Kohlberg

Stages of Moral Development

Focuses on moral reasoning, progressing through 3 levels and 6 stages; stages may not strictly correspond to age.

Preconventional Reasoning

Premoral, egocentric thinking where actions are guided by punishment and reward.

Stage 1: Punishment & Obedience

Obey rules to avoid punishment; “I must follow rules or be punished”; Nursing implication: Reinforce that illness is not punishment.

Stage 2: Instrumental-Relativist

Recognizes multiple viewpoints; satisfy own needs; Child follows curfew to avoid confinement; Nursing implication: Teach consequences without fear-based reasoning.

Conventional Reasoning

Moral decisions guided by societal rules, loyalty, and relationships.

Stage 3: Good Boy–Nice Girl

Seek approval and maintain relationships; Doing chores to be “good”; Nursing implication: Encourage empathy and social responsibility.

Stage 4: Society-Maintaining

Consider societal laws and order; Not attending a party with alcohol because it’s wrong; Nursing implication: Reinforce societal rules and duties.

Postconventional Reasoning

Moral reasoning based on self-chosen ethical principles.

Stage 5: Social Contract

Laws can be changed for societal good; respect basic rights; Advocating policy change for justice; Nursing implication: Encourage critical thinking about laws vs ethics.

Stage 6: Universal Ethical Principle

Decisions guided by conscience and universal principles; Civil disobedience for justice; Nursing implication: Support ethical reasoning and advocacy for justice.

Preconventional reasoning focuses on avoiding punishment.

True

Conventional reasoning is guided by self-chosen ethical principles.

False

Stage 3 emphasizes approval and maintaining relationships.

True

Stage 6 decisions are guided by conscience and universal principles.

True

Instrumental-Relativist stage ignores consequences of actions.

False

A nurse explains that following hospital rules is for patient safety, not punishment. Which stage applies?

Stage 1: Punishment & Obedience – clarifying rule-based reasoning.

A nurse discusses ethical implications of advocating for a patient policy change. Which stage applies?

Stage 5: Social Contract – reasoning beyond personal interest.

A nurse supports a patient’s moral reasoning to make decisions based on conscience. Which stage applies?

Stage 6: Universal Ethical Principle – guided by universal ethical principles.

A child follows rules to get a reward. Which stage applies?

Stage 2: Instrumental-Relativist – satisfies own needs with consideration of consequences.

Which level is premoral and egocentric—Preconventional or Postconventional?

Preconventional Reasoning.

Which stage focuses on societal rules—Stage 4 or Stage 2?

Stage 4: Society-Maintaining.

Which stage involves conscience-guided decisions—Stage 6 or Stage 3?

Stage 6: Universal Ethical Principle.

Which stage emphasizes empathy and social approval—Stage 3 or Stage 1?

Stage 3: Good Boy–Nice Girl.