Cases of conscience: casuistic analysis of ethical dilemmas in expanded role settings.

In the absence of a well articulated conceptual framework for nursing ethics, this article argues for a theory of applied ethics--casuistics--used within a clinical reasoning model, to analyse the complicated issues presented in three cases involving adolescents receiving treatment for abuse through a rural alternative learning centre. The clinical nurse specialist, as an independent practitioner within the community, is presented with many ethical challenges arising from cultural diversity. The inherent independent nature of such practice environments combined with the pluralism which exists in today's multicultural society demands that professional nurses working in these circumstances develop and utilize an ethical framework for the analysis of patient care in situations that involve moral conflict.