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Exploring values in nursing

This assignment is a reflection of my personal values and beliefs and that of others which influence the process of care. I will be concentrating on respect and human dignity in the care of the elderly because as people age, they increasingly become dependant on others to perform activities of daily living. In analysing my personal values, I will define what values are, the factors that influence them and how they affect the delivery of care as fundamentals of the professional practice. Exploring values in nursing is essential because it is a discipline that is rich in values as acknowledged by Florence Nightingale when she said that nursing is not just about scientific knowledge and skills but it is founded on specific human values such as honesty, kindness and truthfulness (Hunt 2002). Our decisions and actions are influenced by values which therefore can be regarded as resources that guide nurses to engage in ethically competent practices.

Values have been defined as principles or standards of behaviour which predispose us to act as we do and lead us into a particular position on specific social issues (Rassin 2008). These differ from person to person because they are acquired and shaped by the environment that people find themselves in. The inconsistency of values can be explained by the differences in social backgrounds encompassing religious, cultural and economic. In the nursing profession it is expected that all healthcare professionals have to conform to the two values of respect and dignity in the treatment of patients as they form the basis of the nursing profession (Department of Health (DH) 2007).

When patients come into the hospital, they do not only expect a high standard of care but also to be treated with respect and dignity to show that they matter and they are worthy. This entitlement is alluded to in The Essence of Care (DH 2003) and therefore is not merely a patient's expectation but the minimum expected standard within the National Health Service (NHS). Respect comes in different forms as there are a variety of factors to consider such as religious and cultural. If this value is lacking in someone's belief system they would find it difficult to enjoy the nursing profession and hence fail to conform thereby becoming incompetent. The principle or value of dignity should be at the heart of everything we do as healthcare professionals (Royal College of Nursing (RCN) 2008). Dignity, which is being worthy of respect (DH 2003) gives basis to the basic human right that prevents anyone from being subjected to inhuman or degrading treatment (Human Rights Act 1998) the Nursing and Midwifery Council (NMC) (2008) states that every person deserves to be treated with dignity and respect therefore dignity should not be optional when caring for a patient. Someone's dignity may be violated unknowingly if they are not in a position to voice their concerns. Nurses fail to meet people's needs for respect and dignity due to lack of time and resources as a result of bed and staff shortages (RCN 2008). A target led or task oriented culture and non-essential paperwork can also have an impact on the delivery of care (Rassen 2008).

In my personal experience I have found it easy to adjust into acknowledging respect and dignity in the nursing profession as these values are also present in my cultural and religious beliefs. A belief is an attitude that is based on faith than fact (Tschudin 2004). However, faith can be influenced by fact hence my personal beliefs are a result of the values upon which I was brought up as they were instilled from a young age. Over time I have gained a conviction on the importance of respect and affording dignity, not only in the treatment of elderly patients but also in the general interaction with fellow human beings.

Having been brought up in a Christian family from an African background, I have observed there is a need to adjust to certain attitudes and approaches in the delivery of care. My nurse training here in the United Kingdom and the social influence has shifted my values, for example, I no longer take it for granted to put a title on a patient's name such as 'Mr' or 'Mrs' which is a sign of respect according to my culture. Instead, I ask them what they prefer to be called. I don't use patronizing and disrespectful phrases such as 'Love' or 'Good girl' because I believe it implies that the person is cognitively impaired. It is also upsetting for the patient to be talked to as if they are little children. Also, as a registered nurse I am obliged to adhere to the nursing standards set by the NMC because failure to do that would lead to fitness to practice proceedings which may result in loss of registration (NMC 2008). This emphasizes the fact that values are acquired and they can also be taught by observing other people's behaviours (James 2008). It is therefore important to be teachable since there are some social aspects I was previously unaware of. For example, patients come from very diverse backgrounds in the NHS and as a result all these need to be taken into account when attempting to deliver care effectively because there is a potential of compromising respect and dignity when assisting patients with activities of daily living (Gallagher 2004). Male Muslim patients for example prefer to be bathed by male members of staff as their religion forbids physical contact with a member of the opposite sex they are not married to (Leners 2006). This however presents challenges in staffing as the female staff complement outnumbers the male complement therefore at times there are no male members of staff to carry out these duties. Forcing bathing on patients affects their dignity and so does leaving them unwashed if they are unable to wash themselves hence there should be a balance between the two.

The humane treatment of patients is advocated in my cultural background as well as religious background. It is important however to state that while different belief systems advocate and exhibit similar or exact characteristics there may be differences in approach. In Christianity for example, it is encouraged to pray for those who are ill as it forms a fundamental part of the healing process. The NMC Code of Conduct (2008) however forbids nurses from using their professional status to promote causes that are not acceptable to the patient. Respect of personal religious beliefs is important in ensuring that patients are not put in a place of discomfort and that individuality is maintained this was shown in the case cited by Kendall-Raynor (2009) where a nurse was suspended after offering to pray for a patient. Maintaining individuality is vital in care as it shows dignity and respect for people's preferences. This promotes person-centred care as advocated by the National Service Framework (DH 2001). From my cultural background I am aware that there has to be a clear and distinguishable separation between facilities meant for men and those meant for females. The sharing of bays and sanitary facilities presents challenges for patients, especially those who come from patriarchal cultures who highly uphold privacy which is defined by the Department of Health (2003) as freedom from intrusions

Some issues transcend religious and cultural boundaries such as putting people from different sexes within the same bay. Opinions and arguments on this issue are mainly based on personal values rather than generally accepted facts. Pro and anti campaigners on this subject base their arguments on personal preference. The Department of Health launched its 'Dignity in Care' campaign which advocates for the quick abolishment of mixed gender bays as a way of affording patients dignity and respect. Due to limitations such as bed shortages, members of staff are forced to breach these values; as a result some patients do not mind but some suffer distress (DH 2009). As not all patients can communicate verbally, it is important to observe their body language as this shows that you are wholly focussed on your duty of care, which is an element of respect (DH 2001). Different advocating groups such as Help the Aged and Age Concern play a key role in assisting nurses to understand important areas of deficiency in the care particular groups such as the aged which provides information on the elderly patients.

Privacy of patients needs to be respected whilst they are in care. Although patients are vulnerable and at times dependent on the nurses it is unfair for nurses to be overbearing in their approach towards patients (Nordenfelt 2004). Unless in desperate circumstances, patients should be able to undertake tasks such as washing and clothing themselves unassisted. This achieves modesty and gives patients a feeling of autonomy. Other factors to consider under privacy are the patient's personal details or details of their ailments not being disclosed to other patients or members of the public (NMC 2008). The establishment of curtained cubicles allows for a one to one conversation to happen between a patient and a member of staff. It is my responsibility as a nurse that I do not disclose this information either accidentally or intentionally to anyone. Nurses are also taught to communicate with patients in distressing situations as a counsellor would to a client. How news of an illness or bad news is delivered to someone can affect their morale and confidence. Careless use of language is a lack of respect as sensitive information should be handled delicately.

Misunderstanding between patients and nurses occurs sometimes because of a lack of good communication. Affording patients respect ensures that misunderstandings can be kept to a minimum though they cannot be totally eliminated. Respect and dignity is shown even by the way we talk to patients. Generation gaps between patients and nurses at times establish barriers in communication as there might be a difference in approach between older practices and new practices. The NHS is also engaging specialist staff such as interpreters for the assistance of service users as this makes communication of key issues more effective and speeds up the care delivery process. How I communicate with my own fellow nurses in front of patients has to demonstrate a high level of professionalism and shows respect to the patients.

In conclusion values and belief are very much at the core of the nursing profession. Respect of patients and affording them their dignity is in effect the basic foundation of nursing. It is important at different stages in our lives to shift our beliefs and values in order to conform to the standards set by governing bodies as they define what good practice is. Above all, this should be undertaken using good communication skills. Nursing is as much about conviction as it is about following set standards. A healthcare professional it is important to be sensitive to the needs of people from different backgrounds even if at times it compromises your own personal values and beliefs. It helps in the provision of an unbiased and tolerant health service.

1840 words

References

Department of Health (2001) National Service Framework for Older People. London: Stationery Office.

Department of Health (2003) The Essence of Care; Patient Focussed benchmarks for clinical governance London: Stationery Office

Department of Health (2007) Privacy and Dignity - A report by the Chief Nursing Officer into mixed sex accommodation in hospital.

Faithfull, S & Hunt, G (2005) Exploring nursing values in the development of a nurse led service. Nursing Ethics 12(5) pp440-449

Gallagher, A (2004) Dignity and respect for dignity – two key health profession values: implications for nursing practice. Nurse Ethics 1(6) 587-599

Human Rights Act 1998 (1998) The Stationery Office: London

http://www.hmso.gov.uk/acts/acts1998/19980042.htm

Hunt, G (2002) The values of nursing. Nursing ethics 9 pp340-341

James, C (2008) Culture starts from the heart. Continuing care professional 57(5) pp 48-49

Kendall-Raynor, P (2009) Prayer row sparks calls for clear guidance on spirituality in care. Nursing Standard 23(23) pp10

Leners DW, Roehrs, C & Piccone AV (2006) Tracking the development of professional values in undergraduate nursing students. Journal of Nursing Education 45(12) pp 504-511

Nordenfelt, L (2004) 'The varieties of dignity', Health Care Analysis 12(2) pp 69-89

Nursing and Midwifery Council (2009) Guidance for the care of older people. London : NMC

Nursing and Midwifery Council (2008) Code of professional conduct London: NMC

Rassin, M (2008) Nurses' professional and Personal Values. Nursing Ethics 15(5) 614-630

Royal College of Nursing (2008) Defending Dignity - Challenges and Opportunities for Nursing. Available at www.rcn.org.uk

Tschudin, V (2004) Ethics in nursing: The caring relationship 3rd Edition. Edinburgh: Butterworth Heinemann