Nursing Care and Moral Reckoning 

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.