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CHAPTER 26 Gladys L. Husted and James H. Husted 531

of Symphonology and the relationships among the Accessibility
concepts. The book may be difficult for beginning nurses Symphonology is a theory grounded in ethical principles
to read because deeper concepts meant for advanced and based in reality. Evidence has demonstrated support
practitioners are included along with basic ideas. The of the theory in nursing practice decision research, and
third edition, Ethical Decision Making in Nursing and the reality of the usefulness of the theory in practice is
Healthcare: The Symphonological Approach, begins with evident. Nurses and other health care professionals can
the basic concepts for understanding and using the easily understand the concepts and apply them in all situ-
theory and then moves to more advanced concepts in ations. The result of using the Symphonological model is
later sections (Husted & Husted, 2001). Along with this a patient-centered, ethically justifiable decision.
improved organization, the third edition shows the
emergence of increasing clarity for all concepts, the Importance
bioethical standards in particular. The fourth edition Being able to identify ethical actions in health care is
provides yet further clarity using tables and figures and of vital importance to patients, health care profession-
includes a user-friendly teacher manual. als, and the health care industry itself. Understanding
This work challenges traditional methods of thought the ethical dilemmas of nursing practice is an impor-
and requires the reader to develop a new understand- tant issue for nursing education, research, and prac-
ing of familiar concepts. Storytelling and examples tice. Before a nurse or any health care professional
provide the opportunity to recognize and understand takes action (regardless of how effective the action has
the importance of alternative and extended meanings been in the past), the action must be justified as ethical
for familiar terms. The conversational tone of the writ- with regard to the particular patient at hand. Reliance
ing is appealing and creates a comfortable atmosphere on concrete directives to guide action serves the direc-
for a complex subject. tives, but only by chance serves the patient. Therefore,
the pursuit of a practice-based ethical theory is essen-
Simplicity tial for nursing practice and health care.
The authors first challenge the truth and efficacy of
traditional ideas about ethical behavior and decision
making. This is a simple matter if the reader is open- Summary
minded to a different view of nursing events. As the The Husteds recognized that the traditional methods
reader accepts the challenge, the simplicity of the of decision making were insufficient to address the
theory is evident. There are few concepts, and the re- bioethical problems emerging in the evolving health
lational statements flow logically from the definitions. care system. They developed a theory of ethics and a
The model clearly demonstrates the elements of the decision-making model based on rational thought
process of ethical reasoning and the manner in which combined with ethical principles, insight, and under-
these elements interact. standing. Their theory is founded on the singular
concept of human rights, the essential agreement of
Generality nonaggression among rational people that forms the
Symphonology is applicable at all levels of nursing foundation of all human interaction. Upon this foun-
practice and in all areas of health care. The princi- dation, health care professionals and patients enter
ples can be applied between nurse and patient, re- into an agreement to act to achieve the patient’s goals.
searcher and subject, manager and employee, and Preconditional to this agreement are recognition
educator and student. Health care professionals of and respect for each person’s unique character struc-
all types can use this method to determine appropri- ture and the attendant properties of that structure:
ate ethical behaviors in practice. This theory can also freedom, objectivity, beneficence, self-assertion, and
be applied to the process of establishing health care fidelity. Ethical decisions are established within the
policy that is ethical in nature. Indeed, these princi- context of a particular situation, using knowledge
ples can be applied in all walks of life, depending pertaining to the situation. Symphonological theory
on the nature of the agreement between the parties and the model for practice ensure ethically justifiable,
involved. individualized decisions.