The PAMSS Model: Ethical decision-making on companion animal presence in nursing practice

Requests for the presence of patients' own companion animals during healthcare institutionalization are increasingly encountered in nursing practice, yet remain insufficiently addressed within existing ethical and organizational frameworks. Decision-making is often guided by safety and logistical considerations, while relational and experiential dimensions of care are marginalized.

This article introduces the PAMSS Model, named after its core concept: the Affective Presence of Patients' Own Companion Animals in Healthcare Services. The model is presented as a theoretically grounded and practice-oriented nursing ethics framework to support structured deliberation in these situations.

Drawing on care ethics, phenomenology of lived experience, relational autonomy, and nursing ethics scholarship, the PAMSS Model was developed as a conceptual framework for ethical decision-making. The model conceptualizes such decisions as ethically non-neutral and embedded within contexts of vulnerability and institutional constraint.

The PAMSS Model articulates seven interrelated ethical dimensions and is illustrated through a clinical case. By foregrounding lived experience, relational dignity, and nurses' moral agency, the framework supports ethical reflection beyond safety-based or logistical decision-making alone.

The PAMSS Model offers implications for nursing leadership, clinical practice, institutional decision-making, and ethics consultation by providing a structured ethical framework for addressing requests involving patients' own companion animals during healthcare institutionalization.