Some ethical issues are obvious and the course of action is clear. A nurse who sees a colleague has documented administering a narcotic when the patient has not received medication requires reporting. However, correctional nurses are often faced with uncertain ethical situations that create decision stress and can lead to immobilization. A nurse who is asked to perform a blood draw for drugs may wonder if the activity will be used for a therapeutic or disciplinary outcome. Moral courage requires skill in dealing with uncertainty in an ethical situation.
Uncertainty of the Moral Situation
An uncertainty about the actual moral situation can hinder the courage to act. Consideration must be given to the actual ethical concern present. Strength for action is developed by clearly articulating the professional values that have been breached. Taking time to thoughtfully consider personal and professional valuing can help pinpoint the real issue embedded in the situation. In addition, confidentially discussing the concern with a spouse, leader, or trusted peer can lead to clarity. Sometimes putting into words the concerns of the situation give voice and vocabulary that strengthen resolve toward action.
Uncertainty of the Outcome of Action
A previous post discussed the C-O-D-E model for moral courage. The 3rd element of this model is managing danger (D). Our uncertainty about the danger involved in acting or ‘speaking up’ about a potential ethical issue can be very real. Anxiety and a visceral ‘fight or flight’ response can ensue. How can we deal with the uncertainty of the outcome of our action?
Self-soothing. In an emotionally charged situation, free-floating anxiety or even anger can cloud judgment and be immobilizing. Immediate stress-reduction activities can be initiated such as taking a deep breath, slowly counting to 10, or speaking calming words to yourself like “I can do this” or “I have handled many things worse than this”. These are methods of self-soothing that can help to reduce anxiety and encourage clear thinking.
Cognitive Reframing. Worry about the negative outcome of an ethical action can be reframed by actively seeking positive alternative perspectives. Although concerns about job security, peer support, or humiliation may be very real, they can be balanced by positive outcomes of taking action such as personal integrity, strength of character, and satisfaction in doing the right thing in a difficult situation.
Lachman provides a logical progression to guide action in response to fear. Working through this list can help to clarify next-steps in an ethically uncertain situation.
- Identify the risk you want to take
- Identify the situational fear you are experiencing
- Determine the outcome you want and what you have to do to achieve it
- Identify resources accessible to you
- Take action
Have you dealt with ethical uncertainty in your correctional nursing practice? Share your situation and how you dealt with it 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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