Moral Reckoning and Nursing Care

Afza.Malik GDA

Nursing Care and Moral Reckoning 

Moral Reckoning and Nursing Care

Whats is Moral Reckoning,Three Stages Process,Situational Binds,Stage of Resolution,Stage of Reflection.

Whats is Moral Reckoning

     The Grounded Theory of Moral Reckoning in Nursing identifies a process that nurses move through when they have experienced moral distress in the workplace. 

    Moral reckoning includes a critical juncture in nurses' lives and explains a process that includes motivation and conflict, resolution, and reflection (Nathaniel, 2003). Moral Reckoning is a three stage process that offers important implications for nursing practice, education, and administration. 

Three Stages Process

    Distinct stages include the Stage of Ease, the Stage of Resolution, and the Stage of Reflection.

    Stage of Ease. During the Stage of Ease, nurses are motivated by core beliefs and values to uphold congruent professional and institutional norms. They are comfortable: they have technical skills and feel satisfied to practice within the boundaries of self, profession, and institution. 

    They know what is expected of them and experience a sense of flow and at homeness. The Stage of Ease continues as long as the nurse is fulfilled with the work of nursing and comfortable with the integration of core beliefs and professional and institutional norms. 

    For some, though, a morally troubling event will challenge the integration of core beliefs with professional and institutional norms. Nurses find themselves in situational binds that herald a critical juncture in their professional lives.

    Situational Binds. A situational bind interrupts the Stage of Ease and places the nurse in turmoil when core beliefs and other claims conflict. Situational binds force nurses to make difficult decisions and give rise to critical junctures in their lives. 

    Binds involve serious and complex conflicts within individuals and tacit or overt conflicts between nurses and others all having moral/ethical over tones. 

    Inner dialogue leads the nurse to make critical decisions-choosing one value or belief over another. Types of situational binds include:

(a) conflicts between core values and professional or institutional norms

(b) moral disagreement in the face of power imbalance

(c) workplace deficiencies. These binds lead to consequences for nurses and patients

    Stage of Resolution. Situational binds constitute crises of intolerable internal conflict. The move to set things right signifies the beginning of the Stage of Resolution. For most, this stage is a critical juncture that alters professional trajectory. 

    There are two foundational choices in the Stage of Resolution: making a stand or giving up. These choices are not mutually exclusive. In fact, many nurses give up initially, regroup, and make a stand. Others make an unsuccessful stand and later give up.

    Stage of Reflection. Moving from the Stage of Resolution, nurses reflect as they reckon with their behavior and actions. The Stage of Reflection may last a lifetime. In most cases, the incidents nurses recall occurred early in their careers. 

    The Stage of Reflection raises questions about prior judgments, particular acts, and the essential self. The properties of the Stage of Reflection include remembering, telling the story, examining conflicts, and living with consequences. These properties are interrelated and seem to occur in every instance of moral reckoning.

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