Foundations_Chapter 2: Values, Beliefs, and Caring

What is helpful to do an instance of conflicting values?

Clarify your values

List five concerns related to beliefs and values that nurses should consider immediately when caring for a patient with a cultural background different from their own.

(1) ability to comprehend language, (2) possible need for care from a nurse of the same gender, (3) preference to have a family member present, (4) potential need to have others involved in health care decisions, and (5) past experiences in the health care environment.

*Madeline Leininger*: Cultural Care Theory Three nursing Actions to provide culturally congruent care:

(1) preserving or maintaining the patient's cultural health practices (2) accommodating, adapting, or adjusting health care practices (3) repatterning or restructuring some cultural practices, as needed.

LO 2.4 Nursing Theories of Caring

* Leininger's Cultural Care Theory *states that culturally based nursing actions are intended to preserve, accommodate, or reconstruct the patient's meaningful health or life patterns. *Watson's Human Science and Human Care Theory *is a holistic model of care in which the nurse's focus is on 10 carative factors. *According to Travelbee's Human-to-Human Relationship Model*, the nurse assists the patient through five phases of a relationship and, if necessary, to find meaning in these experiences. *Swanson's Middle Range Theory of Caring* focuses on five processes of relationship-based caring for the nurse: maintaining belief, knowing, being with, doing for, and enabling the patient.

To be truly effective in professional practice, nurses must recognize the role and responsibility of patients in:

*attaining treatment goals* and must demonstrate patient advocacy rather than codependency while providing compassionate care.

Compassionate healers:

1. Showed instances on how they changed peoples lives 2. Recognized in childhood that they wanted to be a nurse 3. Identify positive and negative role models who allowed them to be more compassionate

What actions by the nurse would have communicated caring and attention to Hwa's beliefs when she was first admitted to the emergency department? What action should the nurse have taken to exhibit concern when Hwa refused the prescribed medication?

Asking Hwa what she traditionally did to treat her headaches or pain and providing distraction or other comfort measures, such as a warm compress, darkening the room, and limiting noise levels, would have demonstrated caring. When Hwa refused the pain medication, the nurse could have explored alternative pain relief options such as acupuncture that might have been more acceptable.

LO 2.1 Describe the differences between beliefs and values and how they develop.

Beliefs are mental representations of reality, or what a person thinks is real or true; values are enduring beliefs that help the person decide what is right and wrong and determine what goals to strive for and what personal qualities to develop. Beliefs and values are developed through personal experiences, family influences, culture, ethnic background, spirituality, religion, and education.

Presence

By simply being present in a patient's room, nurses have the potential to calm the fears of a patient and family and demonstrate caring.

Focused on tasks and the disease process

Executed tasks in a timely manner

*True or False* Use long sentences when working with an interpreter

False! Use short sentences

*Jean Watson*: Caring is a metaphysical event

Human bodies are manifestations of universal energy, and caring is transpersonal, transcending time, space, and the physical realm.

Two types of nursing students:

I Compassionate healers II. Focused on tasks and the disease process

Three types of beliefs:

I. zero-order beliefs II. first order beliefs III. highest order beliefs

What is a belief in a religious or spiritual sense?

In a religious or spiritual sense, to have a belief means to place trust or have faith in a deity such as God or in something such as a religious ritual, tradition, or philosophy

LO 2.4 Discuss the major concepts of four nursing theories of caring.

Leininger's Cultural Care Theory states that culturally based nursing actions are intended to preserve, accommodate, or reconstruct the patient's meaningful health or life patterns. Watson's Human Science and Human Care Theory is a holistic model of care in which the nurse's focus is on 10 carative factors. According to Travelbee's Human-to-Human Relationship Model, the nurse assists the patient through five phases of a relationship and, if necessary, to find meaning in these experiences. Swanson's Middle Range Theory of Caring focuses on five processes of relationship-based caring for the nurse: maintaining belief, knowing, being with, doing for, and enabling the patient.

What are some of the negative affects of Codependency?

May lead to controlling behaviors exhibited by nurses that prevent patients from healing and moving toward independence (

LO 2.6 Identify behaviors that demonstrate caring.

Nurses demonstrate caring through presence, consistency, predictability, touch, and listening.

LO 2.5 *Professional Caring*

Nurses develop caring skills through life experiences, observation of both positive and negative role models, and interaction with strong professional mentors.

LO 2.5 Articulate ways in which nurses develop into caring professionals.

Nurses develop caring skills through life experiences, observation of both positive and negative role models, and interaction with strong professional mentors.

When does a nurse use value clarifications processes? *Instance II*

Nurses use their own personal values in challenging care situations

What follow-up question should the nurse have asked after Hwa stated that she had never had a headache lasting longer than a half-hour?

Other than in length of time, what is different about the headache you have now from others you have had previously?

When do patients experience value conflicts?

Patients may experience a values conflict if evidence-based practice supports interventions that are inconsistent with their preferred, traditional treatment modalities.

*Joyce Travelbee:* Projection of the Lifecourse

People will experience joy, contentment, happiness, and love at some point in life and also will at some time be confronted with illness and pain (mental, physical, or spiritual suffering) and eventually will encounter death.

What does research show about patient care?

Research shows that the beliefs of nurses and other health care workers are equally important factors in determining how patients are treated.

LO 2.2 Explain the use of the values clarification process in dealing with a values conflict.

The nurse needs to recognize when a values conflict exists and seek ways to identify the underlying factors causing the concern. A values clarification tool can be used to help patients examine past life experiences and consider where they spend their time, energy, and money to provide insight into what they truly value and believe. Values clarification can help nurses become more aware of their own personal values and beliefs that impact professional nursing practice.

Note: Nurses should be careful to help patients to identify

Their own values

When does a nurse use value clarifications processes? *Instance I*

Values clarification process occurs when it is used by the nurse to assist a patient or family faced with making a health care decision or decisions concerning end-of-life care.

How do value systems help people?

Values system helps the person choose between alternatives, resolve values conflicts, and make decisions

Identify two assessment questions regarding treatments that Hwa has used in the past to treat headaches that would have been helpful for the nurse to ask.

What do you normally do when you have a headache? Have you found anything to relieve headaches you have had in the past?

When do values conflict?

When a person's values are inconsistent with his or her behaviors or when the person's values are not consistent with the choices that are available

How does a nurse determine a patient's values and beliefs?

a nurse must listen and ask questions

High order beliefs

are ideas derived from a person's first-order beliefs, using either inductive or deductive reasoning

Generalizations may arise

at an unconscious level; as a mental abstraction

A stereotype is a

conceptualized depiction of a person, a group, or an event that is thought to be typical of all others in that category

Research indicates that the interpersonal skills of nurses who demonstrate caring and compassion, such as being present with patients in times of crisis, often are the basis on which patients:

determine the competence of their nurses

Why are values important?

determine the importance and worth of an idea, a belief, an object, or a behavior.

When do people begin developing first order beliefs about what is *correct, real, and true*?

during childhood

Values are

enduring ideas about what a person considers is the good the best and the right thing to do

highest order beliefs

generalizations derived from higher order beliefs

During the process of learning, what do people form? Why?

generalizations; to relate information to what they already know

*Random*: What are the three major contributors to obesity?

genetics, food marketing practices, and reduced physical activity

Patient's trust nurses that:

have a commitment to respecting the ideas of others, lifelong learning, and caring are trusted by patients to provide safe, competent care.

*Jean Watson*: Nursing- Human Science and Human Care

includes social, psychological, and spiritual aspects and may combine interventions that reflect both the science and art of nursing.

*Jean Watson*:holistic approach

incorporates values, beliefs, intentions, and the caring consciousness.

*Swanson* defines nursing as

informed caring for the well-being of others, the emphasis placed on the five caring processes is not unique to the nurse-patient relationship

Codependency

is a dysfunctional relationship in which the person who wants to help acts in a manner that enables harmful behavior by another person.

belief

is a mental representation of reality or a person's perceptions about what is right (correct), true, or real, or what the person expects to happen in a given situation

What is value clarification?

is a process used to help people reflect on, clarify, and prioritize personal values to increase self-awareness or to make decisions (Edwards and Allen, 2008).

value system

is a set of somewhat consistent values and measures that are organized hierarchically into a belief system on a continuum of relative importance

Caring

is having concern or regard for that which affects the welfare of another.

*Kristen Swanson*: Middle Range Theory of Caring *5 processes characterize caring:*

knowing, being with, doing for, enabling, and maintaining belief

*Madeline Leininger*: Cultural Care Theory

nursing is both an art and a science that provides culture-specific care to individual patients and groups to promote or maintain health behaviors or recovery from illness.

Hard working nurses participated in:

nursing unit improvement projects and patient safety programs and provided patient-centered care, showed concern for patient safety, and incorporated evidence-based practices in their nursing care

Nurses find that their paradigm shifts to-

one based on a body of knowledge that focuses on scientific principles and dismisses as superstition other explanations for the presence of disease or illness

personal beliefs are

one of the most important factors in determining how a person responds to a health problem and its treatment

Incorporating patient values and beliefs into a plan of care requires that:

patients and their families or primary caregivers be actively involved in establishing goals and outcome criteria. Patients should be included in determining what interventions will be implemented to assist them in achieving their goals.

What should nurses bear in mind about first order beliefs when presenting information to patients?

presenting information to patients that challenges their first-order beliefs may cause a great deal of emotional or cognitive upset

Nurses with a strong professional work ethic were consistently identified by patients as

providing the highest-quality nursing care.

LO 2.3 Summarize how the beliefs of nurses and patients influence health care.

the beliefs of both nurses and patients influence how patients are treated, what patients listen to and act upon, and patient outcomes.

First order beliefs serve as the foundation of

the individual belief system

Personal values include

the life principles that are most important to people and shape their thoughts, feel ins and ultimately action. Values play a large part of how individuals view and evaluate themselves (self concept

Acts of caring, from a nursing perspective, are the result of:

the nurse's synthesis of scientific principles, artistry, and a deep sense of being present with patients

*Joyce Travelbee: Human to Human Relationships*

the quantity and quality of nursing care delivered to an ill person are greatly influenced by the nurse's perception of the person and the relationship that is established.

*Joyce Travelbee:* Spiritual and Ethical Values about Illness and Suffering

the spiritual and ethical values or the philosophical beliefs of the nurse about illness and suffering will determine the extent to which the nurse will be able to assist individuals and families to find meaning in these difficult experiences.

Caring:

the way the nurse expresses themselves to the patients or their family members in a sensitive and empathetic manner that communicates "authentic concern."

codependency in nursing

those who enter helping professions such as social work, nursing, or medicine have an intense need to be needed.

How do people sometimes negatively use stereotypes?

to rationalize personal bias, preformed opinions, prejudice, usually an unfavorable one

first order beliefs

typically based on ones direct experiences

zero order beliefs

unconscious, object permanence

Make sure to tell the interpreter to:

• Ask for clarification if something is not understandable • Translate everything; do not paraphrase or abbreviate • Follow up on every detail and seemingly unconnected issue

*Swanson's Five Caring Processes with Subdimensions* Knowing

• Avoiding assumptions • Centering on the one cared for • Assessing thoroughly • Seeking cues • Engaging the self of both

*Swanson's Five Caring Processes with Subdimensions* Being with

• Being there • Conveying ability • Sharing feelings • Not burdening

Seven dimensions of caring that were identified as being universal by nurses from around the world include:

• Caring • Compassion • Spirituality • Community outreach • Providing comfort • Crisis intervention • "Going the extra distance"

*Swanson's Five Caring Processes with Subdimensions* Doing for

• Comforting • Anticipating • Performing competently/skillfully • Protecting • Preserving dignity

Watson's Caritas Processes

• Embrace altruistic values and practice loving kindness with self and others. • Instill faith and hope and honor others. • Be sensitive to self and others by nurturing individual beliefs and practices. • Develop helping-trusting-caring relationships. • Promote and accept positive and negative feelings while listening to another's story. • Use creative, scientific problem solving for caring decision making. • Share teaching and learning that addresses individual needs and comprehension styles. • Create a healing environment for the physical and spiritual self that respects human dignity. • Assist with basic physical, emotional, and spiritual human needs. • Be open to mystery and allow miracles to enter.

Life Span and Values

• Families and cultures have attitudes about what and how to eat that they transmit in the form of values • Parents and grandparents use many strategies to transmit their values about healthy eating to their children and grandchildren.

*Swanson's Five Caring Processes with Subdimensions* Enabling

• Informing/explaining • Supportive/allowing • Focusing • Generating alternative/ thinking it though • Validating/giving back

Guidelines for Working with an Interpreter:

• It is always best to use an interpreter who has specialized training in health care terminology • before beginning by providing relevant information about the patient and the purpose of the conversation. • If face-to-face translation is used, ask the interpreter to stand near the patient. • Ask the interpreter to speak to the patient in first person

The most important caring behaviors, according to the nurses, included:

• Knowing how to give shots • Encouraging the patient to call if there was a problem • Giving information so that the patient could make decisions • Appreciating the patient as a human being and showing concern for the patient (

Teaching methods for teaching pregnant women dealing with substance abuse. The nurse should:

• Listen for the subtle signs of denial, such as an unrealistic display of optimism • avoid direct confrontation • Use a matter of fact approach to inform the patient • Provide straight forward information- understanding is integral in motivating change

The professional values that have consistently been shown to be of highest value to nurses across the past two decades are:

• Respect for human dignity • Prevention of suffering • Reliability • Maintaining a faithful relationship with patients

The most important caring behaviors, according to patients, included:

• Respecting confidentially • Treating pain • Speaking in a soft and gentle voice • Being honest • Encouraging the patient to call if there was a problem

Culture, Ethnicity, and Religion *Values*

• arranged marriages • disagreeing with pharmaceuticals

*Values* Disability

• being excluded by society • nurses demonstrate respect for patients with disabilities by including them in their care as much as possible

*Swanson's Five Caring Processes with Subdimensions* Maintaining Belief

• belief in holding esteem • maintaining a hope filled attitude • offering realistic optimism • No one can teach the true sentiment of caring; it is a gift; talent