Fundamentals of Nursing and Midwifery 2e

Chapter 11 Values, ethics and advocacy

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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.

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.