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

BACKGROUND: 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. PURPOSE: 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. METHODS: 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. DISCUSSION: 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. CONCLUSION: 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.