Professional values of nurse lecturers at three universities in Colombia

Abstract

Objective:

To describe the professional values of the nurse lectures according to 241 nursing students, who participated voluntarily, in three different universities of Bogotá.

Methodology:

This is a quantitative, descriptive cross-sectional study that applied the Nurses Professional Values Scale—permission secured—Spanish; three dimensions of values were applied: ethics, commitment, and professional knowledge.

Ethical consideration:

Project had ethical review and approval from an ethics committee and participants were given information sheets to read before they agreed to participate in the project.

Findings:

It was concluded that nursing students, in general, do perceive these values in their professors, and they give priority to the dimension of ethics, followed by the knowledge dimension, and finally, commitment.

Discussion:

It is evident that professional values are transmitted by professors and students place importance to such values. Values related to the other’s care are paramount in nursing training in Colombia as well as in other countries.

Conclusion:

It was found that participating students observed professors directly in relation to values focused on direct patient care, respect for privacy, respect for life, while matters related to professional improvement, participation in unions were not actually analyzed may be due to poor promotion activities and unions during undergraduate studies. The results obtained are primary approach to the study of values related to nursing, a topic which needs to be researched, something vital to all the country offering nursing training programs.

Keywords

Ethics nursing students perceptions professors social values

Introduction

Today’s society demands more competent and ethically qualified nurses to perform healthcare work aimed toward the four nursing duties: care, teaching, research, and administration. But the most significant values for society, such as equality, justice, solidarity, and specific values, for example, at a professional level, are reflected by each person in a different way, depending on their individual experience, interests, and capabilities.

The objective of this study was to describe the values that students perceive in their nurse lectures. This area was selected because while students receive theoretical knowledge of physiology, anatomy, pharmacology, and mathematics, they also require formation in professional values (ethics, commitment, and knowledge) that will serve them throughout their career. This formation supports students to identify and adopt professional values from the behavior of peers and professors that they wish to emulate in their careers.

Materials and methodology

This quantitative, descriptive, transversal study involved a data collection process conducted with 241 students from the final two semesters of Nursing degrees in the three universities selected for participation. Before using the information collection instrument called Nurses Professional Values Scale (NPVS), the process from the ethics committee allows each of the participating universities and students to have an informed consent in which it is stated the importance of participation, objective, and anonymity of both the institution and the participants. This study involves total coverage, which is why it does not imply a sample group as it was feasible to apply the NPVS to the entire target population.

The instrument consists of the following three dimensions: one is ethics with 9 items, the second is commitment with 8 items, and the third one is domain with 8 items. The study received permission from the instrument’s author, and it is recognized by the American Nursing Association (ANA), to use this instrument in Colombia it was analyzed by students different from final participants to allow understanding each of the items comprising the NPVS, in additions it was compared with the Colombian legislation regarding nursing, and it was found that it matches the conditions of nursing in the country, confirming that professional principles are universal, although some of them tailored to each of the cultures in which the profession is performed. Students were asked about the values perceived in their professors both in theory as well as in the practice, and to make this study more objective, the interviewed students were chosen from the last semesters.

After verifying that all of the values contained in the scale validated by Weis and Schank¹ and Basurto² are included in the laws that regulate nursing in Colombia, it was decided to use this instrument for the study, with the values translated and validated by Basurto as they have been adjusted for nursing in Colombia.^3
–5 It is important to clarify that for using the EVPE instrument, the following aspects were taken into account:

Permission of the translator who adapted the document to Spanish.

It was verified that the instructions and statements from the Basurto instrument and also the nursing faculty representatives were understood, also time to fill it was calculated. This study was applied to a group of 21 students from the last semester of a Nursing School different from the three selected to develop research.

The project was presented before the ethics committee of the National University of Colombia for its approval before starting collecting information.

Instrument

The instrument is made up of three dimensions: ethics, commitment, and knowledge.²

Ethics

Ethics covers all of those areas that relate to moral and ethical values (9 items: 13, 16, 18, 20, 21, 22, 23, 24, and 25; see online Appendix).

Commitment

Commitment covers individual, social, and spiritual aspects that involve an active obligation of professional development and that characterize a service-based profession that focuses on caring for individual human beings (8 items: 3, 4, 5, 8, 10, 11, 19, and 26).

Knowledge

Knowledge covers more technical aspects of the profession but is accompanied by an unspoken and intuitive knowledge that contributes to “know-how” and decision-making processes in critical moments (9 items: 1, 2, 6, 7, 9, 12, 14, 15, and 17).

Each of these areas was evaluated by participants in the study through selection one of the following options: “extremely important,” “very important,” “important,” “not very important,” or “not at all important.”

Before the study was undertaken, a pilot study was carried out with the goal of determining the level of understanding of each of the areas included in the scale by Colombian nursing students. As described before, the items comprehension process was conducted by the principal investigator with different participants from the final ones. Finally, only one item was modified which referred to “participating in decisions regarding the distribution of resources,” which was changed to read “participating in decisions about the general distribution of resources.” The data collection process began following approval by the Research Ethics Committee and university authorities from the institutions selected for the study.

Recognizing that this study investigates a population under control of a figure of authority, during the data collection process, the researchers requested that the professors leave the classroom. The researchers obtained informed consent from participants after explaining the study and the importance of their participation. Inclusion criteria were taken into account, such as enrolled students, male, and female students. The principal exclusion criterion was that students did not sign the informed consent.

Results

The results are presented in the following format: first, the area of ethics, followed by commitment, and finally, knowledge. These different areas include two considerations: the first are the general classifications given by the students of the different areas and second are the most relevant findings from the two responses of “extremely important” and “not at all important.” Of the 241 participants from three universities in Bogotá, 90% were female.

Results related to ethical and moral values

Of the nine aspects that this area consists of (see Figure 1), six obtained higher than 90% in “positive responses” (including the responses of “extremely important,” “very important,” and “important”), while three aspects obtained an “extremely important” classification that was higher than 46%.

Figure 1.

Percentage distribution of responses in terms of ethical and moral dimension.

The study found that, within the area of ethical and moral values, in general, students consider that it is important that their professors satisfy a patient’s health needs, protect their moral and legal rights, provide care without discrimination, safeguard their right to privacy, carry out their profession with loyalty and respect, and guarantee confidentiality. All of these considerations included bio-ethical language that teachers had incorporated, intentionally or not, into their teaching practices. Patients’ confidentiality and the protection of the rights of patients are perceived by students as important for their professors. Similarly, principles such as respect, loyalty, and respect of privacy are central in the nursing codes and are highlighted as being important for students.

Discussion

A contradiction was found between the aspects related to protecting the rights of patients, which obtained a 98% positive classification against a 2% “negative” classification (either “not very important” or “not at all important”), while the aspect of defending the rights of the patient scored an 89% positive classification against 11% negative classification. As stated by Peña and Arango,⁶ nurses consider it very important to take into account the habits of the patient and provide them with information.

Protecting the rights of the patient is mediated by the contractual relationship that the system imposes, because the nature of the relationship makes this protection compulsory. Similar to the study carried out by Peña, there is a doubt regarding these results whether the students perceive that their professors protect the rights of patients because they wish to or because the law requires it.

There is also confusion as to whether advocacy on behalf of the patient occurs, that has traditionally been the responsibility of nurses, is a result of what is required by law, or in the words, “because the contract doesn’t cover it.”⁷ In addition, a range of researchers^8

–11 agree on the importance of good treatment of patients by nurses and understood as the protection of their dignity, rights, and privacy. This is evidenced in the results of this study as values that professors transmit, as perceived perceptions by students.

There were three items that obtained the highest percentages in the “extremely important,” “very important,” and “important” categories. The first was respect for privacy, which scored a 95% “positive” classification compared to a 3% “negative” classification, a particularly interesting finding given the limited resources (including appropriate facilities) that currently exist in health institutions in Colombia to provide this privacy. This rating highlights that professors insist that students ensure privacy of the patient. The lack of resources is a situation that both professors and students face in their professional practice. This finding could be related to changes with the indicates that changes in roles in nursing and health systems, as well as the lack of resources, make ensuring a patient’s privacy a difficult task.¹²

The second item with a high classification from students is patient confidentiality, with a 96% positive response compared to 3% negative. This is probably due to the growing and widely publicized cases of nurses being fired when they have leaked information regarding the health of famous individuals.^13,14 In addition, students see the concern that their professors have for confidentiality, given that in the current health system, the image that health institutions have is affected by the care they provide for famous individuals.

The third item refers to providing care without discrimination, which obtained a positive classification from 92% of respondents against a negative response of 7%. This ethical position helps nursing students become aware that they have a duty to tackle discrimination, starting during their training. A study carried by Eliason out with nursing students found that they have a low awareness of issues associated with race, but the students stated that they felt comfortable working with people from other races.¹⁵ This situation was not replicated when students were asked about working with homosexual or bisexual individuals, with students expressing attitudes that were more negative. While the multicultural nature of Colombian society is not comparable to that of the United States where the study was carried out, the finding is interesting in that in Colombia, this issue is probably more associated with not discriminating against a patient because of their health insurance company or the type of health insurance that they have.

Traditionally, it has been frowned upon in nursing whether a professional nurse reports the poor practice of a colleague in order to protect a patient: this is confirmed by this in the results of are study, which revealed that there are strong reprisals against nurses when they report poor professional practice by a colleague, while there are very few consequences if they do not report this, McDonald and Ahern¹⁶ revealed in the results of this study that there is a strong retaliation when nurses report the misconduct, which is different when there are no reports.¹⁷ The study concluded that identifying and reporting poor practice could result in serious professional consequences. The above is directly related to professional ethics, in which the nurse is exposed to avoid expressing a colleague’s or partner’s practice or not to describe the work of their peers objectively and not subjectively.

This finding is alarming in that nurses report that they are “rejected by peers” and treated as “traitors,” among others. This corresponds to bullying between colleagues a growing and alarming phenomenon, due to the implications it has on the workplace and their intentions to leave the profession. As stated by the Security Council of Canada, workplace bullying includes any “undesired behavior that is repeated and hostile, verbal comments, actions, or gestures that affect the dignity of the employee or their physical or psychological integrity, and that result in a working environment that is damaging for the employee.”¹⁸ Bullying in the workplace constitutes offensive behavior through humiliating, malicious, cruel or vengeful attempts to minimize an individual, or a group of employees.¹⁹

What was found so far regarding the nursing profession’s ethical component from the students’ perception is that although studies show attitudes of rejection in other countries, it is a situation that can occur in Colombia, but it has not been reported so far.

Results related to values of commitment

Of the areas that make up this dimension (see Figure 2), only one item was found to have received a positive response higher than 90%, which refers to protecting the health and safety of others. A significant percentage of respondents rated this item as “very important” (29%) and “important” (42%), while three items included in this area obtained responses of “not important” (22%) and “unimportant” (24%).

Figure 2.

Percentage distribution of responses in the areas of commitment values.

The items from this dimension that scored the highest positive percentage among the student respondents were participating in research and protecting the health and safety of patients. These two findings are related to the progress made in the Colombian health system in the area of quality and healthcare and a growing focus on patient safety. In fact, this is one of the areas for quality accreditation, as required by the Worldwide Alliance for Patient Safety. Given that nursing is one of the professions that provides care, it is necessary that nurses contribute to patient safety as part of a multi-disciplinary healthcare team.

Three items that are related directly to the role of nursing professionals are as follows: feedback from colleagues, participation in professional associations, and the role of nursing organizations in formulating healthcare policies. These obtained high levels of “not important” (22%) and “not at all important” (24%) classifications. If these results are considered along with the 17% of respondents who do not consider it ethically important to report other professionals engaging in inadequate practices, this could mean that in general, nursing professionals are not being prepared as citizens or as colleagues with strong ethical values.

Discussion

There is an evident lack of participation in associations and a lack of knowledge around the role of nursing organizations, especially professional nursing organizations, in the formulation and design of health and nursing policies. These organizations promote a different position to other health professionals’ organizations such as medicine, and as a result, it could result in a type of medical hegemony during the formation of students.

The lack of awareness of this area could suggest students that as a professional, they have no say over decisions relating to their profession, the health system, or the provision of health services. The students’ perception about their professors’ participation in nursing unions is not very wide, and it can happen because the professors seeks to convey other types of values as evidenced in the previous dimension where everything related to ethics when addressing and providing care to patients is seen by participants as a very important thing and leaves aside these advance participation from the profession.

Proof of this is the suppression of nursing departments in various public hospitals in cities such as Bogotá. This finding coincides with a study which found low values in relation to these areas. Similarly,²⁰ the results of this study coincide with the results, who found that nurses do not value the aspirations of their profession and their potential and that management functions were the responsibility of bureaucratic staff in their institution.^21,22

This situation privileges the organizational objectives of an institution at the expense of the individual workers’ and clients’ goals, resulting in tension, a lack of motivation in the workplace among nurses.²¹

Results of values in the area of knowledge

Of the items that make up this dimension (see Figure 3), seven obtained at least a 90% “positive” (“extremely important,” “very important,” and “important”) classification, one item obtained a “negative” (“not important” or “not at all important”) classification of 18%, and one item obtained a score of 8% of respondents not answering the question.

Figure 3.

Percentage distribution of responses in terms of values relating to knowledge.

The item referring to continual self-evaluation had an 18% “negative” score among students. This result is not consistent with the concern for quality that students perceive among their professors, which is also expressed in other areas of the study. Given that self-evaluation is an initial way to improve quality, teaching needs to incorporate mechanisms that teach students to recognize their own difficulties and capacities in order to improve their performance as professionals.

Self-evaluation is not a simple exercise. As stated realized, it is important to identify what self-evaluation is used for and how to use it. According to students, professors teach them to self-evaluate and reflect, but there are significant obstacles in place that impede this from occurring.²² The fear of students is if they submit their self-evaluation to the tutor, then they will be compared unfavorably to other students, and there is also a fear of being seen as inadequate by their peers. This is an issue that needs to be seriously addressed in nursing curricula if students are to develop these abilities. The low importance of this item among professors represents a deficiency in their teaching methods in the areas of reflection and self-evaluation.

In the results from this dimension, there were some contradictions that were identified among the positive classifications from students compared to the values described previously in this article.

Discussion

The first of these contradictions is in the item that refers to “request a consultation,” that obtained a positive classification of 92% (“extremely important,” “very important,” or “important”) while “reviewing cases with colleagues” only scored a positive response of 75%.

The student’s perception about their professor participation in nursing unions is not very wide, and it can happen because the professor seeks to convey other type of values as ethical ones and leaves aside progress and participation.

This could suggest that nursing students are directed toward requesting consultations from other professionals such as doctors and therapists instead of fellow nurses. It is also probable that there is a fear of asking a colleague for their opinion in case their colleague considers them incompetent, which can lead to bullying. It shows a lack of comradeship both among nursing peers and with superiors; however, a high percentage reports receiving help when they feel incapable of making a decision on their own.⁷

The second contradiction is between the items referring to “equitable access to care” and “protection of the rights of the patient” described in the first dimension (ethics). As described by Muñoz et al.⁷ in the previously cited study, this contradiction could be affected by the particular type of health insurance that a patient has, and this could be seen by professors as an area that nursing professionals cannot change.

The results found to match Weis and Shank, which describe the values referring to ethics are learned during professional studies time, while social values are found in postgraduate studies.

The third contradiction was in the classifications of the items “being responsible for your own practice and responding for it,” with 3% classifying it negatively (“not important” or “not at all important”), while 9% of respondents gave a negative classification to the value “not participating in inappropriate practices.” This is in contrast to the item from the first dimension (ethics) that discusses the issue of reporting professionals engaged in inappropriate practices, with 17% of students giving this a “negative” classification. This could be a result of students perceiving that their professors assume responsibility for their own performance, but do not demonstrate that they are concerned about the work of others, which affects the public image of the profession. As highlighted previously, this is probably due to the reprisals that occur against those individuals who report inappropriate practices.

Despite these contradictions, the results found in this study coincide with the research, which describe the ethical values that are transmitted in the undergraduate nursing degree and the social values (commitment) taught in postgraduate nursing studies.^23,24

Finally, a comparison was made between the five items with the highest average score of classifications in the study and the findings obtained.²⁵ Based on one that composed similar values between nursing students in Taiwan and the United States. The comparison is included in Table 1.

Table 1.

Comparison of values of students from Taiwan, United States, and three Nursing faculties in Bogotá, Colombia.

Classification	Taiwan	United States of America	Students from three Nursing faculties
1	Maintain patient confidentiality	Maintain professional competency	Safeguard the right of patients to privacy
2	Safeguard the right of patients to privacy	Advocate on behalf of the patient	Protect the moral and legal rights of patients
3	Seek additional education and update knowledge and skills	Accept responsibility and be aware of own practice	Guarantee patient confidentiality
4	Professional practice is guided by the principles of loyalty and respect for patients	Maintain patient confidentiality	Professional practice is guided by the principles of loyalty and respect for patients
5	Protect the health and safety of the public	Protect the moral and legal rights of patients	Protect the health and safety of the public

It is important to note from this comparison that the values that Colombian students perceive in their nurse lectures are four of the five most important values perceived by Taiwanese students, yet in the United States, only two values are shared by the Colombian students. This finding is interesting given the similarities between the Colombian health system and that of the USA.

It is important to see that while students perceive in their nurse lectures four of the five most important values, Taiwanese students perceive only two of the five most important values for Americans, who also share the same Taiwanese values. This is the reference for “maintaining the patient’s confidentiality.” This finding is curious and interesting, given the similarities of the Colombian health system in the North American one. But perhaps, it could be interpreted on the fact that in Colombia legal issues for exercising the profession, issues are strongly rooted in the work of the North American healthcare system, so it is likely that their professionals give more importance to the fact of “accepting responsibility” and maintain “professional competence” from that it would be granted in countries where regulatory and legal sanctions are not as common nor as strong as in the United States.

Conclusion

In conclusion, this study has identified the importance of emphasizing the ethical values of mastery and commitment in the development of theoretical classes and formative practices that contribute to improving the image of the profession, the quality of nursing care, and the health of people. The challenge identified in this study is a first step in the creation of knowledge for an issue that has not been explored in nursing and is essential for dealing with the ethical dilemmas that are faced by nursing professionals in an environment that is more and more competitive, challenging, and uncertain.

The study found that the dimension that is most representative in the extremely important, very important, and important classifications for the students is ethics, followed by mastery of the profession, and finally, commitment. Due to the current state of the profession, the nursing profession is in a constant change and must continue shaping and strengthening values, taking into account the place of origin from the patients, respecting their beliefs and values. Taking into account that nursing is a profession that is required around the world, it is important that during their formation, students experience other cultures, including other nursing cultures, which would allow them to understand the profession from different perspectives.

During the study, it was noted that the values least important for professors, according to the perception of students, are those that cover the relationships between nurses with their peers (supporting colleagues, evaluating peers, and dealing with inappropriate practices). This finding confirms the need to continue research into nursing ethics, focus on the importance of supporting and helping colleagues in students’ education, and facilitate intercultural exchanges to provide a more in-depth understanding of the profession. This approach would support the participation of nursing students in the development of public policy and professional associations, an area that was perceived by students as not being important for their teachers.

In addition, if students learn from professors both through explicit and implicit curricula, once these students graduate, they will continue to put into practice what they have learnt. The results from this study represent an opportunity for individual and collective reflection on the values required to advance the profession, which were not perceived as important by students. It is also important to update professor on international trends in nursing so that they can share this knowledge with their student.

The study evidenced that while the individual classification of the importance of different areas of nursing ethics between countries are different, all of these are important at some level for students. The results obtained from this study constitute an initial approach to the study of a phenomenon that requires further investigation.

The organizations that transmit professional values that help advance the profession, as well as the universities that have nursing programs, should consolidate the professional values that require additional reinforcement as highlighted by this study.

Footnotes

Acknowledgements

The authors thank Dr Weis and Dr Schank for their interest in the project. They also thank Dr Salomé Basurto for her unconditional support and for authorizing the use of the instrument that she validated, as well as excerpts of her doctoral thesis that contributed to this study. This article is the result of a research study about the professional values of nursing. After a thorough literature review, the perception of students and the difference between what is taught and their praxis were identified.

Conflict of interest

The authors declare that there is no conflict of interest.

Funding

This study was self-financed and is a result of a research project for a Master’s degree.

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