Businessman W. Clement Stone opined, “Have the courage to say no. Have the courage to face the truth. Do the right thing because it is right. These are the magic keys to living your life with integrity.”
It takes moral courage for oncology nurses to advocate for what is right in certain situations. This can be the case when a dying patient tells you he only wants comfort care, but his vocal adult children want him to do everything to stay alive. It might be witnessing a new nurse trying to learn his role but a more experienced nurse giving him an unusually hard time and blocking his learning. It could happen when a physician wants to try one more experimental therapy even when your patient has told you she is through.
What Is Moral Courage?
Moral courage involves standing up for your values, ethics, and beliefs, even at the risk of your reputation, emotional anxiety, social isolation, or employment. It is the ability to endure distress inherent in difficult situations when a nurse needs to do what is right. The American Nurses Association’s code of ethics for professional nurses can help guide nurses in these circumstances.
How to Develop Moral Courage
Nurses need to analyze and respond appropriately to a moral dilemma without emotion. However, positive reframing can help nurses counter their emotions. Asking yourself, “What is the worst that could happen?” and “What would be the consequences?” helps you form a plan to address the feared situation. Decatastrophizing allows you to have some control. Other methods include calming exercises such as taking a walk outside, sharing the dilemma with an impartial confidant, and performing deep breathing or centering activities and journaling.
Taking risks can help nurses cultivate their moral courage. For example, a nurse may try to avoid unpleasant conversations with a dying patient’s assertive family, who wants a feeding tube placed so the patient won’t starve. However, by providing information to the family on how the body works when it is shutting down and that tube feedings would be uncomfortable, the nurse overcomes risk avoidance and maintains moral integrity, all while advocating for the patient’s best interests.
Using moral courage appropriately means learning to express oneself in an honest and direct manner at the right place and time. Lachman described a four-part assertion message.
- Non-judgmental explanation of desired behavior change
- Admission of one’s own feelings
- Explanation of concrete effect of the other person’s behavior
- Statement of desired behavior change
Finally, negotiation skills are needed to achieve the best outcome. For example, in the situation where an experienced nurse is giving a new nurse a difficult time and hindering his learning, you could explain to the experienced nurse, “When you talk to your preceptee in a harsh manner, I feel upset, because he is losing confidence in himself. I would like you to be more patient and explain procedures to him in a way that he can succeed.” Regardless of the response, the concern should not be allowed to go uncorrected. This is a confirmation of the nurse’s moral courage.