What are Kohlberg’s Stages of Moral Development?

Jump to Levels of Development

1. The Pre-Conventional Level
2. The Conventional Level
3. The Post-Conventional Level

They can be boring to learn, but nursing theories are essential components of nursing education, research, and practice. Nursing theories provide a universal framework for ethical, legal, and medical practice – one of them being Kohlberg’s stages of moral development. 

Developed by American psychologist Lawrence Kohlberg, Kohlberg’s theory of moral development explains the stages people go through as they develop their moral reasoning and judgment.

Nurses can provide more ethical and patient-centered care by incorporating this theory into their practice.

What is Kohlberg’s theory of moral development?

Kohlberg’s theory of moral development is a psychological theory that explains how individuals develop their moral reasoning and judgment. According to Kohlberg, individuals progress through a series of six stages of moral development, each representing a more complex and sophisticated level of moral reasoning.

He believed that only some reach the post-conventional level of moral development, and some individuals may remain at lower levels throughout their lives. It’s also theorized that various factors, such as cognitive development, socialization, and cultural values influence moral development.

Kohlberg’s Theory of Moral Development in Nursing

Kohlberg’s theory of moral development can be applied to nursing practice in various ways, including understanding patients’ moral reasoning, ethical decision-making, patient education, and professional development. 

By understanding patients’ levels of moral development, nurses can better tailor their care and support to individual needs.

Nurses often encounter ethical dilemmas in their practice. Kohlberg’s theory can help nurses make more informed decisions by encouraging them to consider the moral reasoning of all parties involved in the situation, including patients, families, and healthcare providers.

Kohlberg’s Stages of Moral Development (by Level)

The six stages of moral development are laid out into three levels.

1. The Pre-Conventional Level

The first level of Kohlberg’s stages of moral development, the Pre-conventional level, is focused on self-interest and obedience to authority. 

The two stages in this level involve avoiding punishment and seeking rewards for personal gain. Individuals at this level are typically children or individuals with limited cognitive and social development.

Nurses are encouraged to move beyond Stages 1 and 2 to develop more advanced moral reasoning skills and moral reasoning skills and strive towards the higher stages of Kohlberg’s theory.

Stage 1 – Obedience and Punishment

Individuals at this stage focus on avoiding punishment and seek obedience to authority figures. Moral reasoning is driven by self-interest and the desire to avoid negative consequences. 

Examples

• A patient lying to health care professionals about their symptoms or medical history to avoid getting in trouble or facing negative consequences.
• A nurse disclosing an error made in patient care because they fear punishment or getting into trouble if they don’t. They’re motivated by avoiding punishment and following the rules set by the authority figure.

Stage 2 – Self-Interest, Individualism, and Exchange

At this stage, individuals still focus on self-interest but begin to recognize that other people have their own interests and needs. The desire for personal gain and the expectation of a reward drive moral reasoning. 

Examples

• A patient declining a treatment option because they believe the potential risks outweigh the potential benefits for themselves.
• A nurse collaborating with colleagues, such as nursing assistants and other healthcare professionals, to provide safe and efficient care. They recognize that attending to the interests of others can benefit themselves.

2. The Conventional Level

The second level of Kohlberg’s stages of moral development, the Conventional level, is focused on societal norms and expectations. 

The two stages in this level involve gaining approval from others and maintaining social order. Individuals at this level are typically adolescents and adults with a greater understanding of social conventions and expectations.

Stage 3 – Conformity and Interpersonal Relationships

Individuals at this stage are concerned with gaining the approval of others and maintaining positive relationships. Moral reasoning is driven by the desire to be seen as a good person in the eyes of others. 

Examples

• A patient seeking medical treatment for a condition because they are concerned about the impact it could have on their relationships with family and friends if left untreated.
• A nurse seeking input from colleagues on patient care decisions to ensure that everyone is on the same page and that the patient receives the best possible care. 

Stage 4 – Social Order

At this stage, individuals recognize the importance of social order and following the law. Moral reasoning is driven by the need to uphold laws and maintain social order, rather than just seeking approval or avoiding punishment. 

Examples

• A patient carefully following all healthcare protocols to help maintain order within the facility. 
• A nurse placing a high value on teamwork and collaboration. They may believe that working together and respecting the contributions of others is critical for achieving common goals and maintaining social order in the workplace.

3. The Post-Conventional Level

The third level of Kohlberg’s stages of moral development, the Post-conventional level, is focused on individual principles and values. At this level, individuals make moral judgments based on universal ethical principles and personal values. 

The two stages in this level involve recognizing the importance of protecting basic human rights and democratic values and developing a personal moral code based on universal principles. Individuals at this level are typically adults with a strong sense of personal values and principles.

Stage 5 – Social Contract and Individual Rights

Individuals at this stage begin to recognize that laws are not absolute and can be changed through a social contract. Moral reasoning is driven by the belief in the importance of protecting basic human rights and democratic values, even if they conflict with social norms or laws. 

Examples

• A patient questioning their doctor’s treatment plan and seeks a second opinion because they believe it is their right to receive the best possible care and make informed decisions about their health.
• A nurse prioritizing patient autonomy and informed consent. They may believe that patients have the right to make their own healthcare decisions, and may advocate for patient rights in situations where they’re being infringed upon.

Stage 6 – Universal Principles

At this stage, individuals have developed their own moral code that is based on universal principles and values, such as justice and equality. Moral reasoning is driven by a sense of duty to uphold these principles, even if it means going against established laws or norms. 

Examples

• A patient participating in medical research or treatment protocols that are considered controversial or outside of the mainstream. They may be because they believe in the importance of advancing scientific knowledge and promoting ethical principles.
• A nurse challenging policies or practices that are unethical or unjust, even if these policies are legally sanctioned or accepted by their colleagues. They may be willing to speak out against institutionalized practices that are harmful to patients or healthcare workers, and may advocate for changes that promote ethical principles.

Learn Nursing Concepts More Easily

In nursing school, you’ll learn plenty of theories, including Kohlberg’s stages of moral development – ultimately to include in your practice. 

Nursing theories are important because they create a universal standard for ethical, legal medical practice. Kohlberg’s theory of moral development is infused in everyday nursing, and may be tested on.

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