Learning Objectives
By the end of this section, you will be able to:
- Recognize how values are developed
- Describe the values of professional nursing
- Identify the process of structuring values for patient care
How do humans figure out what is good or bad? Right or wrong? Why do some people feel a strong need to care for others who are less fortunate and other people feel that everyone should be fully responsible for making their own way? What is the difference between an individual who regularly breaks the law by selling illegal drugs and someone who will not even go through a red light because it is against the law? Often, these questions boil down to values. Everyone has them, everyone uses them, and everyone experiences them differently.
A value is a central, guiding principle in an individual’s life. Values help people establish priorities, plan for their futures, choose their careers, and determine how they want to live (Weiss et al., 2019). Values are central to individual identity, allow for common communication within groups, help set up goals and ideals of behavior, and assist individuals in responding to questions and ethical situations (Sagiv & Schwartz, 2022).
Development of Values
People develop their values throughout their lifetimes, with much development occurring early in life. Recent studies of twins have shown that both nature (innate, hereditary tendencies) and nurture (socialization and environment) impact value development (Sagiv & Schwartz, 2022). Much like culture, values tend to be shared among individuals living, working, and worshipping in proximity. Caregivers are the first teachers of values, sharing their values and attitudes with their children (Weiss et al., 2019). Caregivers are often among the strongest sources of values, probably due to the inherited and environmental aspects of value transmission. However, children are also influenced by the values of peers, teachers, and religious systems (Sagiv & Schwartz, 2022).
Professional values also develop throughout a person’s lifetime. Nurses learn professional values in school and the workplace (Kosmidis et al., 2021). Developing a solid sense of values increases professional and patient satisfaction.
Value System
A value system is the sum of an individual’s or group’s values. Just like individuals, groups have sets of values, often clarified as codes of conduct, tenets, commandments, or simply value statements (Sagiv & Schwartz, 2022). The factors that bind individuals as a group can also influence their value system. Multiple factors can bind such groups, including religion, profession, interest, economics, business location/facility/company, and ethnicity.
Individuals’ value systems are often personal and created from their experiences, environment, and genetics. By contrast, groups’ value systems are generally thought-out principles created to guide group members in their behaviors and actions (Poorchangizi et al., 2019).
Link to Learning
The World Health Organization (WHO), the health agency of the United Nations, is an international healthcare agency focused on global health care. The WHO Values Charter discusses values for human rights, life, and healthcare equity. They state their group value system to guide the values with which WHO employees are supposed to perform their jobs.
Professional Nursing Values
Like most professions, nursing has a highly formative system of values. In a concept analysis (an exploration of meaning) of nursing professional identity, 62 percent of the sixty-eight articles analyzed cited shared values and ethics as definitive characteristics of the nursing profession (Fitzgerald, 2020). These values reflect how nurses should conduct themselves and behave toward patients, other healthcare workers, and even themselves (Poorchangizi et al., 2019). Professional values such as altruism, autonomy, integrity, social justice, and human dignity are core components of nursing beliefs and practices. Furthermore, nurses are bound by the Code of Ethics for Nurses (discussed in 16.2 Ethics in Nursing Practice) and the standards of nursing practice. Nurses learn these values and ethical codes and how they are practiced (Fitzgerald, 2020). Additionally, as the single largest group of healthcare workers, nurses must adhere to their core professional values, acting as role models for other professional disciplines (Kosmidis et al., 2021).
Altruism
Working for the well-being of others, or altruism, is one of the core values of nursing practice (Figure 16.2). It is inherently connected to the understanding that nursing is a profession of caring for others. The foundation of nursing practice and decision-making is rooted in altruism, which frequently plays a role in the decision to pursue nursing as a profession (American Nurses Association [ANA], 2021; Chen et al., 2022). Altruism affects the nurse/patient relationship and the willingness of the individual nurse to fully embrace other nursing values (Chen et al., 2022). It is easy to lose sight of altruism in today’s modern healthcare settings, which are often driven by business models rather than models of human caring (Chen et al., 2022). However, nurses must continue to embrace altruism because caring for others is central to the profession.
While altruism is core to nursing, it is sometimes difficult to maintain. Patients may present challenges in their demeanor, exhibiting emotions such as anger, confusion, or manipulation. Occasionally, these circumstances can pose difficulties in providing care with a compassionate and tender approach. Keeping an altruistic attitude through difficult times is essential for nurses to learn (Kubsch et al., 2020). Remembering that all patients are vulnerable, even the “difficult” ones, and providing care for them all with kindness and respect supports the altruistic, caring core of the nursing profession.
Autonomy
The value of autonomy reflects the individual’s ability to make decisions and decide on a course of action based on being well informed, giving consent, and volunteering, all without coercion. There are two prongs to autonomy: patients’ right to self-determination and nurses’ right to act autonomously. The value of autonomy is built into the ANA Code of Ethics and runs through many nursing standards (ANA, 2015).
Ensuring patients’ inclusion and participation in the decision-making process about their diagnosis and treatment is key to preserving their autonomy. Patients have the right to accept or refuse treatment, understand the implications of their choices, and be supported throughout the decision-making process. The nursing value of autonomy supports patients in those choices, ensures that patients receive the information they need, aids in determining whether a patient can understand what they are agreeing to, and supports the entire process (ANA, 2015, 2021).
The value of autonomy is as significant in research as in treatment decisions. Research participants have the autonomy to make their own decisions, and nurses must value that autonomy and ensure it is respected by other members of research teams (ANA, 2015). Nurses must use their involvement at all stages of the research process to protect patient autonomy. “Patients’/Participants’ welfare [and autonomy] may never be sacrificed for research ends” (ANA, 2015, p. 28).
Nurses also share the value of autonomy for their own practice (ANA, 2021). Within the bounds of their professional practice acts, nurses have the right to perform their duties autonomously. Nursing leaders at all levels have championed nurses’ ability to have stronger voices within the healthcare arena and be allowed their autonomy. Thus, nurses are allowed to make decisions, truly advocate for their patients, and deeply engage in the entire process (ANA, 2021).
Integrity
The value of integrity presents as honesty, moral consistency (supporting what is “right” even when it is not popular), and commitment. Nurses must hold themselves accountable for the value of integrity in all their activities. The patient’s interests must always be primary (ANA, 2015). Further, nurses must maintain their integrity and behave within the bounds of their nursing professional values. Nurses must have the integrity to protect patients from incompetent, illegal, unethical, and/or impaired practice, even when others are unwilling to speak. Most agencies have processes for reporting concerns, and nurses must be willing to use them to keep their own integrity and that of the profession (ANA, 2015).
In healthcare environments, there are times when the value of integrity is threatened. Situations may present a conflict of interest when a nurse cannot hold the patient’s interests as primary. The nurse must “address such conflicts in ways that ensure the patient’s safety and that promote the patient’s best interests while preserving the professional integrity of the nurse and supporting interprofessional collaboration” (ANA, 2015, p. 5). Conflicts of interest that can negatively impact a nurse’s integrity might include caring for a family member, friend, or enemy, being asked to bill for services not provided, withholding information from a patient, falsifying records, and/or being asked to act outside of the patient’s best interest. When conflicts arise, nurses must seek guidance from their leadership in deciding the correct actions. Nurses must continuously work to support integrity in the workplace and expect it from themselves and other healthcare professionals.
When a nurse refuses to perform an action that violates their personal sense of integrity, the refusal is known as conscientious objection. Nurses can preserve their integrity and refuse to act as long as they are not refusing based on personal prejudices such as bias and/or convenience (ANA, 2015). If a nurse chooses to use conscientious objection to refuse to violate their professional integrity, they may face consequences. For example, a nurse who holds strong ethical or religious beliefs against participating in certain medical procedures, such as abortion or assisted suicide, may refuse to take part in such procedures, due to conscientious objection. As a result, they might face consequences, such as disciplinary action or a negative performance evaluation. However, many agencies have policies that allow nurses the autonomy to express conscientious objection, provided that the nurse ensures patient safety and does not leave a patient without someone providing for their care (ANA, 2015).
Human Dignity
The belief that every individual has worth based on being human is called human dignity, and all humans share this worth equally. A belief in the value of human dignity is fundamental to the nursing system of values. It should underline every interaction a nurse has with patients, healthcare workers, family members, and community members (ANA, 2015). The importance of human dignity is closely linked to autonomy, as both uphold an individual’s right to make their own decisions. Even if the nurse disagrees with the patient, human dignity allows an individual patient to make their own decisions and be supported by the nurse.
The nursing profession is also committed to championing human dignity beyond the bedside. Nurses are involved in human rights campaigns and collaborative strategies to ensure equality in health care for all people (ANA, 2015). Nurses involved in human subjects research must remember to value the human dignity of research participants and that a human being is being studied; it is important to protect at-risk populations from being disrespected or devalued.
Social Justice
An inherent belief that all people deserve equal treatment and access to health care is called social justice. This value encourages nursing professionalism and influences organizations to work toward health equity for patients and communities (ANA, 2021). Social justice means that nurses supply the same high-quality treatment for all patients, regardless of socioeconomic status. From a nursing standpoint, it does not matter if a patient has insurance, can speak the dominant language of the location, or has racial, ethnic, gender, religious, or political differences. All patients should be treated equally, with dignity and respect (ANA, 2021).
Link to Learning
Nurses have many opportunities to engage in social justice activities locally, nationally, and internationally. Explore some ways members of National Nurses United involve themselves with social justice issues.
A belief in social justice develops naturally from other nursing professional values such as altruism, integrity, autonomy, and human dignity. Together these values represent the social contract for the nursing profession that extends beyond hospital walls and physician offices and into the heart of the community (ANA, 2021). Nurses must look beyond personal biases to fight for the rights of all people to have fair and equal access to health care, both in daily nursing practice and in nursing research. This value is inherent in four of the five current research lenses supported by the National Institute of Nursing Research (Figure 16.3).
Process of Structuring Values
Nursing values are the principles upon which the nursing profession is built. Nursing values become internalized in nurses and throughout the profession. They are structured into nursing standards of practice, codes of ethics, nursing organizations, agency departments of nursing service, and even the nursing process (Habeeb, 2022).
For most nurses, the values of the nursing profession also align with their personal values. Why else would they choose this profession? However, if the personal values of most nurses generally align with the values of the nursing profession, then why do some nurses behave differently? Studies have shown that individual nurses’ emphasis on different nursing values is directly linked to their own personal values (Habeeb, 2022). Since everyone’s personal experiences are different, so are their interpretations of nursing values and their applications to nursing practice.
Assessing Values
There is great benefit in assessing values. Professional values can be taught in classes or textbooks or learned through observing role models. However, understanding one’s personal values is always useful. Some agencies include personality and values inventories before hiring staff members. Some schools also use these inventories to help their students make determinations about ideal professions.
Several values assessment inventories are available to explore values in oneself or others (Chowdhury, 2023). For example, the Personal Values Assessment is one values measurement tool. It focuses specifically on personal, social, and universal values. It provides a basis to understand one’s own beliefs about right and wrong (Chowdhury, 2023). There is also a Nurses Professional Values Scale-3, written using the ANA’s Code of Ethics to measure nursing values. It has been validated in English and several other languages (Weis, 2017).
Link to Learning
There are suggestions to use in considering your own values and knowing your core values. Check some of them out and consider how your own values align with those of the nursing profession.
Application of Values in Clinical Practice
Once professional nursing values are established and learned, how are they applied? How do nurses use these values in clinical practice? How are they recognized by patients, colleagues, leadership, and even friends or family? It would be easy to simply state that they should be obvious based on an individual nurse’s actions and behaviors. However, this response does not provide clarity or concrete discussions of how values are applied or show how they are structured into the fabric of nursing. Instead, let us explore the nursing process, assessment, diagnosis, outcomes/planning, implementation, and evaluation, to see how principles of nursing values are integrated into the strategies that nurses use in clinical practice (Table 16.1).
| Process Step | Description | Examples |
|---|---|---|
| Assessment | The nurse collects and analyzes objective and subjective information about their patient. |
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| Diagnosis | The nurse uses clinical judgment to determine the patient’s needs regarding nursing care. |
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| Outcomes/Planning | The nurse identifies desired outcomes and develops nursing plans to help achieve those outcomes. |
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| Implementation | The nurse puts various interventions and plans into action to help the patient gain/regain the desired outcomes. |
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| Evaluation | The nurse evaluates progress toward outcomes. |
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