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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 678-683
Care: The first priority of professional values from the perspective of Iranian


1 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Nursing and Midwifery Care Research Center, Health Adult Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
4 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Date of Web Publication21-Aug-2017
 

   Abstract 


Background: All nurses from nursing students to the highest levels are expected to act professionally according to professional values. The aim of this study was to evaluate professional values from the perspective of nursing students of School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Materials and Methods: In this cross-sectional survey, we investigated the professional values of the nursing profession among 366 Bachelor's degree nursing students selected through simple random sampling. A two-part questionnaire containing demographic features and the Nursing Professional Values Scale-Revised developed by Weis and Schank with 26 items in the Likert scale were used after translation and validation. Results: The mean total score of the students in this scale was 4.1. Considering the mean and SD of each domain of the scale, the participants gave a higher score to “caring” and a lower score to “activism.” Simple linear regression analysis showed a significant relationship between the score of professional values and age (regression coefficient = 0.023, P = 0.013), grade point average (regression coefficient = 0.080, P = 0.050), and semester (regression coefficient = −0.098, P = 0.001). Conclusions: The present study showed that environmental factors, modeling from other professionals, and overt and covert training affected the students' perspective of professional values.

Keywords: Iran, nursing, perspectives, professional values, students

How to cite this article:
Boozaripour M, Abbaszadeh A, Shahriari M, Hashiani AA, Borhani F. Care: The first priority of professional values from the perspective of Iranian. Ann Trop Med Public Health 2017;10:678-83

How to cite this URL:
Boozaripour M, Abbaszadeh A, Shahriari M, Hashiani AA, Borhani F. Care: The first priority of professional values from the perspective of Iranian. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Nov 15];10:678-83. Available from: http://www.atmph.org/text.asp?2017/10/3/678/213144



   Introduction Top


Nursing is a profession, in which decisions made by the nurse has a direct impact on the patient's life. On the other hand, similar to other countries, the work environment of the Iranian nurses is complicated more than ever due to factors such as workforce shortage, technological advances, care management, and patient variety.[1] This complexity has increased ethical challenges related to decision-making and caring.[2] To work in this situation, the nurses require ethical knowledge [3] and equalization of professional values in the work environment to seek help from these values when they face an ethical dilemma. If there is an ethical climate in hospitals and health centers, nurses execute their duties with more commitment.[1] In fact, the values act as a guide in the context of professional ethical codes for ethical decision-making. Values have a root in the person's beliefs which are themselves under the influence of the family, culture, society, religion, and ethnicity.[4] The development of professional values occurs gradually during a person's lifetime and forms through education and observation.[5] When people need to make a decision to undertake an action, their decisions are in fact a reflection of what they believe is good as a value. Therefore, it could be stated that values are action guides and the people's behavior indicates the values embedded in them.[2]

All nurses are expected to act professionally according to professional values with which all nurses should be familiarized. One of the main objectives of nursing education is to teach these values and the beliefs in cognitive, psychomotor, and emotional domains that are accepted in this profession to nursing students. These skills are modified and expanded through education and clinical and personal experience, and nursing instructors have a confirmed role in this regard.[6] Evaluation of professional values from the perspective of the students could provide useful information to design appropriate educational approaches in clinical education. Considering the above-mentioned and the importance of familiarization with and institutionalization and utilization of professional values, this study was conducted to evaluate professional values from the perspective of nursing students of School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Professional values are standards for action that are acceptable by experts and specialists and provide a framework for the evaluation of values and beliefs influencing human behaviors.[7] Integrated and purposeful teaching of nursing professional values is mandatory for guaranteeing a bright future in the nursing profession. This point has roots in the concept of care and becomes materialized through adopting value-based behaviors.[8] According to Weis and Schank, acquisition of the values is a principle in professionalism to have a common framework of expectations and standards.[9] Eddy developed the Professional Nursing Behavior Instrument for the assessment of professional values in 1989 for the first time [10] and used this tool to study the differences in professional values between nursing faculty members and students in 1994.[11] The results showed that faculty members acquired significantly higher scores of professional values as compared with students; the scores of experienced faculty members were also higher than the scores of their younger counterparts.[12] The nursing professional values (NPV) scale has 44 items and was developed according to the American Nursing Association Code of Ethics by Weis and Schank.[13] It has been used in several studies.[14],[15] This scale was revised in 2009 and reduced to 26 items.[9] This scale has been used to assess professional values in students and nurses.[2],[16]

In 2008, a research was conducted to assess the nurses' personal and professional values and their determinants in 323 nurses using the NPV revised (NPV-R). The results showed that human dignity, equality among patients, and prevention of suffering had the highest scores, whereas health promotion and nursing research had the lowest scores as professional values. As for personal values, honesty, responsibility, and intelligence received the highest, whereas ambition and imaging received the lowest scores. The authors reported significant differences (P < 0.05) among some personal and professional values in culture functions, education, professional seniority, position, and field of expertise.[4]

Since the future of nursing profession is in the hands of nursing students, it is important to evaluate their care management and clinical competency with regard to their perception of professional values. Because Tehran is the capital of Iran and many students from different parts of the country's study in Tehran universities and because maximum cultural variety is important for the assessment of professional values from the perspective of nursing students, the results of this study can be used to design appropriate strategies to use these values in nursing education. With regard to the previous studies in Iran, more research in this area is still necessary.


   Materials and Methods Top


The participants of this cross-sectional descriptive study were the nursing students of Faculty of Nursing and Midwifery of Shahid Beheshti University of Medical Sciences. A total of 366 samples entered the study through simple random sampling using their student ID number. Independent variables including age, sex, marital status, educational semester, student work experience, and grade point average (GPA) were assessed through a demographic questionnaire, and the dependent variable was professional values that were evaluated through the NPV scale (NPVS). The NPVS is a 26-item questionnaire covering five dimensions including caring (9 items: 16, 17, 18, 20, 21, 22, 23, 24, and 25), activism (5 items: 4, 10, 11, 19, and 26), trust (5 items: 1, 2, 9, 14, and 15), professionalism (4 items: 5, 6, 7, and 8), and justice (3 items: 3, 12, and 13) in a 5-point Likert scale from 1 (not important) to 5 (most important). The total score of the scale ranges from 26 to 130, and a higher score indicates more familiarity of the students with professional values. Kobra et al. confirmed the validity of the scale in 2012.[17] However, to re-assess its validity through the content validity method to ensure its appropriateness with regard to the objective of this study, the scale was translated into Persian. Then, the translated version along with its original version was given to ten experts, and the scale was modified according to their comments. After that, the scale was given to experts for final confirmation before using it in the study. Kobra et al. also reported a Cronbach's alpha of 0.91 for its reliability. To determine its reliability, we gave the scale to twenty students, and a Cronbach's alpha of 0.94 was obtained.

After receiving the required authorizations and approvals (ethics code: SBMU2.REC.1394.95), the researcher introduced herself to the students, explained the objectives of the study to them, obtained their informed consent, and asked them to complete the NPV-R scale in the same session within 20 min.

The results are presented as mean, standard deviation (SD), 95% confidence interval (CI), number, and percentage. Tables and figures are also used to depict the results. Data were analyzed with one-way ANOVA, simple linear logistic regression, and independent samples t-test using the STATA software version 13. P < 0.05 was considered statistically significant.


   Results Top


In this study, 239 students were female (66.02%) and 123 were male (33.98%). The mean age of the participants was 21.56 years (SD = 4.07, 95% CI: 21.13–21.98). Moreover, 320 students (89.39%) were single and 38 students (10.61) were married. Seventy-two students (20.22%) had a history of working in health centers. The GPA of the students was 15.93 (SD = 0.13).

The mean total score of the students in this scale was 4.1 (SD = 0.675, 95% CI: 4.02–4.17). Considering the mean and SD of each domain of the scale, the participants gave a higher score to “caring” and a lower score to “activism” [Table 1].
Table 1: The mean score of professional values and its domains in the nursing students of Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences

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[Table 2] shows the relationship between the score of professional values and demographic variables. The mean score of professional values had no significant difference between males and females (P = 0.220) and had no significant relationship with marital status (P = 0.715) and work experience in the health center (P = 0.611). The mean score of professional values was significantly higher in master's versus bachelor's degree students (4.06 ± 0.67 versus 4.57 ± 0.44, P = 0.002).
Table 2: Relationship between the score of professional values and demographic variables

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Simple linear regression analysis showed a significant relationship between the score of professional values and age (regression coefficient = 0.023, P = 0.013), GPA (regression coefficient = 0.080, P = 0.050), and semester (regression coefficient=−0.098, P = 0.001); in other words, the score of professional values increased by 0.023 with every 1-year increase in the students' age and by 0.080 with every 1-point increase in GPA. However, we found an inverse relationship between semester and the score of professional values in such a way that the score of professional values decreased by 0.098 with each 1-semester increase in education.

In this study, among 9 items related to the dimension of “caring,” the students gave the greatest importance to “maintenance of the confidentiality of the patients” and the least importance to “protection of the rights of participants in research;” 83.38% of the students believed that “maintenance of the confidentiality of the patients” was important or very important and 10.67% stated that “protection of the rights of participants in research” was unimportant or of low importance. The mean total score was 4.052 in this domain [Table 3].
Table 3: The mean and standard deviation of the students' responses to the domain of “caring”

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According to [Table 4], of five5 items related to “activism,” “advancement of the profession through active involvement in health-related activities” was an important or very important item according to most students (65.92%) and “participation in activities of professional nursing associations” was unimportant or of low importance according to 16.16% of the students. The mean total score of this domain was 3.709.
Table 4: Mean and standard deviation of the students' responses to the items of the domain of “activism”

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In the domain of “trust,” 75.91% of the students believed that “seeking additional education to update knowledge and skills” was important or very important and 23.48% of them stated that “engagement in ongoing self-evaluation” was unimportant or of low importance. The mean total score of this domain was 3.881 [Table 5].
Table 5: The mean and standard deviation of the students' responses to the items of the domain of “trust”

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Among four items related to “professionalism,” 74.93% of the students scored “initiation of actions to improve environments of practice” as important or very important and “participate in peer review” was unimportant or of low importance according to 11.17% of the students. The mean total score of this domain was 3.862 [Table 6].
Table 6: The mean and standard deviation of the students' responses to the items of the domain of “professionalism”

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According to [Table 7], among three items related to the domain of “justice,” “protection of the health and safety of the public” and “promotion of equitable access to nursing and health care” were the most and least important items from the perspective of the students, respectively. The mean total score of this domain was 4.013.
Table 7: The mean and standard deviation of the students' responses to the items of the domain of “justice”

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   Discussion Top


According to the participants of this study, the items related to the domain of “caring” were of the greatest importance whereas the items of the domain of “activism” received the lowest score. The results of some studies indicate that the values with direct application in a profession are usually regarded as important values in the value prioritization system of the people, and other values which may require more relationships and activities outside normal working hours have a low priority or are considered unimportant.[2],[18] This perspective may explain why “caring,” as the most famous and outstanding duty of the nursing profession, received the highest score among all domains of the scale. Other studies have also shown that the value of caring is of great importance from the students' perspective.[5],[19],[20] The result of a study by Kobra et al. in Tabriz, Iran, using the NPVS questionnaire in 56 nursing students in the last semester showed that “trust” and “activism” received the highest and lowest score, respectively.[17] Comparison of these two studies shows that “participation in activities of professional nursing associations” in our study and “participation in nursing research and/or implementation of research findings appropriate to practice” in the study by Parandeh et al. were of the lowest importance. The difference in the prioritization of the items of this domain may be related to the effect of personal, social, cultural, and educational factors [21] on professional values considering the difference in these factors between the two research environments. It seems that education and support from nursing managers and policymakers are effective in enhancing the rank of these values.

The domain of “trust” includes values related to activities performed to enhance clinical competence and consultation with other professionals to promote the quality of care. In our study, “trust” was the third priority among five professional values from the perspective of the students. Trust is a complex and multidimensional value that forms the nurse–patient relationship and affects the nurses' satisfaction with their organizational environment.[20] Snellman found that trust, nearness, sympathy, support, knowledge, and responsibility, with no hierarchical order, were important and comprised the main values of nursing.[22]

“Protection of the health and safety of the public” in the 4th rank, “assuming responsibility for meeting health needs of the culturally diverse population” in the 12th rank, and “promotion of equitable access to nursing and health care” in the 13th rank were the three items indicating the value of “justice” from the students' perspective as the fourth priority of professional values. In 2005, Alfred et al. compared professional values between Taiwanese and American nursing students and found that “protection of the health and safety of the public” ranked 7th, “promotion of equitable access to nursing and health care” ranked 16th, and “assuming responsibility for meeting health needs of the culturally diverse population” ranked 18th among 26 items.[23] Lack of cultural competency was considered one of the primary factors in health service inequities in 2010.[24] Cultural competency includes a set of appropriate knowledge, attitudes, and behaviors that exist together in a system or institution and among professions and enables the person to work effectively in different cultural situations.[25] In other words, the capacity and ability of working effectively, as a professional or organization, depend on the cultural beliefs, behaviors, and needs of the clients and the society.[26] Since nursing is a profession with a high probability of exposure to people with diverse cultural and health beliefs, it is important to enhance the related values in nursing students, and nursing instructors and professors should give necessary education regarding cultural differences to their students.

The domain of “professionalism” with items such as “participation in peer review,” “establishment of standards as a guide for practice,” “promotion and maintenance of standards where planned learning activities for students take place,” and “initiation of actions to improve environments of practice” was the fourth priority among professional values in this study. The importance of attention to clinical environments to develop readiness and acquire the necessary skills in the curriculum of some professions such as nursing has been long recognized. The experiences acquired in these environments are vital for nursing students, especially novice students.[27] In a study that evaluated the characteristics of a clinical environment from the perspective of first-semester nursing students, satisfaction with clinical education was found to be less than expected. According to this study, promotion of clinical education through hiring skilled tutors, provision of clinical facilities and equipment, and participation of nursing students in decisions related to their clinical training seems necessary.[28]

In our study, the score of professional values had a significant correlation with age, GPA, and semester; the score of professional values increased by 0.023 with every 1-year increase in the students' age and by 0.080 with every 1-point increase in GPA. However, there was an inverse relationship between semester and the score of professional values in such a way that the score of professional values decreased by 0.098 with each 1-semester increase in education. Kobra et al. also reported an inverse relationship between age and the score of professional values [17] whereas this relationship was positive in a study by Hayes.[29] Promotion of professional values is an important aspect of nursing education.

The process of socialization in nursing education includes modification of personal values and internalization of nursing values.[2] To achieve and internalize professional values for socialization, nursing students should learn the required skills and knowledge in cognitive, psychomotor, and emotional domains.[30] These skills will be modified and expanded through education and personal and clinical experience. It seems that age and some factors such as work experience and the experience in nursing clinical activities, environmental factors, workload of the department or ward, and amount of leisure time affect the person's perspective of professional values.


   Conclusions Top


Overall, it can be concluded that environmental factors, modeling from other professionals, and overt and covert training affect the students' perspective of professional values. The students' understanding of nursing and its roles and professional values is different based on their personal characteristics, values, and preferences. In addition, the students' talent and interest play an important role in their selection of certain aspects of nursing and affect their understanding of professional values. The students' interest in understanding the nursing profession and its values has positive effects on their ultimate goal of education and their expectations of the ideal roles and values of nursing.

The caring environment requires professional nurses that can manage complex ethical dilemmas. It is very important that faculties and students be aware of the significance of professional values in the management of patient care according to professional and ethical methods.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Fariba Borhani
Department of Medical Surgical Nursing, School of Nursing and Midwifery, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_230_17

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