Fundamentals of Nursing and Midwifery 2e

Unit II Foundations of nursing and midwifery practice

194

• Value statement 4 : Nurses value access to quality nursing and healthcare for all people. The focus is on awareness of equitable provision of services without discrimination. • Value statement 5 : Nurses value informed decision making. The focus is on the provision of accurate and complete information to consumers, as well as an understanding of the potential impact of ill-health on the individual’s capacity for self-determination. • Value statement 6 : Nurses value a culture of safety in nursing and healthcare. The focus is on risk management and responsibility for reduction of adverse events. • Value statement 7 : Nurses value ethical management of information. The focus is on appropriate and accurate documentation and confidentiality of health information. • Value statement 8 : Nurses value a socially, economically and ecologically sustainable environment promoting health and well-being. The focus is on the nurse’s responsibilities in relation to environmental health issues. The New Zealand Nurses Organisation also has a Code of Ethics (NZNO, 2010), written for nurses who practise in a constantly changing multicultural society. The underlying philosophy of the code is that caring as a nurse requires involvement of self in a real concern for the well-being of another. Caring is an experience that cannot be measured, and the complexities of caring as a nurse defy a neat defini- tion (Johnstone, 2009). The code is based on three assumptions that inform nursing, and on the recognition that nursing takes place in unique relationships with individuals, colleagues, society and organisations: • Assumption 1 : Relationships and interactions take place in a respectful manner. This value is enacted within the concept of cultural safety. Relationships include those between the nurse and colleagues, patients, organisations and society. • Assumption 2 : Respect for the individual encompasses the principles of partnership and collaboration, where the patient/group/community participates actively in the process of nursing. The principle here is that the nurse values the contribution of the client/group/community. • Assumption 3 : Relationships and interactions have the purpose of achieving a positive outcome for the patient/group/community. This value relates to the overarching aim of nursing caring. The framework for the Code of Ethics highlights the underlying ethical values of: autonomy, beneficence, non- maleficence, justice, confidentiality, veracity, fidelity, guardianship of the environments and its resources, and being professional. The code individually relates these underlying values to the relationships a nurse has with the four groups of individuals, colleagues, society and organisations. The code was developed from different ethnic, cultural, employment and practice settings and included Ma – ori, New Zealand European, Samoan, Tongan, Nieuean, Chinese, Korean, Filipino and European people. Incorporated in this code is the concept of cultural safety (Ma – ori translation is

that includes a measure of self-sacrifice, restraint and post- ponement of immediate gratification needs. Common modes of value transmission include: • Modelling : Children learn to value certain behaviours and attitudes by observing parents, peers and significant others. Thus, modelling may lead to socially acceptable or unacceptable behaviours. • Moralising : Children whose carers use the moralising mode of value transmission are taught a complete value system by parents or an institution such as their church or school that allows little opportunity for them to weigh different values. • Laissez-faire: Those who use the laissez-faire approach to value transmission leave children to explore values on their own (no one set of values is presented as best for all) and to develop a personal value system. This approach often involves little or no guidance and can lead to confusion and conflict. • Rewarding and punishing: Through rewarding and punishing, children are rewarded for demonstrating values held by parents and punished for demonstrating values that are deemed unacceptable. • Responsible choice: Finally, carers who follow the responsible-choice mode of value transmission encourage children to explore competing values and to weigh their consequences. Support and guidance are offered as children develop a personal value system. Professional values Professional values provide the foundation for nursing and midwifery practice as distinct caring-healing professions, and guide clinicians’ interactions with patients, clients, col- leagues and the public. These values include compassion, competence, confidence, respect for self and others, relation- ships and connections, responsibility and commitment . While these may describe personal values held by individual nurses and midwives, they are primarily the values that are attributed to the nursing and midwifery role, which requires leadership, advocacy and accountability at many levels. The Australian Nursing and Midwifery Council’s Code of Ethics for Nurses presents six broad value statements as a point of reference against which nurses are encouraged to measure and critique their own practice (ANMC, 2008a). These statements, which represent a decision-making framework for determining the best course of action in the face of conflicting alternatives, are set out below: • Value statement 1 : Nurses value quality nursing care for all people. The focus is on quality and accountability in terms of maintaining professional competence. • Value statement 2 : Nurses value respect and kindness for self and others. The focus is on the importance of appropriate professional boundaries in caring relationships. • Value statement 3 : Nurses value the diversity of people. The focus is on human diversity in contemporary society; respect for individual needs, beliefs and values; and awareness of the impact this has on caring relationships.