E: Expression
The “E” in CODE denotes expression and action through assertiveness and negotiation skills. Knowing one’s obligations and demonstrating specific behaviors can enable you to move past your fear and serve as an effective patient advocate, as Susan did in our case scenario. To avoid blocks to exercising moral courage, nurses need to develop moral courage through education and practice, and to use the tools they learn in making everyday decisions. This helps them develop morally courageous behaviors even before an ethical dilemma occurs. The negative assertion technique is one example of a tool that nurses can use. If Dr. Colton responds defensively when Wendy approaches him (“The family has been hostile to me since I started treating the patient”), she should first state which part of his response she agrees with, and then tell him which part she disagrees with. So she might say, “You’re right. The family has been hostile to you in the past. But we still have the ethical obligation to keep communicating about their mother’s deteriorating condition.”