by Paula Manuel Staff Nurse Interest Group

On any given day or night the following scenario may be seen, two nurses speaking to one another perhaps during shift change, or a call for help with an assignment.  One says “I need help with the patient in Room XXX”, the other nurse responds “what’s wrong with you, you have the lightest assignment and you can’t cope with it”

In the nursing station a nurse asks the responsible physician “why are we adding to this patient’s pain and suffering?  It does not seem to be the right thing…..”  The doctor responds “It’s what the family wants–they want everything done and now everything is about patient experience scores”

These two vignettes though limited in detail provide a snapshot of conversations that occur  for any number of nurses; conflict about what is valued, how one can be perceived, and how to navigate an ethical dilemma when there are competing priorities.  Nursing is a practice discipline and the ethical frameworks we utilize have to consider our perspectives as an individual, within an organization, and the society we live in.  The real life experience of professional values is framed within our education, affiliation with our regulatory bodies, self-reflection about our life experiences related to gender, culture, family, community, and religion to name a few.

One of my courses generated an opportunity to consider in more depth the professional values of nursing  (Shaw and Degazon, 2008) highlighted how nursing programs would need to be more diverse i.e. cultural, racial, age, gender etc. a significant driver for this change was the retiring workforce and high nursing turnover (US based). Their view was that a common nursing ideology and mission were needed so that bridges will be created among nurses of varied backgrounds. The process would involve modifying old personal and professional values and internalizing new ones. The core professional nursing values, not dissimilar from Canada, were adopted by the American Association of Colleges of Nursing in 1998. The values adopted were:

  • altruism,
  • autonomy,
  • human dignity,
  • integrity,
  • social justice.

The article described how nursing students were initially  consumers as they internalized the professional values and the challenges they had as graduates as they transitioned into professional settings, and some employers did not engage in the process of socializing new nurses. The level of support that would include casual and/or part time status versus full time permanent positions.

Altruism is a traditional value considered a primary motivation for entering the nursing profession, the words devotion, caring for others, selflessness are some of the characteristics; but many contemporary students are focused on financial incentives, career mobility and stability. Shaw and Degazon pointed out that altruism must be taught, learned, and integrated into practice, thereby a common understanding will emerge of the meaning and satisfaction of helping others.

Autonomy includes self-determination and being self-directed, and how nurses need to support patients in their decision-making especially when different from their own values. The skill of collaboration is needed with patients, families, and colleagues regarding sensitive topics i.e. end of life, and having awareness of the dilemmas encountered in professional practice when conflicting views and value-laden issues arise. Subjectively a nurse needs to know their own cultural values and consider the elements of truth telling, self-determination and individual options.

Human Dignity this value is the basis of respectful treatment to patients, families, and colleagues and interactions will be more therapeutic, productive, and professional. The caution by the authors was to be aware of the role assumptions may play in personal and professional endeavours, also known as biases, whereby you may not interact with an individual but instead use your assumptions about that individual.

Integrity is linked to the Code of Ethics and the principles of non-maleficence, beneficence, fidelity, veracity, and social justice. The focus on this value was how contemporary society has many examples of ethical standards and integrity lapses by government officials i.e. NY governor and call girls, business executives i.e. Enron, and clergy i.e. priests. The need for integrity by nurses in practice is how we merit public trust. Shaw and Degazon profiled how a number of immigrants admitted to bending the rules to cope with a complex immigration process and making things happen was considered a higher purpose. As nurses we can acknowledge a client/patient’s perspective, but as nurses we understand that knowledge and application of professional standards translates into accountability.

Social Justice is “the moral and ethical imperative to respect the basic rights of others” (Shaw & Degazon, 2008, p.49) and how collective action enhances the power of individuals to create change for individuals, families and communities. Within this value the phrase “Choose a job you love, and you will never have to work a day in your life.” by Confucius is a nurse’s ability to recognize the impact of social policy, and to know about the rich legacy nurses have in activism to improve social and health opportunities and outcomes i.e. SARS, closing coal plants, equal rights for disabled persons, sexual orientation, bullying.

In terms of consumers Bowman (1997) outlined how bioethics had evolved from Western moral philosophy and Western biomedical perspectives. Our patients and families may have very different perceptions, experiences, and explanations of illness as their world-view could be Western or non-Western and this will affect cultural context, how illness is explained, and locus of control. So autonomy maybe a value for some of the consumers but others will value interdependence. Bowman also highlighted how the Western perspective can be an either/or and a non-Western perspective maybe grounded in a dynamic equilibrium i.e. yin and yang.

Truth-telling has a high value in the Western view seen as the patient’s “right to know”, and for the non-Western view it can range from believing the patient should not be told, to the family are given the information and they’re expected to inform and support the patient. Bowman illustrated how important it was to explore the “consumer’s” cultural perspective, as professionals it would be safe to say there is value in clarifying their world view and we have to be open and receptive.

Our professional values likely complement the ones held by our public. So to answer the question similar or different values for nurses from the public; I say on most values we are on the same page and the differences mean we have subjects to explore and to gain insight i.e. to the diversity of world views. Our health care services need to reflect cultural pluralism and here’s the challenge… how to effectively do that in the climate of limited resources, time pressure, and the high value placed on efficiency. Human beings are not tidy boxes, indeed we are not working on widgets but complex beings.  Patient experience metrics and values stay tuned.  Namaste

Sources: Shaw, H.K., & Degazon, C. (2008). Integrating core professional values of nursing: A profession, not just a career. Journal of Cultural Diversity, (15)1, 44-50

Bowman, K. (1997). BIOETHICS AND CULTURAL PLURALISM. Humane Health Care International. Volume 13 (2), 31-34

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