Personal values among undergraduate nursing students: A cross-sectional study

Abstract

Background:

Personal values influence nursing students’ development of professional values, which affect professional outcomes, and how nursing students react to different situations. Personal values can be shaped by different factors, including culture, gender, and age.

Aims:

To explore personal values held by nursing students, and to verify if and how gender and year of study affect nursing students’ personal values.

Research design:

A multicenter, cross-sectional study was used.

Participants and research context:

The whole population of nursing undergraduate students available at the time was recruited from eight centers of two Universities, composing a sample of 947 students. Demographic data were collected and it was administered the Portrait Values Questionnaire.

Ethical considerations:

Ethical approval was obtained from the Institutional Review Boards of the University of the participating centers.

Findings:

The study sample was mainly composed of young (92.6%, n = 877), female (77.3%, n = 732), Italian (95.8%, n = 907), and unmarried (98.6%, n = 934) nursing students. The most important value for nursing students, consistently through the years of nursing school, was Self-transcendence, which has the motivational emphasis on helping others and selflessness. Then, we found that male students had higher levels of Power (p < 0.001) and Achievement (p = 0.031), while female students outscored male students in Benevolence (p = 0.005) and Security (p = 0.006). Year of study showed no statistically significant difference.

Discussion:

Nursing students express high levels in hetero-directed values. Male nursing students, although they choose a stereotypically feminine profession, outscored females in stereotypical masculine values such as dominance and success. This is the first study that describes the personal value profile of undergraduate nursing students, according to the Theory of Basic Human Values, and it is a starting point for future research.

Conclusion:

Nursing educators might want to consider the findings from this study while guiding students in developing awareness for their personal values.

Keywords

Basic human values medical education nursing education nursing students personal values undergraduate student

Introduction

Nursing is a profession founded on values, both professional and personal.¹ Professional values are beliefs about the worth and quality of concepts and behaviors in a discipline.² They are adopted by members of a profession and, in nursing, are linked to the quality of care, job satisfaction, retention, and patient satisfaction.^3,4 Furthermore, they influence healthcare professionals’ fundamental abilities of decision making, communication, and critical thinking.^3,5
–7 Building strong professional values in future nursing professionals is one of the main educational aims.⁸ Professional values are also shaped and influenced by personal values,³ which can act as barriers or facilitators of the acquisition of professional values.^3,4 Thus, nursing educators have the mandate to integrate the personal values of students with the acquisition of the professional ones along the years of study,⁹ because nursing students who are not aware of their personal values may have difficulties in understanding their future professional roles.¹⁰

Background

Personal values are basic convictions regarding what is desirable, moral, right, good or not, and what are the individual interests, goals, and needs.¹¹ According to Schwartz’s theory,^12,13 basic individual values are universal, personal, trans-situational goals serving as guiding principles for people and groups. They are motivating beliefs organized on relative importance, independent across specific situation and behaviors, and used to select and evaluate events, people, and actions.^12,13 Considering undergraduate nursing students, researches that studied personal values are based on different values theories, hindering the possibility to summarize findings.^{1,8,14

–17} That being said, throughout most of these studies, high personal value on social values was found.^1,8,14,15 Altruism, which, by some,¹⁶ is considered to be a core nursing value, was found inconsistently in the literature, either placed as a very high value^1,8,17 or very low.^15,16 As per socio-demographic variables, there seems to be an effect of age on values, with younger nursing students to value more affective and social relationships^15,17 compared to older students¹⁵ or older nurses.¹⁷ While gender has proved itself to have an effect on values in adults¹⁸ or students¹⁹ in general, with women giving more value to Benevolence, Universalism, and Security and men to Stimulation, Power, Hedonism, Self-direction, and Achievement values, it has never been studied in the nursing student population.

Understanding personal values can be useful to explain and understand nursing students’ reactions to various situations^8,20 and support nursing educators in organizing the learning process to boost desired professional attitudes and behaviors.³ Although values are modified along the educational process, formal training in meanings, role, and awareness of nursing core values is yet overlooked in most nursing schools.²¹ Furthermore, only few studies have explored the personal values of nursing students^{1,8,14

–17} and never before with a theoretical framework that allows international and inter-professional comparison. Gender, as said above, has never been studied in the nursing student population and year of study has been explored only by one study,¹ which used a different theoretical approach. Thus, the aims of this study were (1) to explore personal values held by nursing students and (2) to verify if and how gender and year of study affect nursing students’ personal values.

Methods

Study design

A multicenter, cross-sectional study design was employed. The study variables were the socio-demographic characteristics of the study sample and the scores obtained at the questionnaire administered to the undergraduate nursing student participants.

Theoretical framework

According to the Basic Human Values Theory, there are 10 basic individual values, structured on a circular continuum, which can be aggregated in five second-order dimensions:^12,13 Self-transcendence (Benevolence and Universalism), Self-enhancement (Power and Achievement), Openness to Change (Self-direction and Stimulation), Hedonism, and Conservation (Conformity, Tradition, and Security) (Table 1). In general, Self-transcendence and Conservation dimensions underline a social focus while Self-enhancement and Openness to Change, a personal one.¹⁸

Table 1.

Description of the 10 basic individual values, their second-order dimension, and motivational goal, according to Schwartz’s theory.¹³

Value	Second-order dimension	Motivational goal
Benevolence	Self-transcendence	Concern for welfare and preservation of people who are in personal contact with the individual.
Universalism	Self-transcendence	Concern for the protection, appreciation, and welfare of all people and nature.
Power	Self-enhancement	Pursuing dominance over resources and to reach social status and prestige.
Achievement	Self-enhancement	Demonstration of personal competence in order to gain personal success along with social standards.
Self-direction	Openness to change	Pursuing independence.
Stimulation	Openness to change	Tendency to make new experiences, be open to change.
Hedonism	Hedonism	Seeking of enjoying life, gratification, and pleasure for oneself.
Conformity	Conservation	Self-restriction with the intent to not harm others or not violate social norms.
Tradition		Self-restriction in order to respect ideas of traditional culture or religion.
Security		Pursuing stability and harmony of relationships, self, and society.

Sample and data collection

The whole population of nursing students available at the time of data collection was recruited for this study without any exclusion criterion. First-year nursing students were recruited at the beginning of the academic year. Second-year and third-year nursing students were surveyed during the second semester of the academic year. The researchers approached students after class and invited them to participate in the study. Recruitment of participants and completion of the paper-and-pencil survey took approximately 30 min.

Setting

The population of nursing students was drawn from two Universities in northern Italy, which have courses in eight different teaching hospitals. Students were recruited from these eight teaching hospitals, which serve a territory of seven different provinces. These provinces are very different between them and they include very different territories, populations, and cultures. The territories include a big metropolitan city area, four medium-sized towns located in very different areas some more rural some more urban, two different lake areas, and a mountain area. In Italy, nursing education is a 3-year undergraduate program. Academic years begin in October and end in September.

Ethical considerations

Permission for this study was obtained from the University Institutional Review Boards of the participating centers. A reference number is not assigned for this type of authorizations. The study was conducted according to the Declaration of Helsinki.²² A researcher, who had no previous relationship with the students and was not involved in their academic education, explained the rationale of the research study to potential participants. Students were also informed that their responses would be anonymous, that participation was voluntary and that they could withdraw at any point of the study. Signed informed consents were obtained from students who agreed to participate in the study. Students did not receive any monetary or academic credit compensation for their participation in the study.

Measure

Following the Schwartz’s theory of basic human values,¹³ the Italian version²³ of the Portrait Values Questionnaire–40 (PVQ-40)²⁴ was employed to assess the participants’ personal values. This 40-item self-report questionnaire measures the 10 basic human values (Benevolence, Universalism, Power, Achievement, Self-direction, Stimulation, Hedonism, Conformity, Tradition, and Security). The questionnaire adopts an implicit approach to measure personal values: respondents are asked to compare themselves to each of the 40 portraits, specifying how much each description represents them on a 6-point Likert-type scale, from 1 (“not like me at all”) to 6 (“very much like me”). To calculate the total score of each subscale, we computed the mean of the items that refer to each personal value. The cross-cultural validity of the 10-factor structure of the PVQ-40 has been widely examined.^25

–28 In this study, the PVQ-40 ten factors demonstrated good Cronbach’s alpha values, ranging from 0.65 for Tradition scale to 0.80 for Achievement scale.

Statistical analysis

Before performing statistical analyses, a correction for individual differences in use of the response scale for each PVQ-40 value was executed, according to authors’ scoring recommendations.²⁹ We obtained centered scores of each value by subtracting each individual’s mean score across all 40 items from each of the 10 value scores. Centered scores were used to evaluate the individual priority among the 10 values. A higher centered score in one value would mean that the respondent prioritized that dimension over the others. Student’s t-test was used to determine the differences in gender, while one-way analysis of variance (ANOVA) was achieved to determine differences in year of study groups. Post hoc ANOVA pairwise comparisons were performed using the Bonferroni correction test. Outcomes were considered significant at p < 0.05. Effect sizes were computed as Cohen’s d.³⁰ All computations were run with the IBM SPSS statistical software version 24 for Mac.

Results

A total of 947 nursing students participated in this study (71.3% of the whole population of nursing students available at the time). Table 2 shows the socio-demographic characteristics of the nursing student sample, that was mainly composed of young (92.6%, n = 877), female (77.3%, n = 732), Italian (95.8%, n = 907), unmarried (98.6%, n = 934) students.

Table 2.

Socio-demographics of the nursing student sample (n = 947).

Variable	n	%
Gender
Female	732	77.3
Male	215	22.7
Age groups (years)
19–25	877	92.6
26–30	46	4.9
31–40	18	1.9
>40	6	0.6
Year of study
First	448	47.3
Second	271	28.6
Third	228	24.1
Nationality
Italian	907	95.8
Foreign	36	3.8
Dual	4	0.4
Marital status
Unmarried	934	98.6
Live with a spouse	11	1.2
Separated/divorced	2	0.2
Parental status
With children	248	26.2
Without children	699	73.8

As can been seen in Table 3, for the whole sample, Benevolence (M = 0.74, standard deviation (SD) = 0.54) received the highest mean centered score and was ranked first, in the second place there was Universalism value (M = 0.56, SD = 0.55), while Self-direction (M = 0.49, SD = 0.54) was the personal value in third place. On the contrary, Power value (M = –1.43, SD = 0.88) took the lowest mean centered score.

Table 3.

Means, standard deviations (SDs), and rank of the Portrait Values Questionnaire–40 (PVQ-40) values.

	Mean	SD	Rank
Benevolence	0.74	0.54	1
Universalism	0.56	0.55	2
Self-direction	0.49	0.54	3
Conformity	0.08	0.60	4
Stimulation	–0.03	0.75	5
Security	–0.12	0.58	6
Hedonism	–0.28	0.85	7
Achievement	–0.37	0.80	8
Tradition	–0.68	0.69	9
Power	–1.43	0.88	10

For the overall nursing sample, we found a significant gender difference in Benevolence, Power, Achievement, and Security subscales. In particular, male students had higher levels of Power and Achievement dimensions than female, while female students outscored their male counterparts in Benevolence and Security scales (Table 4).

Table 4.

Gender differences and rank for Portrait Values Questionnaire–40 (PVQ-40) values.

	Male			Female			t	p	d
	Mean	SD	Rank	Mean	SD	Rank	t	p	d
Benevolence	0.65	0.61	1	0.76	0.52	1	–2.819	0.005	0.20
Universalism	0.58	0.58	2	0.55	0.54	2	0.791	0.429	–
Power	–1.08	0.84	10	–1.53	0.87	10	6.756	<0.001	0.52
Achievement	–0.26	0.83	8	–0.39	0.79	8	2.156	0.031	0.16
Self-direction	0.46	0.59	3	0.51	0.53	3	–1.366	0.182	–
Stimulation	–0.03	0.78	5	–0.03	0.74	5	0.108	0.914	–
Hedonism	–0.22	0.98	7	–0.30	0.81	7	1.223	0.222	–
Conformity	0.07	0.61	4	0.08	0.60	4	–0.307	0.759	–
Tradition	–0.75	0.78	9	–0.66	0.67	9	–1.648	0.100	–
Security	–0.21	0.61	6	–0.09	0.56	6	–2.736	0.006	0.21

One-way ANOVA showed that students from the three different years of nursing program did not have statistically significant differences in PVQ-40 scores (Table 5).

Table 5.

Year of study differences and rank for Portrait Values Questionnaire–40 (PVQ-40) values.

	First year			Second year			Third year			F	p
	Mean	SD	Rank	Mean	SD	Rank	Mean	SD	Rank	F	p
Benevolence	0.75	0.58	1	0.73	0.49	1	0.71	0.51	1	0.507	0.602
Universalism	0.56	0.58	2	0.57	0.49	2	0.54	0.54	2	0.175	0.839
Power	–1.49	0.91	10	–1.43	0.88	10	–1.32	0.81	10	2.922	0.054
Achievement	–0.38	0.84	8	–0.37	0.78	8	–0.34	0.75	8	0.242	0.785
Self-direction	0.48	0.56	3	0.51	0.52	3	0.53	0.55	3	0.782	0.458
Stimulation	–0.01	0.79	5	–0.04	0.69	5	–0.07	0.71	5	0.597	0.550
Hedonism	–0.30	0.95	7	–0.26	0.76	7	–0.27	0.77	7	0.174	0.839
Conformity	0.07	0.65	4	0.08	0.55	4	0.10	0.56	4	0.261	0.770
Tradition	–0.62	0.72	9	–0.74	0.66	9	–0.71	0.67	9	2.855	0.058
Security	–0.13	0.62	6	–0.07	0.56	6	–0.16	0.51	6	1.704	0.182

Discussion

The aim of this study was to explore personal values held by nursing students and to verify if and how gender and year of study affect nursing students’ personal values. To the best of our knowledge, this is the first study that addressed this issue using the theory of basic human values, which has been used extensively in different professional cohorts and countries, allowing international and inter-professional comparisons.^28,31

–34 We found that the most important value for nursing students, consistently through the years of nursing school, is Self-transcendence, which focuses on helping others and selflessness. Furthermore, we found that male and female students had significant differences in their higher ranked values. Our results are important because values are motivating beliefs and can explain the students’ reaction to various situations and challenges. Furthermore, nursing educators can use this information in organizing and supporting the learning process of professional values.

According to Schwartz theory, it is the relative importance of multiple values that, combined, guides action,³⁵ so values must be considered together. In our sample, the first ranked values were Benevolence and Universalism, which are linked to the higher order value of Self-transcendence. These values share the motivational emphases on enhancing others and transcending selfish interests.^13,35 The third value is Self-direction, which has defining goals of choosing, creating, and exploring. The fourth is Conformity, which has the goal to contain actions likely to upset others or social norms and, when expressed with Benevolence, to promote cooperative and supportive social relations.^13,35 The fifth value is Stimulation that, with Self-direction, are linked to the higher order value of Openness to Change. These values share the motivational emphases on the interest in novelty and mastery.^13,35 It is relevant to notice that the lower the rank, the higher the standard deviation, showing that there is a higher variability in how students in our sample consider Power and Achievement, while there is more consistency toward Benevolence and Universalism. The relative importance of these values, therefore, paint a picture of a nursing student who is oriented to the well-being of other people, promotes cooperative and supportive relations, and is excited and interested in learning new things and master them.

These findings confirm previous literature that showed, even though using a different theoretical approach, how nursing students value more hetero-directed values that focused on social values and affective relationships.^1,8,14,15 The three lower ranked values are Power, Tradition, and Achievement. These values have the motivational emphases of social superiority and social esteem, and acceptance of respect and acceptance of customs of one’s own culture or religion.^13,35 First, this seems typical of Millennials (people born between 1981 and 1996), mainly represented in our cohort of students at the time of data collection, who—also in other studies—valued more Benevolence, Self-direction, Hedonism, and Universalism.³¹ However, in previous studies, Self-enhancement values (Power and Achievement) were inversely correlated with age³⁶ showing that these findings might be peculiar of nursing students who exhibit a pattern different from the general population, as suggested by previous studies.¹⁷ Second, it seems that Self-enhancement values are linked with authoritative leadership,³⁷ and people who express Self-enhancement seem to have low interpersonal relationships and low performance.³⁸ Therefore, it seems to be that these nursing students are equipped to become transformational rather than authoritative leaders,³⁷ coherently with their values.

Our second aim was to verify if and how gender and year of study affect nursing students’ personal values. Genderwise, we found that male students valued more Power and Achievement than female students did, while female students valued Benevolence and Security more than male students. This is consistent with previous studies that showed undergraduate female students scored higher in Universalism, Benevolence, and Security than males,²⁴ and men evaluate as more important values of Power, Stimulation, Hedonism, Achievement, and Self-direction compared to women.⁵ However, the ranking of the values is the same between male and female students, with hetero-directed values as more important. Female nursing students seem to value statistically more stereotypically feminine values, which might also be accentuated by the fact that they chose a stereotypically feminine profession, possibly because it gave them the possibility to work by their values. On the contrary, male nursing students, although they choose a stereotypically feminine profession, are still valuing more than their female counterparts stereotypically masculine values. This is interesting because it could signify that males are drawn to nursing because it has good employments rates and, somehow, give them the possibility for self-enhancing. However, all the students regardless of their gender value more hetero-directed values, which might suggest that is common in people who choose nursing as a profession.

In our data, the year of study did not show any significant difference. In fact, values were ranked the same by students of first, second, and third year. The only difference was in standard deviation, which was higher for all the values in the first-year students, suggesting that there might be an uniformization process within the group through the years. This shows differences and similarities with the only previous study¹ who accounted for the difference of personal values in the different years of study in a nursing student sample. This study showed a slight decreased importance through the years of nursing school in some values such as financial and aesthetic. They used a different theoretical approach¹ and, in the Basic Human Value Theory,^13,35 values are considered to be relatively stable over time and a longitudinal study in a population of Italian young adults seems to support our findings.³⁹ Also in their sample the first ranked values in all the years of nursing school were social values that have their main feature, in this framework, on the altruistic love of people, helping others and selflessness.¹ These findings are coherent with our results. Hence, it is possible that incorporation of professional values, which should happen gradually during nursing school, does not radically change one’s personal value but adding to that it might soften diversities between the students. Interestingly, our students maintain high hetero-directed values, which might be coherent with the choice of the nursing profession.

Overall, we have to consider that these data were collected in an Italian setting and we know that personal values are embedded with cultural characteristics.³² Our findings are coherent with previous studies in the Italian population for values ranking, Universalism and Benevolence were the highest and Power the lowest ranked values in the whole population, regardless of gender and age.⁴⁰ Furthermore, women valued more Benevolence and Universalism, while men valued Stimulation, Hedonism, Power, and Success.⁴⁰ Finally, in the general population, younger people (20–30 years old) valued more Self-direction, Universalism, and Benevolence.⁴⁰

Limitations and strengths

This study has some limitations and some strengths. It is a cross-sectional, mono-country study, which could potentially hinder generalizability of results because of the effect culture has on values. However, we utilized a widely used, reliable, and cross-culturally validated instrument^25

–28 and recruited participants from eight different centers. Furthermore, although the Basic Human Values Theory³⁵ was used in several social and professional groups,^33,34,41,42 it was never used to describe values in nursing students. Thus, this study’s results could be useful also for cross-cultural or cross-professional future comparisons.

Conclusion

Personal values can act as barriers or facilitators for the acquisition of professional values in nursing students. Furthermore, they are linked with quality of care, job satisfaction, retention, patient satisfaction, decision making, communication, and critical thinking. Thus, nursing educators might want to assess personal values and consider them for guiding students in developing strong professional values. Interventions raising awareness for personal values might be developed. This could help nursing students reflect and address ethical concerns in all the situations in which their personal and professional values or personal and patients values conflict. Furthermore, we know from evidence-based practice that patients’ values are pivotal in decision making. Being aware of one’s personal values might help nursing students recognize and pay attention to patients’ values and, therefore, provide better nursing care.

Our results are a starting point for future research that could use a longitudinal approach to verify the stableness of values in the nursing student population and to measure personal and professional values together to verify the effect on the first to the latter. A longitudinal approach could also verify whether those expressing more Self-enhancement values will express leadership stiles differently to other students. Furthermore, future research could investigate whether there are some personal values that are more desirable or functional than others in the nursing profession, and whether personal values have an effect on the choice of the nursing profession. Future research should also take into account socio-economic and cultural variables, such as religious, political, and so on, as confounding factors and possibly use qualitative data to deepen our understanding of gender differences and in year of study. Finally, the revised version of the PVQ could be used to account for the advancements of the theory of basic human values.

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.

ORCID iDs

Michela Luciani

Giulia Rampoldi

Stefano Ardenghi

Maria Grazia Strepparava

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