A recent news story describes an investigation into 148 female inmate sterilizations in the California Prison System between 2006 and 2010. Inmates report being coerced into tubal ligation surgery following in-custody births. Although the situation is still under investigation, this news story reveals one of many moral situations encountered in correctional health care. One wonders if others in the facilities questioned the actions of the physicians performing these procedures in violation of prison healthcare policy which requires administrative approval of any elective procedure.
Possibly more than any other nursing specialty, correctional nurses confront moral dilemmas in the clinical setting. Clashing worldviews of security and healthcare along with the political and social implications of healthcare delivery to criminals create a quagmire of ethical concerns. Many correctional nurses work in solo practices in small facilities without benefit of a healthcare management structure that supports standard healthcare practices. Even in larger systems, ethical practices may be overruled by a security structure that is not attuned to the patient care implications of custody practices.
Moral courage is the courage to take action on a moral issue by overcoming fear of the consequences. The potential for reprisal, social isolation, and termination can lead to fear in responding to a moral issue such as patient coercion. Self-doubt can also cloud the issue. If no one else in the organization is addressing or responding to unethical or immoral practice, a nurse can question her interpretation of the situation.
Do you have what it takes to respond with courage when confronted with a similar ethical or moral issue? How can correctional nurses strengthen their moral courage?
Back to Your Roots
One way to gain moral courage is through reflection on the defining elements of our professional practice. In addressing concerns nurses can have as whistleblowers, Lachman suggests a need to return to our professional roots. As professionals we must be loyal to the definition of nurses as those who alleviate suffering and advocate on behalf of a patient’s well-being. Therefore, as nurses, we can garner the moral courage to act in the face of unethical colleagues, patient safety violation, or fraud by reflecting on the need to report these behaviors as part of who we are as professionals.
Tempered with Wisdom
Moral courage in nursing practice also requires wisdom. The courageous among us can be rash in responding to what, on first review, is an unethical practice. Yet, a wise nurse considers all the facts and perspectives before sounding the alarm. A wise response is determined based on full information; while misdirected courage can lead to foolhardy actions. Wisdom tempers courage to, instead, seek the right response in any situation.
Practice Makes Perfect
Intentionally practicing moral courage can develop the skill and habit of responding even in the face of fear. Some consider courage to be equivalent to fearlessness; but that is a distortion of the concept. Courage means overcoming fear by acting in the face of adversity. By practicing the skill of overcoming small fears, a nurse can develop moral courage by progression. For example, courageously overcoming fear to respond to rude behavior from a colleague develops the moral courage muscle. Like strength training for our physical muscles, our moral courage muscle must be stressed with ever increasing weight.
What would you do if you saw that providers in your setting were performing elective procedures without appropriate administrative clearance as noted in the opening story? How would you seek out enough information to take the right action? Would you know the mechanism to use to report the situation? Would you have the moral courage to take action? Share your thoughts in the comments section of this post.
Read more about ethical practice in corrections in Chapter 2: Ethical Principles of Correctional Nursing from Essentials of Correctional Nursing. Order your copy directly from the publisher. http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4 Use promotional code AF1209 for $15 off and free shipping.
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