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Hi, I'm Jodi.

I've been a registered nurse since 2003.

Something that means a lot to me is moral courage.

It's a serious professional issue, and it's a skill that

will always be in demand.

So today I'll present the topic to nurses.

Speak up, having the moral courage to do good.

And my goal today is not to cause death by

PowerPoint, so I hope to bring some interesting topics to

this discussion.

So because moral courage is critical for the environment and

culture we all work in.

Some of our objectives today will be what is moral

courage. We need to define it.

And if we wish we had a backbone and not

a wishbone, we might ask, what happens if I do

speak up?

Also, societal norms at times tend to a press freedom

of choice, especially for women.

So we'll discuss theories that apply to courage and discover

ways that we as nurses can display moral courage.

So let's get some background information and some definitions here,

Um, what is courage?

We know that feeling.

Fear is human.

I appreciate Winston Churchill's quote when he said that fear

is a reaction, while courage is a decision, and Webster's

Dictionary defines courage as the strength to venture, persevere and

withstand danger, fear or difficulty.

So according to this definition, it sounds like it's something

that nurses display every day.

Um, and maybe just come natural to some of us.

So before we can know what something is, sometimes it

helps to know what the opposite is.

According Thio, Farthing and Posey, another idea for the opposite

of courage is recklessness.

Now some people might think it's cowardice, and we all

have weak moments or times when we're really unsure or

insecure about what to do.

And and truly, some words are just a bit judgmental.

So I really appreciate using this opposite comparison here of

courage and recklessness.

And because eight out of 10 Americans describe nurse ethics

is very high, it's really important that we do understand

the difference.

So why don't we compare the two?

We know that courage does not need pride toe act,

Um, oftentimes, if pride is involved, it's not necessarily courage.

We've all kind of heard that term a loud mouth,

someone who feels that leveling uninformed opinions across everyone is

the right thing to do, so we might try to

show them how their opinion might not be correct.

But then the pride comes out instantly.

So we do recognize this is not a courageous, um,

situation is certainly not one that we want to emulate.

Courage is also self sacrificing.

Um, courageous people don't put their own interests ahead of

of others, and they're looking for the best for everyone.

And sometimes that can be a really difficult thing to

do. If you know, a certain policy that you have

the authority to enact might not help you, but it

is in the best interest of others.

Also, courage is something that we don't all naturally have.

Um, so because of that, we might want to take

time to observe and meditate on the animal kingdom, and

we often think of maybe lions as courageous.

And that's true.

But oftentimes courage can also be observed among animals.

We would never imagine to be courageous, such as an

elefant or a badger or even a little hummingbird.

So what?

What is this word?

Recklessness. What is this about?

So recklessness is a conscious disregard for the safety of

others, and I kind of have in mind maybe a

surgeon who is operating under the influence of alcohol.

Recklessness is also intentional, maybe even retaliatory breach of private

health information.

Um, it's also opinionated, kind of like what we talked

about earlier.

We do know that when a personal opinions override facts

and reason, trouble is brewing.

So what is the balance?

Why don't we take a look here at some modern

day examples of how our speech can affect other people

on one side here we have protestors who have likely

endured years of unjust treatment.

So they take to the streets to be heard.

And on the other side, we have one of the

worst train wrecks in modern history, and employees knew something

was off with the tracks, but they were afraid to

speak up to their boss.

So in both cases, destruction and loss of life occurred.

And in both cases, someone just needed to stop talking

and listen.

And sometimes that can be the most difficult thing for

all of us to dio.

So have you ever wanted to speak up?

But you just didn't know, maybe the right thing to

say at the right time.

You know, lots of people do have courage as mentioned

before, even animals display courage.

But the difference between humans and animals is the ability

to think morally and with a conscience, that moral guide

doing the right thing because it's right, even at personal

sacrifice. That's what sets us apart.

And it's what nurses strive for with that type of

courage, though absolutely comes, ah, level of fear.

So let's discuss some theory and practice that applies to

us and displaying moral courage.

So Laurence Colberg theory of moral development addresses moral courage

is divided into three levels that consists of a total

of six stages, according to PETA print.

Everyone starts out at the first stage and then develops

morally as they mature.

So each stage represents a graduation in the level of

moral development, with stage one being the least moral and

stage six being the most moral.

And I appreciate these quotes here from Ramirez and Craddick.

Will, um, they're they're very realistic.

Fear is normal.

Even one of our most important emotions, however, fear can

become irrational and cause us to avoid pursuing important things.

So we know that fear is healthy when it subsides

with the threat.

I appreciate the Scripture at second, Samuel, 17 10.

It says he that is valiant.

Who whose heart is like that of a lion, shall

utterly melt.

So everyone has their good days, and they're bad days,

even the valiant guy.

So as nurses, how can we have the heart of

a lion?

Well, the online Journal of Issues and Nursing has an

article called Strategies Necessary for Moral Courage, and they use

this acronym code.

So let's take a minute and look at that.

We can probably guess what the C stands for.

And that, of course, is courage.

So this requires having the ability to assertively address the

moral problem.

And sometimes that can be one of the hardest things

to do.

The article goes on to say that the nurse who

lacks courage generally knows what to do or say, but

they don't do so because maybe of self confidence, um,

fears. Or maybe they're afraid of being embarrassed or punished,

maybe losing their jobs.

So when they do speak up in the past, maybe

somebody has berated them rather than applaud them, and that

drives them back into that emotional cycle of retreat.

But of course, on on the flip side, If a

nurse's too touchy and sensitive, they won't be able to

accept that constructive criticism that is so important for all

of us.

So learning to be assertive over passive, that's that's highly

important here.

Um, most people who are nervous by nature typically don't

have to worry about aggressive speech, but they may have

to worry about being trampled on by others.

And so moving on to the next letter, that would

be, Oh, and that stands for, um, obligations to honor

our ethical obligation.

So according to this article, um, in order to act

in a courageous manner, a person must have, um, understand

the situation.

I have wisdom in the situation and use good judgment.

We know that in action is an action.

So according Thio, the American Nurses Association, when a nurse

is aware of inappropriate or questionable practices, um, in the

provision or denial of health care, concern must be expressed

to the person carrying out that questionable practice.

And, of course, failure to do so may result in

disciplined by the Board of Nursing and D stands for

danger management.

What do I need to handle my fear?

Um, and that is typically emotional control.

So these coping skills that that we've learned over the

years, ideally at home and not at work, um, they

help us to manage our anger.

I really appreciate this quote here.

That anger is danger without the d.

But to be able to manage that anger, we have

to have coping skills, which includes cognitive reframing d catastrophe

izing, recognizing emotional triggers and having the ability to self

soothe cognitive reframing is one of those things that I

personally really struggle with.

I try to use, um, to practice things at home

so that I have those skills once I get toe

work, Um, but when we do have those skills, it

could be even more difficult in an unexpected, emotionally charged

situation. So let's take a look at the final letter

in our acronym here That would be E.

That stands for expression and action.

What action do I need to maintain my personal integrity?

According to this article, um, central to the nurses ability

to act in a morally courageous manner is the nurses

management of the risk?

We know that timing is everything.

We wanna make sure that we can address the problem

at the right time because no one likes to be

caught off guard.

So if you're tired or emotional, it's probably not the

right time to try to address a serious problem.

And, if necessary, bring a witness with you.

Thio be there.

If you do have to confront someone on Dhe, once

you do decide to address that problem, we absolutely should

expect a defense from the other person.

So going back to the ability to self soothe those

coping skills there we want.

Once we get that defense, we want to pause before

we react with another defensive response.

And we don't want to respond in kind of someone

and go down to that level.

That would just be unprofessional.

Also, nurses are adept at Mary, mirroring emotions.

So if we observe a situation, um, that's maybe getting

little stressful.

We can always say, I can see this makes you

upset and validate that person's feelings.

If they choose to walk away, Maybe let it go

for now.

But not allowing the concern to die is a subsequent

check of the nurses.

Moral courage.

So let's go ahead and wrap this up today with

a summary here, Um, when What kind of tips can

we get from the pros?

When should we speak?

When should we not speak?

And these are a few things that I've gathered that

I like to keep for myself.

We don't want to speak if our words or emotional

or degrading.

If we plan to maybe publicly humiliate someone, that would

be terribly unprofessional.

We want to avoid opinionated or judgmental words, weak words

or things that are exaggerated or profane.

And we do want to plan to speak up if

we're calm and were respectful.

Um, we have good timing.

We have plenty of research and we can be prepared

for pushback.

So here are just a couple of little closing thoughts

and references for this article that I'd like to share.

I love this quote.

Active listening is an act of love, and we've all

been here in the situation where we feel like we're

on our deathbed and every would he come back we

ever needed just flashed before our eyes.

But if we're still unsure about things, um, it's important

to remember that everyone feels like doctors and nurses are

superheroes right now.

We have completely lived up to that thought, and we

should all be proud of ourselves.

I love this artistic expression by Banksy.

He donated this to a hospital in the UK Um,

it's a picture of a little boy.

Instead of playing with Batman and Superman, he's now playing

with his nurse.

He recognizes who is the real superhero now.

So as nurses, when we display moral courage, we're on

a different level of achievement.

And I'd like to share one last quote with you

from the Book of Proverbs, Chapter 31.

It says, Speak up on behalf of the speechless, defend

the rights of all who are perishing.

Um, now I have mine references for this presentation.

And, um, as you look through those, I would just

like to take a minute to thank my professors for

their patients and allowing this project to be turned in

and also for my family, for living with me.

Even when I say the wrong thing, I appreciate you

all very much.

Thank you.

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