This study investigated the relationship between ethical leadership of nursing managers, conscientiousness, and moral courage . Find your courage: 12 acts for becoming fearless at work and in life. 2008 Oct;9(4):248-56. Susan, in the meantime, speaks to Brenda, a new nurse graduate, about Mr. Yarrows apparent need for more sedation. Fowler, M. D. M. 2023 Mar 8;20(6):4763. doi: 10.3390/ijerph20064763. J Nurs Adm. 2009 May;39(5):228-35. (2008). I knew on day one I was going to have problems. American Nurses Association (ANA). Plato's ethics: An overview. Nursing social policy statement. The second barrier is the anxiety or fear that nurses experience when they do speak up. Furthermore, bedside nurses and nursing administrators should use ethical decision-making practices to resolve value-based conflicts that lead to moral distress. Background: Moral courage is the ability to defend and practice ethical and moral action when faced with a challenge, even if it means rejecting pressure to act otherwise. I recently was given DON position over a group of nurses who had not had a DON in years. The E in CODE denotes expression and action through assertiveness and negotiation skills. This helps them develop morally courageous behaviors even before an ethical dilemma occurs. MedSurg Nursing Journal, 17(2), 126-128, 134. Nurses' self-assessed moral courage and related socio-demographic factors. The role of character in ethical decision-making. ), Danger management (What do I need to handle my fear? Risk-takers are willing to put themselves on the line in various ways, because they judge the outcome will be worth the risk even though they have no assurance this will be the case. During this step, explore possible actions and consider adverse consequences associated with those actions. Developing Cognitive Strategies to Promote Ethical Competence. Patterson et al. Nursing educators therefore have a huge responsibility for building a strong moral and ethical foundation upon which future nurses will build their practice. Consequences included personal and professional development and empowerment (Numminen et al., 2016), Table 2. Finally, in negotiation both individuals jointly decide on one or more of the alternatives. Moral courage is the willingness to stand up for and act according to ones ethical beliefs when moral principles are threatened, regardless of the perceived or actual risks (such as stress, anxiety, isolation from colleagues, or threats to employment). Dr. Lachman has authored over 100 publications and her second book,Applied Ethics in Nursing, was released at the end of 2005. Role-playing is one strategy for learning new behaviors in difficult situations. Professional obligations are spelled out in the ANA Code of Ethics for Nurses. In this way, peer support for nurses efforts to exhibit moral courage can improve the effectiveness of individual attempts. How good people make tough choices: Resolving the dilemmas of ethical living(1st Fireside ed.). MeSH In this article the author discusses the CODE acronym she has created to help nurses remember key components for actualizing moral courage. Moral courage in undergraduate nursing students: A literature review. Required fields are marked *. However, since the pecking order in an organization can change over time, it is judicious to know when to individually manage the conflict and when it is prudent to have an important person higher up in the organization intercede for you. They understand that negative responses from upset patients and/or families may be an expression of their fear or pain. Moral courage involves more than considering ones professional obligation and thinking about what risk-taking action to take. Numminen,O., Repo, H. & Leino-Kilpi, H. (2016). Silence kills: The seven crucial conversations for healthcare. But technological advances in healthcare require that nurses expand their . Armed with an understanding of their obligations, nurses must assess the risks in speaking or acting in ethically charged situations. Patterson et al. Kidder, R. M. (1996). Developing care environments in which hierarchy does not inhibit nurses' moral courage seems justified. Moral courage: A virtue in need of development? Moral courage in nursing: an integrative literature review. Nurses' self-assessed moral courage and related socio-demographic fact. Morally courageous people know how to use affective and objective information to determine whether a situation warrants further exploration. Silver Springs, MD: American Nurses Association. good read. With Brenda present, Julie talks with Susan about options for speaking up for what she believes is in the patients best interest. Curriculum redesign to build the moral courage values of accelerated bachelors degree nursing students, Strengthening moral courage among nurse leaders, The Nightingale still sings: ten ethical themes in early nursing in the United Kingdom, 1888-1989, Moral courage in healthcare: acting ethically even in the presence of risk, Envisioning an ethical climate in nursing education programs, Organizational cultures that stifle discussion regarding unethical behaviors and tolerate unethical acts, Willingness to compromise personal and professional standards in order to avoid social isolation from peers or to secure a promotion/favoritism within the organization, Unwillingness to face the tough challenge of addressing unethical behaviors, Apathy of bystanders who lack the moral courage to take action, Group think that supports a united decision to turn the other way when unethical behaviors are taking place, Tendency to redefine unethical behaviors as acceptable. For this reason, educational strategies should be used both in nursing care settings and academia. All rights reserved. Demonstrating moral courage means taking personal and professional risks; every nurse should understand this. Nightingales letters portray her as a strong-minded meddler who didnt hesitate to go above the physicians she worked with. Conscientious objection: a possible nursing response to careat the end of life which is harmful, causes suffering, or torture. Only when these virtues are implemented and the nurses voice is heard can justice prevail in the clinical situation in which the right thing is not being done for the patient (Lachman, 2007b). Nurses who fail to report the above behaviors are held accountable by State Boards of Nursing. Disclaimer. Moral courage in action: Case studies. But based on her assessment, the nurse determines the patient is cognitively impaired (which is an acute change) and has no family members who could care for her postoperatively. An official website of the United States government. She role-plays with Susan how to approach team members when she has a concern about patient care, and suggests she use the technique with Dr. Shoen. Others, such as Johnstone and Hutchinson ( 2015 ), argue that the entire concept . Lachman (2009) has expressed her belief that behaviors necessary for moral courage can be taught. Lachman, V. D. (2008b). This can make nurses better equipped to demonstrate moral courage when difficult situations arise. Julie, age 45, works in a telemetry unit at a university medical center. Begley, S. (2007). Additionally unlawful and unethical behaviors on the part of practicing nurses may be reported on state board websites (Pennsylvania State Board of Nursing, 2009). Moral courage is one of the fundamental values of nursing profession and a powerful method of coping with ethical problems. Inductive analysis with clear steps for defining and synthesizing themes in research reviews revealed three categories concerning moral courage in nursing: definition and descriptions of moral courage, characteristics of the morally courageous nurse, and skills and acts of the morally courageous nurse. Unfortunately, he chose the easy route and let me go. But we still have the ethical obligation to keep communicating about their mothers deteriorating condition.. government site. I have personally experienced the back lash for speaking up about issues directly related to moral/ethical/legal issues involving patient related issues and those we as non-managerial nurses are actually forced to submit to by those in the position to effectively end our employment. Further research on moral courage with varying methodologies and multi-disciplinary and international approaches is needed. Murray JS. Retrieved July 15, 2010 from www.wisdomquotes.com/topics/action/index8.html. To avoid becoming overwhelmed when deciding how to act, focus on one or two critical values. eCollection 2023. Strong preceptors and nurse mangers know the importance of turning even negative outcomes into learning opportunities; they can help risk-avoidant nurses to become risk tolerant. Moral courage is a virtue and needs to be developed (as does emotional intelligence) to determine when action is required. By meeting these challenges the surgeons have realized that the tides have changed and now my fellow nurses are doing the same (: It took one nurse willing to stand up to each doctor every time there was a real issue and hold my ground explaining respectfully and professionally why whatever was happening was wrong and immoral to finally change the course of things. Among leadership styles, the ethical leadership has a special value. The American Nurses Association (ANA) Center for Ethics and Human Rights was established to help nurses navigate ethical and value conflicts, and life and death decisions, many of which are common to everyday practice. However, more moral courage was found in nurses who had never been married, had graduated from a public university, had been employed in the emergency room and critical care ward, and had worked the night shift. However, if a nurse cannot deal withthe worst case outcome, then it is best to not take the risk, but rather refer the issue to someone who can tolerate the risk. 2022 Feb;29(1):114-130. doi: 10.1177/09697330211003211. Treasure, B. (See Conscientious objection by clicking the PDF icon above. Nurs Philos. These behaviors enable nurses to recognize their fears but not allow these fears to keep them from serving as an advocate for their patients. Lachman, V.D. Retrieved July 16, 2010 from www.silencekills.com/Download.aspx and www.silencekills.com/AboutTheStudy.aspx. McKay, M., Davis, M., & Fanning, P. (2007) Thoughts and feelings: Taking control of your moods and your life. Envisioning an ethical climate in nursing education programs. Whistle-blowers - morally courageous actors in health care? Lachman, 2007, p. 131 Moral resilience The ability and willingness to speak and take right and good action To develop moral sensitivity, nurses must take the time to reflect not only on their personal and professional values but on their moral obligations. 2008 Mar;108(3):38-9. doi:10.1097/01.NAJ.0000312253.48872.56. Morality refers to conduct, character, and motivation based on internalized social values acquired from life experiences. VitalSmarts. Nurses' Perceptions of Ethical Conflicts When Caring for Patients with COVID-19. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous. Risk involves the possibility of suffering harm or loss; hence it carries the potential of danger (The Free Dictionary, 2010). These crucial skills help individuals deal with the hostility, defensiveness, and a variety of other tactics used by people to prevent one from acting in a morally courageous manner. 14 CATHOLIC SOCIAL TEACHING Risk tolerance is the extent of uncertainty that a nurse is able to handle in regard to a potentially negative outcome. Also, most hospitals have ethics committees that offer consultation and can be called on to provide education. I have contacted the ethics board on more than occasion. For example, the nurse would see the failing neurological status of the 56-year-old patient and also see the relevance of assuring that an advance directive was in place. If this conversation fails, they know they can demonstrate moral courage by calling an ethics committee consultation. One should stand up for what is right even if it means standing alone (Murray, 2010). Those with moral courage resolve to do the right thing even if it puts them at personal risk of losing employment, isolation from peers and other negative consequences. Now up to him to fix it. For example, a nurse in a busy emergency department (ED) could catastrophize the line up of emergency vehicles outside the ED, focusing on how terrible this situation could be. Your email address will not be published. However, nurses who have moral courage recognize their professional obligation, outlined in the professional Code of Ethics for Nurses (ANA, 2001) that states, The role of the surrogate is to make decisions as the patient would, based on the patients previously expressed wishes and known values (p. 8) and act on this obligation. Developing ethical competence in health care organizations. Florence Nightingale used her talents, education, and political connections to crusade for healthcare reform. An hour later, she tells Julie, Its always been hard for me to step forward and say something when I know a patient should be getting better care. Doing the right thing: Pathways to moral courage. The Dutch-language version of the Nurses' Moral Courage Scale is a reliable and valid instrument to measure nurses' self-assessed moral courage in speciality care nursing environments and further validation studies in other countries, languages and nurse samples representing different healthcare environments would provide additional . This is important because the stories individuals invent from an occurrence, and the associated emotions affect their actions. doi: 10.1590/0034-7167-2022-0225. Aristotle wrote He is courageous who endures and fears the right things, for the right motive, in the right manner, and at the right time and who displays confidence in a similar way (Aristotle 350 BCE/1998). Concept analysis; moral courage; nursing; qualitative research; virtue ethics. O'Mathna D, Smith J, Zadvinskis IM, Monturo C, Kelley MM, Tucker S, Miller PS, Norful AA, Zellefrow C, Chipps E. Nurs Ethics. This site needs JavaScript to work properly. National Library of Medicine This integrative review aimed to explore moral courage in nursing and possible associated individual and organizational factors. Domar, A. D., & Dreher, H. (2001). .nurse leaders must develop, role model, and practice moral courage as the first step to decreasing moral distress in the profession. American Association of Critical-Care Nurses. Lachman, V.D. (September 30, 2010). Danger management is an important aspect of moral courage. A registered nurse (RN) for 20 years, she is now a charge nurse on the 7 A.M.-to-7 P.M. shift. With guidance and practice, a nurse can gain confidence in demonstrating moral courage. The authors of Crucial Conversation address deliberations about tough issues, which they describe as having three components: (a) differing opinions, (b) high stakes, and (c) strong emotions (Patterson, Grenny, McMillian, & Switzler, 2002). Leaders must ensure these structures are used to make individual and organizational accountability expected behaviors. sharing sensitive information, make sure youre on a federal National Library of Medicine Obligations to honor (What is the right thing to do? For example, an experienced oncology nurse might openly disagree with the attending physician who wants to continue a painful treatment for a patient who has only a 20% chance of survival. Nurses need moral courage in all areas and at all levels of nursing. It also describes effective management strategies to help nurses resolve these problems. 2007 Apr;16(2):131-3. Design: Moral courage is defined as brave behavior, accompanied by anger and indignation, intending to enforce societal and ethical norms without considering one's own social costs. Open Access Moral courage in nursing - An integrative literature review Elina Pajakoski BNSc, RN, Corresponding Author Elina Pajakoski BNSc, RN etpaja@utu.fi orcid.org/0000-0002-3077-394X Department of the Nursing Science, University of Turku, Turku, Finland Correspondence Rocking the boat - nursing students' stories of moral courage: A qualitative descriptive study. Generally the withdrawal is best left unaccompanied at that time. courage); a habit of practicing virtue (Aristotle, 350 BCE/1998), Moral wisdom - understood to include moral perception, moral sensitivity, and moral imagination (Lachman, 2009), Moral perception - ability to observe what is happening from a moral perspective (Lachman, 2009), Moral sensitivity - ability to incorporate an extensive array of information, take action on it, and respond to individual needs in a moral way (Lachman, 2009), Moral imagination - ability to reflect on what it might be like to be an individual in this set of circumstances (Lachman, 2009), Moral integrity - to feel good about oneself in a fundamental way, to perceive oneself as both a professional who does good work and as a person of character who strives to live a moral life (Laabs, 2007), Ethical competence - ability of a person to analyze and respond to a moral problem, unrestrained by automatic responses and belief/emotional fixations. Moral courage defined by the article: Moral courage in healthcare "is considered to be the pinnacle of ethical behavior; it requires a steadfast commitment to fundamental ethical principles despite potential risks, such as threats to reputation, shame, emotional anxiety, isolation from colleagues, retaliation, and loss of employment" (Murray, 20. Each of these four components of the CODE acronym will be discussed in turn. Nurses have a responsibility to report unsafe, unethical, or illegal behaviors to individuals within an organization who are in a position to stop these behaviors. A discussion with another nurse might also help a risk-averse nurse to focus on the worst case scenario and realize that she would be able to deal with the worst possible outcome. Please let me know if you are interested in participating. I taught an Ethics course for a decade, please inform us, as to what ethical principle is being violated here. Countering worry about the potential negative consequences of an interpersonal interaction with positive thoughts can facilitate moral courage. However, if Dr. Schoen had continued to resist and discount her opinions and the hospital had refused to address the potentially ineffective pain management, Susan would have been obligated to complain to the medical board and possibly consider resigning and seeking employment elsewhere. Nurse may witness the consent, but should never be sent into the room to get an informed consent from the patient. Retrieved from www.constitution.org/ari/ethic_00.htm. Would you like email updates of new search results? Organizations that take their ethical responsibility seriously have a published infrastructure to deal with ethical violations (Lachman, 2008b). 2021 Nov-Dec;28(7-8):1402-1415. doi: 10.1177/0969733021999763. Before blowing the whistle, learn to protect yourself. Empathy is a necessary ingredient of moral sensitivity. New York: Simon & Schuster. In one study less than 10% of physicians, nurses, and other clinicians confronted their colleagues when they skipped standard infection control procedures, or when they saw an individual who was incompetent in practice (VitalSmarts, 2005). The Paul Revere Freedom to Warn Act: legislation to protect federal whistleblowers from retaliation. Data sources: One of the main qualities a leader must possess is courage. I have zero qualms about doing it again if necessary. Nursing Ethics, 14(6), 825-837. Einstein, A. The self-soothing and cognitive reframing strategies already discussed may be helpful in these situations. All nurses should comply with the Code of Ethics for nurses. Epub 2023 Jan 31. Lachman VD, ed. Moral courage in healthcare: acting ethically even in the presence of risk. The nurse desires to maintain her moral integrity, and therefore musters the moral courage to share the evidence regarding the limited effectiveness of the suggested treatment with the physician and the patient. COVID-19 biomarkers: What do they tell us? Kathryn M. Ganske is director and associate professor of the Division of Nursing at Shenandoah University in Winchester, Virginia. In response to comment dated July 24, 2012. Individual and organizational factors, such as positive personal experiences, commitment to ethical principles, supportive work environment and teamwork, were associated with moral courage in nursing, contributing to a more comprehensive description of nurses' moral courage. In Standard 13 of this document, it is specifically mentioned that the registered nurse integrates ethical provisions in all areas of practice (p. 39). 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How to use affective and objective information to determine whether a situation warrants further exploration 20 years, is!
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