Chapter 2 Values, Beliefs, and Caring PDF

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Notes from Fundamentals of Nursing Yoost/Crawford...

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Beliefs and Values • A 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. "# • Values are enduring ideas about what a person considers is the good, the best, and the “right” thing to do and their opposites— the bad, worst, and wrong things to do—and about what is desirable or has worth in life. #

First-Order Beliefs • First-order beliefs serve as the foundation or the basis of an individual’s belief system."#

• Information that challenges patients’ first-order beliefs may cause emotional or cognitive upset.!

Higher-Order Beliefs # • Higher-order beliefs are ideas derived from a person’s first-order beliefs, using either inductive or deductive reasoning."# • Generalizations versus stereotypes"#

Values System • A values system = a set of somewhat consistent values and measures that are organized hierarchically into a belief system on a continuum of relative importance "#

Diversity Considerations Life Span"# Culture, Ethnicity, and Religion"# Disability"# Morphology#

• • • •

Values Conflict •A values conflict occurs 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. "# • When people experience values conflicts or exhibit incongruent stated values and actions, values clarification may be helpful. #

Values Clarification • Values clarification is a process used to help people reflect on, clarify, and prioritize personal values to increase self-awareness or to make decisions. "# •Nurses may use the values clarification process to better identify their own personal values in challenging care situations. "# • While helping patients with values clarification and care decisions, nurses must be aware of the potential influence of their professional nursing role on patient decision making.#

Patient Education and Health Literacy • Assessment Interview:"#

• The beliefs of nurses and other health care workers are equally important factors in determining how patients are treated."# • A large number of health care disparities can be traced to the health beliefs of either patients or health care providers."# • Patients’ beliefs affect their health behaviors."#

• As nurses learn about their discipline, their paradigm (or worldview) gradually changes to one: #

• • • • • • •

Brief the interpreter before beginning."# Ask the interpreter to stand near the patient. "# Be sure to look at the patient and not at the interpreter when speaking. "# Ask the interpreter to speak to the patient in first person. "# Use short sentences and stop often to allow time for the interpreter to translate"# Tell the interpreter to ask for clarification if needed."# Ask the interpreter to translate everything the patient says and not to paraphrase or abbreviate.

Nursing Theories of Caring

• Caring, according to the American Nurses Association Code of Ethics, is having concern or regard for that which affects the welfare of another. "# • The four nursing theories in this chapter have the concept of care as their primary focus and are used by nurses around the world. "# • A nurse’s paradigm, or the way the nurse views the world, significantly affects how the nurse " provides care. Understanding theories of caring can positively influence nursing practice.#

Madeleine 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."# • Nursing actions for culturally congruent care:#

• Embrace altruistic values and practice loving kindness with self and others.# • Knowing involves performing thorough assessments "# • 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.#"

Joyce Travelbee: Human-to-Human Relationship Model • According to Travelbee, the purpose of nursing is achieved through human-to-human relationships. "# • The model describes steps toward “compassionate” and “empathetic” care, which is not included in other theories, making it as relevant today as it was when the theory was developed.#

Kristen Swanson: Middle Range Theory of Caring"# # # # # # # Professional Caring • There is widespread disagreement about whether it is possible to teach caring. "# • Hudacek says that “no one can make another care; it has to be a free offering of oneself. No one can teach the true sentiment of caring; it is a gift, a talent.”

Developing Compassion • Compassion - force that impels and empowers one to recognize and act to alleviate suffering • For people who have not experienced caring as a product of their childhood and everyday life or as a part of their culture, values, and experiences, the concept may seem strange and foreign, making it difficult to act in caring ways. "# •In work with patients, however, as nurses witness the depth of suffering incurred with illness or injury, they may learn caring ways as part of their professional role.# • Compassion fatigue !

How Values and Caring May Affect Professional Practice A student who sees a nurse turn his or her back on a weeping patient or learns about the use of touch by watching a “caring” nurse remembers and experiences a greater impact from both negative and positive examples than by hearing a lecture on “caring theories” in the classroom.!

Codependency in Nursing • Codependency is a dysfunctional relationship in which the person who wants to help acts in a manner that enables harmful behavior by another person. "# • Codependency may lead to controlling behaviors exhibited by nurses that prevent patients from healing and moving toward independence. #

Behaviors That Demonstrate Caring In Nursing • Nurse’s presence"#

• The use of touch"# • Listening in the nurse–patient relationship#

Studies that Demonstrate Values and Caring in Nursing Practice • Nurses’ values are evident even to pediatric patients by what they do to genuinely care and by what they fail to do that shows lack of caring."# • Patients in an acute care setting rated the quality of their health care experience on the basis of the nurses’ caring behaviors."#

‣ Treating pain"# ‣ Speaking in a soft and gentle voice"# ‣ Being honest"# ‣ Encouraging the patient to call if there was a problem# • Seven dimensions of caring identified as being universal by nurses from around the world include:#

being present with patients.#

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. "# • 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.!

Consistency and Predictability • Provision of care that is consistent and is delivered in a predictable way can make the experience less intimidating for the patient."# • Practice standards and clinical guidelines help ensure a more consistent approach to nursing care and help optimize patient outcomes."# • Providing treatment based on standardized best practices allows all patients to receive similar high-quality care. !

Touch • Task-Oriented Touch"#

Listening # • A vital aspect of providing effective and appropriate nursing care is being able to actively listen to a patient in a way that conveys understanding, sensitivity, and compassion. "#

• Active listening means paying careful attention and using all of the senses to listen rather than just passively listening with the ears. !

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