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Values Paper Danielle Danoski University of Florida

2 Nursing is a profession that requires more than just skills. As Florence Nightingale once said Nursing is an art. It requires an exclusive devotion as hard a preparation, as any painter's or sculptor's work (Dossey & Keegan, p.37). In the nursing profession, nurses need to be able to have a clear idea on their own personal and professional values before they are able to care for their patients properly. Before we make decisions we must analyze carefully how we will be affecting our patient and their values. Having self-awareness of our own values and the patients will allow for a better patient relationship and overall healing process. There are countless values that nurses should have, however three that are most essential to me are compassion, mindfulness, and honesty. These three values are the foundation blocks that create exceptional nurses today. Compassion is an essential value to have as a nurse because it allows you to be empathetic toward your patient. This is crucial when working with patients because they are going through a life changing experience or transition, big or small, while being in the hospital. According to Torjuul et al (2007), compassion involves being close to and perceiving the suffering of patients and relatives. During my clinical experience I try to put myself in the patients shoes. I think of how I would want to be treated and cared for if I was severely ill or in pain. Out of the five professional values discussed, I think compassion relates the most to altruism. According to the AACN Essentials (2013), Altruism is a concern for the welfare and well being of others. In professional practice altruism is reflected by the nurses concern and advocacy for the welfare of patients, other nurses, and other healthcare providers. Compassion relates to altruism because these values require more than just skills, such as taking out an IV carefully or administering medication. They both have to do with caring about the patient and taking action that is in their best interest. Altruism relates to my clinical experience because I get

3 enjoyment out of helping and interacting with others, which is the basis of altruism. During clinical I work with patients to make them feel as comfortable as possible in their beds and retrieve whatever it is they need. These are simple tasks but I was able to make a difference and make the patients stay in the hospital a more positive experience. According to Justine (2008), If a nurse performs care to a patient without their full attention and being, the patient will be susceptible to a negative environment causing a negative outlook and outcome for the patient. Compassion and altruism are two values that people need to carry with them for as long as they are in the nursing career because they create a more optimistic experience for the patient. Mindfulness is another important value I believe all nurses should have because one should be aware of their surroundings at all times while in the hospital. According to Sitzman (2002), Watson alludes to the concept in her writings: Practices such as centering, meditation, breath work, yoga, prayer, connections with nature and other such forms of daily contemplation are essential to the theory of human caring authenticity and success. In other words, if one is to work from a caring healing paradigm, one must live it out in daily life. I personally do not practice all of the forms of mindfulness mentioned above, however I have practiced breathing methods and yoga. Right before entering clinical I practice some breathing techniques to focus my thoughts and I found that it helps me listen more attentively to my patients. I found yoga to be very helpful because it allows me to be calmer during clinical. Nurses can also incorporate mindfulness in hand washing and listening. According to Advance Healthcare Network for Nurses (2013), when nurses wash their hands they can focus on the water, the soap, their breaths and surroundings. Being mindful of all these things can help you to center yourself. When speaking with a patient, the Advance Healthcare Network for Nurses

4 explains to focus your attention to your patient through appropriate eye contact and actively listening to their needs. A nurse should be mindful of a patients perspective regarding their health. In addition, when assessing a patient I believe a nurse should also be mindful of the their age, gender, race, cultural background, etc. This allows the nurse to act more efficiently during their interactions with the patient. Mindfulness relates to autonomy when discussing professional values because they both involve respecting the patients decision about themselves and their next step in treatment. According to the ACCN Essentials (2013), Autonomy is the right to selfdetermination. Professional practice reflects autonomy when the nurse respects patients rights to make decisions about their health care. Respecting patients decision is key to developing a professional and positive relationship with them. According to Moore (2012), As nurses, we also must respect the cultural beliefs and values of others. Just because we think it is the right thing to do, does not necessarily make it so. A Jehovahs Witness has the right to refuse blood products, even when their life is in jeopardy. We must respect that belief. A patient may decide not to receive chemotherapy; that is his choice. It may not be right for us, but we have to honor the wishes and beliefs of the patient. When relating autonomy to my clinical experience one example stands out in my mind. An older patient on my floor decided against surgery that would leave him bed-ridden for the rest of his life. Instead, he decided to be discharged and spend the rest of his days at home with his wife. A nurses ultimate goal is to keep the patient alive but I observed that the nurse had to respect the patients decision because being in a bed for the remainder of his life was not living to him. I have not experienced or observed a situation where the patient had a different view of health care

5 due to cultural differences, however I am sure I will encounter these situations many times over during my nursing career. Honesty is the third personal value that is important to me regarding nursing. Telling patients the truth about their illness allows them to make clear decisions about their next step in care. If nurses focus on being honest with their patient then a more positive professional patient relationship will develop, which then initiates a more enjoyable healing process for the patient. According to Jones & Sachs (2012), The public continues to rate registered nurses (RNs) as the most trusted profession according to this years Gallup survey that ranks professions based on their honesty and ethical standards. Nurses are looked at as the most honest profession not only because they follow the Code of Ethics for Nurses, but also because they are always there for the patient and advocating for them. The patients physician might only see them for 30 minutes out of the whole day, but the nurse is there for them at all times. Therefore, the nurse is a majority of the patients support system. A strong support system for the patient is built on many values, but an essential component is honesty. Honesty relates to the professional value of integrity because both values overlap each other and relate to ethical standards. According to the ACCN Essentials (2013), Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. Nurses use the Code of Ethics as a guide to uphold their reputation as nursing being a profession of integrity. I think integrity is measured when no one is looking around to see if you are doing your job right. During clinical I took vitals for some patients that I was not assigned to but another member of my group who was

6 supposed to take them and forgot to. I didnt have to take them but I completed the deed without looking for any recognition. Out of the five professional values discussed in the AACN Essentials document I believe that is most challenged by the current healthcare system today is social justice. The AACN Essentials (2013) describes social justice as acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation. Even though nurses are trained to treat all patients with same amount of extraordinary care, discrimination still exists. Nurses have an obligation to not only care for patients in the hospital but to promote realistic, beneficial interventions to continue the treatment process for their patients once they are discharged as well. The American Nurses Association Code of Ethics (2001) states: Nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups, and communities. Nurses act to change those aspects of social structures that detract from health and well-being. (p.2) The primary idea in this statement is that nurses should work towards promoting health not only for an individual but in the community as well. Nurses should not allow any social structures such as race, age, economic status, cultural, etc. that would discriminate the individual from getting the best optimal care possible. Discrimination in the nursing profession is ethically incorrect. If nurses promoted health care in their communities rather than just the individual there would be less illness, injury, and diseases in society as a whole. According to Ellis (2013), Ethical nursing practice is one that adopts a role as social advocate outside the clinic. In this role, nurses will prevent illness by promoting

7 policy changes to obtain/restore equity in all societal structures - not just health care. In fact, both Codes of Ethics encourage nurses to do exactly this. Unfortunately, it does not occur as it should. Thus, nurses must place social advocacy higher up in importance in their practice, understanding it is a necessity to the prevention of illness and promotion of health. For that ethical understanding, a more developed sense of social justice will be needed. (p. 43) This statement supports the notion that nurses should prevent illness and also refer back to their Code of Ethics to promote wellness not only for the individual but for society as well. Deficiencies in the community can have a detrimental impact on an individuals health. According to Healthy People 2020 (2013), some social determinants are availability of resources to meet daily needs, access to health care services, language, social attitudes, and many more. Nurses should have a holistic mindset and be able to promote good health for all. They need to be able to recognize the social determinants of health that their patient faces to be able to care for them properly. In my clinical we have not been able to promote wellness for the future for our patients yet. However, I have observed that there is a certain social structure and the social detriments that go along with it. From my observations it seems that the lower and middle class face social detriments relating to health on an everyday basis. For example, after completing a physical exam on one patient I noticed that he barely had any teeth. When I asked him if he has had a dental check up to acquire dentures he told me that he could not afford a dentist. He also stated to me that his teeth were in terrible condition because he tries to save money for food so he doesnt buy toothpaste that often. This is one example of many that shows that nurses not only need to care for their patients when they are in the hospital but also promote wellness for society so

8 instances like this one does not occur. Nurses should care to all of societies needs and it will therefore reduce the number of illness and deaths.

References Code of Ethics for Nurses With Interpretive Statements (2001). American Nurses Association. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/C ode-of-Ethics.pdf Dossey, B. & Keegan, L (2013). Holistic Nursing: A Handbook for Practice. Massachusetts: Jones & Bartlett Learning Ellis, S. (2013). The existing intersection of social justice and nursing. Retrieved from http://publications.theseus.fi/bitstream/handle/10024/55352/schuyler_ellis_thesis_final.pdf?sequ ence=1 Healthy People 2020 (2013). Social Determinants of Health. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39 Jones & Sachs (2012, December 4). Nurses Earn Highest Ranking Ever, Remain Most Ethical of Professions in Poll. Nursing World. Retrieved from http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/ Nurses-Remain-Most-Ethical-of-Professions-in-Poll.pdf Justine (2008). Altruism in Nursing. Retrieved from http://simplyjustanonymous.blogspot.com/2008/12/altruism-in-nursing.html Moore, C. (2012, November 28). Ethics in Nursing: Deciding What Is Right and Wrong. Retrieved from http://www.nursetogether.com/ethics-in-nursing-deciding-what-is-rightand-wrong

10 Table 1 Mindful Nursing Defined (2013). Advance Healthcare Network for Nurses. Retrieved from http://nursing.advanceweb.com/Web-Extras/Online-Extras/Table-1-MindfulNursing-Defined.aspx The Essentials of Baccalaureate Education for Professional Nursing Practice (2008). Retrieved from http://www.aacn.nche.edu/education-resources/baccessentials08.pdf Torjuul, K. et al (2007) Compassion and Responsibility in Surgical Care. Nursing Ethics; 14: 4, 522534. Retrieved from http://planetreegrove.com/wpcontent/uploads/2013/08/Compassion-and-responsibility-in-surgical-care.pdf Sitzman, K (2002). Interbeing and Mindfulness A Bridge to Understanding Jean Watsons Theory of Human Caring. Nursing Education Perspective. 23, 118-123. Retrieved from http://watsoncaringscience.org/files/PDF/Ovid_%20SITZMAN_%20Nursing.pdf