Reflective based learning for nursing ethical competency during clinical practices

BACKGROUND

A combination of theoretical and practical approaches is required to learn and acquire ethical competencies in caring. Occasionally, reflection on practical action differs from theoretical learning. In the context of reflective learning, issues such as ethical values can be discussed since they evoke conflict among nursing students.

AIM

To identify ethical conflicts encountered by nursing students during clinical placements and to determine their cooperation strategies.

RESEARCH DESIGN

Qualitative study with a content analysis according to Elo and Kinglas framework.

PARTICIPANTS AND RESEARCH CONTEXT

Students enrolled in a nursing program at a Spanish university aged between 22 and 35, mainly women.

METHODOLOGY

The study includes 134 ethical reflections from nursing students in the last year of the nursing program, written during their clinical practices in a variety of learning environments. The research team analyzed the reflections using an inductive content analysis method.

ETHICAL CONSIDERATIONS

Ethical permission was obtained by the management center according to Law 3/2028, and all the participants accepted to participate through the informed consent form.

FINDINGS

Three main categories emerged from the analysis of the ethical reflections: (1) evaluation of professional performance and patient care; (2) the student as the protagonist of the dilemma; (3) student coping. Student dilemmas and concerns are related to ignorance, student-patient communication, mistakes made and self-confidence. Some situations conflict with the autonomy of patients and their rights, and can contribute to stressful situations for patients. Stress factors include hospital routines, which the patient cannot modify, and asymmetric relationships with staff, which encourage passivity.

CONCLUSION

All ethical problems detected by the students begin with the professional-patient relationship, including issues related to bad news, errors or malpractice. Reflection on the ethical values of nursing, both in the classroom and in clinical practices, allows students to develop a greater ethical awareness of care, enhancing their decision-making skills in ethical dilemmas.

Professional values and perception of knowledge regarding professional ethics in physical therapy students: A STROBE compliant cross-sectional study

Undergraduate students start the acquisition of a professional identity, and begin to achieve professional values and consciousness of an ethical behavior as future health professionals. The aim of this study was describe professional values and perception of knowledge regarding professional ethics of physical therapy students. A cross-sectional study was performed. A total of 351 students participated in the study. Professional values and perception of knowledge regarding professional ethics were assessed. Ethical approval was obtained from the University Ethics Review Board. The most important value was equity, while the least one was abnegation. The second educational year showed higher scores in importance of scientific quality (P = .010 vs first year), the third year in respect for life (P = .041 vs first year, respectively), and the fourth year in respect to patient's autonomy (P = .033 vs first year). First-year students showed lower scores in perception of knowledge regarding professional ethics (P < .001 vs second, third, and fourth year), while second-year students had higher scores (P < .001 vs first and third; P = .006 vs fourth year) and no differences between third- and fourth-year students were found. Those professional values highly considered by the students were mainly shared professional values, with equity ranked highest and abnegation lowest. Furthermore, second-year students had a well-established perception of knowledge regarding professional ethics, showing significant higher scores when compared to the rest of the educational years. This is the first cross-sectional study that describes these variables among physical therapy students and it is a starting point for future. Physical therapy educators might want to take into account these findings when teaching and guiding students in developing awareness for their professional values and perception of knowledge regarding professional ethics.

"I've had horrible things said about me": An inductive content analysis of nursing academic experiences of contra-power harassment from undergraduate nursing students

AIM

The aim of this study was to describe the experiences of nursing academics exposure to contra-power harassment by under-graduate nursing students.

BACKGROUND

Contra-power harassment by nursing students is a growing phenomenon which is defined as the harassment of those ni formal positions of power by those who are not. Harassing behaviours can include verbal, physical and sexual and digital harassment through mediums such as social media. Cited behaviours perpetrated by under-graduate nursing students are often experienced after the release of grades.

DESIGN

A self-administered online questionnaire was used to elicit responses to four open-ended questions regarding nursing academics experiences of contra-power harassment and nursing student incivility.

METHOD

Inductive content analysis was used to identify text patterns from the academic comments. Each of comments was read through to get a sense of the whole. Re-reading the comments allowed for open coding into broad headings which described a specified meaning. Categorising the broad headings into higher order sub-categories then made it permissible to record comments that belonged to a particular group. The development of the main category using abstraction was first undertaken by creating generic categories from the sub-categories using content-characteristic words. The development of the broad and sub-categories were assessed independently by two of the authors and after discussion, agreement was reached as to the structure of the generic categories.

RESULTS

A total of 159 comments received from 82 nursing academics each describing incidents of contra-power harassment. Nursing academics were faced with several differing behaviours that were seen as aggressive, anger, manipulation and threats. These were viewed as both verbal and isolation attacks In all, four generic categories were identified - Experiencing Harassment; You're Adding to My Stress; Being Set-up to Fail; Feeling Unsafe Professionally and Academically. Nursing academics describe experiencing the behaviours of contra-power harassment as being distressing, disturbing, frustrating, saddening and disappointing.

CONCLUSION

The behaviours expressed by nursing students tended to occur at the release of grades. Most academics were concerned for their own safety both emotionally and physically because of the unpredictability of student behaviour. Most academics understood the pressures nursing students faced, especially the international students. However, they were often challenged by the need to support student learning and maintaining professional standards of behaviour.

Professional Values in a Sample of Nursing Students from Different Countries

AIM

This study aimed to determine the professional values of nursing students from different countries.

METHODS

This descriptive study was conducted with a convenience sample of nursing students from different countries. The data were collected using an identification form and the Nurses’ Professional Values Scale–Revised. A total of 305 nursing students from Turkey, Tanzania, and Spain were included in the analysis.

RESULTS

In this study, the mean nursing professional values scores were 113.5±12.8, 105.8±16.0, 107.9±8.4 for Turkey, Tanzania, and Spain, respectively (minimum–maximum: 44–130). There were no statistically significant differences between the Turkish and the Spanish students’ professional value scores, but the Turkish students’ scores were higher than the Tanzanian students.

CONCLUSION

The factors affecting the level of professional values of students for each country were different. For educators, it is important to develop teaching strategies to empower professional values. Understanding cultural differences can guide professional values and universal ethics in nursing practice, education, and research.

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.

"The COVID-19 outbreak"-An empirical phenomenological study on perceptions and psychosocial considerations surrounding the immediate incorporation of final-year Spanish nursing and medical students into the health system

The COVID-19 pandemic has caused an unprecedented health crisis worldwide, with the numbers of infections and deaths worldwide multiplying alarmingly in a matter of weeks. Accordingly, governments have been forced to take drastic actions such as the confinement of the population and the suspension of face-to-face teaching. In Spain, due to the collapse of the health system the government has been forced to take a series of important measures such as requesting the voluntary incorporation of final-year nursing and medical students into the health system. The objective of the present work is to study, using a phenomenological qualitative approach, the perceptions of students in this exceptional actual situation. A total of 62 interviews were carried out with final-year nursing and medicine students from Jaime I University (Spain), with 85% reporting having voluntarily joined the health system for ethical and moral reasons. Results from the inductive analysis of the descriptions highlighted two main categories and a total of five sub-categories. The main feelings collected regarding mood were negative, represented by uncertainty, nervousness, and fear. This study provides a description of the perceptions of final-year nursing and medical students with respect to their immediate incorporation into a health system aggravated by a global crisis.

The effect of professional values of nurses on their attitudes towards caregiving roles

AIM

This study was conducted to determine the effect of professional values of nurses on their attitudes towards caregiving roles.

METHODS

This is a cross-sectional, correlational and descriptive study. The data were collected from 319 nurses working at different units in a public hospital between January and May 2019. The data collection tool included a 10-question participant information form, the nursing professional values scale and the attitude scale for nurses in caregiving roles. The variables were analysed using the multiple linear regression.

RESULTS

The nurses had professional values and attitudes towards caregiving roles at high levels. Significant differences were found in the overall scales and their subscales especially due to nurses loving their profession (P < 0.05). Attitudes of the nurses towards caregiving roles were predicted by human dignity (β = 0.52, P < 0.01), action (β = 0.34, P < 0.01) and autonomy (β = -0.29, P < 0.01). Human dignity, action and autonomy accounted for 30% of the variance in their attitudes towards caregiving roles (∆R² = 0.30).

CONCLUSION

Scores obtained by the nurses loving their profession from the nursing professional values scale and the attitude scale for nurses in caregiving roles were higher. In addition, nurses' caregiving roles were explained with professional values.

Determination of the Personal Values of the University Students in Different Departments

This research aims to examine the personal values of the first-year university students studying in different departments. This is a descriptive cross-sectional survey study. Research population is composed of first-grade students approving to participate and studying in the Nursing Department in the School of Health, Biology Department in the Faculty of Science and Letters and the Department of Early Childhood Education in the Faculty of Education of Uludağ University. "Student Information Form" and "Schwartz Values Inventory" were used for data collection. When the values inventory is examined, it is seen that the point averages of the students are the highest in safety sub-dimension and the lowest in power sub-dimension. Power, achievement, and hedonism and tradition point averages of the students in the Nursing Department of Health Sciences are higher than those of the students in the departments of science and educational sciences, and the difference in between was found out to be statistically significant. Point average in the achievement sub-dimension was found out to be high among male students (p < 0.01). It was found out that the point averages of female students for hedonism, universalism, benevolence and conformity are higher than those of male students, while the achievement point averages were higher among male students.

Personal values among undergraduate nursing students: A cross-sectional study

BACKGROUND

Personal values influence nursing students' development of professional values, which affect professional outcomes, and how nursing students react to different situations. Personal values can be shaped by different factors, including culture, gender, and age.

AIMS

To explore personal values held by nursing students, and to verify if and how gender and year of study affect nursing students' personal values.

RESEARCH DESIGN

A multicenter, cross-sectional study was used.

PARTICIPANTS AND RESEARCH CONTEXT

The whole population of nursing undergraduate students available at the time was recruited from eight centers of two Universities, composing a sample of 947 students. Demographic data were collected and it was administered the Portrait Values Questionnaire.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the Institutional Review Boards of the University of the participating centers.

FINDINGS

The study sample was mainly composed of young (92.6%, n = 877), female (77.3%, n = 732), Italian (95.8%, n = 907), and unmarried (98.6%, n = 934) nursing students. The most important value for nursing students, consistently through the years of nursing school, was Self-transcendence, which has the motivational emphasis on helping others and selflessness. Then, we found that male students had higher levels of Power (p < 0.001) and Achievement (p = 0.031), while female students outscored male students in Benevolence (p = 0.005) and Security (p = 0.006). Year of study showed no statistically significant difference.

DISCUSSION

Nursing students express high levels in hetero-directed values. Male nursing students, although they choose a stereotypically feminine profession, outscored females in stereotypical masculine values such as dominance and success. This is the first study that describes the personal value profile of undergraduate nursing students, according to the Theory of Basic Human Values, and it is a starting point for future research.

CONCLUSION

Nursing educators might want to consider the findings from this study while guiding students in developing awareness for their personal values.

Differences in professional values between nurses and nursing students: a gender perspective

AIM

To compare Spanish nursing students' and registered nurses' perception of professional values from the perspective of gender and professional experience.

BACKGROUND

Nursing has traditionally been a female profession; however, the analysis of professional nursing values from a gender perspective has received little attention. The integration of professional values typically begins during academic life and is, thereafter, reinforced during professional activities.

METHODS

A descriptive cross-sectional study was conducted with 159 students (97.4% females) and 386 registered nurses (86.8% females) from primary healthcare centres, hospitals and management positions within the public health system. The validated Spanish adaptation of the Nurses Professional Values Scale was used. This instrument measures three dimensions: ethics, commitment and professional mastery. Descriptive statistics were used to analyse the data, together with bivariate analysis using the chi-squared test.

RESULTS

Females granted more importance to professional values. Important gender differences among students were detected. Ethical values were considered to be the most important for both students and nurses, followed by professional mastery and commitment. The importance given to values progressively decreased in the groups under study: students, less-experienced nurses and expert nurses (in decreasing order).

CONCLUSIONS

Significant gender differences exist with regard to professional nursing values. The values related to professional commitment and mastery should be integrated and promoted during academic education and specifically focus on male students' perceptions. As professional experience increases, the importance attributed to professional values decreases.

IMPLICATIONS FOR NURSING POLICY

Professional nursing values should be promoted among universities, health services and professional organizations, encouraging their dissemination, implementation and evaluation.

Curriculum Redesign to Build the Moral Courage Values of Accelerated Bachelor's Degree Nursing Students

The increasing complexities of health care coupled with the decreasing importance of ethical values held by college students, including nursing students, compel nurse educators to step up efforts to strengthen the moral courage values of their students. While the nursing curriculum is the ideal breeding ground for building moral courage values, few studies describe how these values were embedded in any nursing curriculum, much less an accelerated bachelor's degree in nursing (ABSN) curriculum. This study outlines an ABSN curriculum with teaching-learning activities designed to build moral courage values in its classroom and clinical settings. Faculty perceptions of 29 ABSN students' honesty, respectfulness, responsibility, fairness, and compassion were surveyed 4 weeks after beginning, and again at the end of the ABSN program. The ABSN exit questionnaire administered annually by the College Office of Institutional Research, assessed the effectiveness of the ABSN curriculum. Of the 20 learning outcomes on the questionnaire, five related to moral courage values. The 5-point response scale ranged from Not at All, to Somewhat, Moderately, Well, and Extremely Well. t-test calculations revealed significant growth for four of the five values surveyed. Honesty, responsibility, fairness, and compassion were each positively significant at the p < .05 level. For the 27 of the 29 ABSN students who responded to the exit questionnaire, the Well and Extremely Well responses ranged from respectfulness and responsibility at 73%, to compassion and honesty at 78%, and fairness at 82%. Teaching-learning activities to build moral courage values successfully promoted the nursing program objective that the student will demonstrate proficient clinical, technological, and ethical competence in the delivery and management of health care.

Operating room nurses' perception of professional values

BACKGROUND AND SIGNIFICANCE OF RESEARCH

Nurses' awareness of professional values and how those values affect their behaviors is an integral part of nursing care. There is a large body of research on nursing professional values, however, a careful survey of the available literature did not yield any studies investigating the status of professional values in operating rooms.

OBJECTIVE

This study aims to investigate the perception of operating room nurses of university hospitals toward professional values.

RESEARCH PLAN

In this cross-sectional study, data were collected using Schank and Weis's Nurses Professional Values Scale-Revised. The collected data were analyzed in SPSS version 16.

PARTICIPANTS AND SETTINGS

The 513 participants of the study consisted of operating room nurses and nurse anesthetists from six university hospitals.

ETHICAL CONSIDERATIONS

This study has been approved by the ethics committee of the university.

FINDINGS

The mean total professional values score of the operating room staff was found to be 100.84 ± 15.685, which indicates that the participants had a positive perception toward observance of nursing professional values in practice. The results showed that the participants considered the domains of justice and activism as, respectively, the most and the least important. The operating room staff's overall professional values scores were not found to correlate significantly with their ages, professional experience, university majors, or attendance at ethics workshops. However, a significant difference was found between the professional values scores of the female and male staff. The professional values scores of the operating room nurses and the nurse anesthetists were not significantly different (p value = 0.494).

CONCLUSION

Operating room staff's awareness of professional values is essential to providing care to patients based on professional principles. Accordingly, there is need for programs to raise operating room nurses' awareness of their professional duties and improve their professional performance.

The effects of nursing education on professional values: A longitudinal study

BACKGROUND

It is considered to be extremely important to ensure that nurses adopt professional values during their education in order to improve nursing practices and develop a professional identity.

OBJECTIVES

The aim of this study is to investigate the effects of nursing education on development of professional values.

DESIGN

This study was designed as a longitudinal study.

SETTINGS

The study was conducted in a nursing department at a nursing school in the western Turkey.

PARTICIPANTS

The population of the study consisted of nursing students who were enrolled in the nursing department in academic year of 2011-2012. The data of the study were collected from 59 first-year students in 2011 and 83 fourth-year students in 2015.

METHODS

The data of the study were collected using Personal Information Form and Nursing Professional Values Scale-NPVS. The participants responded to the same questionnaire in their first and fourth years in the department.

RESULTS

The scale mean score of the students in their first year was 3.44±0.635. The highest scores were obtained from the subscales of responsibility, security, and autonomy. Their scale mean score in their fourth year was 3.93±0.727. The highest scores were obtained from the subscales of dignity and autonomy. The difference between the mean scores was statistically significant (p=0.001).

CONCLUSIONS

It was concluded that nursing education had a significant effect on development of professional values.

Challenging nurse student selection policy: Using a lifeworld approach to explore the link between care experience and student values

AIM

This study uses a lifeworld perspective to explore beginning students' values about nursing. Internationally, increasing care demand, a focus on targets and evidence of dehumanized care cultures have resulted in scrutiny of practitioner values. In England, selection policy dictates that prospective nursing students demonstrate person-centred values and care work experience. However, there is limited recent evidence exploring values at programme commencement or the effect of care experience on values.

DESIGN

Mixed method study.

METHODS

A total of 161 undergraduate nursing students were recruited in 2013 from one English university. Thematic content analysis and frequency distribution to reveal descriptive statistics were used.

RESULTS

Statistical analysis indicated that most of the values identified in student responses were not significantly affected by paid care experience. Five themes were identified: How I want care to be; Making a difference; The value of learning; Perceived characteristics of a nurse; and Respecting our humanity. Students readily drew on their experience of living to identify person-centred values about nursing.

The development of the Professional Values Model in Nursing

One of the most important criteria for professionalism is accumulation of knowledge that is usable in professional practice. Nursing models and theories are important elements of accumulating nursing knowledge and have a chance to guarantee the ethical professional practice. In recent years, there has been an increase in the use of models in nursing research and newly created terminology has started to be used in nursing. In this study, a new model, termed as the Professional Values Model, developed by the authors was described. Concepts comprising the conceptual framework of the model and relations between the concepts were explained. It is assumed that awareness about concepts of the model will increase not only the patients’ satisfaction with nursing care, but also the nurses’ job satisfaction and quality of nursing care. Contemporary literature has been reviewed and synthesized to develop this theoretical paper on the Professional Values Model in nursing. Having high values in nursing increases job satisfaction, which results in the improvement of patient care and satisfaction. Also, individual characteristics are effective in the determination of individual needs, priorities, and values. This relation, proved through research about the Professional Values Model, has been explained. With development of these concepts, individuals’ satisfaction with care and nurses’ job satisfaction will be enhanced, which will increase the quality of nursing care. Most importantly, nurses can take proper decisions about ethical dilemmas and take ethical action when they take these values into consideration when giving care. The Professional Values Model seems suitable for nurse managers and it is expected that testing will improve it. Implementation of the Professional Values Model by nurse managers may increase motivation of nurses they work with. It is suggested that guidance by the Professional Values Model may help in enhancement of motivation efforts of the nurse managers and therefore should be taken into account.

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.