FON: YOOST: Chapter 2 " Values, Beliefs, and Caring

Active listening:

Is a specific communication technique in which one fully concentrates on what the other is saying in a conscious effort to fully understand the other.

beliefs:

A mental representation of reality or a person's perceptions about what is right, true, or real or what the person expects to happen in a given situation.

caring:

Having concern or regard for that which affects the welfare of another.

compassion:

The force that impels and empowers one to recognize, acknowledge, and act to alleviate human suffering.

compassion fatigue:

An extreme state of distress experienced as the progressive and cumulative result of exposure to stress in the therapeutic use of self in caring for others.

generalization:

Broad statements or ideas about people or things.

Nursing presence:

Is defined as the shared perception of human connectedness between a nurse and a patient.

paradigm:

Is a worldview that gradually changes to one based on a body of knowledge that focuses on scientific principles and may dismiss other explanations for the presence of disease or illness.

Patient-centered care:

Is care that is defined as "providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions" IOM 2006

prejudice:

A preformed opinion, usually an unfavorable one, about an entire group of people that is based on insufficient knowledge, irrational feelings, or inaccurate stereotypes.

stereotype:

An idea about a person, a group, or an event that is thought to be typical of all others in that category.

values:

Enduring ideas about what a person considers is good, best, and the right thing to do—and the bad, worst, and wrong thing to do—and about what is desirable or has worth in life.

values clarification:

A process used to help individuals reflect on, clarify, and prioritize personal values to increase self-awareness or to make decisions.

values conflict:

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.

First-order beliefs Purposes:

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1. Provide basic information about what is real or true

2. Indicate what a person expects on the basis of information shared or obtained from others

3. Are the foundation for the formation of all other beliefs

First-order beliefs are derived from:

1. Life experiences

2. Respected authorities

3. Parents or caregivers

4. Culture

5. Ethnicity

6. Education

7. Religion

8. Spirituality

First-order beliefs examples are:

1. Most nurses are female.

2. Anyone, regardless of gender, can become a nurse.

Higher-order belief purposes are:

Categorize or bring order to a multitude of ideas

Higher-order beliefs are derived from:

Assumptions based on first-order beliefs

Inductive reasoning

Deductive reasoning

Higher-order belief examples:

Generalization: All nurses wear white uniforms.

Stereotype: Nurses are more caring than other adults.

Prejudice: Women are better nurses than men.

The purpose of values:

1. Establish the foundation of self-concept

2. Indicate a person's judgments of ideas, objects, or behavior.

3. Provide a framework for decision making

4. Guide life decisions on the basis of what a person views as most important

Values are derived from:

1. Personal experiences

2. Family of origin

3. Spirituality

4. Religious beliefs

5. Cultural/ethnic background

6. Education

7. Professional development

Examples of values are:

1. Professional nursing values include advocacy, altruism, collaboration, compassion, confidentiality, integrity, fidelity, responsibility, social justice, courage, autonomy.

2. Others include respect for human dignity, professionalism, caring, equality, freedom, justice, safety, and accuracy

Describe the differences between beliefs and values and how they develop:

Beliefs are mental representations of reality, or what a person thinks is real or true; values are enduring beliefs that help the person decide what is right and wrong and determine what goals to strive for and what personal qualities to develop.

Beliefs and values are developed through:

personal experiences, family influences, culture, ethnic background, spirituality, religion, and education.

Collecting information on patient values during the interview and assessment process is:

essential to providing patient-centered care.

Nurses need to understand how beliefs and values are different. A nurse begins to offer information to a patient and the patient says, "I've already heard all of that before and I don't agree with any of it." How should the nurse proceed?

A. Ask the patient to explain his values.

B. Ask the patient to explain what he believes.

C. Ask the patient about his prejudicial attitude.

D. Confront the patient about the values conflict he's experiencing.

B. Ask the patient to explain what he believes.

EXPLANATION: The purpose of the question is contained in the stem, to determine whether the student can distinguish between a belief and a value. By asking the patient to explain what he or she believes, the nurse is asking an open-ended question to find out what part of what the nurse is saying the patient believes and what part he or she does not believe. Asking the patient to explain his or her values is incorrect because there is no mention in the stem about the patient saying his or her values are different from what the nurse is trying to say. Asking the patient about his or her prejudicial attitude is incorrect because there is nothing in the stem that indicates a prejudicial attitude. Confronting the patient about the values conflict he or she is experiencing is incorrect because there is nothing in the stem that indicates the patient is experiencing a values conflict. He or she simply does not believe the same thing the nurse believes.

Explain the use of the values clarification process in dealing with a values conflict:

1. The nurse needs to recognize when a values conflict exists and seek ways to identify the underlying factors causing the concern.

2. A values clarification tool can be used to help patients examine past life experiences and consider where they spend their time, energy, and money to provide insight into what they truly value and believe.

3. Values clarification can help nurses become more aware of their own personal values and beliefs that impact professional nursing practice.

The nurse needs to recognize when a values conflict exists and:

seek ways to identify the underlying factors causing the concern.

A values clarification tool can be used to help patients examine:

past life experiences and consider where they spend their time, energy, and money to provide insight into what they truly value and believe.

Values clarification can help nurses become:

more aware of their own personal values and beliefs that impact professional nursing practice.

Which statement best describes for new parents how and when children develop first-order beliefs?

A. During infancy, and once developed, such beliefs seldom change

B. From life experiences during the toddler and preschool years

C. Throughout life from first-hand experiences and information provided by authority figures

D. From teen and young-adult peer interaction and mentorship of professional role models

C. Throughout life from first-hand experiences and information provided by authority figures

EXPLANATION: Individuals develop first-order beliefs beginning in childhood and continue to acquire them throughout life from first-hand experiences and what they are told by various authority figures. Therefore, first-order beliefs are acquired throughout life and not just in infancy, the first years of life, or adolescence. They form as the result of life experiences and from information provided by people perceived as having authority.

List five concerns related to beliefs and values that nurses should consider immediately when caring for a patient of a culture different from their own.

When caring for a patient from a different culture, although many could be listed, five concerns that always should be taken into consideration are the patient's

1. ability to comprehend language

2. possible need for care from a nurse of the same gender

3. preference to have a family member present

4. potential need to have others involved in health care decisions

5. past experiences in the healthcare environment.

When caring for a patient from a different culture, although many could be listed, five concerns that always should be taken into consideration are the patient's:

1. ability to comprehend language

2. possible need for care from a nurse of the same gender

3. preference to have a family member present

4. potential need to have others involved in health care decisions

5. past experiences in the healthcare environment.

Summarize how the beliefs of nurses and patients influence health care:

The beliefs of both nurses and patients influence how patients are treated, what patients listen to and act upon, and patient outcomes.

As the nurse explained the preoperative instructions to the patient, the patient's older brother suddenly stepped into the doorway and yelled, "People who go under the knife always die. Don't do it! They're going to kill you." What type of higher-order belief is the patient's older brother displaying?

A. Distress

B. Stereotype

C. Prejudice

D. Denial

B. Stereotype

EXPLANATION: The patient's brother is making a generalization that is a stereotype, which is a belief about a person, group, or an event that is thought to be typical of all others in that group. Although it is true that people occasionally die during surgery, it does not always happen as the brother fears. Distress is incorrect; the male is distressed, but distress is not a higher-order belief. Prejudice is incorrect because a prejudicial belief is a preformed opinion, usually an unfavorable one, about an entire group of people based on insufficient knowledge. Denial is wrong because he is not in denial, which is defined as a behavior of refusing to admit something is true.

After admitting a homeless patient to the floor, the nurse tells a colleague that "homeless people are too dumb to understand instructions." What action should the colleague take first?

A. Ignore the nurse's prejudicial comment without responding

B. Offer to trade assignments and care for the homeless patient

C. Ask the nurse about the patient's personal history assessment data

D. Challenge the nurse's thinking, pointing out the ability of all people

C. Ask the nurse about the patient's personal history assessment data.

EXPLANATION: The colleague should first ask the nurse to share information about the patient's background. This should encourage the nurse to consider the feelings and values of the patient and hopefully help the nurse to view the patient as a total individual. Ignoring the statement, offering to change assignments, or challenging the nurse's statement does not promote an enhanced nurse-patient relationship and may prevent the nurse from professional growth or make the nurse defensive.

The nurse in the emergency department is caring for an 8-year-old who has had a serious asthma attack. When the nurse attempts to explain the problem to the child's mother, she smells cigarette smoke on the mother's breath. The nurse asks the mother if she has been smoking and the mother responds, "Yes, and I know they've told me before I can't smoke around him." What should the nurse do next?

A. Ask the patient's mother what she values more, her child or her habit.

B. Ask the patient's mother to explain what she believes about smoking and asthma.

C. Ask the patient's mother about her prejudicial attitude toward smoking.

D. Confront the patient's mother about the values conflict she's experiencing.

B. Ask the patient's mother to explain what she believes about smoking and asthma.

EXPLANATION: The nurse should begin by asking the mother what she believes because the nurse does not know at this point.

1. When working with a patient who has an addiction, the nurse should begin at the assessment phase of the nursing process and attempt to build a trusting relationship with the patient.

2. Asking the mother what she values more, her child or her habit, is incorrect because the issue is not about the mother's values but about what she knows and what she believes.

3. Asking the mother about her prejudicial attitude toward smoking is incorrect because there is nothing in the stem to indicate the mother is prejudiced toward or against smoking.

4. Confronting the mother about the values conflict she is experiencing is incorrect because there is nothing in the question to indicate the mother is having a values conflict.

5. She may not believe what the health care professionals are telling her or she may not believe that she can quit smoking. She may need to be convinced that she can do it, and the best way to make that happen is to build a trusting relationship with her rather than alienate her with accusatory remarks.

A nurse is working with a 35-year-old patient who needs to decide whether to donate a kidney to his brother who has been in renal failure for 5 years. The patient shares with the nurse that the decision is especially difficult because he would not be able to continue to work in his current profession and would be unable to support his three small children if he ever needed dialysis. Which intervention(s) would be most appropriate for the nurse to implement in this situation? (Select all that apply.)

A. Explain that it is unlikely that he will ever need dialysis even if he has only one kidney.

B. Guide the patient through a values clarification process to help him make a decision based on his values.

C. Provide information the patient needs to help him make an informed decision.

D. Ask for his permission to contact the kidney donation team to answer any questions he may have.

B. Guide the patient through a values clarification process to help him make a decision based on his values.

C. Provide information the patient needs to help him make an informed decision.

D. Ask for his permission to contact the kidney donation team to answer any questions he may have.

EXPLANATION: Encouraging the patient to make a decision based on his personal values, providing necessary information, and offering consultation with individuals most familiar with the kidney donation process are all excellent interventions. It would be impossible to predict whether a patient will need dialysis in the future, making this type of statement misleading.

Safe Practice Alert/Nurses must collaborate effectively with patients to find treatment methods:

that are congruent with the patient's' belief systems and that promote healthy outcomes. 1. requires excellent assessment skills

2. willingness to listen carefully to determine how patients' personal beliefs impact their health beliefs

Failure to consider the patient's belief systems may result in:

ineffective implementation of the plan of care.

Identified four integral facets of interprofessional patient-centered care:

1. Patient needs to be a member of the team

2. Provision of support needs to be consistent with the patient's experience and level of involvement

3. Respectful care reflects patient's values and goals not those imposed by the health care professional

4. Collaboration among all members of the team needs to occur consistently and regularly

Madeline Leininger is considered the:

founder of transcultural nursing and developed an ethnonursing method of research used by many nurse scientists

Leininger's Theory of Cultural Care Diversity and Universality is based on several beliefs including but not limited to the following assumptions:

1. care is a central unifying focus of nursing

2. a cure cannot occur without caring

3. culture is embedded in all aspects of one's being

4. culturally congruent care promotes health and well-being

Watson's Theory of Human Caring:

The Theory of Human Caring was derived through Jean Watson's exploration of her own beliefs, values, and experiences regarding personhood, nursing, medicine, health, and healing

Watson's Ten Caritas Processes:

1. Practicing loving-kindness and equanimity within context of caring consciousness.

2. Being authentically present and enabling, and sustaining the deep belief system and subjective life world of self and one-being cared for.

3. Cultivating one's own spiritual practices and transpersonal self, going beyond ego self.

4. Developing and sustaining a helping-trusting, authentic caring relationship.

5. Being present to and supportive of the expression of positive and negative feelings.

6. Creatively using self and all ways of knowing as part of the caring process; engaging in artistry of caring-healing practices.

7. Engaging in genuine teaching-learning experience that attends to wholeness and meaning, attempting to stay within other's frame of reference.

8. Creating healing environment at all levels, whereby wholeness, beauty, comfort, dignity, and peace are potentiated.

9. Assisting with basic needs, with an intentional caring consciousness, administering "human care essentials," which potentiate alignment of mind-body-spirit, wholeness in all aspects of care.

10. Opening and attending to mysterious dimensions of one's life-death; soul care for self and the one-being-cared for; "allowing and being open to miracles."

Discuss caring and four nursing theories with the concept of caring as their primary focus:

Caring is having concern or regard for another and can be conceptualized as a human trait, a moral imperative, an affect, the nurse-patient interpersonal relationship, and a therapeutic intervention.

Leininger's Cultural Care Theory states that:

culturally based nursing actions are intended to preserve, accommodate, or reconstruct the patient's meaningful health or life patterns

Watson's Theory of Human Caring is a:

holistic model of care in which the nurse's focus is on ten carative factors or processes.

Swanson's Theory of Caring focuses on:

five processes of relationship-based caring for the nurse: maintaining belief, knowing, being with, doing for, and enabling the patient.

Boykin and Schoenhofer's Theory of Nursing as Caring focuses on:

persons living caring and growing in caring with the nursing situation.

Swanson's Five Caring Processes With Subdimensions/ KNOWING:

Avoiding assumptions

Centering on the one cared for

Assessing thoroughly

Seeking cues

Engaging the self of bot

Swanson's Five Caring Processes With Subdimensions/ BEING WITH:

Being there

Conveying ability

Sharing feelings

Not burdening

Swanson's Five Caring Processes With Subdimensions/ DOING FOR:

Comforting

Anticipating

Performing competently/skillfully

Protecting

Preserving dignity

Swanson's Five Caring Processes With Subdimensions/ ENABLING:

Informing/explaining

Supporting/allowing

Focusing

Generating alternatives/thinking it through

Validating/giving feedback

Swanson's Five Caring Processes With Subdimensions/MAINTAINING BELIEF:

Believing in/holding in esteem

Maintaining a hope-filled attitude

Offering realistic optimism

"Going the distance"