The value of nursing: a literature review

Promoting dignity in nursing education - How educators manoeuvre to promote dignity

BACKGROUND

Dignity is a core value in nursing. One of the objectives in nursing education is to promote dignity and contribute to the students' discovery of this value. Research shows that dignity in nursing education is threatened, due to lack of attention and an increasing problem with incivility.

PURPOSE

The study aims to explore how nursing educators experience their contribution in promoting dignity in nursing education.

METHOD

Five focus group conversations were conducted with nursing educators, and Gadamer's philosophical hermeneutics was chosen as the study's scientific theoretical approach.

FINDINGS

The educators experienced that they promoted dignity by safeguarding the dignity in the nursing profession in general, by promoting the dignity of the nursing students in particular, and through promoting dignity in challenging situations.

CONCLUSION

The study emphasizes the importance of promoting dignity in nursing education. It found that the nursing educators promoted dignity by safeguarding the dignity of both the nursing profession and the nursing students, and by manoeuvring judiciously between these two when there was disharmony between them. By manoeuvring challenging situations using discretion, the ethical demand will be given room. Dignity can then be fulfilled between people in harmony with professional, social and cultural norms, and in that way promote dignity in nursing education.

An integrative literature review and critical reflection on nurses' agency

The idea of agency has long been used in the nursing literature in the study of nurses' roles regarding the patients they take care of, but it has not often been used to study its relationship with nurses themselves and their status in the healthcare system. The purpose of this article is to analyze how the idea of agency is used in nursing research to better understand how we might advance our thinking around nurses' agency to shape nursing and healthcare with an emancipatory intent. Based on the results of a literature review focused on the study of conceptions, treatments, and applications of the concept of agency in nursing, we present a critical discussion to reflect on the need to consistently define the idea of nurses' agency, to guide research concerned with this topic in theoretical frameworks with emancipatory and social change tenets, and to make a call to develop the idea of agency as a central one to rework nurses' relationship with themselves. The idea of agency provides a valuable analytical framework for the study of a wide range of issues around nurses' status in healthcare organizations and in the healthcare system while offering a means for nurses' emancipation.

The impact of university-based education on nursing professional identity: a qualitative examination of students' experiences

OBJECTIVES

To examine graduate students' perceptions of their nursing professional identity within the university-based educational system.

METHODS

A qualitative phenomenological approach was adopted involving the completion of in-depth interviews and focus groups among master's degree students in Morocco.

RESULTS

The shift to university-based nursing education system was associated with the development of a positive self-image, sense of empowerment, and attachment to professional values in addition to role extension and involvement in research.

CONCLUSIONS

The perceived external barriers such as negative social image, role ambiguity, and unsupportive work environments, limit the reach of the positive influence of the educational shift and may lead to doubts in integrating the clinical workspace.

Comparison of the effectiveness of the electronic portfolio and online discussion forum methods in teaching professional belonging and ethical behaviors to nursing students: a randomized controlled trial

BACKGROUND

Nursing is a profession that has had many ethical aspects and understanding professional belonging and ethics as a deep and complex process is one of the basic concepts in this field. This study aimed to compare the effectiveness of training professional belonging and ethical behaviors in two methods: electronic portfolio and online discussion forum in nursing students.

METHODS

This study is a single-blinded randomized-controlled trial (RCT) with two parallel intervention groups and a third control group. The sample size was 90 selected by block randomization method. The educational contents of professional belonging and ethical behaviors were presented to the participants in two ways: electronic portfolio and online discussion forum. Demographic information form, professional belonging questionnaire, and ethical behaviors questionnaire were applied to collect data. Data were analyzed using SPSS version 24 software. Respectively mean, standard deviation and repeated measured, analysis of variance tests was used in descriptive and analytic statistic. (P value < 0.05).

RESULTS

Comparison of the mean score of professional belonging and ethical behavior in the three stages of pretest, immediately after the test and four weeks after the test in all three groups was significant (P < 0.001). The control group had a higher mean score of professional belonging immediately after the test (108.18 ± 48.9) compared to the other two groups. Also, the online discussion forum group had a higher mean score on ethical behavior in four weeks after the test (104.2 ± 0.8) compared to the other two groups.

CONCLUSION

Training based on two methods of the electronic portfolio and online discussion forum increases and enhances the level of ethical behaviors in students. Therefore, the implementation of such methods of training can be useful in improving, promoting, and learning ethical behaviors in nursing students. On the other hand, training based on the two methods had a negative impact on professional belonging. Therefore, it is suggested that future studies be conducted with a greater focus on areas of professional belonging.

TRIAL REGISTRATION

This research has been registered in Iranian Clinical Trial Registration Center (IRCT) with registration number "IRCT20180612040063N1" and registration date "16/07/2018".

Dignity at stake in educational relations - The significance of confirmation

INTRODUCTION

It is a goal in nursing education to promote students' dignity and facilitate this core value. Students' experience of dignity is shaped by the student-supervisor relationship. Literature shows limited knowledge about how nursing students experience their own dignity during education.

RESEARCH AIM

The aim of the study is to develop an understanding of how nursing students experience their own dignity in relation to supervisors, and what significance these experiences have in education.

RESEARCH DESIGN

Gadamer's philosophical hermeneutics was chosen as the approach, and narratives and qualitative interviews were conducted. The interpretation process was inspired by Fleming, Gaidys and Robbs.

PARTICIPANTS AND RESEARCH CONTEXT

Nineteen nursing students in the final year of their education were included in the study. They represented six different campuses at three different educational institutions. The qualitative interviews took place at the educational institutions.

ETHICAL CONSIDERATIONS

The research recommendations of the Declaration of Helsinki were followed. Access to the students was given by the educational institutions. All interested students signed a continuous informed consent.

FINDINGS

Students' dignity was at stake in encounters with supervisors during education. Decisive for experience of dignity was the supervisor's ability to confirm the student through acknowledgment, reassurance and seeing them as individuals. Experienced dignity had a crucial impact on students' life courage and their ability to be present.

DISCUSSION

The discussion emphasizes the vulnerable dignity of students, the importance of confirmation and the significance perceived dignity has.

CONCLUSION

Students' experiences tilted between perceived dignity and offense, and placed students' dignity in a vulnerable position. Crucial for perceived dignity was the confirmation the students received from their supervisors. Perceived dignity gave the students courage and increased their ability to be present, which provided better opportunities for learning and development.

Exploring nurses' experiences of value congruence and the perceived relationship with wellbeing and patient care and safety: a qualitative study

Background

Values are of high importance to the nursing profession. Value congruence is the extent to which an individual's values align with the values of their organisation. Value congruence has important implications for job satisfaction.

Aim

This study explored nurse values, value congruence and potential implications for individual nurses and organisations in terms of wellbeing and patient care and safety.

Method

Fifteen nurses who worked in acute hospital settings within the UK participated in semi-structured telephone interviews. Thematic analysis was utilised to analyse the data.

Results

Four themes were identified: organisational values incongruent with the work environment; personal and professional value alignment; nurse and supervisor values in conflict; nurses' values at odds with the work environment. Perceived value incongruence was related to poorer wellbeing, increased burnout and poorer perceived patient care and safety. The barriers identified for nurses being able to work in line with their values are described.

Conclusions

Value congruence is important for nurse wellbeing and patient care and safety. Improving the alignment between the values that organisations state they hold, and the values implied by the work environment may help improve patient care and safety and support nurses in practice.

Moral and Professional Values of Nurses in Lebanon

BACKGROUND

Moral and professional values vary among cultures. The purpose of this study was to explore the moral and professional values of registered nurses at a university medical center in a Middle Eastern country and determine the relationship among formal ethics education, background variables (age, gender, nursing degree, regular daily prayer), and nurses' professional and moral values.

METHOD

A cross-sectional survey method with 123 nurses was used. Data on background variables, moral and professional values, and confidence in ethical decision-making were assessed.

RESULTS

Professional values were significantly higher among older nurses and nurses with master's degrees compared with younger nurses and nurses with bachelor's degrees. Daily prayer was related to higher mean scores for moral values. Nurses were confident in their ethical decision-making; however, formal education in ethics did not influence professional or moral values.

CONCLUSION

Although formal education in ethics did not influence the professional or moral values of nurses in Lebanon, this finding does not negate the need for future studies to investigate the content and duration of ethics education that is likely to affect professional or moral values. [J Contin Educ Nurs. 2021;52(9):429-437.].

An integrative review to identify how nurses practicing in inpatient specialist palliative care units uphold the values of nursing

Background

Caring for individuals and their families with a life-limiting, symptomatic illness and those who are dying has long been an integral role of palliative care nurses. Yet, over the last two decades, the specialty of palliative care has undergone significant changes in technology and medical treatments which have altered both the disease trajectory and the delivery of palliative care. To date, there is little evidence as to the impact of these medical and nursing advancements on the role of nurses working in palliative care and how in clinical practice these nurses continue to uphold their nursing values and the philosophy of palliative care.

Methods

An integrative review was conducted searching seven academic databases from the time period of January 2010 – December 2019 for studies identifying research relating to the role of the palliative care nurse working in specialist palliative care units and hospices. Research articles identified were screened against the inclusion criteria. Data extraction was completed on all included studies and the Crowe Critical Appraisal Tool was utilized to appraise the methodological quality and thematic analysis was performed guided by Braun and Clarke’s framework. The review was conducted and reported in lines with PRISMA guidelines.

Results

The search yielded 22,828 articles of which 7 were included for appraisal and review. Four themes were identified: (1) enhancing patient-centred care (2) being there (3) exposure to suffering and death (4) nursing values seen but not heard. The findings highlight that while palliative care nurses do not articulate their nurse values, their actions and behaviors evident within the literature demonstrate care, compassion, and commitment.

Conclusion

These findings suggest that there is a need for nurses working in specialist palliative care units to articulate, document, and audit how they incorporate the values of nursing into their practice. This is pivotal not only for the future of palliative nursing within hospice and specialist palliative care units but also to the future of palliative care itself. To make visible the values of nursing further practice-based education and research is required.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00810-6.

Does professional identity play a critical role in the choice to remain in the nursing profession?

AIM

To explore aspects of professional identity in nurses' written narratives of what is significant to their choice to remain in the profession.

DESIGN

This study used a qualitative design and was underpinned by a hermeneutical approach.

METHODS

The participants were recruited via purposive sampling procedures and included 13 nurses aged 26 to 62 years. The data were collected in the form of written narratives to initiate the nurses' reflections on the decision to remain in the profession. A thematic analysis was conducted.

RESULTS

The analysis revealed two themes: acting as a professional contributor and realigning to maintain professional belongingness. In the nurses' written narratives, these aspects of professional identity were clearly significant to their choice to remain in the profession. In a complexly interwoven way, the aspects constructed who the nurses were as professionals, and thus, professional identity seems to play a critical role in the choice to remain.

Professional values and nursing self-efficacy in the Italian context. Correlational descriptive study

INTRODUCTION

Nurses' professional values (NPVs) and self-efficacy (SE) are two fundamental elements in nursing care that influence its professional identity, competences, resulting in changing the behaviour of professionals and their response to the patient's health needs. The various studies produced so far have not investigated a possible relationship between these two areas. Therefore, the objective of the following study is to identify and deepen the relationship between NPV and SE, in order to improve the knowledge of these issues.

MATERIALS AND METHODS

An observational, correlational and multicentric study has been carried out through a questionnaire based survey. The sampling was conventional. The data collection took place through Nursing Professional Values Scale, version 3 (NPVS-3), which investigates professional values; and Nursing Professional Self-Efficacy Scale (NPSES), which investigates self-efficacy and a socio-demographic questionnaire.

RESULTS

The total sample was 532 nurses and 65.6% was female, with a median age of 42 years and a median of 15 working years. Positive statistically significant correlations between the various domains of the NPVS-3 and NPSES scales were found. These relationships also emerged in the analyses between geographical areas. Overall, the relationships between self-efficacy and values were similar in all the analyses.

DISCUSSION

As the professional values of nurses increase in their response to the patient's health needs, self-efficacy perceived by them increases and vice versa, significantly effecting the clinic and care outcomes of the patients and improving nursing outcomes. The stratification of the sample by geographical area regarding the relationship between age, years of work and professional values indicated that these variables strongly influence the NPV and SE of nurses. Therefore, in some contexts, more support in maintaining a stable value structure may be needed; moreover, it is necessary to incentivise nurses with more effective interventions, as an example and a basis of motivation for future generations.

Examination of the professional values of the nurses and the associated factors

PURPOSE

This study is conducted to examine the professional values of nurses and their personal and professional characteristics affecting these values.

DESIGN AND METHODS

A total of 369 nurses completed a questionnaire on personal information and nursing professional values scale (NPVS-R).

FINDINGS

The total scores of the nurses on the NPVS-R were found to be 100.87 ± 21.07, and the item mean scores were found to be 3.87 ± 0.81. When the scores for individual scale factors were examined, the highest scores were observed for the "caring" (4.02 ± 0.87) and "activism" (3.90 ± 0.89) factors.

PRACTICE IMPLICATIONS

The fact that nurses are aware of their individual values and how these values affect their behavior can be a guide in human-focused value nursing planning.

Relationship between Personal Values, Work Experience and Nursing Competencies among Cancer Care Nurses in Malaysia

Oncology nurses are an essential component of cancer care teams. Nurses play a vital role in ensuring that cancer patients comply with their cancer treatment. In the cancer care nursing context, competency is not merely being skilled, but also implies the characteristic of being able to perform effectively. In addition to the need for competence, nursing is a discipline rich in values including human dignity, caring, humanity, and respect for personal privacy. Research from a variety of disciplines indicates that values often influence human behaviour in professional and work settings. It is often believed, therefore, that nurse' values and work experience influence and contribute to their work performance. Few studies have attempted to examine these relationships, particularly in the context of cancer care nursing. The purpose of this study was to determine the relationship between personal values, work experience and competency among cancer care nurses in Malaysia. Quantitative surveys were used to collect the data. A total of 845 cancer care nurses from 38 public hospitals in Peninsular Malaysia participated in the study. Descriptive statistics and Pearson Product-Moment Correlations were used to analyse the data. The findings revealed positive and significant relationships between personal values and competency (r = 0.59, p < 0.01) and work experience and competency (r = 0.11, p < 0.047). The findings support the assertion that Malaysian nurses' values and work experience are related to performance-related competency.
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Countries' cultures and professional nursing values: Cross-cultural evidence from Spanish and Colombian nursing students

This study aimed to identify countries' cultural values associated with the importance given to certain professional nursing values by nursing students from Spain and Colombia. Weis and Schank's Nurses Professional Values Scale-Revised (NPVS-R) in its Spanish version and the Hofstede cultural classification were used for this purpose. The sample was composed of 880 nursing students. Nursing students from both countries showed a greater importance for professional nursing values compared to evidence from other countries. Significant differences were also found in the total score, dimensions, and items, always being higher for Colombian students. Based on regression results, the impact that the academic year had on the importance given to NPVS-R is non-linear (U-inverted). Both groups of students gave the highest importance to the same group of items. Those showing the largest difference in the rankings were associated with country culture differences based on the scores identified by Hofstede. Colombian and Spanish societies present similarities in Power Distance and Uncertainty Avoidance, as well as differences in the other cultural dimensions.

It is possible to develop the professional values of nurses

BACKGROUND

The awareness and development of professional values affect the quality of nursing care. This study is the first interventional study conducted to develop the professional values of nurses in a clinical setting.

OBJECTIVES

The aim of this study is to determine the effect of a structured Professional Values Development Programme on the development of the professional values of nurses.

RESEARCH DESIGN

This study was a non-randomised controlled trial that measured with pre-test and post-test. Data were collected by using an Individual Identification Form and the Nurses' Professional Values Scale-Revised. The intervention group was involved in a 12-week programme. Participants in the control group received the programme after all data had been collected. Data collection for both groups was conducted at baseline and a 12-week follow-up. Expert opinions were evaluated by the Kendall Coefficient of Correlation test. Chi-square tests and t-tests were used to evaluate group differences. This study was registered at ClinicalTrials.gov.

PARTICIPANTS AND RESEARCH CONTEXT

This study was conducted with 80 nurses (intervention group = 40, control group = 40). This study was conducted in paediatric clinics in two university hospitals in Turkey.

ETHICAL CONSIDERATIONS

In order to conduct this study, ethics committee approval was obtained. This study was performed according to the Helsinki Declaration. Participants were informed verbally and in writing, and informed consent was obtained by giving explanations.

INDINGS

In the analysis, the two groups were similar in demographic variables. The only significant difference between the groups was between weekly working hours. Participants in the intervention group reported statistically significantly higher levels of professional values (p = 0.001) than those in the control group.

DISCUSSIONS AND CONCLUSIONS

This study provides evidence of the positive effectiveness of the Professional Values Development Programme in the development of professional values of clinical nurses. It also demonstrated the feasibility of implementing the programme with clinical nurses.

The influence of experiences of involvement in the COVID-19 rescue task on the professional identity among Chinese nurses: A qualitative study

Aims

To explore the influence of experiences of involvement in the COVID‐19 rescue task on professional identity among Chinese nurses from a qualitative method perspective.

Background

Professional identity of nurses is not static and easily affected by many factors. The COVID‐19 epidemic brings the tremendous physical and psychological challenges for rescue nurses. At present, there are limited data on the influence of rescue experiences on the nurses’ professional identity.

Methods

This study used a face‐to‐face interview with semi‐structured questions to learn about the influence of rescue experiences on the professional identity of nurses. Purposeful sampling was used to collect participants (n = 14), and interview data were analysed following the Colaizzi's phenomenological analysis.

Results

The ‘impression of exhaustion and fear’, ‘feeling the unfairness’, ‘perceiving incompetence in rescue task’ and ‘unexpected professional benefits’ were the main factors affecting the professional identity of rescue nurses.

Conclusion

The present study showed that special attention and targeted support measures should be provided to improve the professional identity of rescue nurses.

Implications for Nursing Management

Nurse managers should make a post‐epidemic recovery plan to help nurses to improve the professional identity. Designed education programmes and complete disaster response system should be developed to deal with infection disease in the future.

An interesting result of a qualitative research: Academic exhaustion barrier to professionalism in medical students

INTRODUCTION

Professionalism is an important measure of the efficacy of the medical education. Some studies showed that dominant values changed during clinical education, and some negative values might replace positive ones. In this regard, this study aimed to explore barrier to professionalism in clinical medical education.

METHODS

This was a qualitative study conducted with the content analysis method. A total of 34 interviews with 23 participants were done.

RESULTS

Two hundred forty-eight original codes were extracted from the research data, which were classified under the theme of "Academic Exhaustion" and the four following categories: "stressful environment, "human conflict," "Poor Inter professional collaboration," and "emotional exhaustion."

DISCUSSION

It can be admitted that having full knowledge of the factors influencing professionalism from the viewpoint of stakeholders can improve the environmental and organizational conditions to prevent professional misconduct.

Effects of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among midwives in community health centers: a randomized clinical trial in Iran

Introduction

Compliance with ethical principles is regarded as one of the key components in providing services in midwifery profession. This study was to evaluate the effects of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among midwives working in community health centers in the city of Karaj, Iran.

Methods

This randomized controlled trial (RCT) was conducted in 2018 on a total number of 84 eligible midwives in two intervention and control groups, selected through multistage sampling method. The intervention group took part in six counseling sessions but the control group only received a training manual. Both groups then completed the Self-Reporting Questionnaire of Ethical Codes of Reproductive Health Providers (including 95 items in 14 domains) at three time points (before, immediately, and four weeks after intervention). Finally, the data were analyzed using the IBM SPSS Statistics (version 22) software via descriptive and inferential statistics.

Results

The findings showed that level of compliance and applicability rate in all 14 domains of midwifery professional codes of ethics were higher in the intervention group (after intervention) than those in the control group and trend of time changes in mean level of compliance and applicability rate of codes of ethics during the three time points were significantly different between both groups (p < 0.001).

Conclusion

Given the effectiveness of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among the midwives working in community health centers, designing and applying this counseling approach was recommended to improve quality of reproductive health care services.

Moving towards a contemporary chiropractic professional identity

Since the inception of the chiropractic profession, debate has continued on differing practice objectives and philosophical approaches to patient care. While the political and academic leaders of the profession continue to dominate the discourse, little is known on the perspectives of the everyday practising chiropractor on their professional identity. In this paper, professional identity within the profession of chiropractic was evaluated using a systematised search strategy of the literature from the year 2000 through to May 2019. Initially 562 articles were sourced, of which 24 met the criteria for review. The review confirmed three previously stated professional identity subgroups; two polarised approaches and a centrist or mixed view. The musculoskeletal biomedical approach is in contrast to the vertebral subluxation vitalistic practice approach. Whilst these three main chiropractic identity subtypes exist, within the literature the terminology used to describe them differs. Research aimed at categorising the chiropractic profession identity into exclusive subtypes found that at least 20% of chiropractors have an exclusive vertebral subluxation focus. However, deeper exploration of the literature shows that vertebral subluxation is an important practice consideration for up to 70% of chiropractors. Patient care with a musculoskeletal spine focus is dominant in clinical practice. This review found that practising chiropractors consider themselves to be primary care or primary contact practitioners with a broad scope of practice across a number of patient groups not limited to musculoskeletal management. Across the research, there is a marked difference in the categories of practice objectives evaluated, and future research could examine the relatedness of these. Additionally, future research could explore the professional identity construct over time and within different practice contexts to help facilitate the progression of the profession.

Moral resilience through harmonised connectedness in intensive care nursing: A grounded theory study

OBJECTIVES

To examine intensive care nurses' main concerns in respect of ethical practice, and to investigate how nurses continue to practise in an ethical way despite challenges in order to offer a conceptualisation of moral resilience.

RESEARCH METHODOLOGY/DESIGN

This qualitative study followed Glaser and Strauss' version of grounded theory. The study was reviewed, and approved, by research ethics committees in Switzerland and in England.

MAIN OUTCOME MEASURES

Data consisted of field notes and in-depth interviews with 16 nurses working in intensive care in Switzerland and memos developed during the analysis. Data analysis followed the constant comparative method. This study took place between 2014 and 2017.

FINDINGS

This study identified new understanding in how intensive care nurses manage their concerns and challenges regarding moral practice. The main category for moral resilience is harmonising connectedness, which represents intensive care nurses' main concern with regard to their moral life, and at the same time, represents the pattern of behaviour in their social interactions and what they yearn for.

CONCLUSIONS

This study offers new insight into intensive care nurses' moral practice, moral resilience and strategies nurses use to achieve moral wellbeing.

Professional values and ethical ideology: Perceptions of nursing students

Background:

Moral philosophical positions and professional values have been shown to influence nurses’ practice behaviours. Understanding nursing students’ professional values and ethical ideologies, therefore, is important as they may help inform evidence-informed curriculum decisions and education strategies to develop students’ professional reflective competencies. However, there is a dearth in current empirical data on Canadian nursing students’ perceptions of professional values and ethical positions.

Objectives:

This study’s purpose was to examine undergraduate nursing student’s perceptions of professional values and ethical ideology and explore relationships in data and selected participant demographic variables.

Research design, participants and context:

A descriptive cross-sectional research design was conducted with a convenience sample of undergraduate nursing students recruited from a university in Canada. An online encrypted survey consisting of two validated instruments was administered to participants who met study eligibility criteria. Descriptive and inferential statistics were employed to analyse the data and classify nursing students’ ethical ideologies into four categories based on mean scores for idealism and relativism.

Ethical considerations:

This study received ethical approval from the institutional Behavioural Research Ethics Board and was executed in-line with ethical principles for research involving humans.

Findings:

Nursing students scored high on professional values and ethical idealism and differed significantly on a measure of ethical relativism in terms of age and year of study. Professional values were significantly associated with ethical idealism. Based on mean scores for idealism and relativism, most nursing students in the study were classified as situationists.

Discussion and conclusion:

Findings suggest that faculty pay attention to influences of moral philosophical positions in facilitating nursing students’ professional values development. Implications for future research and curriculum are highlighted to strengthen nursing students’ professional values.

Perception of compassion and professional values in nursing students: A cross-sectional multivariate analysis from Turkey

Professional values have been acknowledged as the foundation of nursing care, and compassion is recognized as one of these professional values. The aim of this study was to determine the relationship between compassion and professional values and the factors that affect the perceptions of nursing students. A cross-sectional research design was used. There were two sample groups: 141 first-year and 185 third-year nursing students (N = 326). The data were collected using a Personal Information Form, a Compassion Scale and the Nursing Professional Values Scale-Revised. Study data were evaluated with univariate and multivariate regression analyses. No statistically significant difference was found between the students' compassion levels. At the same time, the mean professional values score of the third-year students was determined to be statistically significantly higher. Furthermore, it was determined that the compassion levels of female students were greater than those of male students, and the perception of professional values of those whose fathers' education levels were high was greater. This study concluded that professional values increased as education levels increased but the level of compassion did not change. It is suggested that nursing education be shaped in order to include factors affecting the perception of professional values and compassion levels.

Design and psychometric properties of an instrument to assess metacognition in moral reasoning in medicine

AIM

The present study aims at designing and assessing the psychometric properties of MCMR instruments to lead the medical ethics education to further goals and more definite steps.

DESIGN

This is a cross sectional study.

METHOD

This study was conducted in two phases; identifying the items and designing the instrument. In the preliminary phase, the qualitative study was carried out using conventional content analysis method. In the second phase, psychometric evaluation of instrument was done using face and content validity, construct validity and reliability.

RESULTS

On the first phase of this study, 135 items were identified. After determining face and content validity, 111 items reached the stage of exploratory factor analysis. This instrumental analysis indicated the existence of 74 items and ten factors whose variance of the total is explained as 46.883%. Cronbach's alpha value was 0/75. And the intra-cluster correlation coefficient was 0.808.

Islamic and Western Ethical Values in Health Services Management: A Comparative Study

PURPOSE

This research was performed to compare Islamic and Western ethical values in health services management.

APPROACH

Whittemore and Knafl's integrative review was employed.

FINDINGS

Eight final categories of Islamic values (i.e., honesty, piety, foresight, dignity, justice, good temperament, widened heart, and certainty to God) and nine final categories of Western values in health services management (i.e., honesty, freedom, forgiveness, altruism, justice, dignity, responsibility, tolerance, and wisdom) were extracted in this study.

CONCLUSIONS

The results showed some discrepancy between Islamic and Western ethical values, which are partially due to a different definition of values in Islam and the West.

IMPLICATIONS

The comparison of ethical values can facilitate the exchange of intellectual, cultural, and experimental ideas between Islamic and Western healthcare management.

The Point of View of Undergraduate Health Students on Interprofessional Collaboration: A Thematic Analysis

Interprofessional education (IPE) is essential to prepare future professionals for interprofessional collaboration (IPC). Learning together is essential for students because it is a way to understand the roles of other colleagues, improve their skills, knowledge, competencies, and attitudes to collaborate with the interprofessional teams. To explore how undergraduate students who attend IPE courses define IPC, a qualitative study using semistructured interviews followed by a thematic analysis was performed. Four main themes were identifed: IPC as a resource, requirements for IPC, emotions linked to IPC, and tutor's role to facilitate students' perception of IPC. Students considered IPE important to build IPC, where clinical placement tutors play a key role. The most important findings of the present study include the students' considerations about the importance of IPE when building their IPC definition and the key role played by the tutor during the placement in building IPC in clinical practice.

Effects of perceived stress and professional values on clinical performance in practice nursing students: A structural equation modeling approach

BACKGROUND

Clinical performance is regarded as a basic and core content of nursing quality. Professional values of nursing students may play an important role in improving clinical performance. Few studies reveal the relationship between professional values, perceived stress and clinical performance. This research has found that professional values play a moderating role in the relationship between perceived stress and clinical performance.

OBJECTIVE

To examine the negative association between perceived stress and clinical performance among practice nursing students, and to determine whether professional values plays a moderating role in the relationship between perceived stress and clinical performance among Chinese practice nursing students.

DESIGN

A cross-sectional descriptive design has been used.

METHODS

From May to June 2017, a total of 435 Chinese practice nursing students from 4 hospitals filled out the questionnaires. The response rate was 94.57%. Three questionnaires including the Perceived Stress Scale (PSS), Nursing Professional Value Scale-Revised (NPVS-R), and Clinical Performance Scale (CPS). Structural equation modeling was used to deal with the relationships among perceived stress, professional values, and clinical performance.

RESULTS

Perceived stress was negatively associated with clinical performance (P < 0.01). Professional values significantly affected clinical performance (P < 0.01) and moderated the relationship between perceived stress and clinical performance (P < 0.01).

CONCLUSIONS

Perceived stress is negatively related to clinical performance among Chinese practice nursing students, and professional values moderates the relationship between perceived stress and clinical performance, which can form scientific evidence to develop intervention strategies to improve clinical performance.

Student-related factors affecting academic engagement: A qualitative study exploring the experiences of Iranian undergraduate nursing students

Background and aim

Academic engagement is an important indicator of quality of higher education. This study aimed to explain the experiences of undergraduate nursing students in terms of student-related factors affecting academic engagement.

Methods

This qualitative study was conducted in 2017 at Mashhad University of Medical Sciences in Iran. Data were collected using semi-structured interviews and focus groups with 7 and 16 undergraduate nursing students at Mashhad School of Nursing and Midwifery; respectively. Undergraduate nursing students of both genders who enrolled in different academic semesters with various academic achievements were selected. Data were analyzed using conventional content analysis approach proposed by Graneheim and Lundman, with the support of MAXQDA software.

Results

After analyzing the data, 374 initial codes were extracted, which ultimately conceptualized within six main categories including: “learning motivation”, “interest in learning”, “student participation in extracurricular scientific programs”, “self-directedness”, “mental concentration”, and “demonstration of emotions”.

Conclusion

The findings of this study indicated that student-related factors such as individual motivation and interest, mental concentration, participation in extracurricular activities, and self-directedness in learning, as well as students’ sense of satisfaction with learning could play important roles in the creation of academic engagement in undergraduate nursing students that need to be of interest to nursing educators and planners.

Evaluation of Ethical Attitude Approaches in Midwives and their Relationship with their Demographic Features

Background:

Ethical approach is one of the paramount aspects of life. The position of this approach in medical occupations has always been noticed. This study was carried out to analyze the types of ethical approaches in midwives and their relationship with their demographic features.

Materials and Methods:

The current descriptive-correlation and cross-sectional study was conducted from October to December 2014 using quota random sampling technique. The participants consisted of 189 midwives employed in Isfahan, Iran. The data collection tool was a researcher-made questionnaire. The midwives' attitudes were examined in the four fields of virtue ethics, deontologism, utilitarianism, and religious ethics. Data were analyzed using descriptive and inferential statistics in SPSS software (p < 0.050).

Results:

The highest score belonged to religious ethics with the mean value of 64.36 out of 100. A positive significant relationship was found between deontologism and education level (F = 8.74; p = 0.004), and total ethical approach and workplace (F = 2.60; p = 0.053). There was a reverse significant relationship between age and work experience and virtue ethics (r = −0.15; p = 0.035 and r = −0.20; p = 0.005, respectively).

Conclusions:

The existing high percentage of religious ethics shows the religious tendency of the participants. The determination of ethical approach among midwives as one of the important medical groups and creation and improvement of the most appropriate attitude among them based on the present regulations and requirements in society are principles that we should attempt to achieve.

The effect of organizational and personal variables on the ability to practice compassionately

BACKGROUND

Nursing governing bodies assert that compassion is essential to nursing practice. Despite the relevance compassion has in nursing, and ample theoretical literature, until now, there has been little empirical work conducted to examine the nature of compassion in nursing and how the expression of compassion in nursing practice may be affected.

OBJECTIVES

This study aimed to examine the personal and organizational variables that might affect nurses' ability to practice with compassion.

DESIGN

A predictive, non-experimental cross-sectional design was used to explore the relationships amongst the variables of structural and psychological empowerment, inter-professional collaboration, and compassion.

PARTICIPANTS

191 registered nurses of any age, with any length of experience, in any inpatient or outpatient unit, in any hospital (community, long term care, and teaching) with any education level participated in the study.

DATA COLLECTION

Data were collected via surveys sent to randomly chosen registrants from the College of Nurses of Ontario (Canada) Registry.

RESULTS

Statistically significant correlations were found amongst all the variables. A simple linear regression was calculated to predict the effect of the independent variables of structural empowerment, psychological empowerment, and inter-professional collaboration on the dependent variable compassion. All three had a statistically significant positive relationship to the dependent variable compassion.

DISCUSSION AND CONCLUSIONS

Each of structural empowerment, psychological empowerment, and inter-professional collaboration has been discussed in the literature as a possible predictor of compassion. This study shows that that is the case. This is critical information for both organizations and individual nurses to have, as currently there is an inclination to blame nurses for having insufficient compassion rather than considering there may also be environmental and structural reasons for nurses being unable to practice with compassion. With this study as a beginning, future studies could test for models of how these variables interact in order to make more informed decisions about how to enable compassionate nursing practice. These strategies as it turns out, may be both personal and environmental. This study is a step towards the building of nursing compassion literacy.

Professionalization of nursing in Slovenia: challenges and responsibilities for nurses with a higher education degree

Fast-paced development of society and increasing needs for healthcare services call for a discussion on knowledge in nursing which could help meet these new demands. This leading article further develops some topics previously touched on in the leading article Professionalism in nursing: what is its current level in Slovenia (Skela-Savič, 2016a), adding new evidence from the project Nursing as a scientific discipline in Slovenia (Skela-Savič, et al., 2017a).

The mediating effect of ethical climate on religious orientation and ethical behavior

Background:

Nurses’ behavior in Educational-Medical centers is very important for improving the condition of patients. Ethical climate represents the ethical values and behavioral expectations. Attitude of people toward religion is both intrinsic and extrinsic. Different ethical climates and attitude toward religion could be associated with nurses’ behavior.

Aim:

To study the mediating effect of ethical climate on religious orientation and ethical behaviors of nurses.

Research design:

In an exploratory analysis study, the path analysis method was used to identify the effective variables on ethical behavior.

Participants/context:

The participants consisted of 259 Iranian nurses from Hamadan University of Medical Sciences.

Ethical considerations:

This project with an ethical code and a unique ID IR.UMSHA.REC.1395.67 was approved in the Research Council of Hamadan University of Medical Sciences.

Findings:

The beta coefficients obtained by regression analysis of perception of ethical climate of individual egoism (B = −0.202, p < 0.001), individual ethical principles (B = −0.184, p = 0.001), local egoism (B = −0.136, p = 0.003), and extrinsic religious orientation (B = −0.266, p = 0.007) were significant that they could act as predictors of ethical behavior. The summary of regression model indicated that 0.27% of ethical behaviors of nurses are justified by two variables: ethical climate and religious orientation.

Discussion and conclusion:

Intrinsic religious orientation has the most direct impact and then, respectively, the variables of ethical climate of perceptions in the dimensions of individual egoism, individual ethical principles, local egoism, global ethical principle, and ethical behavior and extrinsic religious orientation follow. All the above, except global ethical principles and intrinsic orientation of religion have a negative effect on ethical behavior and can be predictors of ethical behavior. Therefore, applying strategies to promote theories of intrinsic religious orientation and global ethical principles in different situations of nursing is recommended.

Advancement of the German version of the moral distress scale for acute care nurses-A mixed methods study

AIM

Moral distress experienced by nurses in acute care hospitals can adversely impact the affected nurses, their patients and their hospitals; therefore, it is advisable for organizations to establish internal monitoring of moral distress. However, until now, no suitable questionnaire has been available for use in German-speaking contexts. Hence, the aim of this study was to develop and psychometrically test a German-language version of the Moral Distress Scale.

DESIGN

We chose a sequential explanatory mixed methods design, followed by a second quantitative cross-sectional survey.

METHODS

An American moral distress scale was chosen, translated, culturally adapted, tested in a pilot study and subsequently used in 2011 to conduct an initial web-based quantitative cross-sectional survey of nurses in all inpatient units at five hospitals in Switzerland's German-speaking region. Data were analysed descriptively and via a Rasch analysis. In 2012, four focus group interviews were conducted with 26 nurses and then evaluated using knowledge maps. The results were used to improve the questionnaire. In 2015, using the revised German-language instrument, a second survey and Rasch analysis were conducted.

RESULTS

The descriptive results of the first survey's participants (n = 2153; response rate: 44%) indicated that moral distress is a salient phenomenon in Switzerland. The data from the focus group interviews and the Rasch analysis produced information valuable for the questionnaire's further development. Alongside the data from the second survey's participants (n = 1965; response rate: 40%), the Rasch analysis confirmed the elimination of previous deficiencies on its psychometrics. A Rasch-scaled German version of the Moral Distress Scale is now available for use.

The Value of Nursing Care: A Concept Analysis

AIM

To report an analysis of the concept of value of nursing care.

BACKGROUND

Value-based health care delivery and reimbursement models are focused on value as a product of quality and cost. Nursing care provides tangible and intangible contributions to patient and organizational outcomes. The nursing profession must be able to proactively and effectively communicate the value of nursing care.

DESIGN

Concept analysis.

DATA SOURCES

Thirty-five separate sources were chosen from database searches of CINAHL Complete and ABI/INFORM Complete. Key terms utilized for the search were "nursing value" OR "nursing care value" OR "value of nursing".

METHODS

Caron and Bowers' (2000) dimensional analysis method was used as a guide for the project.

RESULTS

Dimensions identified from this concept analysis included: (a) economic, (b) relational, and (c) societal.

CONCLUSION

Direct care nurses experience the relational and societal dimensions of the value of nursing care. Patients and/or families experience the relational dimension of value in nursing care. Health care administrators, third-party payers, and nurse researchers interpret value from the economic dimension. Future nursing research should better quantify the economic value of nursing care. Qualitative research which focuses on how patients and families experience the value of nursing care would also contribute to further refinement of this concept.

Nurses', nursing students', and nursing instructors' perceptions of professional values: A comparative study

BACKGROUND

In order to prove their commitment to the nursing profession, nurses need to base their professional activities on certain acknowledged values. Although a large number of studies have addressed professional values in nursing, only a few studies are available on the identification and comparison of nurses', nursing students', and nursing instructors' understanding of such values.

OBJECTIVE

The study aims to compare nurses', nursing students', and nursing instructors' perception of nursing professional values.

RESEARCH DESIGN

In this descriptive-comparative study, data were collected using Weis and Schank's Nurses' Professional Values Scale-Revised. The data were analyzed using the SPSS statistical software (v 22).

PARTICIPANTS AND RESEARCH CONTEXT

A total of 299 nurses, 341 nursing students, and 100 nursing instructors from multisite, 20 different wards from 3 university hospitals and associated nursing schools located in the cities of Shiraz, Fasa, and Jahrom in Fars province, participated in 2016.

ETHICAL CONSIDERATIONS

The Institutional Review Board of the researchers' primary university has verified that the study complies with research ethics.

FINDINGS

The total mean scores of the nurses', nursing students', and nursing instructors' perception were found to be 4.23 (0.44), 3.92 (0.50), and 4.34 (0.35), respectively, in the domain of justice-this domain was the subjects' top priority-and 3.40 (0.56), 3.29 (0.49), and 3.55 (0.36), respectively, in the domain of activism-this domain was attached the least importance by the subjects. There were significant differences across the three groups' perception in all of the dimensions of professional values ( p < 0.001).

DISCUSSION

The three study groups' overall mean scores fall within the range of relatively important or important. Several studies show the same results, but there are still controversies in this regard.

CONCLUSION

There is need for plans to increase nurses' awareness of certain professional duties and improve their professional performance in all areas alongside their care duties.

Professional nursing values: A concept analysis

AIM

The aim of this concept analysis is to clarify the meaning of professional nursing values.

BACKGROUND

In a time of increasing ethical dilemmas, it is essential that nurses internalize professional values to develop and maintain a professional identity. However, nursing organizations and researchers provide different conceptions of professional nursing values, leading to a lack of clarity as to the meaning and attributes of this construct.

DESIGN

Walker and Avant's (2011) method was used to guide an analysis of this concept.

DATA SOURCE

Resources published from 1973 to 2016 were identified via electronic databases and hand-searching of reference lists.

REVIEW METHODS

A review of the literature was completed and the data were analyzed to identify uses of the concept; the defining attributes of the concept; borderline, related, contrary, and illegitimate examples; antecedents and consequences; and empirical referents.

RESULTS

Professional nursing values were defined as important professional nursing principles of human dignity, integrity, altruism, and justice that serve as a framework for standards, professional practice, and evaluation.

CONCLUSIONS

Further research is needed in the development and testing of professional nursing values theory, and the reassessment of values instruments. Core professional values that are articulated may help unify the profession and demonstrate the value of nursing to the public.

How work setting and job experience affect professional nurses’ values

Background:

The development of professional values in nursing is directly related to quality and ethical clinical practise and may also increase practitioner and patients’ satisfaction. Some factors, such as work setting or work experience, can influence the importance granted to the professional values of nursing.

Objectives:

To compare in primary care nurses and hospital care nurses the importance granted to professional values and to contrast this perception as a function of professional experience.

Research design, participants and research context:

Descriptive cross-sectional study. Participants were 380 nursing professionals from the public health system (primary care and hospital care). Three dimensions were analysed: ethics, professional expertise and professional mastery. Data were collected from January to June 2015.

Ethical considerations:

We obtained permission from the Ethics Committee and participants’ informed consent.

Findings:

Hospital care professionals attached more importance to all the values analysed, regardless of their work experience. Ethical values, such as confidentiality and respect for the person, were considered to be very important in both systems. Values related to professional expertise obtained lower scores, especially in primary care. In general, professionals with more than 20 years’ experience granted less importance to the values.

Conclusion:

The professional setting influenced the importance assigned to professional nursing values, and clear differences were observed between primary and hospital care. The domain of ethics was considered the most important. It is necessary to reflect on the significance attributed to professional values, especially in more expert nursing staff.

Slovenian Nursing Review facing contemporary publishing challenges

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A cross-sectional analysis of the factors that shape adult nursing students' values, attitudes and perceptions of compassionate care

Nursing students are the future of nursing, and are situated between the expectation of the public (that the public will receive compassionate care) and the profession (that the profession will continue to develop technically to meet the needs of the changing healthcare economy). Research has focused on the factors affecting registered nurses' values in care. However, less is known regarding the factors that shape nursing students' values, attitudes/and perceptions of compassionate care. Six focus group discussions with 23 adult branch nursing students (years 1–3) from a UK university were conducted to ascertain the nursing students' understanding of personal and professional values, factors influencing these values, and whether they felt these values influenced the way they provided compassionate care. Qualitative thematic analysis resulted in five themes, three of which were the focus of this paper: general values, fundamental nursing and nursing values. Participants considered a range of influencers of their general values, and demonstrated a transparency between their personal and professional values, with respect and dignity being important. Fundamental nursing was complex to consider but was considered to orientate around the provision of care in a compassionate way.

Nursing's professional respect as experienced by hospital and community nurses

BACKGROUND

There is growing awareness that patient care suffers when nurses are not respected. Therefore, to improve outcomes for patients, it is crucial that nurses operate in a moral work environment that involves both recognition respect, a form of respect that ought to be accorded to every single person, and appraisal respect, a recognition of the relative and contingent value of respect modulated by the relationships of the healthcare professionals in a determined context. Research question/aim: The purpose of this study was to develop better understandings of perceptions of nursing's professional respect in community and hospital settings in England.

RESEARCH DESIGN

The research design was qualitative. Focus groups were chosen as the most appropriate method for eliciting discussion about nursing's professional respect. Participants and research context: A total of 62 nurses who had been qualified for at least a year and were working in two localities in England participated in this study.

METHODS

Data were collected using 11 focus group sessions. The data were analysed by means of an inductive content analysis, extracting meaning units from the information retrieved and classifying the arising phenomena into conceptually meaningful categories and themes. Ethical considerations: To conduct the research, permission was obtained from the selected universities.

RESULTS

Recognition respect of human beings was perceived as ingrained in the innermost part of nurses. Regarding appraisal respect, a great importance was placed on: the interactions among healthcare professionals, the time to build trust in these relationships, the influences of the workplace characteristics and nurses' professional autonomy and decision-making.

CONCLUSION

Recognition respect of persons was embedded in the inmost part of nurses as individuals. Concerning appraisal respect, it was thought to be deeply enshrined in the inter- and intra-healthcare professional interactions. The forging of trusting relationships over time was deemed to be strongly associated with good quality interactions with other healthcare professionals.