Exploring Moral Agency

The notion of moral agency could be defined differently from profession to profession. However, one thing that stands out is that the various meanings revolve around: an agent who is basically any person with the ability to take a deliberate action progressively (Angeles, 2002) Moral agency has been defined by many elites and their implicit meaning is within the bracket of philosophy, autonomy and self-inclinations. Essentially it revolves around people taking self-expressive decisions.

There are many perspectives and theories within which moral agency is operable. Feminist and other contextual theorists opine that moral agency is enacted through relationships in specific contexts and environments. The traditional perspective is however different as it is. It assumes that the moral agents are autonomous and all carry out their lifelong activities in identical contexts, situations and environments (Rodney et al, 2006). This is faced with criticism from other theorists mainly because the traditional perspective does not appreciate the different kinds of relationships existing within the society where the agents have varying power and capacities. In particular the feminist perspective which calls for meticulous concentration on social and police contexts of people. The most common downside of the traditional perspective is that it is mainly concerned with philosophy and self-interest and overlooks the rational contextual nature of moral agency (Sherwin, 2007).

Basically, moral agents work in a diverse of contexts with a spectrum of relationships. In order to look into the features and capabilities of an agent, one cannot afford to overlook the wealthy and sophisticated social and historical contexts in which they typically operate. These contexts indicate the need to take autonomy as a characteristic of agents who are actually human and would therefore show such concepts as emotions, desire, feelings, and creativity as well as various schools of philosophy from their end.

The agents are seen as social beings since their identities have their spring in the social environments in which they exist and the fact that their behavior is profoundly dictated by some historical and social conditions. There also is an implicit interconnection between an agent and the structures (cultural and resources which may enhance or constrain their social action). For an agent to exercise their action effectively they must be able to make sensible choices. In addition, for them to be independent, they have to viciously repel oppression.

This compels us to consider the kind of choices that agents make and additionally the circumstances, feeling and relationships that by and large undermine or empowers their capacities to make the said choices (Rodney at al., 2006)

Enactment of the moral agency in my practice

The health care elite nurses for example are considered to have special kind of moral agency because of their specialized skills and hence the inherent power they hold. Their commitment to patient’s forms a ground for the inquiry about moral agency and their ethical practice. The nurse-patient relationship is an important moral foundation of the nursing practice. The commitment also indicates that nursing in its own element is a moral effort (Austin, 2007).

In my profession as a nurse I have had many situations where I implemented my moral responsibility. I was attending someone diagnosed with blood cancer (leukemia). During the first encounter and based on the doctor’s prognosis I figured that part of the patient’s prescription is social support from their family’s close relatives friends or acquaintances where I squarely fell. I spearheaded a contracted inquiry into the patients’ health history from the family and found that his condition was actually a chip if the block. The condition was in the family line. I guided the patient into a soul-searching spree before administering any treatments. Based on the newly found knowledge about the patient I figured that the patient was allergic to antibiotics; I therefore ruled out any antibiotic prescription as it were. I finally took the patient through the nature of their condition emphasizing on the survival possibility should they follow the prescriptions to the letter.

During my practice I am almost always in the resourceful company of my counterparts who come in handy when making important choices amid the treatment drill. Actually I prefer mobilizing my counterparts and enlist their help to the medical written policies and procedures. This is mostly because a case may come into play on my end which is not featured anywhere in the document and I have never been faced with it before which may jeopardize the patients’ health.

There are various factors which by and large affected my capacity to enact the moral agency in my practice either positively and or negatively: –

To start with is the social stereotype that nursing profession is a female domain and by and large an extension of the women domestic roles. This has had profound negative impact on the way I would carry out the enactment of the moral responsibilities in my practice. Concern about the socials status of the women and nursing are beacons of what the nursing profession entails. In the cultural tradition of the 19^th century where women and men had had unequal social status. The contempt for women is a long-standing headache for the nursing work as a female-dominated professional sphere. Because of this, I experienced profound social invisibility which greatly eroded on my capacity to enact the moral agency (Liaschenko, 2008)

The social respect and trust attached to the profession nurses by the society went a long way in helping me enact the moral agency. To be precise I would attend to patients with confidence knowing that I had been entrusted with someday. I therefore would carry out my responsibility with so much care and aplomb and the outcomes would be impressive just like clockwork. This would leave us (patient and me) fully satisfied. (Rodney at al., 2006)

The ‘caring theory’ is common place in the nursing sphere. However, the theory depicts nursing as evolving from a nurse character and individual motivation for caring while turning a blind eye to both the physical conditions and knowledge relations in the specific contexts where nurses work. More often than not the nursing work is reduced to a race against the clock. They almost have no say in the administrative duties by their superiors in their working setups. The nurses are required to work without paying attention to the socio-political context of their profession and the inherent possibility of being overworked.

The collaboration in my nursing between the students and the new graduates practice was quite impressive. In the daily routines of nursing one is faced with health situations which might be tiresome in a way. This is where the harmonized unity among my counterparts came into play where we cooperated in addressing backlogs of critical patients’ conditions and managed to save a life or two.

It was quite challenging when the more experienced nurses would at times view me, the inexperienced one, as inept and not legible to carry out any medical procedures even the most basic ones. This would in one way or the other prick on my self -esteem and self- belief which are essential if any field practice would be effective.

In one instance it was not possible to effectively attend to all the cases and especially the emergency cases due to lack of the necessary equipment and under-staffing. Chronically ill people had to be held for long ours in the consultations rooms enraging huge backlogs of waiting patients who menacingly called our names. The institution was overwhelmed tremendously which made enactment of the moral agency. Moral disengagement was also inevitable here. (Angeles, 2002).

My ability to enact moral agency

Moral agency could be as simple as applying a number of policies during the actual nursing practice. In my practice I put up effective means to ensure that my capacity to enact the moral agency was enhanced.

To start with as a student in the medical field I ensured full collaboration with fully graduated nurses, social workers, dieters and therapeutics. This would later help me in grasping the case knowledge about a certain illness e.g. the resistance of a certain virus strain against medications. Secondly it would go a long way in helping me understand the patient knowledge which helps in knowing whether or not the medical procedures applied are effective by examining their response to the procedures or medications for that matter. Third it would assist in understanding what the family of the patient thinks about the kinds of procedures used and whether or not they are necessary. Finally, it helped me in understanding how well a societal setting is ready to consult a physician should there be unforeseen emergencies (Austin, 2007).

Secondly the next determinant of my enacting prowess was my actual presence. By presence I mean being involved in all the steps a patient goes through during the treatment and understanding what the families to the patient and other medical practitioners are experiencing during the process.

The next one be would trust among the nurses and the patients. I learnt that trust would create a supportive matrix provided there is no inherent moral distress, residue nor disengagement. Trust on the part of patient would mean that I am capable of treating a patient and secondly on the side of nurses it would mean that I would have a reservoir of reference when need be.

MORAL DISTRESS AND MORAL RESIDUE.

Moral Distress

Moral distress is the experience that a moral agent goes through when they are constrained from moving from moral choice to moral action. This experience is associated with feelings of anger, frustrations, guilt and powerlessness. It’s mainly as a result of the ambiguous values, actions and the outcomes. It also could be as a result of nurses internalizing external factors such that their moral position could possibly be altered which may at times culminate into harmful nursing practice. (Rodney at al., 2006).

To be precise it’s not only the external factors for example excessive workload that scuttles the moral action but also how the intertwined individuals act with a view to facilitate or undermine moral action which closely overlaps with the nurse’s moral integrity.

Reliable research over the past two decades has shown that moral distress in nursing impairs one’s capacity in the end-of-life decision-making spree (Austin, 2007). Moral distress is of interest not just because its overwhelming human effect on Medicare providers but also because its interconnected with the staff-conflict, staff-attrition and patient safety Moral distress could be important because it sheds light on value-based conflicts in nursing.

Moral residue

Moral residue is basically what one may harbor or carry for that matter when they know how to act, the wherewithal for the action but are apathetic towards or are incapacitated thus they do not do so. (Mitchel,2001). Experience of moral residue can motivate the moral agent to deliberate on and raise their practice a notch higher. However, moral agents may gravitate towards self-denial, trivialization, or the unreasonable endorsement of the ambiguous beliefs and actions.

moral disengagement

Moral disengagement is when an individual decides to work against the palatable self or corporate standards. This is especially because people play against the set standards and would want to avoid self-condemnation that essentially goes along with behaving in ways they think are wrong. This is a progressive process having slow self-sanctions that could initially go without notice till finally few hurdles remain to deter individuals from behaviors once thought wrong and at which juncture meager distress is experienced when engaging in such behaviors. (Bandura,2006).

Moral disengagement typically operates under two mechanisms: Euphemistic language and advantageous comparison. Euphemistic language blends in the actual meaning of an unethical behavior with ethical one to conceal it and make palatable for selfish ends or assigning moral quality to an unethical behavior to enhance moral justification of such a behavior. Advantageous comparison on the other side employs the ‘contrast principle’ whereby unethical behavior is made admissible by comparing it to yet another behavior which is even worse than the behavior in question for example ‘a hallway bed is better than no bed at all’ (Bandura, 2006)

Moral disengagement is definitely responsible for the erosions of nurse integrity, inadequate medical resources which scuttles the provision of safe, competent, compassionate and ethical care to the patients. It could also be responsible for the preventable negligence and the subsequent preventable deaths in hospitals.

Code of conduct for nurses

Nurses are expected to play by a set of professional ethics. When pursuing a degree in nursing ethics are required. The codes embody a number of responsibilities and ethical obligations that all nurses should follow.

ICN code of ethics

This code of ethics for nurses has been divided into four parts: –

Nurses and people. This states that the nurse’s basic professional responsibility is to people requiring nursing care.
Nurses and practice. This states that nurses are personally accountable and accountable for the nursing practice and for the maintenance of competent and continual learning.
Nurses and professionals. Nurses play a role in determining and carrying out palatable standards of the nursing practice, management and research.
Nurses and co-workers– They should sustain a collaborative and respective relationships with their co-workers in nursing and other fields.

CNA code of ethics.

This is divided into two parts:

Nursing values and Ethical Responsibilities. This highlights the core responsibilities central to ethical nursing practice in their professional relationships.
Ethical Endeavors. This involves the nurses taking efforts to address the wide sector of societal justice that are associated with health. The nurse basically addresses health inequalities inherent in the society.

CNO code of ethics

This has broadly been divide into five parts of operation:

Patient-wellbeing. Nurse should promote the patients’ health and welfare where the latter incurs minimal harm.
Privacy and confidentiality. They should maintain health care processes that ensure that ensures that the dignity of the patient remains intact.
Respect for life. The nurses ought to make every rational endeavor to preserve life. Any medical procedure where the sanctity of life is questionable should be avoided.
Truthfulness- Nurses believe that the patient has the right to and may eventually benefit from being informed about their illness.
They should allocate health resources and services based on objectivity and impartiality.

References

Angeles L. A. (2002). Dictionary of philosophy. Routledge.

Austin, W. (2007). The ethics of everyday practice: Healthcare environments as moral communities. Advances in Nursing Science, 30(1), 81-88.

Bandura, A. (2006). Toward a psychology of human agency. Perspectives on psychological science, 1(2), 164-180.

Rodney, P. P., Doane, G. H., Storch, J., & Varcoe, C. (2006). Toward a safer moral climate. Canadian Nurse, 102(8).

Sherwin M. & Louis H.W. (2007). Postnatal parental concerns: The first six weeks of life. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 6(3), 27-32.