026-05-08text/htmlen-USEthical Dilemmas in School Nursing: A Virtue-Centered Reading of Care, Courage, and Character2026-05-082026TWOProject MUSE®269272026-05-12T00:00:00-05:002026-05-08Moral Distress in Pediatric Residents: Mapping Experiences, Ethical Guidance, and Challenges in Navigating Ethical Conflicts
https://muse.jhu.edu/article/989499
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Conflicts of Interest. None to report.Moral distress is well-documented in nursing literature, but there is growing recognition that it affects all healthcare professionals (HCPs) (Austin et al., 2008; Chen, 2009; Epstein & Delgado, 2010; Førde & Aasland, 2008; Hamric & Blackhall, 2007; Houston et al., 2013). HCPs who experience significant moral distress include, but are not limited to, nurses, physicians and respiratory therapists (Epstein & Delgado, 2010; Lee & Dupree, 2008; Quek et al., 2022; Schwenzer & Wang, 2006; Thomas et al., 2021). Factors contributing to moral distress include real or perceived powerlessness, feeling complicit in distressing decisions and repeated negative experiences (Epstein & Delgado
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallMoral Distress in Pediatric Residents: Mapping Experiences, Ethical Guidance, and Challenges in Navigating Ethical Conflicts2026-05-08text/htmlen-USMoral Distress in Pediatric Residents: Mapping Experiences, Ethical Guidance, and Challenges in Navigating Ethical Conflicts2026-05-082026TWOProject MUSE®1270412026-05-12T00:00:00-05:002026-05-08Evaluating Parental Refusal of Treatment: Thinking Beyond the Principles
https://muse.jhu.edu/article/989500
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Conflicts of Interest. The authors declare that they have no conflict of interest.Funding Statement. None.One of the foundations of forming a strong therapeutic alliance between a patient and clinician is establishing trust and understanding, most commonly through a mechanism of shared decision-making in which information is exchanged in both directions. A clinician's medical knowledge and recommendations should be balanced with the patient's stated values and goals to craft an appropriate path forward (US Preventive Services Task Force, 2022). While adult patients may make choices which are not medically advisable so long as they understand the consequences, the clinician has an additional obligation for pediatric
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Project MUSE®https://muse.jhu.edu/2026-05-12T00:00:00-05:00https://muse.jhu.edu/journal/521/image/coversmallEvaluating Parental Refusal of Treatment: Thinking Beyond the Principles2026-05-08text/htmlen-USEvaluating Parental Refusal of Treatment: Thinking Beyond the Principles2026-05-082026TWOProject MUSE®503922026-05-12T00:00:00-05:002026-05-08