Values of Nursing, Person, Health, and Environment Assignment.

The values of nursing are acquired during socialization into nursing code of ethics, nursing experience, teachers and peers. Watson (1982, pp 20-21) outlined four important values of nursing; strong commitment to service, belief in the dignity and worth of each person, commitment to education and professional autonomy. Nursing education, concepts and programs for improving the knowledge in health facility are provided to maintain moral, theoretical and clinical values in the health setting Socalsy, 2008).

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The personal values of a person depends on the richness or intensity of the inculcation of knowledge, positive values and skills not simply based on the innate capacity of one to evaluate, think, reason and interact in a learning situation but the availability moral standards. It also equally depends on the quality of personal experiences which are either limited by the person’s ability and will to choose or by what is desirable to her which is readily accessible in the environment (Craney, 2008). Values of Nursing, Person, Health, and Environment Assignment.

Health is valued automatically by an individual regardless of the existence of other personal priorities and values. People value health as important priority despite other things. Health considered as a good individual experience (Socalsy, 2008).

Environmental Values is concerned mainly with the justification and basis of policy regarding the environmental. Its objective is to bring together the law, philosophy, economics contributions, which can be relate to the current and future of human environment and other living things; and to clearly understand the relationship between more fundamental underlying assumptions or assumptions and practical policy issues (Craney, 2008).

Describe how teaching/learning best occurs? Compare the various levels of nursing education? (LPN, ADN, BSN, MSN)

The key to successful knowledge development is competent learning and effective communication during the practice to achieve the goal of competency. This will determine the path of being an effective and competent nursing professional. This is where the teaching and learning best occurs (Aikon, 2009). Values of Nursing, Person, Health, and Environment Assignment.

Approved practical or vocational nursing programs (LPN) are provided by community colleges, vocational schools, hospitals, or other independent health agencies. These programs usually last 9 or 12 month and provide both classroom and clinical experiences. License Practical nurse practices under the supervision of a registered nurse in a nursing home, clinics, hospital or rehabilitation. Taeching best occurs in this level through formal classroom instruction, students learned by doing, that is, providing care to clients in hospitals. Associate degree programs (AND) are offered in the Unted States primarily in community colleges although some 4-year colleges also have AND programs. The graduating student receives an AND or an associate of arts (AA) or associate in applied science (AAS0 degree with a major in nursing. Learning best occurs in through provision of specific information about type of knowledge, skills, and abilities of ADN’s education program. ADN’s currently function under the same practice acts as BSN graduates. Today’s baccalaureate nursing programs (BSN) are located in 4-year colleges and universities and are 4 to 5 years in length. The curricula offer courses in the liberal arts, sciences, humanities and nursing. Graduates must fulfill both the degree requirements of the schools or universities and the nursing program before being awarded a baccalaureate degree (Silber, 2003). The BSN program meet the learning needs of students through challenges and opportunity to pursue a self-paced, independent study or online programs. Master’s degree program (MSN) provides specialized knowledge and skills that enable nurses to assume advanced roles in practice, education, administration and research. Values of Nursing, Person, Health, and Environment Assignment.Today’s master’s program generally takes one and half to two years to complete. Learning best occurs in MSN program through provision of specialized knowledge and skills that enable student to have an advanced knowledge in practice (Aikon, 2009).

Overview of what should be some expected teaching knowledge, skills, and abilities. Name three goals for the first year of teaching?

Nurses are expected to possess leadership skills, critical thinking ability, health promotion and case management skills in teaching. Their ability to be competitive in teaching satisfies a variety of learning. This improves knowledge as well as educational requirement, nursing practice and patient outcomes (Giovanetti, 2007). They provide sufficient information that will aid policymakers, practice leaders and researchers to recognize that entry level education makes a difference in nurses’ practice. Nurses should make them aware of every situation happening in the field and make it a motivational means to improve the profession by proper preparation and education. Possession of knowledge and competency in teaching interventions which can be acquired in hands on training is essential in practicing the profession (Silber, 2003). Values of Nursing, Person, Health, and Environment Assignment.

Goals for the first year of teaching includes; embracing of personal ethic of social responsibility and service, apply new knowledge of sciences, understand the role of primary care and continue to learn and help others (Aikon, 2009).

NURSING VALUES

Insaf Altun 1.

1, Kocaeli Univ., Nursing High School, The Dept. of Fundamentals Nursing,

Umuttepe, Kocaeli, 41380 Turkey

insafaltun@mynet.comialtun@kou.edu.tr

This article are addressing bellow subjects that are also vitally important to understanding

what moves the hearth of nursing

What are values?

What kinds of values?

What are personal values?

What are professional values?

What are the main values that govern nurses and nursing?

What are the kind of values that guide nursing as a profession.

How can the values we hold and we hold and promote also ensure that nurses are and

become persons of integrity, and nursing a profession of integrity?

What are the kind of values nurses hold in practice,

Are the values we hold and promote the relevant ones?

Are there certain values that are more valuable, more right, more desirable than others?

What should this be so?

Why should we challenge the values we hold?

Do nurses change their behaviours and attitudes as a result of changing values,

To what should they be changed?

Can education change our values?

Should we expect nurse education to change values?

In this issue the authors scrutinize the values in and of education, practice, and the very

existence of nursing: those we come with, those we acquire and those we promote. Nursing

educators have a professional obligation to teach and reinforce professional nursing values

that are consistent with the professional nursing role. Especially today, there is a definite need

for values education in nursing education programs. Values of Nursing, Person, Health, and Environment Assignment.

VALUES IN NURSING EDUCATION

When you begin to look at why nursing exists we see a health profession that is

concerned with promoting and maintaining the health of individuals, families, and the public,

preventing illness, helping patients with recover process, relieving suffering, and so on. The

delivery of health care services is changing dramatically. Increasing longevity, shortening of

hospital stays, scientific and technological advances and population mobility, social justice,

equality, cultural values, poverty, discrimination contribute to the growing complexity of

nursing.

Accoding to Tschudin (2003) the future for nursing lies in some distinc areas: 1) the care

the increasing population of older people, 2) care will be in the home for people with long-

term illness, 3) issues of genetics will play a major part in health care, 4) medical and nursing

research will guide practice, 5) nurses world wide are caring for people who are suffering the

consequences of conflict and diseasters, leading them to foster non-violent ways of

resolutions. These kinds of things lead the profession and professional values.

Nursing education must keep pace with these changes, which require new knowledge,

skills and values. Nursing students‘ professional education should formalize and systematize

these values, becoming the basis of their professional ethic. Then, as nurses practise good

nursing, they should adhere to these values appropriately (Hall, 2006).

Nurses work by knowing with the help of knowledge, by feeling with the help of values,

and by doing with the help of skills. Values have a much wider application than feelings.

There is an aspect that relates to feelings, but feelings can be quickly changing. Values also

have to do with conscience, and fundamental ways of understanding something.

Nursing educators are preparing professional nurses who can think critically, use sound

clinical judgment, and participate as full partners in shaping health-care delivery and policy.

Nursing education equips the student with cognitive, affective, and psychomotor

competencies integral to professional nursing practice. The purpose of professional nursing

education is to provide the knowledge base, values and skills necessary for the student learner

to become a professional practitioner of nursing.

Learning is the acquisition of knowledge, skills, and competence that result in changes in

values. To achieve these changes, nursing faculty defines the framework for acquisition of

knowledge, examination of values, and application of concepts and skills.

Each student enters a nursing school with a set of values that may change during the

socialization process to reflect the values that the profession holds in high esteem. Values are

learned, modified, and expended through education. Values emerge over time, permeate daily

operations, impact nursing practice, direct nursing behaviors, and serve as the basis for

determining the means to accomplish nursing objectives.

The education for professional nursing should facilitate the development of profession

values, professional values and value-based behaviors. Education for nursing must be value-

focused, providing guidance for future practice, yet reality-based to prepare practitioners for

the current health care system. Nursing faculty members are challenged to teach core nursing

values that embody the caring professional nurse. Education for nursing role should facilitate

the development of profession values, professional values and value-based behaviors. when

we are aware of the professional needs can we begin to understand our real personal values.

Our behaviour is the outcome of our value judgement. Nursing educators have a professional

obligation to teach and reinforce professional nursing values that are consistent with the

professional nursing role. If nurses are to remain central in restructuring efforts, their

professional values must be at the core. Especially today, there is a definite need for values

education in nursing education programs. The nursing schools respondents reported that

teaching concerning the core values was woven into the curriculum as a whole.

Educational efforts and the process of socialization into the profession must build upon,

and as appropriate, modify values and behavior patterns developed early in life. Nurses in any

setting must be helped to identify the progressive relationship of values to philosophy and

mission.

All professions largely understand their responsibilities to be tied to their professional

practice. However, responsibility starts further back and reaches further out. The

responsibilities to oneself and to one‘s values guide a person‘s professional values and often

override these. It may be unrealistic to try to teach nursing students the kinds of values and

attitudes they need to bring to their work because these values are formed when children are

very young. What is more realistic is that, in group discussions and reflection on practice, set

values are challenged and options presented for better ones. This is perhaps the most useful

function of any teaching in values. Teachers and lecturers therefore have a crucial

responsibility in how they make their students aware of issues of global professional concern

in this area, and how they influence their students, especially in their understanding of values.

The development of professional values begins in formal educational programs. Students

enter nursing programs with values that are modified and expanded through the educational

process. Nurse educators facilitate this process in two ways: (1) by exhibiting their

commitment to professional values through role-modeling behaviors related to these values;

and (2) by systematically providing other value development experiences both in classroom

and clinical settings that serve to socialize nursing students to the profession.

If an individual nurse values responsibility, it should be reflected in behaviors. For

example, if the research component which is valued, it could be evidenced by the use of

clinical practice guidelines in care delivery, evidence-based practice, as well as attending

research conferences and in-service programs and consulting with experts to enhance client

care. It is this internalization of values that is pivotal for initiating the sequence of thoughts

requisite for making clinical judgments. Habitual response patterns imply connectedness to

internalization of values. There is a continuing role for education, service, and the profession

in helping to maintain professional excellence, a requisite component of which is professional

values.

Values Defıned

What Are Values?

To talk more precisely about value, we need to operationally define the term.

Dictionary.com says: ―values, sociology. the ideals, customs, institutions, etc., of a society

toward which the people of the group have an affective regard. These values may be positive,

as cleanliness, freedom, or education, or negative, as cruelty, crime, or blasphemy.‖ Longman

Active Study Dictionary of English says: values are principles and beliefs about what is

important in life and how people should behave. According to the Concise Oxford Dictionary

―value‖ means: ―One‘s principles or standards; one‘s judgement of what is valuable or

important in life.‖ The American Heritage® Stedman’s Medical Dictionary says ―A

principle, standard, or quality considered worthwhile or desirable‖. This definition, therefore,

refers primarily to subjective and self-defined values, standards and principles that an

individual attributes to him or herself. As regards etymological origins, the Oxford Dictionary

mentions the Latin ―valere‖ meaning ―to be (of) worth‖. What the psychologists call “values,”

occultists would more typically call “true will.” Dictionary.com says: ―Ethics. any object or

quality desirable as a means or as an end in itself.‖ American Ethical Union says ―Values are

the deeply held beliefs of individuals and groups (i.e., organizations, communities, nations,

schools, etc.) that drive the choices we make. In this respect concept of the value is a ethical

concepts and the principles of conduct governing an individual or a profession. As a matter of

fact ethics includes values, codes, and principles that govern decisions in profession practice

and relationships. Viewed within this contect, values have a standard of behavior and are

ideals and beliefs that individuals, professionals and professions upholds. Values may be

individual or collective or both; they embrace ethical values, but are somewhat wider. Values

are guiding principles, often implicit, that inform perceptions and standards of what is right or

wrong, appropriate or inappropriate, worthy or unworthy, acceptable or unacceptable in our

behaviour, important or less important. Values are signals giving direction, meaning, and

purpose to our lives.

Personal Values

With regard to personal values, we refer to people’s personal standards and rules of

behavior. These rules deal with behaviors they feel good about and find reinforcing as proper

kinds of conduct. Personal values are personal belief about worth that acts as a standard to

guide one’s behavior. Personal values are principles that define you as an individual. Personal

values established traits that are representative of an individual‘s moral character. These may

have an order of importance to us such as; honesty, trust, reliability, responsibility, loyalty,

moral courage and friendliness. The values’ people have integrated into their character are

made apparent by their attitudes, beliefs and actions.

Each individual has his or her own values, which develop and form over a lifetime and

are learned by observation and reasoning and through experience. Values are standards of

behavior. Behavior is guided by personally held principles, beliefs, and values. Personal

values are based on experience, religion, education, and culture. Personal values are reflected

in individual attitudes. Attitudes, which are made up of several beliefs, are feelings towards a

person, object, or idea. Personal values and beliefs that influence attitudes. İnduviduals thus

think, feel, make choices and act from within well-known values, which are a person‘s own

moral judgement about his or her morality. Others also reflect their beliefs and their acts.

İnduvidual values influence choices, behaviors and actions, often serving as motivators.

Moreover, the values that a person holds may determine his or her personal needs, social and

cultural influences and interactions with important others.

Our values are those things, activities or qualities that are worthy, high priorities, in our

lives. Values are a function of our beliefs, knowledge, and skills. People’s values can only

really be known by their actions. That’s why so many wisdom traditions, including our own,

advise us to judge others and let ourselves be judged more by actions than by words.

Values are beliefs or ideals to which an individual is committed and which are reflected

in patterns of behavior. Values are standards that guide behavior, needs, and desires. Values

are beliefs and considerations that are held to be true and significant. The values vary,

developing and changing over time. So although a belief goes further than that which is

obvious, it is at least initiated in some fact. As a result of the motivational element usually

involved, values tend to be less fixed than attitudes and beliefs.

Beliefs are the assumptions we make about ourselves, about others in the world and about

how we expect things to be. Beliefs are about how we think things really are, what we think is

really true and what therefore expect as likely consequences that will follow from our

behavior. Beliefs are a type of attitude where “the cognitive component is based more on faith

than on fact.‖ Beliefs, ideals and purposes are the basic ingredients of values.

Professional Values

In talking about professional values, on the other hand, we refer to norms and rules

thought best for activities and behaviors by the prevailing professional group generally.

Professional values are a word used to describe professional‘ moral knowledge.

The professional group determines professional values. Professional values are standards

for action that are accepted by the practitioner and professional group and provide a

framework for evaluating beliefs and attitudes that influence behavior. Professional values,

the recognized standards for action that are embraced by members of the profession, are used

to guide both education and practice..

Professional values are primarily beliefs and statements that describe practices, or

established sets of behavior, that are supported by a community or group. Typically, value

statements describe behaviors that the members of a community ―feel good about.‖ Value

statements also describe or imply behaviors that are likely to be sanctioned or punished by

other members of a group or culture. These values are the fundamental beliefs that guide our

behaviors and decision-making process.

Professional values may include professional responsibility, loving interpersonal

relationships, social consciousness, equality, justice, liberty, freedom, and pride in “our

country.” A professional value is learned. It involves one‘s relationship to society.

A well-developed value systems may help what a person ought to do and how one ought

to be in relation to others (Altun, 2002; Altun, 2003). Values are the rules by which we make

decisions about right and wrong, should and shouldn’t, good and bad. Values are embedded in

what it is to know the good, and are reflected in the character of the person. Values live up to

what is desirable and ethically justifiable

Professional values are also standards for action that are accepted by the practitioner

and/or professional group. Professional values are provide a framework for evalation beliefs

and attitudes that influence behavior. Development of professional values begins upon entry

into the profession education environment, continues throughout the educational experience

and the professional career. Upon graduation, nurses enter a chaotic work environment. The

relationship between professional values, professional education, work environment,

experience, and the profesionals‘ personal commitment to the profession influence the

perception of the significance of values in a professional‘s life. The development of

professional values begins during the professional education experience and continues

throughout the practice years. Professional values serve to guide the delivery of professional

service and decision-making (Babadağ, 1998).

‘The Profession’s Values’

Purposeful action requires values. Values are the motive power behind purposeful action.

A profession’s values — including its ethical values — are reflected in the degree to which its

structures. Profession‘s values are vital to the integrity of the profession as a whole. The

profession expresses its values through the decisions of the people who are members of the

profession to addresses effectively barriers to access or to maintain those barriers through

action or inaction.

An profession establishes its mission according to its values; it then formulates goals and

aligns priorities according to those values. The values held by profession form the basis for

definitions and descriptions of profession. They guide standards for action, provide a

framework for evaluating behaviour and influence practice decisions. Such values provide a

framework for the development of standards and expectations within the profession. Potter

and Perry (1997, 310) point out that, “Because values give identity, influence actions, and

sustain what is meaningful, professions are as strong as the values on which they are based”.

It is expected that each individual within a profession will revere the fundamental values of

the particular profession.

The values of profession are found in professional codes of ethics. The Code identifies

values common to profession. The Code identify the fundamental moral commitments of the

profession. Institutions particularly espouse values that ideally make up their code of ethics.

However, there is often a wide chasm between what is espoused and what is practiced. The

code presented by professionals reflects the real practice of the profession, addressing the

myriad of roles of practitioners and setting forth guidelines for ideal ethical conduct in those

roles. Such detail indicates that the professional culture of professions well understood

Values In Nursıng

Nursing, like all professions, is based on the ideal and beliefs of service to humanity.

Nursing is an inherently value-based endeavor, with a long and rich tradition. As a discipline,

a science, a profession, a value nursing encompasses the complex interaction of technical skill

and professional conviction with the welfare of other humans.

The essence to the practice of nursing are caring, coordination, and advocacy, and are

based on the special relationship between the nurse and the patient. The practice of nursing

involves altruistic behavior, is governed by a code of ethics. Therefore nursing is by natura a

moral endeavour. The moral significance of nursing is not just a matter of the objectives that

are sought (i.e. the promotion of the patient‘s well-being), it is also a matter of the moral

attitudes on the basis of which nurses carry out their tasks.

It is impossible to be a nurse without considering what is of value. Within nursing,

specific values and moral requirements are necessary to maintain the interprity of the

profession. Nursing values are fundamental to the practice of nursing and professional

compass. Regardless of the nursing practice setting, professional nursing values influence the

environment of nursing practice, nursing activity, and the development of nursing as a

profession (Şahin-Orak, 2005; Hendel et al, 2006). The values of nursing are those basic

assumptions about what is of value in the practice and profession of nursing: what is of

fundamental importance in nursing. A value framework in nursing is essential in developing a

sense of professional commitment and social responsibility. Nursing values constitute the

organizational culture of nursing. The values of nursing are standards for action and

responsibilities that are accepted by the practitioner and professional group. Regardless of the

nursing practice setting, professional nursing values influence the environment of nursing

practice, nursing activity, and the development of nursing as a profession. The values of

nursing give nurses direction, guide nursing behaviors and are pivotal in decision making. In

addition, values are explained to the public in a way that clarifies professional obligations to

society at large. They guide standards for action, provide a framework for evaluating

behaviour and influence practice decisions. Despite the importance that can be attributed to

nursing values, acknowledgement of them is difficult to find in the current debate about how

interprofessional working is changing the healthcare system in which nurses currently work.

Professional nursing values can be traced in the discipline‘s history and traditions.

A Brief history of the Nursing and Nurses -A Look Back – From Value to

Virtue-

That values changes is welcome and inevitable; how it changes is not always easy to

elucidate. By analysing over nursing history, it is possible to see the directions taken so far

and the indications of future development. The trends indicate that nursing values reflects

fairly closely what is happening in society in general. Nursing’s roots are firmly planted in

service to others – individuals, groups, and communities. Early nursing service were primarily

voluntary and related to religious practice. In ancient times, when medical lore was associated

with good or evil spirits, the sick were usually cared for in temples and houses of worship. In

the early Christian era nursing duties were undertaken by certain women in the church, their

services being extended to patients in their homes. These women had no real training by

today’s standards, but experience taught them valuable skills, especially in the use of herbs

and drugs, and some gained fame as the physicians of their era. In later centuries, however,

nursing duties fell mostly to relatively ignorant women (Fealy GM, 2004)

In the latter part of the nineteenth century the Christian virtues (good character trait) of

charity, humility and compassion were important motives that prompted an occupational

choice such as nursing. (Rognstad &Nortvedt et al, 2004). Altruism, or the selfness giving of

oneself for the welfare of others, was a prominent aspect of nursing during this time.

For centuries, nurses have worked to help people and have served the health needs of

society. The professional nursing which was pioneered by Florence Nightingale in the XlXth

century, was directly influenced by the teachings of love and fraternity. As stated by Florence

Nightingale in 1860, the goal of nursing is to “put the patient in the best condition for nature

to work upon him.” In addition, other contributions from the religious orders / associations

were the concepts of altruism, valorization of an adequate environment for the care of

patients, and the division of work in nursing. Religian, the military and technology are three

primary influences on the development of the profession. Religion and the military are built

on loyalty and unquestioning obedience (Manthey & Wolf et al, 2000).

Nursing subsequently became one of the most important professions open to women until

the social changes wrought by the revival of the feminist movement that began in the 1960s.

Until the beginning of the twentieth century, the prevailing virtues in nursing were, for

example, benevolence, self-sacrifice, obedience, serious-mindedness, faithfulness,

compassion, obendience, serious-mindedness, patriotism as well as love of humanity. These

new professional values are leading to an inescapable revaluation of the patient-nurse

relationship model as well as of our understanding of what nursing is. The modern nursing

model has resulted in a preference for a contemporary relationship which presents mutual

responsibility in place of a one-way patient-nurse relationship and patient centered nursing in

place of physician-centered.

Nursing education has been subject to many changes over the years, and one educational

change that has been questioned is the move into universities. They are increasingly expected

to take an active role in nursing development and quality improvement by being critical,

problem-solving and by using research findings. The nursing role has changed during recent

decades. From being disease-oriented and subordinated to the medical paradigm and the

physician, nursing has become more of an independent profession focusing on but also on

holistic care. Nurses today are increasingly driven by innovations and technological

transformation and by constantly changing new roles and values (Heikkinen & lemonidou, et

al., 2006).

‘The Role of the ICN’: A View Today and Forward

The values held by profession and professional form the basis for definitions and

descriptions of profession and are outlined in code for professional. Code for nurses are

sets of standarts based on universal moral principles or values. International Council of

Nurses (ICN) is the body that speaks for nurses globally. ICN is the first and widest reaching

health care organisation in the world, representing the millions of nurses in just 128

countries. ICN is a federation of national nurses‘ associations (NNAs), representing nurses in

more than 128 countries. Founded in 1899, ICN is the world‘s first and widest reaching

international organisation for health professionals. Operated by nurses for nurses, ICN works

to ensure quality nursing care for all, sound health policies globally, the advancement of

nursing knowledge, and the presence worldwide of a respected nursing profession and a

competent and satisfied nursing workforce (ICN, 2006).

Nursing’s values are consistent: it is the code of ethics for nurses. The tenets of the code

of ethics are based on shared values and a shared responsibility to uphold them. Members

have an obligation to exercise fairness in dealing with others and to provide support and

assistance when required. Members should avoid any actions or statements which can be

construed as being unfairly critical of a colleague or intended to favour their own position at

the expense of a colleagu. ICN codes were constructed by nurses for nurses; they therefore

reflect the values of nursing in terms of the requirement to provide patient care based on the

identified needs of an individual. The ICN code of ethics for Nurses delineates the

fundamental values of professional nursing. The code for nurses provides direction for

relationships of nurses to clients, the community, and the profession. The ICN code of ethics

for nurses, most recently revised in 2005, is a guide for action based on social values and

needs. The code has served as the standard for nurses worldwide since it was first adopted in

1953. The code is regularly reviewed and revised in response to the realities of nursing and

health care in a changing society. Nursing’s professional values are articulated in the Code for

Nurses.

The Code makes it clear that inherent in nursing is respect for human rights, including the

right to life, to dignity and to be treated with respect. The ICN Code of Ethics guides nurses

in everyday choices and it supports their refusal to participate in activities that conflict with

caring and healing.

The ICN Code of Ethics for Nurses has four principal elements that outline the standards

of ethical conduct. The nurse in relation to (1) people, (2) practice, (3) profession, (4) co-

workers. Inherent in nursing is respect for human rights, including cultural rights, the right to

life and choice, to dignity and to be treated with respect. Nursing care is respectful of and

unrestricted by considerations of age, colour, creed, culture, disability or illness, gender,

sexual orientation, nationality, politics, race or social status

Accoding to ICN the need for nursing is universal. ICN says: ―Nursing encompasses

autonomous and collaborative care of individuals of all ages, families, groups and

communities, sick or well and in all settings. Nursing includes the promotion of health,

prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a

safe environment, research, participation in shaping health policy and in patient and health

systems management, and education are also key nursing roles.‖

TABLE 1. International Council of Nurses (ICN) Code of Ethics for Nurses

The ICN Code

The ICN code of ethics for nurses has four principal elements that outline the standards

of ethical conduct.

Elements Of The Code

1. Nurses and People

The nurse‘s primary professional responsibility is to people requiring nursing care. In

providing care, the nurse promotes an environment in which the human rights, values,

customs and spiritual beliefs of the individual, family and community are respected. The

nurse ensures that the individual receives sufficient information on which to base consent for

care and related treatment. The nurse holds in confidence personal information and uses

judgement in sharing this information. The nurse shares with society the responsibility for

initiating and supporting action to meet the health and social needs of the public, in particular

those of vulnerable populations. The nurse also shares responsibility to sustain and protect the

natural environment from depletion, pollution, degradation and destruction.

2. Nurses and Practıce

The nurse carries personal responsibility and accountability for nursing practice, and for

maintaining competence by continual learning. The nurse maintains a standard of personal

health such that the ability to provide care is not compromised. The nurse uses judgement

regarding individual competence when accepting and delegating responsibility. The nurse at

all times maintains standards of personal conduct which reflect well on the profession and

enhance public confidence. The nurse, in providing care, ensures that use of technology and

scientific advances are compatible with the safety, dignity and rights of people.

3. Nurses and the Professıon

The nurse assumes the major role in determining and implementing acceptable standards

of clinical nursing practice, management, research and education. The nurse is active in

developing a core of research-based professionalm knowledge. The nurse, acting through the

professional organisation, participates in creating and maintaining safe, equitable social and

economic working conditions in nursing.

4. Nurses and Co-Workers

The nurse sustains a co-operative relationship with co-workers in nursing and other

fields. The nurse takes appropriate action to safeguard individuals, families and communities

when their health is endangered by a coworker or any other person.

According to ICN (2006) Nurses have four fundamental responsibilities:

. to promote health,

. to prevent illness,

. to holistic care and

. to alleviate suffering.

According ICN (2006) Nurses have six key roles

. advocacy,

. promotion of a safe environment,

. research,

. participation in shaping health policy,

. in patient and health systems management,

. education

This fundamental responsibilites and roles are values of the nursing profession. These

values are reflected in the practice of professional nursing. Nurses delineates the fundamental

values of professional nursing. This values is fundamentally the same in any society, these

values give an ethical basis for nursing which is global – nurses can adopt it in whatever

society and mix of cultures they find themselves. The values of the profession give nurses

direction, guide nursing behaviors and are pivotal in decision making. The values of nurses

would typically reflect a professional duty to provide a certain level of care. This would have

to be one of the factors that should be taken in to account in the construction and application

of any nuırsing care. National nursing associations should just go ahead and do it and be

done with it adopt the values which are necessary for successfully fulfilling nursing‘s basic

role and objective. Since this role is fundamentally the same in any society, these values give

an ethical basis for nursing which is global – nurses can adopt it in whatever society and mix

of cultures they find themselves.

The need for nursing care will grow and change in the future. Tschudin (2006) point out

that, there is no doubt that nursing will change significantly in the next decade, with

professional nurses taking on different roles, especially in the long-termcare of people in the

community who are increasingly suffering from lifestyle illness. Such people need long-term

professional contact with nurses, which demands specific skills, especially communication

and building relationships. This means that individual nurses- and whole profession of

nursing – put into action in far more obvious ways the ―preventive‖ or ―up–stream‖

responsilities and values laid on them by the ICN. Regardless of the practice setting, these

value documents influence nursing activity and the development of nursing as a profession.

That values can guide individual nurses toward satisfaction, fulfillment.

To Promote Health

We can trace the origins of nursing‘s responsibility for healthy communities directly to

Florence Nightingale. Never before has health promotion beeen more important than is today.

(Chiverton & Votava et al, 2003). The concept of the promotion of health is embedded within

tenets of the ICN definition of Nursing. According to ICN promotion of a safe environment

are also key nursing role (ICN, 2006). ICN’s Vision For the Future of Nursing. ―Our highest

reward is the certain knowledge that our work is shaping a future of healthy people in a

healthy world.‖ The ICN‘s responsibilities of nurses, to ‗promote health [and] to prevent

illness‘ ICN’s mission for the future of nursing. ―Our mission is to lead our societies toward

better health. Working together within ICN, we harness the knowledge and enthusiasm of the

entire nursing profession to promote healthy lifestyles, healthy workplaces, and healthy

communities. We foster the health of our societies as well as individuals by supporting

strategies of sustainable development that mitigate poverty, pollution, and other underlying

causes of illness.‖

Health promotion as defined by the World Health Organization is the process of enabling

people to increase control over, and to improve, their health ( WHO, 2001).

In 1978, the Declaration of Alma-Ata, signed by nearly all member states of the World

Health Organization and UNICEF, issued a bold call for “Health for All” (Who, 2006) Its

core strategy was primary health care, comprising essential elements ranging from safe water

to basic health care services.

The Ottawa Charter for health promotion outlines the role of health promotion, especially

the importance of increasing people’s control over their own health. According to the Ottawa

Charter for health promotion the basic principles of health promotion are as follows:

Prerequisites for health the fundamental conditions and resources for health are peace,

shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and

equity. Improvement in health requires a secure foundation in these basic prerequisites.

According to WHO (2001) advoncate good health is a major resource for social,

economic and personal development and an important dimension of quality of life. Political,

economic, social, cultural, environmental, behavioural and biological factors can all favour

health or be harmful to it. Health promotion action aims at making these conditions

favourable through advocacy for health.

Health promotion is the science and art of helping people change their lifestyle to move

toward a state of optimal health. Optimal health is defined as a balance of physical, emotion,

social, spiritual and intellectual health. It is more than lifestyle change, it is also about

changing environments so they are more supportive of making healthy decisions. Lifestyle

change can be facilitated through a combination of efforts to:

1. enhance awareness,

254

2. change behavior and

3. create environments that support good health practices.

Of the three, supportive environments will probably have the greatest impact in

producing lasting changes.

In the purest sense, health promotion is associated with wanting to improve one’s health

via ―behavior motivated by the desire to increase well-being and actualize human health

potential.‖ (p7). Such behavior changes might include engaging in more physical activity or

getting more sleep. Health promotion, consistent with the Healthy People 2010 mandate, also

includes health protection, or ―behavior motivated by a desire to actively avoid illness, detect

it early, or maintain functioning within the constraints of illness.‖ (p7) (Pender, 2002)

Health promotion includes the facilitation of an individual‘s potential and energy use, an

improved quality of life, productivity and use of one‘s abilities regarding health. Therefore it

is necessary to make people aware of their health and to provide them with sufficient

information and skills.

According to this opinion, individuals have a critical role in the determination of their

own health status. To reach a state of complete physical, mental and social well-being, an

individual or group must be able to identify and to realize aspirations, to satisfy needs, and to

change or cope with the environment. Health-promoting behaviors are an integral part of an

individual‘s lifestyle and determinants of health status; these include taking charge of

personal health responsibilities, taking part in physical activities, and maintaining good

nutritional habits. A healthy individual should also have self actualization, and be able to

maintain good interpersonal relations and stress-management. Self-care activities that

maintain and improve functional competence, well-being, and personal development

minimize health risks.

One of the most important ways to promote health is to improve the self-care agency of

an individual which may be carried out through health education. Health education seeks to

motivate the individual to accept a process of behavioral change through directly influencing

their value, belief and attitude systems, where it is deemed that the individual is particularly at

risk or has already been affected by illness/disease or disability. As more people grow in their

awareness of activities that lead to good health and become knowledgeable about their own

health status, the overall health of population will improve (Chiverton & Votava et al, 2003).

To Prevent İllness

The prevent illness refers to the protection of health, to prevent infection and ensure a

safe, healthy environment. Health protection might include incorporating more hygienic or

safer practices into daily routines, participating in disease screenings, or obtaining

immunizations and vaccinations. Health protection refers to the protection of health by

personal and community wide effects, such as preserving good nutritional status, physical

fitness, and emotional well-being, immunizing against infectious diseases, and making the

environment safe.

Prevent infection might include immunizing against infectious diseases, and making the

environment safe. The goal of prevention:

1. Primary prevention – to prevent the initiation of illness through the reduction of risk

factors and the promotion of wellness. Primary prevention refers to the protection of health by

Nursing Values

255

personal and community wide effects, such as preserving good nutritional status, physical

fitness, and emotional well-being, immunizing against infectious diseases, and making the

environment safe.

2. Secondary prevention – to arrest the development of illness through early detection of

illness and the promotion of wellness. Secondary prevention can be defined as the measures

available to individuals and populations for the early detection and prompt and effective

intervention to correct departures from good health.

3.Tertiary prevention – to minimize the consequences of illness and disability through the

promotion of wellness. Tertiary prevention consists of the measures available to reduce or

eliminate long-term impairments and disabilities, minimize suffering caused by existing

departures from good health, and to promote the patient’s adjustment to irremediable

conditions. This extends the concept of prevention into the field of rehabilitation. There are

no precise boundaries between these levels.

Ensure a safe, healthy environment refesrs to the the reduction of risk factors, working to

prevent infection and ensure a safe, healthy environment

Health challenges are constantly changing with time, due to the impact of many different

factors. Considerable progress was made in the 20th century in combating infectious diseases

with the development of drugs for the treatment of bacterial infections and a wide range of

metabolic disorders as well as vaccines to prevent some bacterial and viral infections.

Achievements included the eradication of smallpox and progress towards eradication of polio.

However, major challenges now arise from new, emerging and re-emerging infectious agents.

In parallel, the epidemiological transition towards noncommunicable diseases that was

perceived as a characteristic of affluence is now being seen in many low- and middleincome

countries, presenting a new range of challenges for prevention, diagnosis and treatment of

these chronic conditions. Additional factors that are stretching the capacities of all countries,

but especially those at the lower end of the income scale, include the rising tide of injuries,

impacts of globalization on health and the recognition that social, economic and political

determinants of health are also important and that many factors outside the health sector or

system impact on the health of populations. Specific targets, whether for improvements in

efficiency or cost-effectiveness or for the achievement of international goals such as the

Millennium Development Goals, are also stretching the capacities of planners, managers and

service deliverers—often in situations where factors such as HIV/AIDS or migration are

depleting an already understrength health workforce ( Martin , 2006).

All nurses are teachers, helping people learn to prevent illness and manage health

problems. The nurse also protects the patient, working to prevent infection and ensure a safe,

healthy environment in the hospital. Finally, the nurse teaches the patient and family about

health-related matters and promotes patients‘ well-being in all situations, speaking for them

(advocating), if necessary. The hospital nurse plays many roles on the health care team

To Care Holistically

Health, how health is perceived depends on how health is defined. The World Health

organization (WHO) defines health as a ―state of complete pyhsical, mental, and social well

being and not merely the absence of disease and infirmity.” *Preamble of the Constitution of

The World Health Organization

Disease may be defined as the abnormal state in which part or all of the body is not

properly adjusted or is not capable of carrying on all its requered functions. Disease can have

a number of direct causes, such as the following: Disease-prodicing organisms, malnutrition,

physical gents, chemicals, birth defects, dejenerative processes, neoplasms. Examples of

predisposing causes (indirect) include the following: Age, sex, heredity, living conditions and

habits, occupation, physical exposure, preexisting illness, psychogenic influences.

When a person becomes ill or is injured, generally the doctor assesses the patient,

diagnoses the patient’s problem and decides on the treatment needed to cure the problem or

relieve the patient’s symptoms.

Throughout most of medical history, the physician‘ aim has been to cure patients of

existing diseases.

In the past only the doctor assessed and diagnosed (Breier-Mackie, 2006) Today,

however, nurses play a large role in evaluating patients and detecting problems. In some rural

areas, nurses admit patients to hospital and manage their care, referring only the most critical

patients to distant medical centres. In every hospital nurses carry out many of the treatments

prescribed for the patient. For example, the doctor may prescribe surgery orbed rest or a

certain therapy. The doctor will perform some of these treatments, such as surgery. It is the

nurse who gives most of the treatments.

Once a patient‘s disorder is known, the physician prescribes a course of treatment can be

much else besides therapy. Specific measures in a course of treatment are carried out by the

nurse and other health care providers under the physician‘s orders. If a patient needs

intravenous therapy, usually the nurse sets up the intravenous line and gives the patient the

fluids and drugs prescribed. If the patient needs an injection, it is the nurse who gives it. The

nurse changes the patient’s dressings and monitors the healing of the wound. The nurse gives

medication for pain. Many physicians order medication for pain “to be given as needed”.

They let the nurse decide when to give the medication. The nurse also monitors the patient’s

progress to make sure that the recovery has no complications. Because nurses have more

frequent contact with patients than other staff, they often find problems before anyone else.

Nurses care for patients continuously, 24 hours a day. Nurses play an extremely valuable

role in this process by observing closely for signs, collecting and organizing information from

the patient about his or her symptoms, and then reporting this information to the physician.

They help patients to do what they would do for themselves if they could. Nurses take care of

their patients, making sure that they can breathe properly, seeing that they get enough fluids

and enough nourishment, helping them rest and sleep, making sure that they are comfortable,

taking care of their need to eliminate wastes from the body, and helping them to avoid the

harmful consequences of being immobile, like stiff joints and pressure sores. The nurse often

makes independent decisions about the care the patient needs based on what the nurse knows

about that person and the problems that may occur. For example, the nurse may decide that,

in order to prevent pressure sores, the patient needs to be turned every two hours. However,

the nurse may consult the doctor about this if it is possible that turning the patient might cause

some other problem. Thus the nurse uses understanding of medical conditions, as well as

knowledge of nursing, in deciding on patient care. The nurse not only takes care of the patient

but also gives comfort and support to the patient and his or her family. When the patient

cannot recover, the nurse helps to make sure that the death is peaceful. In caring for the

patient, the nurse cares about the patient. The holistic care is really the only possible type of

care that nurses want to give and patients want to receive (Breier-Mackie, 2006)

To talk more precisely about caring, we need to operationally define the term. Values of Nursing, Person, Health, and Environment Assignment.The

concept of care and caring can be explained in various ways, and it can present a different

meaning to each person. The American Heritage Dictionary says ―care, attentive assistance

or treatment to those in need: a hospital that provides emergency care. ―Caring, to be

concerned or interested: Once inside, we didn’t care whether it rained or not. To provide

needed assistance or watchful supervision: cared for the wounded; caring for an aged relative

at home. WorldNet ―caring‖ means. ―feeling and exhibiting concern and empathy for others;

“caring friends” n : a loving feeling ― Longman Active Study Dictionary of English says:‖

caring to be worried, concerned about, or interested in someone or something‖. In anorher

defined ‖caring providing care and support: the caring professions. Such as nursing.‖

Caring may be defined as intentional action that conveys physical and emotional security

and genuine connectedness with another person or group of people (Miller, 1995).

Defined by Yancey (1995, 83), as ― an action, a virtue, an ethical principles, or a way of

being in the world.‖ Caring has also been described as a basic nursing virtue and as a

fundamental value that informs the nurse–patient relationship. The idea that human caring is

central to nursing is certainly relevant to the role of nursing in contemporary healthcare.

Caring is often seen as an admirable thing in itself and as a virtue (Skott & Eriksson ,2005).

Nurse are being challenged to “ensure the ethic of caring remains a central, essential, and

unique focus of nursing” (Kurtz 1991, 8; Esterhuzen, 2006). Caring is now commonly

recognized within nursing as the profession’s central value in all health care settings (Potter

and Perry 1997, 310). Values of Nursing, Person, Health, and Environment Assignment.

According to Gastmans (1999) ―Caring as a moral attitude can be considered as a

sensitive and supportive response of the nurse to the situation and circumstances of a

vulnerable human being who is in need of help.‖

The values of care as applied to nursing were addressed by reflecting on the ICN codes.

Nursing is a caring profession more than any profession. Because nursing is focused on

assisting individuals, families and communities in attaining, re-attaining and maintaining

optimal health and functioning. Therefore caring is described as the ―essence of nursing‖ and

the most central values. Caring encompasses empathy for and connection with people.

Teaching and role-modeling caring is a nursing curriculum challenge. Caring is best

demonstrated by a nurse‘s bability to embody the core values of professional nursing

(Fahrenwald et al, 2005).

A nurse‘s training as a caring person is thus not limited to the theoretical transfer of

knowledge during the period of education. The attitude to care is the result of a life of care,

not of professional training or of a theoretically sound argument. As a result, it is worthwhile

to direct the efforts made in developing a nurse as a caring person towards the nurse‘s life in

its totality, and so promote the gradual growth of a caring attitude caring is a moral pursuit

centred on the beneficent attention of one person shown to another. Caring can be explained

as an affect, a feeling of compassion or empathy towards the recipient of care. Caring about

also implies that there is a genuine concern about the well-being of the other. Care can be

described as an attitude or orientation that leads to the beneficent attending, through acts or

omissions, of one person towards another. Caring as a virtue and an act of ethics is from both

a natural and a professional point of view inseparably related to love as a

universal/ontological value. A ethic of care leads a nurse to respond to each situation with

tecnical and moral knowledge, compassion, competence, and integrity. (Yancey, 1995, 85;

Esterhuzen, 2006)

Nurses are increasingly aware that good nursing care consists of ‗more‘ than the

competent performance of a number of caring activities. This type of caring relationship is

not limited to the nurse–patient dyad, but also comprises the relationship nurses have with

other nurses, physicians and co-workers. To refer to the term ‗ethical‘ on a theoretical level

with principles and theories and apply the term ‗moral‘ to the manifestation of what is right

and wrong, good and bad in practice is an oversimplification. Caring about is characterized by

the individual‘s ability, for example, to feel, to have insight and to be genuine in a caring

situation. When a person is seen as a living being (a whole person, not fragmented into

objective parts of the body) then every relationship becomes unique to both the receiver and

the giver of care. Values of Nursing, Person, Health, and Environment Assignment.

Values of Nursing, Person, Health, and Environment Assignment.

To Alleviate Suffering.

The concept ‘suffering’ has been central within nursing since Florence Nightingale.

Rodgers and Cowles (1977), stated that ‖Suffering is defined as an individualized, subjective,

and complex experience that involves the assignment of an intensely negative meaning to an

event or a perceived threat. Kahn and Steeves (1986), stated that ―suffering is experienced

when some crucial aspect of one‘s self, being, or existence is threatened‖. Whether suffering

occurs or not depends on the meaning that the person gives to the threat to personal integrity. Values of Nursing, Person, Health, and Environment Assignment.

If illness, deprivation, pain, or disability obstructs one‘s access to the world and constricts

one‘s horizons, suffering occurs. Suffering also attacks one‘s sense of meaning and purpose.

The suffering of patients can be of a physical, psychological or spiritual nature, but it is

always unique to each individual. In addition to physical pain, there can be a sense of loss,

especially a loss of autonomy. Other examples are feelings of loneliness, fear of death or

disfigurement, and threats to the manner in which meaning and purpose are found in patients‘

lives.

How Can Nurses Help?

Patients need to feel supported, experience minimal symptom distress, and maintain as

much control over their lives as possible (Lewis, 1982; Taylor, 1993).

Patients have reported finding meaning and thus having their suffering at least

temporarily relieved when they were able to accept help, assist others, find pleasure in their

environment, practice their religion, maintain an attitude of hopefulness, and if terminally ill,

accept the inevitability of death (Coward, 1990; Steeves, 1992; Steeves & Kahn, 1987).

Nursing actions that address the above patient needs provide caring amid the suffering

experience.

The need to experience meaning is a spiritual need that touches the core of one‘s being

and is intensified during the illness experience. Some nursing interventions that can enhance

meaning-making include listening to patients, employing insightful questioning, asking

patients to tell their stories, and maintaining a compassionate presence (Taylor, 1993).

Nurses must not run from their feelings of helplessness in the presence of patient

suffering. Nurses can assist patients to give voice to their suffering and expression to the ways

that the suffering can be relieved and can be cahange the patient‘s understanding of life

(Rehnsfeldt & Eriksson, 2004).

NURSES’ PROFESSIONAL VALUES

Nurses‘ professional values are a word used to describe nurses‘ moral knowledge

(Yancey, 1995). Nurses‘ moral knowledge may promote a reflective, ethical attitude and

thereby support them in their professional growth. Kluchohn (1951) stated that a value is a

‘conception explicit or imphcit, distinctive of an individual or characteristic of a group of the

desirable which influences the selection from available modes, means, and ends of action’

(p395). He views values as personal in nature and contributing to one’s sense of identity.

Kluckhohn asserted that a value has persistence over time and is organized into a system of

action or a way of being for the individual. A link can be made between the action-orientation

of values and the role of values in mediating the decision making of nurses. Bevis (1988)

noted that all choices are made from one’s value system. (Parker (cited in fawcett, 2003) said

that ―The values held by nurses form the basis for definitions and descriptions of nursing‖

(p.134). According to Raths et al (1966), determined that values are chosen freely,

thoughtfully prized or cherished, and acted on. Values of Nursing, Person, Health, and Environment Assignment.

Professional nurses values are the foundation for practice; they guide interactions with

patients, colleagues, other professionals, and the public. Profesional nurses values provide the

framework for commitment to patient welfare, fundamental to professional nursing practice

and critical decision making processes. Values are important in nursing care because nurses

need to make decisions about value-laden practice dilemmas on a regular basis (Weis &

Schank, 1997; Weis &McNeese-Smith & Crook, 2003; Şahin-Orak, 2005).

The nursing code of ethics is a collective statement about the nurses‘ expectations and

standarts of behavior (Yancey, 1995). The nurses‘ code expresses the moral commitment to

uphold the goals, values, and distinct ethical obligations of all nurses. The code of ethics

establishes a nonnegotiable ethical standard for the nursing profession. It demonstrates

accountability and responsibility to the public, other members of the nurses team, and the

profession overall. The code of ethics is the nurses‘ value statement. Codes of ethics define

nurses‘ responsibilities, and provide direction for nursing obligations. The code of ethics give

establish norms of behavior (Yancey,1995). The Code provide professionals with a basis for

professional and self reflection and a guide to ethical practice; The Code indicate to the

community the values which professionals hold. The sources of professional values for nurses

are the nursing profession and employing institutions. Nurse demonstrate their professional

values in their attitudes and behaviors (Verpeet & Dierckx de Carterle‘. et al, 2006)

The nurse functions both as a professional and as a human being within a variety of

contexts. Frequently, nurses‘ values are challenged, either strengthening or weakening the

foundational beliefs. The socialization process in nursing education involves the modification

of personal values and internalization of nursing values. At the core of professional nursing is

the value that nursing practice serves to act in the best interest of the patient.

The values of the professional give nurses direction, guide nursing behaviors and are

pivotal in decision making. The values central to the profession of nursing are caregiving,

altruism, respect for human dignity, service to society, accountability and recognition of the

client as an individual, empathetic understanding and reciprocal trust (Creasia & Parker,

2001).

Values of Nursing, Person, Health, and Environment Assignment.

Nursing Education

According to Manthey (2000) the timeless values of nursing include advocacy of the

patient, intentional caring, promoting community health, awareness of the mind-body-spirit

connection and a belief in the fundamental equality of people.

American Association of Colleges of Nursing (AACN, 1998) espouse that baccalaureate

education programs facilitate the development of professional nursing values. The five core

values embraced by the (AACN, 1998) include human dignity, integrity, autonomy, altruism,

and social justice. Values of Nursing, Person, Health, and Environment Assignment.

The American Association of Colleges of Nursing (AACN) published, in 2003, a

document entitled of College and University Education for Professional Nursing in which it

identified the values (as well as the knowledge and skilled practice) which were consider

essential for nursing. The AACN identifies it as an attitude or personal quality, which nurses

will demonstrate as a result of altruism, accountability, human dignity, integrity and social

justice. These values are considered to be essential to the practice of professional nurses.

These values are reflected in individual attitudes; they influence choices, behaviours and

actions.

Nurses, guided by these values, demonstrates ethical behaviors in the provision of safe,

humanistic health care. The sample behaviors are not mutually exclusive and may result from

more than one value. Conversely, the value labels provided are intended to encapsulate a core

set of values and behaviors that can be elaborated in a variety of ways. The values and sample

professional behaviors listed below epitomize nursing. Professional nurses values include: a)

autonomy, b) human dignity, c) integrity, d) responsibility /accountability, e) social justice.

Usually colleges and university are evaluated by the quality of the knowledge and technical

training offered to the students.Values of Nursing, Person, Health, and Environment Assignment. Little attention is given to the acquisition of the values,

behaviors and attitudes necessary to assume their professional role. Value-based nursing

education appeals to the moral and character development of students. Values and behaviors

are influenced by College years, studying at a College of Nursing during four years leads to a

difference in values and professional behavior. Professional values are difficult to teach as

part of professional education. Nevertheless, faculty must design learning opportunities that

support empathic, sensitive, and compassionate care for individuals, groups, and

communities; that promote and reward honesty and accountability; that make students aware

of social and ethical issues; and that nurture students’ awareness of their own value systems,

as well as those of others (Dinc & Görgülü, 2002).

NURSING’S TIMELESS VALUES

Autonomy

Autonomy (Greek: Auto meaning ‗self‘ Nomos – nomos meaning “law”: one who gives

oneself his own law) means freedom from external authority. Autonomy is a concept found in

moral, political, and bioethical philosophy. Within these contexts it refers to the capacity of a

rational individual to make an informed, uncoerced decision. In moral and political

philosophy, autonomy is often used as the basis for determining moral responsibility for one’s

actions. In nursing autonomy, defined as the right to self determination (AACN, 1998, p. 8).

This nursing value is including patient autonomy. Patient autonomy focuses on respect for the

patient‘s right to make decisions, even when those decisions conflict with the values of the

nurse. Nurses have a moral obligation to the profession and to society to advocate for a

patient‘s rights to self-determination. Autonomy is grounded in respect for patients’ ability to

choose, decide and take responsibility for their own lives. Values of Nursing, Person, Health, and Environment Assignment.

Learning experiences emphasize how to facilitate the patient‘s right to make informed

health-related choices. Autonomy has to do with personal qualities such as knowledge,

realism, curiosity, honesty, rationality, inquisitiveness, responsibility, accountability, self-

confidence, authenticity, and it can be explained as to document nursing care accurately and

honestly. Autonomous behavior includes the provision of information so patients can make

informed choices. Nurse autonomy reflects a moral obligation to provide competent care to

clients and to protect clients from unsafe practice. (AACN, 1998).

Nurse autonomy takes a strong stand on the duty to respect autonomy and to keep

promises. By virtue of their specialized knowledge, nurses are permitted to exercise their own

judgment in the delivery of their services. Nurse who give priority to autonomy succesful in

problem solving, performance positively, self-esteem highly, low levels of emotional

exhaustion, high feelings of personal achievement, inquisitive and risk-taking, high in critical

thinking skills (Ersoy&Altun, 1998; Altun, 2002; Altun, 2003; McNeese-Smith & Crook,

2003)

Values of Nursing, Person, Health, and Environment Assignment.

Human Dignity

Human dignity is respect for the inherent worth and uniqueness of individuals and populations

(AACN, 1998). Dignity involves the day-to-day choices by which individuals create who they will

become and how they will be perceived in the context of human culture. The ICN emphasizes that

―In providing care, the nurse promotes an environment in which the human rights, values, customs

and spiritual beliefs of the individual, family and community are respected.” The ICN emphasizes

that the use of science and technology should be compatible with the safety, dignity and rights of

people.

Dignified care requires a caregiver-patient relationship that values autonomy, individual

diversity, truth, justice, rights, and responsibilities. Because authoritative practice does not

acknowledge the rights and dignity of others, those who have power must constrain themselves

and use caution in applying judgement.

Human dignity includes personal qualities such as consideration, empathy, humaneness,

kindness, respectfulness, trust, and it can be reflected in safeguarding the individual’s right of

privacy, and in treating others with respect, regardless of background. In professional practice,

human dignity is reflected when nurses values and respects all clients and colleagues. Sample

professional behaviors include: promotes self determination, does good, a voides harm, tells the

truth, respects privileged information, keeps promises, treats people fairly, high self-esteem, low

levels of emotional exhaustion, high heelings of personal achievement, provides culturally

competent and sensitive care; protects the client’s privacy; preserves the confidentiality of clients

and health care providers; and designs care with sensitivity to individual client needs. Nurses are

responsible for the well-being and quality of life of many people, and therefore must meet high

standards of technical and ethical competence. The most common form of ethical guidance is a

code of ethics/professional practice

Nurses are responsible for the well-being and quality of life of many people, and therefore

must meet high standards of technical and ethical competence. The most common form of ethical

guidance is a code of ethics / professional practice

Nurses also reflect on human dignity as applied in their own performance of health

assessment and interventions such as maintenance of safety, provision of privacy, sensitivity to

ethnic and cultural differences, and professional accountability (AACN, 1998; Altun, 2002; 2003)

Nurses also reflect on human dignity as applied in their own the caring attitude who is a

characteristic of a nurse who is part of a network of communicative and narrative

communities. Caring can be characterized in qualities such as compassion, giving of self,

respectful, competence, confidence, conscience, perseverance, benevolence, sympathy,

empathetic, generosity, altruism, kindness, concern, love of self and others and commitment,

and can also be based on sharing and mutual respect. These feelings and characterizes are

motivating elements that move the nurse to attend to and on the other; they propel the nurse

into a caring mode. Values of Nursing, Person, Health, and Environment Assignment.These foundational elements influence the caring milieu to preserve the

unique nature of the human dignity. This undertaking demands a commitment to care,

appropriate underpinning knowledge, and an appreciation of the possible consequences that

can occur when these factors are applied. These elements illustrate that caring in nursing

embraces a therapeutic ethos that can be beneficial to both nurse and patient. In professional

nursing practice, is reflected by nurse’s concern for the welfare of clients, other nurses, and

other health care providers. Nurses demostrates altriustic behaviors such as advocates for

clients, being patient, doing for another, takes risks on behalf of clients and colleagues, the

welfare, protection, enhancement of the one being cared for, understanding of cultures,

beliefs, and perspectives of others, recognizing another‘s humanity weakness and strength.

Nurses also demostrates behaviors such as respect for human dignity, responding to the

patient‘s care needs, to benefit another, a concern for the welfare and well being of others

Values of Nursing, Person, Health, and Environment Assignment.

Integrity

According to the 0nline dictionary.reference.com ―Integrity are adherence to moral and

ethical principles; soundness of moral character; honesty.‖ In addition to this integrity refers

to the values of the profession, which are clarified in codes of professional ethics.

Professional integrity is acting in accordance with an appropriate code of ethics and accepted

standards of practice. Values of Nursing, Person, Health, and Environment Assignment.A professional code articulates the morality or ethical conduct expected

of members of the profession (ie, what ought one to do, what ought to be done for the

patient). These codes articulate rules of etiquette and the responsibilities of individual

members of a profession. Codes of professional ethics foster and emphasize member

identification with and conformity to the core values and underlying ethical principles of the

profession. The fundamental ethical principles that are the foundation for the ICN code for

nurses and the explications for nursing are autonomy, which relates to a patient’s right to self

determination; beneficence and nonmaleficence, meaning to do good and avoid harm; justice,

which relates to equity; fidelity, or keeping commitments and promises; and veracity,

otherwise described as honesty. Values of Nursing, Person, Health, and Environment Assignment.

Integrity is reflected in professional practice when nurses is honest and provides care

based on an ethical framework that is accepted within the profession. Only when nurses

experience the integrity of the profession can they act with personal integrity. Sample

professional behaviors include: does good, avoides harm, tells the truth, respects privileged

information, keeps promises, treats people fairly, provides honest information to clients and

the public; documents care accurately and honestly seeks to remedy errors made by self or

others; and demonstrates accountability for own actions and those of other health care team

members under the supervision of the ICN.

Values of Nursing, Person, Health, and Environment Assignment.

Responsibility /Accountability .

Responsibility involves the obligation to answer for actions. Resposibility also refers

to the execution of duties associated with a nurse‘s partikuler role. Responsibility appeared in

various ways. The ICN asserts that nurses have a responsibility to alleviate people‘s social

and health needs, especially those in vulnerable populations. The fourfold responsibilities of

promoting health, preventing illness, restoring health and alleviating suffering imposed on

nurses by the ICN Code. In this context the nursing approach to the nursing concept can be

applied internationally. It is from these values that priorities will be set, standards will be

developed, resources will be allocated, and all facets of work life will be influenced. The

nurse has a responsibility to be aware not only of the specific health needs of individual

patients but also of broader health concerns such as world hunger, environmental pollution,

lack of access to nursing and health care resources.

Nurses are also responsible for the well-being and quality of life of many people, and

therefore must meet high standards of technical and ethical competence.

Responsibility includes personal qualities such as trustworthiness, courage, openness, and

experience, as well as choices of empathy and love. Sample professional behaviors include: to

focus on individual patients‘ needs, to prioritize the individual patient‘s needs, to accept

limitations, to suit the patients‘ condition better

Competencies should be assessed across this continuum from entry to graduation. Each

of the competencies defined can be attributed, at some level or degree, to a wide range of

roles and health care providers. Nurses attains a level of competence to provide high quality,

client-focused, accountable practice as a health care professional and clinical leader. In

professional practice, competencies is reflected when nurses values and respects all clients and

colleagues. Sample professional behaviors include: does critical thinking, does good

communication, good assessment and technical skills, good teaching, gives humanistic-

caring, rather well management, successful leadership, and successful integration of

knowledge skills. The most common form of ethical guidance is a code of ethics/professional

practice. Values of Nursing, Person, Health, and Environment Assignment.The availability and accessibility of high quality health services to all people require

both interdisciplinary planning and collaborative partnerships among health professionals and

others at the community, national, and international levels. The nurse, as a professional, has

responsibility to make judgments as an individual clinician responsible for quality nursing

care for individuals, families, and groups (Fowler & Levine-Ariff, 1987). To be a professional

requires the willing assumption of responsibility in every dimension of nursing practice. The

nurse’s professional responsibility encompasses a willingness to act on one’s beliefs and to

accept accountability for one’s actions and behaviors.

Accountability is the aspects of responsibility involving giving a statistical or judicial

explanation for events. Accountability refers to being answerable for one‘s own actions.

Accountability is the capacity to decide and to exercise choice. Accountability is a concept in

ethics with several meanings. It is often used synonymously with such concepts as

answerability, resposibility, blameworthiness, liablity and other terms associated with the

expectation of account-giving.

Accountability includes the autonomy, authority and control of one’s actions and

decisions. Freedom having accountability / responsibility is the right, power, and competence

to act. Freedom involves personal qualities such as self-direction, self-discipline, confidence,

hope, independence, openness, and it can be explained as to honor the individual’s right to

refuse treatment. Values of Nursing, Person, Health, and Environment Assignment.

Professional practice reflects accountability when nurses evaluates individual and group

health care outcomes and modifies treatment or intervention strategies to improve outcomes.

Nurses also uses risk analysis tools and quality improvement methodologies at the systems

level to anticipate risk to any client and intervenes to decrease the risk. Sample professional

behaviors include: evaluates client care and implements changes in care practices to improve

outcomes of care; serves as a responsible steward of the environment, and human and

material resources while coordinating care; uses an evidence-based approach to meet specific

needs of individuals, clinical populations or communities; manages, monitors and

manipulates the environment to foster health and health care quality; and prevents or limits

unsafe or unethical care practices.

Values of Nursing, Person, Health, and Environment Assignment.

Justice

To talk more precisely about justice, we need to operationally define the term.

Dictionary.com says: ―justice, the quality of being just; righteousness, equitableness, or moral

rightness: to uphold the justice of a cause.‖ The American Heritage® Stedman’s

Medical Dictionary says ― justice, the principle of moral rightness; equity. Conformity to

moral rightness in action or attitude; righteousness. ‖ On-line Medical Dictionary says:

―justice are the ethical principle that persons who have similar circumstances and conditions

should be treated alike; sometimes known as distributive justice.‖ This definition, therefore,

refers primarily to subjective and self-defined justice, standards and principles that an

individual attributes to him or herself. American Association of Colleges of Nursing says

―justice are upholding moral, legal, and ethical principles.‖ Let us translate its meaning into

actions that will contribute to the well-being of the people whom we serve and of ourselves as

members of the nursing professions. In this respect concept of the justice is a ethical concepts

and the principles of conduct governing an individual or a profession. Let us feel justice as a

virtue of man, founded in love and respect for our own rights and obligations and those of our

fellow men. Values of Nursing, Person, Health, and Environment Assignment.

The fourfold responsibilities of promoting health, preventing illness, restoring health and

alleviating suffering imposed on nurses by the ICN Code, have to be seen in the context of

distributive justice and equality. The fourfold responsibilities of nurses, the need for social

justice, and the advocacy role of nurses and nursing make it clear that nursing work is

political work. Nurses have long believed themselves to be the patient‘s advocate, seeing this

as a core function of nursing and a natural extension of the nurse–patient relationship. In this

respect advocacy is a core value within a nurse‘s practice. The concept of advocacy is

embedded within tenets of the ICN definition of nursing as key nursing roles. (ICN, 2006).

ICN calls on nurses and nursing organizations to promote advocacy as ‗ a key nursing role‘.

This call has been taken up internationally by regulatory organizations, many of whom have

included advocacy in codes of professional conduct. ICN’s vision for the future of nursing

―being advocates for our patients, helping people to help themselves, and doing for people

what they would do unaided if they had the necessary strength, will, or knowledge.―

ICN (2006) stipulates four fundamental responsibilities that nurses have: ‗to promote

health, to prevent illness, to restore health and to alleviate suffering‘. One can apply these

functions with a short-term and a long-term perspective. In the present context, it is nursing as

a profession and the short-term perspective and the personal scene that are mainly considered. Values of Nursing, Person, Health, and Environment Assignment.

They apply as much to an individual nurse as to nurses collectively, as much to a single

person for whom a nurse is caring as to society, with a local situation in mind or with an

international and societal intention. It is increasingly evident that there is a significant ethical

responsibility for nurses in the international arena. Advocacy is required on behalf of

communities and societies, not only for individuals, and for the prevention of situations that

are detrimental to the well-being of people. Advocacy in nursing has two components. The

first is that advocacy in the nursing role implies that nurses support patients‘ autonomy or

patients‘ rights to freely choose, regardless of whether the nurse agrees with patients‘

decisions. Second, advocacy in nursing includes the nurse‘s ability to take action on behalf of

the patient (Schroeter, 2000; Zulfikar & Ulusoy, 2001). Advocacy must be understood better.

The issues in advocacy are complex and it is too easy to see only one side and identify with a

person or a cause against some authority. Much has been written about advocacy, but it

remains an issue that is open to abuse and frustration. It is however vital to any nursing work,

in particular to the concerns of work in and with any minority groups. Hand in hand with

advocacy must go ethical responsibility. That is to say the advocate includes the protection of

rights, values-based decision making, to respect patients‘ decisions, assistance in asserting, to

teach patients and enhance their autonomy (Altun, 2003).

The ICN identify that the nursing value of team co-operation should also be applied at

managerial level, where nurse involvement could include a responsibility for resource

allocation. Concerns about the provision of resources to support safe patient care could be

articulated by nurses. These days we hear a lot about the loss of species and ecosystems, and

if one such system disappears, systems further up the chain also have problems and may

disappear. If you get rid of good and well qualified nurses, mental health, school health,

occupational health, and such systems also collapse, simply causing problems. This is where

your social justice matters (Tschudin, 2006).

Let us work for a kind of justice that will move nurses to promote the existence of

adequate and fair health systems or services for all of mankind, breaking down in this way

existing inequalities: A kind of justice which will be reflected permanently in nursing practice

by means of respect, defense and promotion of human rights; A kind of justice that bravely

defends the rights of individuals, of families and of communities to receive timely and quality

health care without distinction because of social class, race, sex or religious or political

beliefs.

The idea of ‗justice‘ may not have figured large yet in the nursing mindset, let alone in

the curriculum, but it cannot be avoided any longer. This must become a fundamental

principle in nursing and in the kind of work in which nurses engage. All nurses everywhere

have to become politically aware and act quickly before more people suffer. The demands of

justice are pressing in two areas, distribution and retribution But health care has nothing to do

with retribution, but distributive justice is big and needs attention. Distributive justice may

require equality, giving people what they deserve, maximising benefit to the worst off,

protecting whatever comes about in the right way, or maximising total welfare. Retributive

justice may require backward-looking retaliation, or forward-looking use of punishment for

the sake of its consequences. Ideals of justice must be put into practice by institutions, which

raise their own questions of legitimacy, procedure, codification and interpretation.

Professional behaviors that exemplify social justice include ―supporting fairness and

nondiscrimination in the delivery of care, promoting universal access to health.“ (Hirskyj,

2007) Justice embodies personal qualities such as fairness, courage, morality, integrity,

objectivity, and it can be reflected in acting as a health-care advocate, and in allocating

resources fairly. This value is reflected in professional practice when nurses works to assure

equal treatment under the law and equal access to quality health care. Sample professional

behaviors include supports fairness and non-discrimination in the delivery of care; promotes

universal access to health care; and encourages legislation and policy consistent with the

advancement of nursing care and health care. Values of Nursing, Person, Health, and Environment Assignment.

ACKNOWLEDGMENTS

Values of Nursing, Person, Health, and Environment Assignment.

İnsaf Altun, Kocaeli Univ., Nursing High School, The Dept. of Fundamentals

Nursing, Umuttepe, Kocaeli, 41380 Turkey

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