kawa whakaruruhau
), which was first described in 1989. In
Chapter 12, the impact this concept has on law is discussed,
but cultural safety also has an ethical or value orientation.
Therefore, the nurse or midwife delivering the service must
undertake a process of reflection on their own cultural iden-
tity and recognise the impact their personal culture has on
their professional practice.
A shared understanding of both the nurse’s and the
patient’s beliefs and values concerning the illness experience
and planned nursing care can be gained through establishing
a relational narrative focusing on stories of declining health,
precipitating factors and issues of concern. This engagement
in the patient’s world places the nurse in a privileged position
of confidante, educator and guide, who can, through these
dialogues, facilitate meaningful explanations of experiences
and explore options and possible outcomes. Whether people
have an acute illness, which is usually manifest through a
severe and possibly life-threatening episode, or exhibit the
symptoms and limitations associated with chronic illness,
which usually occur over a protracted period of time, the
experience may have left them feeling vulnerable or power-
less. When these people are actively encouraged to
participate in relational narratives they effectively form a
power-sharing partnership with the nurse (Hess, 2004) and
this in turn has the potential to improve their psychological
well-being, reduce their stress and promote wellness.
Values clarification
As the values statements in the previous section illustrate,
values often guide people’s decisions as to what is good and
right in a given situation, but this depends as much on their
feelings as on their thoughts. People’s values change over
time in response to their life experiences, and values clarifi-
cation is a process by which they may come to recognise
these changes, to gain an understanding of their own values,
thoughts and feelings and how they influence their current
actions and behaviours. A
values clarification
exercise is a
tool frequently used within practice development for devel-
oping a common, shared vision and purpose (Warfield &
Manley, 1990; Manley, 1992). It can be used for developing
a common vision about many areas, including role defini-
tions, working effectively in a team, and developing
strategic directions for different purposes.
For the purpose of values clarification, Evans and Brown
(2012) identify a three-step approach that must be met if
a value is to be considered a ‘full’ value. These three cat-
egories are:
•
Choosing
—the value must be chosen freely from a list
of alternatives, with thoughtful consideration being
given to the consequences of each alternative.
•
Prizing
—refers to cherishing the value, being happy
with the choice, and willing to affirm the choice with
other people when appropriate.
•
Acting
—done so that the value is translated into
behaviours consistent with the chosen value and
integrated into the lifestyle.
195
Chapter 11 Values, ethics and advocacy
Example of values clarification
If respect for human dignity is a value that characterises
your practice: you
choose freely
to believe in the worth and
uniqueness of each individual;
realise that you have other
options
(e.g. you could treat with dignity only those people
who are most like you);
and believe
that respecting each
person’s human dignity yields the best consequences for you
and for all of society.
You will also
prize your choice
. For example, you espe-
cially enjoy when people let you know they appreciate your
care, and when colleagues and supervisors compliment you
on interpersonal skills.
You also prize your ability to defend
this value
when someone’s human dignity is being ignored.
Clarifying this value of respect
for human dignity will
motivate you to incorporate this value into your practice.
You strive to respect human dignity consistently in your
personal as well as professional life.
As you become more conscious of this value,
you will be
sensitive to those of your actions
that are inconsistent with it.
For example, you may feel uncomfortable gossiping with other
nurses during break about a patient no-one likes, realising that
this behaviour contradicts your basic respect for human dignity.
Box 11-1 illustrates how the steps in the valuing process
can be used in clinical practice to help a person with high
blood pressure take charge of his health and manage his
medications. Other clinical scenario examples follow.
Practising values clarification
Practise clarifying values for the people in the following
scenarios.
Scenario 1: Person who places a low value on health and
health behaviours
You become frustrated when repeated attempts to teach or
counsel a 26-year-old pharmaceutical salesperson meet with
failure. Although hospitalised with a serious duodenal ulcer,
all he can talk about is his job and meeting his sales quota.
Values clarification
First help this person to identify his basic
life values. Ask him ‘What three things are most important to
you in life?’, or have him rank the following behaviours in
terms of how he would most likely spend an unexpected free
day:
_____ Enjoy some quiet time alone (e.g. thinking,
reading, listening to music)
_____ Spend time with family or friends
_____ Do something active (e.g. walking, playing ball,
swimming)
_____ Watch television
_____ Volunteer time and energy to help someone else
_____ Use time for working in his job.
Discuss with the person what these rankings suggest
about his values. Determine whether his rankings would be
different if he were asked how he wished he could spend the
free day versus how he would most likely spend it.
