The development of the Professional Values Model in Nursing

Abstract

One of the most important criteria for professionalism is accumulation of knowledge that is usable in professional practice. Nursing models and theories are important elements of accumulating nursing knowledge and have a chance to guarantee the ethical professional practice. In recent years, there has been an increase in the use of models in nursing research and newly created terminology has started to be used in nursing. In this study, a new model, termed as the Professional Values Model, developed by the authors was described. Concepts comprising the conceptual framework of the model and relations between the concepts were explained. It is assumed that awareness about concepts of the model will increase not only the patients’ satisfaction with nursing care, but also the nurses’ job satisfaction and quality of nursing care. Contemporary literature has been reviewed and synthesized to develop this theoretical paper on the Professional Values Model in nursing. Having high values in nursing increases job satisfaction, which results in the improvement of patient care and satisfaction. Also, individual characteristics are effective in the determination of individual needs, priorities, and values. This relation, proved through research about the Professional Values Model, has been explained. With development of these concepts, individuals’ satisfaction with care and nurses’ job satisfaction will be enhanced, which will increase the quality of nursing care. Most importantly, nurses can take proper decisions about ethical dilemmas and take ethical action when they take these values into consideration when giving care. The Professional Values Model seems suitable for nurse managers and it is expected that testing will improve it. Implementation of the Professional Values Model by nurse managers may increase motivation of nurses they work with. It is suggested that guidance by the Professional Values Model may help in enhancement of motivation efforts of the nurse managers and therefore should be taken into account.

Keywords

Care job satisfaction nurse patient satisfaction values

Introduction

The main goal of nursing as a professional discipline is to reveal the content of scientific knowledge likely to be used in practices of this profession. This is possible only when nursing theories and models are used in practice.^1,2 A model is presentation of reasonable relationships between concepts in a graph.³ In other words, models are broad statements which can be tested through scientific methods.^3,4 They also help nurses to organize nursing care daily and allow them to offer higher quality care.^1,4 Basis for sustainability in care practices depends on a clear expression of ethical values and the implementation of nursing-oriented models. This promotes continued research into those values central to sustainability in healthcare and the design of a nursing-oriented model for ethically accessible care.⁵

The conduct of evidence-based research and practices on the basis of models are at the centre of current discussions. Recently, it has become of great importance to use models in nursing research and practices in Turkey although there have been few nursing studies using models.² Several studies from Turkey have shown that clinical nurses did not know much about nursing models.⁶ One study has shown that there was a total of 62 studies based on nursing theories and models in Turkey between 1995 and 2010. Of 62 studies, 49 were postgraduate studies (PhD dissertations) and 13 were scientific studies. The nursing theories and models most frequently used in nursing research in Turkey were Watson’s Human Care Model, Orem’s Self-care Model, Roy’s Adaptation Model, Peplau’s Interpersonal Relations Model, Pender’s Health Promotion Model, and Neuman’s General System Model.² However, no nursing model appropriate for Turkish culture and values has been developed.

Nurses’ professional values were created by the members of political and social systems, including professional nursing unions and educational institutions. For example, International Council of Nurses (ICN)⁷ declares that the nurses demonstrate professional values such as respectfulness, responsiveness, compassion, trustworthiness, and integrity. However, when literature was examined, it is observed that professional values in different cultures are defined by different names with different orders of priority. One study identified the top five values of American nurses as maintaining competency, accepting responsibility and accountability, providing high-quality nursing care, acting as a patient advocate, and providing care without prejudice.⁸ Similarly, in the mid-Atlantic region of the United States, the researchers found that caring and trust values received the highest professional values.⁹ One study from China measured the four domains of professional value and researchers expressed that oncology nurses placed the value of caring as first and reliability as the last on the values list.¹⁰ Another study conducted with Korean nurses relieved self-concept of the profession on top of the list¹¹ while Dutch nurses mentioned that their main value was being able to contribute to the well-being of their care recipients.¹² Taiwanese nurses identified six important values: humanistic caring, professionally competent holistic care, fostering growth, experiencing the give and take in caring, fair compensation, and health promotion.¹³ However, studies from Turkey consistently revealed that human dignity was the most important professional value for nurses, indicating that Turkish nurses respected human and individuality the most in their clinical practice.^14

–17

Models in nursing practices are beneficial for clinical practices and provide guidance for achievement of nursing care goals and evaluation of outcomes.⁴ Therefore, models should not only be used in nursing research but also in nursing practice both in Turkey and all countries. The best way to describe nursing as a profession within the framework of its facts is to know nursing models and to use them in practice. Therefore, the authors developed a nursing model, namely, Professional Values Model (PVM), by creating a conceptual framework in order to improve nursing practices based on values. In this article, PVM, based on research, academic, and clinical experiences and knowledge and awareness of the authors, will be described. Concepts comprising the conceptual framework of the model and their relationships will be explained. The model emphasizes that individuals and nurses should be made aware of importance and responsibility of perceived values. It is assumed that with maturation of these values, both the individuals’ and nurses’ satisfaction with their job will increase with a subsequent improvement in the quality of care. In addition, this new model will also contribute to nursing profession and provide guidance for nurse researchers.

Aims of the professional values’ model

The aims of the PVM are to describe features, values, and experiences of individuals and thus to offer individual care based on the whole person approach; to describe individual and professional values of nurses and to help them to get to know themselves; to raise professional values of nurses with increase in nurses’ job satisfaction; and to offer high-quality care to increase patients’ satisfaction with care.

Assumptions of the professional values’ model

The PVM assumes that individuals attempt to create living conditions in which they can display their health behavior typical of their own values, and they are affected by their own experiences. Also, individuals always exhibit change and development and they have the capacity of expressing themselves depending on their own abilities. Finally, we assume that individuals affect and are affected by their environment in all stages of their life and nurses are an important part of human–environment interactions. When nurses have a high sense of professional values, they have a high job satisfaction and quality of care.

A framework of the professional values’ model

The PVM places importance on values of individuals who receive care and on professional values of nurses. It describes the relationships between these two concepts and responsibilities for improvement of patient satisfaction and nurses’ job satisfaction and for access to high-quality care (Figure 1). The concept of value is related to the human behaviors, and it is a series of principles that form personal acts. Each person has individual, social, and cultural values. These values by interaction with each other shape the lives of individuals, make their lives meaningful, and influence their moral decisions.^17
–19 They are also considered as standards affecting beliefs and attitudes of individuals.²⁰ Individuals gain occupational experiences and acquire new knowledge, and they can adapt their own values to new situations and improve their professional values.²¹

Figure 1.

Conceptual framework of Professional Values Model.

It is known that perceived professional values and job satisfaction play a very important part in nurses’ life. These variables have been reported to be interrelated.^22,23 It has also been noted that development of professional values is an important factor in improvement of individuals’ satisfaction with care they are given, nurses’ job satisfaction, and the quality of nursing care.²⁴ The PVM describes the relationships between individual and professional values in light of the literature. The idea that improvement of patient satisfaction and nurses’ job satisfaction has been supported by several studies.^22,24
–26 There is also evidence that implementing the two concepts in nursing practices enhances the quality of nursing care.^24,27,28 This relationship at PVM has been explained.

The framework of the professional values’ model is composed of three basic concepts

Individual values

Professional values of nurses

Nursing care quality

Individual values

Values refer to beliefs of individuals about their ideal types of behavior or goals of life and are defined as multifaceted standards which guide behavior in different ways.²⁹ It is known that individuals basically have two value systems, that is, individual values created by personal choices and learning and social values created by socio-cultural, political, and economic factors.^20,30

The basis of individual values is formed by families.²⁵ Individual characteristics, experiences, perceived health and disease status, needs, priorities, environment, and society play an important part in acquisition of values and creation of a value structure.^21,25 Honesty, truthfulness, goodness, democracy, solidarity, goodwill, friendship, tolerance, patience, love, family, racism, culture, patriotism, and freedom are among individual values.^30,31

Altun²⁰ stated that values are principles and standards which play an important and valuable role in decision-making processes. Individual values guide individuals in their selections and priorities during their decision-making processes. Therefore, values have an important influence on individuals’ decisions about their body and determination of their needs when they are healthy or ill. They play a role in individuals’ participation in or rejection of their care. Therefore, individuals should be well aware of their values so that they can make the best choice in accordance with their needs.^15,31

Personal features

Personal features have been dealt with under three categories, that is, physical, psychological, and social. Physical characteristics include variables such as age, gender, educational level, physical abilities, endurance, body mass index, agility, and adaptation. Psychological characteristics involve variables such as self-respect, self-motivation, perception of individual abilities, and health status. Social characteristics involve variables such as ethnic origin, cultural structure, education, and socioeconomic status.^32,33 All these features are effective in individual values, interpretation of experiences, determination of needs and priorities, and perceived health and disease.¹⁵

Prior experiences

Individual characteristics can provide guidance for individuals in interpretation of their experiences and determination of their needs and priorities. Success and failure in prior behavior affect outcomes of later behavior. It has been reported that experiences are effective in acquisition of new behavior by 75%. In fact, several experimental studies have shown that the same or similar behavior displayed in the past was very effective in future behavior likely to be acquired.^32,34

Perceptions of health and disease

Prior experiences of individuals are affected by their own values.¹⁵ Individual characteristics and experiences are important factors having an impact on their perceptions of health and disease and their involvement in care given.³² As importance placed on health increases, so does attention given to start and continue health behavior. Individuals’ participation in their own care is an important component of success in nursing practices. If individuals consider health only as absence of disease, it becomes difficult for them to get involved in their own care. In contrast, if they consider health as feeling very well, it is more likely for them to acquire positive health behavior.^27,34,35 Levels of distress among infertile women living in developing and non-Western societies are higher than those among infertile people living in developed and Western societies.^36
–38 For instance, infertility in Turkish women is an important negative social phenomenon. According to Turkish cultural beliefs, it is very important to get married and, soon after, to have children.^39,40 Despite such intense cultural/social values, a woman with infertility treatment may not perceive herself as ill or unhealthy. Alternatively, a woman having treatment for infertility for so many years may identify herself in a condition worse than cancer.³⁹ Only if and when the nurses discover the meaning of the phenomenon or disease for person and the society in a particular culture, they can reach an ethical practice. According to Watson, care is an ethical task and the nurses should ask themselves the following questions: “Who is this individual? How can I clarify the personal values of this individual?⁴¹

Needs and priorities

Characteristics of individuals can help them to determine their needs and priorities.¹⁵ It is required that they should actively participate in their own care so that they can maintain their good health and recovery in case of an illness.^35,40 To achieve these aims, individuals should believe that they need care. The beliefs that care practices are hard or invalid to implement make it considerably difficult for individuals to get involved in care behavior.^27,34 However, taking account of needs prioritized by individuals while nursing practices are planned will have an influence on outcomes of nursing care.^27,32

Professional values of nurses

Professional values are standards adopted by members of a profession, providing guidance for education and practices and affecting beliefs and attitudes.^20,21,42 As the basis of a profession, they are influenced by individual and professional values.²⁹ Another important factor contributing to the development of professional values is that members of a profession really consider themselves as members and integrate their profession and personality to each other.¹⁵ Nurses take these values into consideration when giving care, arguing for their behavior and attitudes and making decisions about ethical dilemmas.²⁸ Consequently, it is important that nurses should be aware of professional values so that they can fulfill their roles effectively and sufficiently.^21,43 Nursing professional values were identified by American Association of Colleges of Nursing.⁴⁴ Besides that, many nursing researches have added new values to the literature by supporting these values.^17,29,42 As a result, basic professional values of nursing were defined as truth (adherence to the fact or reality), integrity (acting in accordance with an appropriate code of ethics and accepted standards of practice), altruism (regard for the welfare of others), autonomy (ability to make the choice in decisions or actions), equality (having the same rights and privileges), human dignity (the inherent worth of an individual), and esthetics (different conventions of what is proper, tasteful, stylish, or pleasant and what we appreciate and value in a fundamental way).^18,20,45,46 High perceived professional values in nursing result in job satisfaction, professional identity development, occupational socialization, high-quality nursing care, and good decision-making skills.^23,43 It has been shown by studies that nurses becoming aware of their own professional values can transfer them into their professional life, which brings about improved patient care and high job satisfaction.^22
–24,47

Nursing care quality

Nursing care refers to cognitive, emotional, and physical effort to keep an eye on and protect other people to fulfill their needs and to support them.^27,47 The aim of the nursing profession is to offer effective and high-quality care in accordance with individual needs of patients using continuously updated evidence-based knowledge.^47,48 High professional values of nurses cause an improvement in nursing care and job satisfaction.^24,42 In addition, individuals receiving high-quality care feel more satisfied.²⁶ If nurses are not aware of their individual and professional values, they have difficulty in understanding their professional roles.^31,43 So that nurses can offer the best care in accordance with individuals’ personal choices and needs, and they should be aware of professional values having an impact on their behavior.²⁰

Patients’ satisfaction

Patient satisfaction is defined as fulfillment of patient expectations about care given to them.⁴² It is related to many factors including life style, prior experiences, future expectations, and individual and social values. It has been reported that professional behavior of health staff considerably increases patient satisfaction.^27,47 Several other studies also showed that patient satisfaction was considerably influenced by the quality of nursing care.^26,47

Nurses’ job satisfaction

Job satisfaction is defined as fulfillment of employees’ expectations from their work and workplace and involve their knowledge, beliefs, feelings, evaluations, and attitudes toward their work.²⁴ High job satisfaction of nurses maximizes their physical and mental health and helps them to make accurate decisions. This underlines the importance of job satisfaction in nurses’ life.²³ You et al.²⁷ reported that low job satisfaction in nurses had a negative impact on patient satisfaction and the quality of care.

Using the professional values’ model in practice

So that the PVM can be used in practice, first the framework of and the concepts utilized in the model can be understood and internalized. The PVM is suitable for nurse managers. According to the PVM, high professional value of nurses increases their job satisfaction. As a result, nursing care quality and patient satisfaction will increase. Guidance by the PVM should be considered in the motivation enhancement studies of the nurse managers. The content of in-service training applications should address the basic concepts and relationships in the model. Nurse managers play an important part in creation of safe working environments and enhancement of job satisfaction, thanks to tasks and responsibilities they fulfill and their authorizations.^21,24,27 Therefore, it is thought that implementation of the model by nurse managers can increase motivation of nurses they work with. They have the chance of designing in-service training programs to promote the concept professional values based on the assumption that these values affect all other nursing concepts. The purpose of in-service training is to raise individual and professional values. It is presumed that improvement of individual and professional values will mediate improvement of patient satisfaction, job satisfaction of nurses, and the quality of nursing care. Evaluation of effectiveness of these programs by determining the responses to the same measurement tools before and after in-service training programs will allow testing the relationships between the concepts of the model and will contribute to improvement of nursing profession.

In this article, the PVM as well as its thought system, assumptions, concepts, and relationships between its concepts have been explained. It is expected that use of the PVM will improve nurses’ job satisfaction, patient satisfaction and the quality of nursing care. Implementation of the PVM as a guide in practice and further studies with this model are needed to evaluate strong and weak sides of the model. Studies carried out in different cultures have revealed many positive results in the approach of priority to professional values in nursing, supporting the view that the PVM can be used in different cultures.^24,27,28 The model is advantageous in that it does not require a special environment where it can be implemented. It can be tested and implemented wherever there are healthy individuals, patients, and nurses. Indeed, testing the PVM in different cohorts with different cultures may contribute substantially to its improvement. Furthermore, qualitative studies examining patient and nurse experience can be applied in assessment of the PVM-based nursing care.

Relevant measuring tools for evaluation of professional values’ model

The effect of nursing care on the outcome of patient care can be examined based on the PVM. There are many accessible measuring tools in literature seemed to be appropriate for evaluation of the PVM. The model can be evaluated with Nursing Professional Values Scale (NPVS), Minnesota Satisfaction Scale, and Newcastle Satisfaction with Nursing Scale (NSNS) before and after in-service training programs.

The NPVS was developed by Weis and Schank in 2000 and revised in 2009.⁴⁹ NPVS-revised (NPVS-R) is composed of 26 items. It is a five-point Likert scale and has five subscales. The total score for the scale is obtained by adding scores assigned to each item. High scores indicate high importance given to professional values.⁴⁹ Minnesota Satisfaction Scale was created by Weiss et al.⁵⁰ to determine job satisfaction levels. It is a five-point Likert scale composed of 20 items revealing internal and external satisfaction factors. The overall satisfaction score is obtained by adding scores assigned to each item. The score 3 assigned to items indicate a neutral satisfaction status. High scores show high job satisfaction levels. NSNS was developed by Thomas et al. in 1995.⁵¹ It is a five-point Likert scale and is composed of 19 questions. High scores are indicative of high levels of patient satisfaction with given nursing care.

Conclusion

The PVM describes relationships between professional values and job satisfaction, patient satisfaction, and patient care with an emphasis on awareness of professional values in nursing. It is expected that description of professional values and relevant concepts will mediate improvement of patient satisfaction, job satisfaction of nurses, and the quality of nursing care. In the PVM, the relationship of professional values with job satisfaction has been explained and responsibilities for enhancement of patient satisfaction, job satisfaction of nurses, and access to high-quality nursing care have been described. Literature data reveal that high professional values of nurses are an important factor which increase job satisfaction and the quality of nursing care together with satisfaction of patients with nursing care they receive. Future studies based on PVM might reveal whether the model helps nurses to offer more effective care and raise both patient satisfaction and job satisfaction of nurses. Using the model in further studies with different samples and cultures will make great contributions to evaluation of functionality of the PVM. Future data with the PVM in different cohorts with different cultures are expected to make a great contribution to the evaluation of functionality of the PVM.

Footnotes

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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