Nurses working across community and primary care settings face a number of ethical issues in their everyday work. Ethical principles underpin optimal practice. There are two main approaches to ethical reasoning: normative ethics, based on the rights and obligations of an individual; and teleological ethics, based on anticipating the consequences of an action. Issues can arise when ethical principles based on the obligations of the nurse or an analysis of the possible consequences of an action are applied to care. Nurses have to manage patients’ expectations, service protocols and economic constraints, as well as proceed in a person-centred and ethical way.

This article explains the two main approaches to ethical reasoning, before identifying their limits and proposing some person-centred principles of care negotiation that will enable nurses to provide care that is principled and practical.