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08.02 Kohlberg’s Theory of Moral Development

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  1. Kohlberg’s Moral Development
    1. Overview
    2. Level I
    3. Level II
    4. Level III
    5. The Nurse’s Role

Nursing Points


  1. Overview
    1. Kohlberg’s research
      1. Focused on moral development
      2. Followed Piaget
      3. Broken into 3 levels with 2 stages in each
  2. Level I – Preconventional Reasoning
    1. Stage 1
      1. Obedience vs punishment
        1. Follow rules or punishment will follow
        2. Avoiding punishment guides choices
        3. No real understanding between doing “right” and avoiding punishment
        4. Infancy
    2. Stage 2
      1. Self interest
        1. More than one view exists
        2. Reward vs punishment
        3. Choices based on greatest benefit
        4. Preschool
  3. Level II – Conventional reasoning
    1. Stage 3
      1. Conformity and interpersonal accord
        1. Gain approval and respect
        2. Maintain friendship
        3. School age
    2. Stage 4
      1. Social order
        1. Maintain social order
        2. Aware of self
        3. School age
  4. Level III – Postconventional reasoning
    1. Stage 5
      1. Social contract
        1. Law exist, but not the same as morality
        2. Can change law depending on needs of society
        3. Teens
    2. Stage 6
      1. Universal principles
        1. Morality includes how everyone benefits
        2. Adults
  5. Nurse’s role
    1. Understand your own moral level
    2. Helps to separate your morality from the patient’s view
    3. Utilize entire health care team to resolve conflicts

Nursing Concepts

  1. Human Development
  2. Health Promotion
  3. Cognition

Reference Links

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Video Transcript

In this lesson we’re going to talk about moral development based around Lawrence Kohlberg’s theories.

In order to understand our patients we really have to have a good understanding of what moral development is. And what I mean by moral development is how patients view things from right versus wrong.

Lawrence Kohlberg was a psychologist who focused on how we develop morals in our understanding of right and wrong and he also followed Jean Piaget’s work.There’s a lesson on Piaget, so go check that out.

What he really ended up doing was developing three different levels of moral development and within each level there are two stages. They’re really based on how we view morality as we age.

Level one is based around infancy to preschool age, level 2 really focuses around that school-age children, and level 3 starts in around adolescence all the way into adulthood. So let’s break these down a little bit further.

Level one is the preconventional morality level. And it’s broken down into two stages the first one being obedience versus punishment, and the second is self-interest.

For obedience versus punishment the child is really going to focusing on following rules. And the other point of that is that they really want to avoid punishment. They have no real understanding between what is right and avoiding punishment. So they’ll do whatever they can to not get in trouble without realizing that it’s the right choice.

Self-interest starts to separate that a little bit more. As a child ages they understand that there is a reward and there is also a punishment and that the two things are very separate. They realize that more than one view of right exists. An example of this would be like a teacher and a parent can both do things that are right, even though they’re two separate people. And at this point they really understand that they start to have a choice. Your patients typically are going to be pre school-age children.

Now level 2 has stage 4 and Stage 5, and both of these are for school-aged children. The first one is based on conformity and interpersonal relationships. In this stage the really focusing on maintaining friendships and gaining approval and respect from other people. As that develops a little bit further, you’re going to go into the stage of social order.

So what they want to do is they’re starting to realize that they have their own self morality and their understanding right versus wrong but they also want to do things that are going to maintain the status quo, meaning that they don’t want to disrupt what’s going on. So for instance kids raise their hands in class because they realize if they were to just shout out and answer or to get the teacher’s attention then they would disrupt social order. So for these kids raising their hand is going to allow them to get the teacher’s attention but also maintain the calmness of the classroom.

Now the last level is called the postconventional level. And it’s broken up into Stage 5 and 6 which are the social contract and Universal principles.

With the social contract, this is going to be most of your adolescents and teens, and they start to realize that law exist but laws are not the same as morality. They understand that they have to follow the law because these are rules set up for society, but they understand that some of the laws May sometimes not make sense, or the they may not conform to their idea of morality. They also understand that they can also begin to change the law depending on the needs of society. So if they find that a particular law or rule doesn’t make sense, they can begin to challenge the system.

In stage 6, with universal principles, adults really start to understand how their view of morality starts to include everyone. It starts from this simple idea that we have our own morality, and we should extend our view of morality to everyone else. Obviously that doesn’t always go as smoothly as everyone would like, but it’s important to realize that this is the time where the adult will actually start to reach out and do whatever is going to benefit everybody the most based on how they have their own view of morality.

So after all of that I bet you’re wondering how does this fit in for me. Well like we talked about and the other lesson about the overview of all the stages of development, it’s important to understand your own position. If you don’t understand where you’re at for yourself, you’re not going to be able to take care of your patients. So when we’re dealing with morality, it’s important to understand your own morality and that you separate your morality from your patients’ morality. What you view as right or wrong may differ from somebody else, and it’s really important that you understand their perspective, because it’s going to allow you to anticipate the choices they make.

I’ll use vaccinations as an example. Not everyone agrees that vaccinations are good. Your patient may not agree that there beneficial for everybody, and then they may perceive vaccinations to be a bad thing. As your role as a nurse, your view of vaccinations may be different, and that you are there to promote health and wellness. So this is the point where you would separate your own morality from your patient.

Also your views of morality may differ from other people within the healthcare team. So it’s really important to work with your other providers to make sure that your patients are receiving everything that they should be.

Today’s lesson really focuses on the idea of human development and cognition for the patients as they develop their ideas of morality. And also focuses on health promotion so that you can focus on taking care of your patients.
So let’s recap.

Lawrence kohlberg developed the theories on morality, and he also piggybacked a lot of his stuff based on Piaget.

For your preconventional stage, your patients really focus on reward versus punishment and this is really your infant seat of preschool-age patients.

Your school age patients are going to start to think about relationships and how they fit into society.

And as your patient start to get into teens in adulthood they start to understand how morality start to benefit all of society.

The last thing that you need to focus on is making sure that you separate you from your patients, so that you can have a better understanding of how your patient views right from wrong, and how that’s going to impact their care.

So that’s our lesson on the theory of moral development. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

  • Question 1 of 5

Select all of the following that describe the difference between a nurse’s ethics and a nurse’s morals.

  • Question 2 of 5

A nurse feels very discouraged because many of the clients in the nurse’s care do not survive their hospitalizations. Select all of the following elements that describe the concept of moral suffering.

  • Question 3 of 5

Which of the following best describes common morality?

  • Question 4 of 5

The home care nurse is visiting a terminally ill client with no DNR order. The client has clearly stated she wants all lifesaving measures implemented despite her diagnosis, the advice of her provider, and her family’s wishes. During a visit, the deteriorating client goes into cardiac arrest.The nurse calls 9-1-1 and starts CPR. The client in this scenario has demonstrated which of the following stages of Kohlberg’s theory of moral development?

  • Question 5 of 5

A nurse is caring for a client who has just returned from a cardiac catheterization procedure. The nurse notes that the client has developed a hematoma at the catheter site because the post-op nurse did not provide appropriate pressure. The nurse feels the need to report this occurrence. Which activity listed would best support the nurse’s sense of moral courage in this situation?

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