Fundamentals of Nursing and Midwifery 2e

Unit II Foundations of nursing and midwifery practice

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BOX 11-1 Steps in the valuing process

Situation: Mr Jefferson is a 49-year-old man with uncontrolled high blood pressure. Choosing Choosing freely: Mr Jefferson decides from now on to take his medication as prescribed following his readmission to hospital as a result of abruptly stopping his antihypertensive medication. Choosing from alternatives: After a teaching–learning session with a nurse, Mr Jefferson understands he has basically three options: • Adhere with prescribed treatment regime • Refuse to take the medication but try harder to control his blood pressure through diet, exercise, and stress management • Refuse to take the medication and assume a ‘we’ll see’ attitude. After consideration of the consequences. Mr Jefferson understands the probable consequences of these options: • Adherence with the treatment regime will yield the best control of high blood pressure (but may cause some annoying side-effects). • Diet, exercise and stress management may reduce his blood pressure somewhat but did not yield sufficient control in the past. • High blood pressure may result in serious complications such as stroke, kidney disease or impaired vision. Prizing • With pride and happiness. Mr Jefferson states: ‘Now that I understand high blood pressure better and know what I can do to control it, I feel more in charge of my life—and I like that!’ • With public affirmation. Mr Jefferson states to his wife: ‘I now know I was wrong to stop taking that medicine when I blamed it for how lousy I was feeling. That won’t happen again. If you ever hear me complaining about my pills, remind me to see my doctor right away.’

Acting by incorporating the behaviour into lifestyle on a consistent basis • After discharge from the hospital, Mr Jefferson takes the medication as prescribed.

• Mr Jefferson seeks to understand any new medication he is prescribed (i.e. reason for the medication, possible side- effects, consequences of the non-adherence) and successfully manages the treatment regime; he feels proud of his new knowledge and self-care abilities.

Now consider these questions: • How might this activity help this person examine his health-related behaviours? • What changes might you expect the person to make to his lifestyle? • What strategies might assist him to incorporate the changes into his daily routine? Scenario 2: Values of patients and family members in conflict You sense a growing tension while talking with the young parents of a child with asthma. Your questions to them (e.g. ‘You seem uncomfortable with what I’m saying now. Is there something wrong?’) reveal that the wife is a smoker and cat- lover who has told her husband that, even if these behaviours are hurting their child, she is unwilling to give them up. Values clarification Suggest both parents complete the fol- lowing exercise. Ask them ‘Where do you stand on the following issues? Indicate your responses in the following manner: SA, strongly agree; A, agree; D, disagree; SD, strongly disagree; U, undecided’, and then talk with them about their responses:

_____ A parent’s primary obligation is to meet the needs of his or her child. _____ Each member of a family is entitled to pursue personal pleasures, even if these are not in the best interest of all. _____ Pleasure is more important than health. _____ The choices one family member makes can dra- matically affect other family members (positively or negatively). This exercise will help the parents to evaluate their basic values, explore areas of conflict and, perhaps, move towards jointly choosing, prizing and acting on several health-promoting values. Now consider these questions: • How might this activity be seen as threatening or intrusive by the parents? • What support might you require to make this a positive experience? • What strategies might assist these parents to incorporate the changes into their lifestyle?