Symphonology (from “Symphonia”, a Greek word meaning agreement) is a system of ethics based on the terms and preconditions of an agreement. In the health care setting this is the agreement between a patient and a nurse, or any health care professional, which establishes and defines the relationship they share. Ethical and professional responsibilities – the norms of practice - are set by the nature of this relationship.

Symphonology is a practice-based approach to ethical decision making. A practice-based ethical system is intended to be appropriate to the purposes of a health care setting, the role of a nurse, and the well-being of a patient. It is based on an implicit agreement - a shared state of awareness on which bioethical interactions between professional and patient occur.
Nurses motivated by a contemporary, non-practice-based system, guided by an external motivation, move away from their patients and their profession. They abandon concern for their patients in favor of an unrelated ‘duty’ or they speculate on the expectations of their society, and/or they sink into their emotions for guidance.

The judgment that a nurse, guided by a non-practice-based system, will sometimes betray the profession and the best interest of patients is both unexpected and disquieting. But it is the only honest judgment one can make. Under the contemporary ethical systems, a patient has no reason whatever to place trust in a nurse. A patient has no way of knowing what individual nurses might consider to be their ‘duty’ or what a nurse will assume society desires or what the emotional response of a nurse might be to the situation.

Under symphonology, a nurse as a professional and as an ethical agent is one person – a health care professional. Under the contemporary ethical systems, a nurse is compelled to be two persons – a professional when she is not compelled to be an ethical agent and an ethical agent when her ethical decisions will no longer permit her to a professional.
Symphonology gives a firm foundation to a patient’s trust. Symphonological bioethical theory holds that:

• A nurse is the agent of a patient doing for patients what they would do for themselves if they were able, and acting to restore their ability to take actions for themselves.
• A patient is one who, in one way or another, has lost or suffered a decrease in his or her ability to take the actions required for survival or well-being. This fact defines a nurse’s role.
• The nurse/patient agreement, and fidelity to this agreement, is the basis of all understanding, benevolence, and trust in the health care setting.
• There are standards of bioethical action that are preconditions and, therefore, sub-agreements of the health care professional/patient agreement. Ethical action is action in accordance with these standards. Such actions satisfy bioethical responsibilities.
• Ethical action takes place in a context and a change in the context can change the decision that ethically needs to be made.

A practice-based bioethic requires that a nurse who practices it possess an above average degree of personal integrity. A very high degree of personal satisfaction and emotional fulfillment can be built on this integrity.

Symphonology never loses sight of what is necessary to the personal and professional development of a nurse. A nursing ethic can be, and ought to be, a source of enthusiasm and professional pride. It is obvious that this is also a profound benefit to the well-being and welfare of patients. These two elements of nursing practice “walk together.”

Husted, J. H., & Husted, G. L. (2008). Ethical decision making in nursing and health
care: The symphonological approach (4th ed.). New York: Springer.

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