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Chapter 3

NURSING 2MM3 Chapter Notes - Chapter 3: Whistleblower, Mnemonic, Simulated Patient


Department
Nursing
Course Code
NURSING 2MM3
Professor
Tracey Jewiss
Chapter
3

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Doing the Right Thing: Pathways to Moral Courage
- Patient advocacy requires nurses to support and protect their patients
o Sometimes speaking out for the patients requires moral courage
Defining Key Terms
- Moral courage: the willingness to stand up for and act accordingly to one’s ethical beliefs
when moral principles are threatened, regardless of perceived or actual risks
- Moral distress: occurs when nurses feel powerless to act after witnessing improper
behavior, if organizational constraints make doing the right thing difficult or impossible
o These situations challenges virtue, which involves acting in accordance with one’s
moral and ethical principles
o Moral courage is a virtue and needs to be developed to determine when action is
required moral courage is linked to virtue ethics, which emphasizes the role of
character rather than doing one’s duty to bring about good consequences
o Virtue ethics appreciates that conflicts occur and that more than just moral wisdom
is needed to ensure a moral outcome
Case Scenario: Susan’s Dilemma
- The following scenario illustrates the moral distress a nurse may experience when her
patient advocacy meets resistance, or her moral courage is challenged
- Also describes effective management strategies to help nurses resolve these problems
- Julie, age 45, works in a telemetry unit at a university medical center. A registered nurse
(RN) for 20 years, she is now a charge nurse on the 7 A.M.-to-7 P.M. shift. She has an in-
depth understanding of the goings-on at her hospital and is highly respected by her peers.
This weekend, Julie is busy as usual when Dr. Shoen, an attending physician, tells her she’s
unhappy with Susan, a staff nurse. According to Dr. Shoen, Susan seems to question
everything Dr. Shoen does for Mr. Yarrow, her agitated semi comatose patient. Susan, in
the meantime, speaks to Brenda, a new nurse graduate, about Mr. Yarrow’s apparent need
for more sedation. She says she hesitates to ask Dr. Shoen for a sedative order because of
her experiences with retaliation in similar circumstances. Brenda, who has studied moral
courage at nursing school, finds it disheartening that an experienced nurse like Susan
seems to lack the courage to speak her mind about a patient’s care because she fears
negative consequences. She recognizes that Susan’s concern over her patient needs to be

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elevated and finds Julie to tell her Susan might need help. After Brenda speaks with Julie,
Julie enters Mr. Yarrow’s room, assesses him, speaks with Susan and Brenda, and validates
their concerns about his care. With Brenda present, Julie talks with Susan about options for
speaking up for what she believes is in the patient’s best interest. Julie presents the option
of using objective datanamely, the SBAR (Situation-Background-Assessment-
Recommendation) techniqueto help resolve the situation. 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. Taking Julie’s advice, Susan speaks to Dr. Shoen. An
hour later, she tells Julie, “It’s always been hard for me to step forward and say something
when I know a patient should be getting better care. But the technique you showed me
helped me present the facts to Dr. Shoen in a professional way without making her feel
threatened. Now she understands the need for medication, and the patient is comfortable.”
Later, Brenda tells Julie she’s grateful she had the opportunity to witness moral courage in
action
Barriers to Showing Moral Courage
- All healthcare organizations and professionals have a responsibility to uphold high ethical
standards
o Not all situations in which nurses advocate for patients turn out the way Susan’s did
o Sometimes nurses face obstacles when advocating for patients, and some nurses
may try to circumvent morally courageous behavior
o Ethics experts have identified several barriers to morally courageous behavior:
organizational culture, which sets the stage for how individuals respond to
unethical behavior
In an organizational culture that eschews the interdisciplinary
dialogue crucial to resolving unethical behavior or that disregards
unethical actions, staff may shy away from morally courageous
behavior
Some nurses may be willing to compromise their personal and
professional standards if their organization tolerates unethical
situations, preferring to avoid the risks of displaying moral courage
Some nurses may grow more reluctant to face the challenge of
confronting unethical behaviors
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lack of concern by colleagues who don’t have the moral courage to take
action
groupthink, in which individuals collectively decide to look the other way
when unethical behaviors occur, with loss of independent thinking
preference for redefining unethical actions as acceptable (nurse observes,
but pretends not to see)
CODE: An Aid to Demonstrating Moral Courage
- Remembering what actions to take when you face a moral dilemma can be emotionally and
cognitively difficult. Vicki Lachman, a coauthor of this article, developed the mnemonic
CODE to help nurses recall the steps to take
C: Courage
- determine whether moral courage is needed to address it
- Morally courageous people know how to use information to determine whether a situation
warrants further exploration
O: Obligations to honor
- When caught in a moral dilemma, you should self-impose a purposeful time-out for
reflection to help determine what moral values and ethical principles are at risk or are being
compromised
- Consider: What’s the right thing to do? What principles need to be expressed and defended
in this situation?
D: Danger Management
- What do you need to do to manage your fear of being morally courageous?
- This step requires the use of cognitive approaches for emotional control and risk-aversion
management
- Explore possible actions and consider adverse consequences associated with those actions
- To avoid becoming overwhelmed when deciding how to act, focus on one or two critical
values
- The cognitive reframing method helps a person learn to stop negative thought processes
that interfere with effective analysis of a situation
o By replacing negative thoughts with positive self-talk, you can focus on viewing the
situation clearly
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