essay on nursing values

Top 25 Professional Nursing Values + Why They're Important

If you are a nurse seeking to find ways to boost your career and your relationships, the best way to start is by developing strong professional nursing values. Maybe you are wondering, “What are the top professional nursing values?” or “How do I learn about professional nursing values?” If that sounds like you, this article is for you. As you continue reading, you will find 25 top professional nursing values and why they are important to successful nursing.

What Exactly Are Professional Nursing Values?

7 main reasons why professional values are important in nursing, what are the top professional nursing values, 1. trustworthiness, what is it:, why is it important in nursing:, 2. accountability, 3. compassion, 4. integrity, 5. value diversity, 6. curiosity, 7. autonomy, 8. positive self-esteem, 10. professionalism, 11. desire for excellence, 12. altruism, 13. ingenuity, 14. respect for human dignity, 15. ethical, 16. advocacy, 17. precision, 18. loyalty, 19. cultural humility, 20. dedicated to learning, 21. selflessness, 22. supports social justice, 23. sympathy, 24. professional competency, 25. commitment to nursing, my final thoughts.

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Nursing Values in Nursing

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Published: Mar 13, 2024

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• Iran J Nurs Midwifery Res
• v.18(1); Jan-Feb 2013

Nursing ethical values and definitions: A literature review

Mohsen shahriari.

Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Eesa Mohammadi

1 Department of Nursing, Medical Sciences Faculty, Tarbiat Modares University, Bridge Nasr (Gisha), Tehran, Iran

Abbas Abbaszadeh

2 Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Masoud Bahrami

3 Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Background:

Ethical values offer a framework for behavior assessment, and nursing values influence nurses’ goals, strategies, and actions. A literature review was adopted in order to determine and define ethical values for nurses.

Materials and Methods:

This literature review was conducted based on the Centre for Reviews and Dissemination guidelines. The key words used to search relevant sources were nursing, ethics, ethical values, and nursing values. The search of articles in English was carried out in Medline, CINAHL, PubMed, Scopus, Ovid, and Proquest databases. The search of articles in Persian was conducted in databases of Magiran, SID, and Irandoc publications. After assessing and analyzing the obtained data, 17 articles which had a distinct definition of ethical values were chosen and subjected to a thorough study.

The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.

Conclusions:

This study showed that common ethical values are generally shared within the global community. However, in several areas, influences of social, cultural, and economical status and religious beliefs on values result in a different definition of these values. This study revealed that based on humanistic nature of nursing, common values in nursing protect human dignity and respect to the patients. Recognizing and definition of ethical values can help to improve nursing practice and develop codes of ethics.

I NTRODUCTION

Nurses as one of the health service providers and members in health system who are responsible for giving care to the clients and patients based on ethical issues.[ 1 ] They need ethical knowledge to conduct their appropriate function to manage situations and to give safe and proper legal and ethical care in today's changing world.[ 2 ] With regard to practical care, they always try to answer the question of “What can I do?,” whereas they should try to answer what is essential to be done for the patients in the context of ethical principles.[ 3 ] Ethics seek the best way of taking care of the patients as well as the best nursing function.[ 4 ]

Nurses are responsible for their clinical function, and their main responsibility is to take care of the clients and patients who deserve appropriate and safe care.[ 5 ] They act based on the values they have selected. These values form a framework to evaluate their activities influencing their goals, strategies, and function.[ 6 ] These values can also be counted as a resource for nurses’ conduct toward clinical ethical competency and their confrontation with contemporary ethical concerns. Values conduct human life priorities and form the world we live in. They act as one of the most basic parts of human life. Ethical values are inseparable components of the society and, as a result, nursing profession.[ 7 , 8 ]

Discovery of basic values and reaching an agreement on clinical ethical values are essential with regard to constant changes in nurses’ social class and role.[ 9 ] Nurses’ awareness of their values and the effect of these values on their behavior is a core part of humanistic nursing care.[ 10 ] They need to tailor their function to the value system and cultural beliefs of their service recipients.[ 11 ] Values originate from cultural environment, social groups, religion, lived experiences, and the past. Social, cultural, religious, political, and economic considerations influence individuals and their value system,[ 6 ] and ultimately, health, education, social strategies, and patients’ care. Numerous documents have been prepared in nursing texts and literature concerning these values and clarification of their traits.[ 7 , 9 , 12 , 13 , 14 , 15 , 16 ]

Recognition and definition of nursing ethical values in various communities can help nurses have mutual understanding in international level. It can also bring nurses closer to reach a common meaning of care in patients with different cultures. However, there is a paucity of research particularly in the Iranian context to deeply explore nursing ethical values. Therefore, in the first step, the main aim of the study was to identify and explore nursing ethical values reflected in nursing texts. This search was then used to prepare code of ethics and clinical guidelines for Iranian nurses, along with other documents and evidences. Results of other aspects of the study have been reported in other articles from the researchers.

M ATERIALS AND M ETHODS

This study is a part of a bigger study conducted in the Isfahan University of Medical Sciences. A literature review was carried out in 2010 to determine ethical values and related definitions in nursing systems of various countries.

In this literature review, the York University four-step approach was applied. These steps are as follows: Forming questions and determining search strategies, extracting synthesis, providing quality assessments and applying study evaluation tools, and suggesting methods to analyze and data synthesis.[ 17 ]

Search strategy

The study tried to answer the following questions:

• What nursing ethical values are determined and offered in this study?
• What is the definition of each value?

In this literature review, all published articles in English language from 1995 to 2010, as well as articles in Persian from 1996 to 2010 were searched by separated keywords and then keywords in combination, respectively. AND/OR was used combination and collection of various key words together. A manual search was also adopted and the references of the articles were studied as well. The search yielded about 82 articles whose titles and abstracts were studied. The articles not meeting the inclusion criteria were left out. Inclusion criteria were: Articles published in English or Persian and those articles on nursing ethical values in patients’ care. At this stage, 37 articles were excluded and 45 were selected and comprehensively reviewed. In the next stage, the articles were completely studied with regard to inclusion criteria and their answers to the questions of the present study.

Finally, 17 related articles were selected and considered for the study. Data were extracted through firstly writing down the detected values and their definitions in the related articles. Then, the research team compared the findings and recorded them in a table, and selected the best definition of each value among the suggested definitions. Finally, after comparison of the names and words, a unique definition for each value was achieved based on the trait of definition.

Research team checked all selected articles concerning assessment of quality based on criteria of study quality evaluation tool. This tool was designed by the research team with regard to the study goal. Two questions were considered with respect to the various research methods employed in the selected articles. The questions were as follows:

• Does the article express nursing ethical values?
• Does the article contain a clear and specific definition for the expressed ethical values?

In order to increase study credibility, the abstracts were studied by researchers individually and the obscure points were discussed by the research team. In case of a disagreement to include an article in the study, a third member of the research team conducted further investigations, the obscure points were discussed in the group, and a final decision was made.

In the stage of data combination, all textual obtained data from the selected articles were classified and completely described. After textual data had been extracted and studied critically, the traits were separated and finalized based on the obtained definition for each value or ethical concept and finally a unique definition was obtained. Each obtained defined value has been explained in the section “Discussion.” These defined values suggested appropriate answers to literature review questions.

Articles methodological traits

The articles were from 12 countries: Four from US, two from Canada, five from European countries (Belgium, England, Finland), and six from Asian countries (Iran, Japan, China, Thailand, and Taiwan).

Reviewed articles included two quantitative studies, eight qualitative studies, three literature reviews, two philosophical inquiries, and two action research philosophical methods. Various sampling methods had been precisely employed in these studies. 1360 subjects comprised the recruited subjects in these 17 articles. In two quantitative descriptive studies, 922 clinical nurses and nursing students had been randomly selected through census sampling. In qualitative researches, the participants comprised 438, randomly selected through purposive sampling. The number of participants ranged between 20 and 300 individuals. In most of these qualitative studies, the participants included clinical nurses accompanied by nurse educators.[ 9 , 18 , 19 , 20 ] In one study, the participants were just clinical nurses, and in another,[ 21 ] they were just nursing students.[ 22 ]

The data were mostly collected through individual interviews which were, in some cases, the only source of data and in some other cases accompanied by other methods. The data had been collected by different methods: One by individual interviews and group discussion,[ 20 ] one by individual interview and observation,[ 18 ] one by narration and individual interview,[ 19 ] one by group discussion and narration,[ 22 ] and finally, in only one by group discussion.[ 9 ] In two studies, data had been collected through literature content analysis;[ 10 , 13 ] in two, by applying intervention;[ 16 , 23 ] in two other, through literature review;[ 7 , 24 ] and finally, in two studies, the data had been collected through philosophical inquiries.[ 6 , 25 ]

In two quantitative studies adopted to collect data, standard tools had been employed. In the study of Weis (2000), Nurses’ Professional Values Scale (NPVS) with confirmed reliability and validity had been utilized.[ 26 ] Rassin (2008) used nursing code of ethics related to International Nursing Association to evaluate nurses’ professional values as well as the Rokeach Values Survey with confirmed reliability and content validity to assess nurses’ personal values.[ 15 ]

Quality appraisal

The selected articles were reviewed concerning their quality. Application of a systematic literature scientific method in the present literature review study let the research review the articles based on research questions, research project, data collection method, data analysis method, data credibility, ethical considerations, and the results.

In quantitative studies reviewed, standard questionnaires had been adopted for data collection, data analysis method had been clearly defined, and the necessary permissions had been obtained from university and other needed institutes to respect ethical considerations. The results were also in the direction of research questions.

In qualitative studies, research methodology and data analysis had been clearly stated, and participants’ consents had been obtained to respect ethical considerations. Various methods had been employed for credibility: Data collection from various methods,[ 19 , 20 , 22 ] precise transcription, and data recheck and conformability with participants and colleagues.[ 18 , 19 , 20 ]

Data analysis methods of the studies, conducted based on philosophical research methodology and action research, had not been clearly mentioned, but their results were related.

General traits of reviewed studies

General traits of reviewed studies in the context of nursing ethical values have been presented in Table 1 . The reviewed articles had investigated nurses’ ethical values from different aspects.

Outline of studies included in the review

In various studies, the values had been differently introduced and defined. Most of the reviewed articles had focused on common nursing ethical values.[ 22 ] In some, several values and in some other, only one value had been introduced and defined. Konishi (2009) had only studied the value of harmony in nursing and had suggested that as one of the most fundamental values in Japan.[ 13 ] Verpeet (2003) had defined values as nurses’ responsibility against their patients, profession, other health team members, and society.[ 10 ] Naden (2004) in his study to define components of human dignity indicated braveness, responsibility, respect, commitment, and ethical desires.[ 18 ] Wros (2004) reported a significant difference in ethical value of decision making among the nurses in two countries.[ 19 ] Trailer (2004) claims that respect to the patients has the highest priority among codes of ethics and acts as a basic value to design the nursing ethical codes which include three main elements of respect, reliability, and mutuality.[ 25 ]

Shih (2009) reported that 75% of the participants had indicated taking care of the patients and their related individuals and altruism as the most common nursing values. Other values in his study were provision of holistic professional and appropriate care, promotion of personal and professional competency, disease prevention, health promotion, promotion of interpersonal communication skills, and receiving fair reward.[ 9 ]

Weis (2000), through factor analysis, introduced eight factors for professional values of which the most important one was nurses’ role in care and dimension of commitment.[ 26 ] Pang (2009) stated nursing professional values in seven themes of altruism, care, respecting the dignity, trust, accountability, independency, and justice.[ 20 ] Mahmoodi (2008) indicated responsibility, having mental and emotional communication, value, and ethics criteria such as honesty in work, mutual respect, religious margins and confidentiality, justice and fairness.[ 21 ] Shaw (2008) and Fahrenwald (2005) in our studies, in a different way, investigated application of five nursing professional values in nursing education, including altruism, independency, respect to dignity, nursing interventions’ integrity, and social justice.[ 16 , 23 ] Horton (2007) stated that personal and organizational values have effects on nursing and introduced values such as responsibility, honesty, patients’ participation, integrity and humanity protection, patients’ independency, deep humanistic relationship, dignity, hope, passion, teamwork, differentiation, versatility, altruism, nurturing, integrity and support, reciprocal trust, sound knowledge, clinical competence, communications, unity, homogeneity, coordination, self-sacrifice and devotion, self-protection, privacy preservation, creativity, aesthetics, management, economizing, braveness, commitment, ethical attitude, personal orientation, judgment, freedom, individualism, acknowledgment, and personal success.[ 7 ] Two studies had stated detection of ethical values as the basis for collection of codes of ethics.[ 24 , 27 ]

D ISCUSSION

In all of the articles studied in the present literature review, patients’ dignity and respect had been stated as the most frequent value indicated in 12 articles, equality and justice in 8 articles, and altruism and precise care and making appropriate relationships were indicated in 6 articles, respectively.

Comparison and finalization of the obtained data concerning nursing ethical values in patients’ care yielded 10 values mostly indicated in the articles: Human dignity, altruism, social justice, autonomy in decision making, precision and accuracy in caring, responsibility, human relationship, individual and professional competency, sympathy, and trust. The 10 obtained values in this literature review and their definitional traits are presented subsequently.

Human dignity

Respecting human dignity was the most common value indicated in the reviewed articles. Respect to individuals including the persons, their families, and the society has been mentioned as an important nursing ethical value. Dignity respect has been defined with definitional traits as consideration of human innate values, respecting patient's beliefs and preservation of their dignity and privacy during clinical procedures, and communication with the patients, and contains understanding the patients and devoting to fulfill clients’ needs.[ 15 , 16 , 18 , 20 , 22 , 23 , 24 , 27 ] Pang (2009) argues that nurses should accept that people deserve respect and dignity in action. They should practically cover patients’ body parts if exposed and keep patients’ secrets confidential.[ 20 ]

This value has been suggested in most of the articles possibly as a result of humanistic nature of nursing profession in helping others. This value had been emphasized in all articles of Asian countries, reflecting cultural similarities in these countries. This value has also been indicated in most of the codes of ethics in various countries all over the world.

Social justice

Justice is an ethical value suggested in nursing literatures. Social justice has been defined by the traits which, in addition to consideration of individuals’ dignity and respect, focus on equal access to health services and the right of being fairly treated and cared free of economic, social, and cultural status.[ 9 , 10 , 15 , 16 , 20 , 21 , 23 ] Social justice had been the indication in most of the countries and had been defined as fair distribution of resources and provision of individuals’ equal treatment and care.

Verpeet (2003) stated that equality means access of all individuals to health services. She claims every individual in Belgium is supposed to have equal right of receiving equal nursing care.[ 10 ]

Altruism is a common nursing value in various countries. It has been defined with traits of consideration of human as the axis of attention and focus in nursing, helping others and provision of the utmost health and welfare for the clients, their families, and the society, selflessness, and self-devotion.[ 6 , 9 , 13 , 15 , 16 , 18 , 22 , 23 , 27 ] Therefore, altruism is defined as focusing on clients as a human and struggling to preserve their health and well-being. Pang (2009) debated that based on the principle of altruism, nurses should have spirit of selflessness and helpfulness toward others.[ 20 ]

Autonomy in decision making

Independency in decision making is a value suggested in some studies as a nursing ethical value. Nurses have defined its traits as having right of independency in decision making, right to accept or reject suggested treatments, interventions, or care. In addition, autonomy in decision making necessitates giving appropriate and adequate information to the clients and, if necessary, to their families.[ 13 , 15 , 23 ] So, autonomy in decision making occurs when nurses let patients be informed, free, and independent to decide on the diagnosis, treatment, and prevention through giving them appropriate information.

Konishi (2009) debates that conscious adult patients should themselves decide. With regard to nursing profession, nurses should provide the patients with information, explain suggested interventions, and let them free to either accept or reject oncoming procedures so that they and their families can make a decision about their condition.[ 13 ]

Precision and accuracy in caring

Precise and accurate care has been indicated as a nursing ethical value. Based on this definition, this sort of care is a precise, safe, appropriate, multidimensional, and kind care given to the patients by nurses. This is also thoughtful, based on adequate clinical skills and nursing knowledge to fulfill clients’ needs, promote their health, and relieve their pain and suffering. It is also based on standards and results in patients’ safety and satisfaction.[ 6 , 9 , 15 , 23 , 24 , 27 ] In this regard, Shih (2009) states that holistic and appropriate professional care is to prevent diseases, promote health, and make the feeling of comfort and safety for the patients.[ 9 ]

Responsibility

Responsibility has been defined as a nursing ethical value. It is defined with traits of commitment, feeling responsible for the duties toward patients, and respecting the patients’ rights for decision making.[ 15 , 18 , 19 , 21 , 24 , 26 , 28 ] Based on this definition, nurses are responsible for giving evidence-based care, best clinical function, and applicable and valid research, and are accountable for their actions and duties. Verpeet (2005) argues that nurses are responsible for promotion of patients’ well-being, having a holistic approach toward them and completing their duties.[ 28 ]

Human relationship

Human relationship has been indicated as a nursing ethical value with traits of mutual respect, trust, and reliance which are accompanied by patients’ confidentiality and privacy. It can be verbal or non-verbal and defined through having honesty in words and practice, sympathy and mutual understanding, courtesy, and friendliness.[ 9 , 15 , 19 , 21 , 25 ]

In this regard, giving care is possible only through making humanistic, efficient, and effective relationship, a relationship based on mutual respect and understanding.

Individual and professional competency

Individual and professional competency as a nursing ethical value has been defined with traits of struggling to make nursing as a profession, feeling the need to acquire personal and professional competency so that nurses can grow and develop in the direction of advances and new technology. Personal competency and development of the nurses result in acquiring up-to-date knowledge and promotion of clinical skills and practical abilities, and the ability to give more holistic and comprehensive care. Promotion of personal and professional competency comes true when nurses make a background for the best patients’ care by trying to give evidence-based care, and their empowerment for participation in activities in relation with other health team members and interpersonal and inter-professional skills development.[ 7 , 9 , 15 , 20 , 24 ] Pang (2009) debates that participation in continuing professional development suggests that individuals should preserve their competency in their activities and participate in professional continuing education programs throughout their occupational life.[ 20 ]

Sympathy has been indicated as a nursing ethical value with traits of understanding patients’ and their families’ needs and giving care based on making a fair communication.[ 6 , 19 ] In some cultures, such as Japanese, nurses share patients’ physical and mental pains and sufferings.[ 19 ]

Trust has been indicated as a nursing ethical value and is defined by traits of honesty in words and practice. Nurses should gain patients’, their families,’ and society's trust through understanding patients’ situation and status and appropriate conformation with them.[ 15 , 20 , 23 , 24 ] Based on this definition, gaining clients’ trust and reliance comes true when nurses are honest in their words and practice, and gain individuals’ trust and reliance by doing their duties appropriately.

C ONCLUSION

This study showed that nursing ethical values in patients’ and clients’ care are similar in many cases due to a common core in humanistic and spiritual approach of nursing profession, which is taking care of a human. Values such as human dignity, kindness and sympathy, altruism, responsibility and commitment, justice and honesty, and personal and professional competency were similar in most of the cultures.

Despite the similarities in ethical and professional values among various countries, it is essential to detect and highlight these values in each country, for example, in Iran, with regard to the prevalent social, cultural, economic, and religious conditions. Detection and declaration of nursing ethical values in each country can be a valuable, scientific, valid, and essential document to design nursing codes of ethics. This search was used to prepare proposed code of ethics and clinical guidelines for Iranian nurses. Findings of this study search must be considered within its limitation. An attempt was made to conduct a search as vast as possible. However, it might be possible that we could not access to all articles available in the period of the search.

A CKNOWLEDGMENT

The authors would also like to acknowledge the Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, for supporting this work.

Source of Support: Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences

Conflict of Interest: None

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Professionalism in nursing 1: how to develop professional values

07 March, 2022

This article explores the professional values in nursing and is the first article in a six-part series for student nurses that explores professionalism

Professionalism is integral to the role of a nurse and nursing students need to become familiar with this concept. The importance of professionalism should be understood and adopted as students undertake their studies but it can be complex to try and break down the key aspects of the Nursing and Midwifery Council Code and apply them in practice. This article, part one in a series, is aimed at undergraduate students beginning their journey towards registration. It breaks down the Code into the four key themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust. The article includes learning activities to help you develop your understanding of professionalism.

Citation: Smart A, Creighton L (2022) Professionalism in nursing 1: how to develop professional values. Nursing Times [online]; 118: 4.

Authors: Alison Smart and Laura Creighton are lecturers in education at Queen’s University Belfast.

• This article has been double-blind peer reviewed
• Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)
• Download the Nursing Times Journal Club handout here to distribute with the article before your journal club meeting
• Click here to see other articles in this series

Introduction

The popular image of a professional nurse is someone in a uniform with a fob watch; they are taking a blood pressure, administering medication or helping to carry out a medical procedure. However, being a professional encompasses numerous different components that go beyond individual tasks and procedures. It is about upholding professional values, your attitude and behaviour towards your patients, colleagues and staff both within clinical practice and at university.

This professionalism in nursing series will help you, as you enter the nursing profession, to build your knowledge of how to be a professional. It will break down some of the key components of being a professional and provide practical advice you will be able to apply as you begin your career.

To become a professional nurse, you must undertake a professional qualification. You are then bound by a code of conduct from a professional governing body. The Nursing and Midwifery Council’s (NMC) Code (2018) states that registered nurses must promote professionalism and trust. For undergraduate nursing students, this can be a difficult concept to grasp until they undertake clinical placements. Formal teaching of the concept of professionalism in the academic curricula can often seem detached from students’ experiences in the clinical environment (Rees et al, 2014) and sometimes students experience a mismatch between theory and practice.

A student becomes a registered nurse when they have completed a set period of study and supernumerary practice and are registered with the NMC. The NMC (2019) has highlighted that the development of professionalism in students is paramount during training. Professionalism can be described as how you demonstrate your values and standards in practice, which is reflected in work attitudes and behaviours (Zulipiye et al, 2018).

Essentially, the NMC Code provides clear guidance on how to conduct yourself to maintain a caring rapport with patients when you are in clinical practice. Historically, there is evidence that when this professional trust and confidence in nurses is questioned the reputation of the nursing profession can be damaged, not just in relation to specific incidents but more widely (Hoyle et al, 2017). This risk is exacerbated in a world where news reporting and social media disseminates information at a rapid rate. A recent example was the media coverage of nurses creating videos for the social media platform TikTok in personal protective equipment (PPE) during the coronavirus pandemic. It was a trend in many countries but provoked criticism from the general public at a time when professionalism was expected and PPE was limited in stock.

Once you embark on a nursing programme or become a registered nurse, it is important to understand that the NMC Code is not only relevant to clinical practice but also extends to your personal life. For example, if a nurse fails to abide by the law, such as using a phone while driving, this could affect their registration.

“Values are an internal compass that guide us through decision making”

Regulation and standards

Nursing and midwifery are among 32 regulated professions within healthcare. They are regulated by the NMC, which regulates nurses, midwives and more recently nursing associates. The NMC aims to protect the public, maintain confidence in the profession and ensure that standards of care are upheld. The NMC has set out these standards of care in its Code (NMC, 2018). The standards have been updated in the past decade due to the rise in use of social media and the publication of several reports citing poor standards and sub-optimal care in healthcare settings, including the failures of care at Mid Staffordshire NHS Foundation Trust (Francis, 2013).

The NMC maintains a register of nurses, midwives and nursing associates who meet the professional registration standards, promotes life-long learning and encourages concerns to be raised should poor practice be demonstrated. From an educational perspective, the NMC sets standards that students are required to achieve before they become registrants. Standards for pre-registration nursing programmes state that students should have a 50:50 clinical and academic course structure, be of good character, and undertake 2,300 clinical practice hours to become a registrant (NMC, 2019). It is important to understand that, although students are not held to account in the same way that a registered nurse would be, they are still accountable for their own acts and omissions. Students can be referred to their university for fitness to practise concerns. This can lead to them being removed from their professional course, and, can ultimately, mean they are unable to become a registered nurse.

The four elements of the NMC Code are:

• Prioritise people;
• Practise effectively;
• Preserve safety;
• Promote professionalism and trust.

Prioritise people

The Code advises that people should be treated as individuals and their dignity upheld. A nurse, midwife or nursing associate should always act in the best interests of people, making sure that their physical, social and psychosocial needs are assessed and responded to (NMC, 2018). This concept is known as the person-centered care approach. Person-centered care is underpinned by values, mutual respect and understanding of people (McCormack and McCance, 2016). Right to privacy and confidentiality should be respected and this has multiple implications including when to share information, how to communicate with relatives, and safe and accurate record-keeping. Consider the scenario presented in Box 1.

Box 1. Confidentiality

Gavin is a third-year nursing student finishing his six-week clinical placement. Gavin takes a selfie on the ward with a patient and another member of staff, and posts it on social media, naming the ward and the hospital.

• What does the Nursing and Midwifery Council (NMC) Code say about confidentiality?
• What could this mean for Gavin as a student nurse with regards to university and the NMC?
• What is the legal position of the hospital trust?

Practise effectively

To practise effectively, it is essential that you use the best available evidence, more commonly referred to as evidence-based practice (EBP) and ensure you are using the most up-to-date techniques and procedures so that patients are assured the highest-quality care. The NMC Code also notes that nurses should share their skill, knowledge and experience for the benefit of both patients and colleagues. This is essential for students and the relationship they build with practice assessors and supervisors in the clinical area is vital for learning. The Code is also a valuable tool for patients in that they become empowered with knowledge given to them by experts in their field.

The NMC Code indicates that communication should be effective between patients and colleagues to enhance patient safety and improve teamwork. The gold standard in healthcare is to provide safe and effective care that is of a high quality for patients and clients.

Clinical governance is a term used to describe the activities that help improve and sustain patient care (Scally and Donaldson, 1998), for example, audits and quality improvement initiatives. The process of clinical governance has been used to respond to reports of poor-quality or sub-optimal care, such as those highlighted by Francis (2013) and National Confidential Enquiry into Patient Outcomes and Death (2021). Consider the scenario presented in Box 2.

Box 2. Communication

Mae is a newly qualified nurse. She is looking after a bay of male patients and has delegated obtaining clinical observations on each patient to the care assistant. Two hours later, a patient becomes very unwell. When Mae looks at the NEWS2 chart the score is 8, illustrating that the patient is unwell and requires urgent review what but she was unaware.

Discuss what the Nursing and Midwifery Council Code expects with regards to delegation and communication.

• What should Mae have done?
• What is the potential outcome for this patient?

Preserve safety

The safety of those in your care is paramount. Among care pathways and care plans in modern nursing are countless risk assessments and strategies for keeping patients safe from falls, pressure damage and malnutrition. The NMC Code recommends that record keeping should be accurate and contemporaneous, but these assessments are only useful if the recommendations from the assessments are implemented.

Integrity and honesty are essential qualities in a nurse, midwife or nursing associate. These are not skills that can be acquired but are the framework on which professionalism is hung. Patients and clients should be informed when clinical procedures go wrong, or medications are incorrectly administered. Human error is in every workplace, but in healthcare these errors can have negative consequences for health and wellbeing. Registrants should raise concerns immediately if they believe that there is risk to patient safety (NMC, 2018). This may sound easy, as everything should be in the best interest of patients and their families. However, often health professionals find it difficult to raise concerns in the environment in which they practise, because they may fear a negative reaction from staff or be subject to bullying – an issue that has been highlighted in multiple inquiries, including by Francis (2013). Complete the scenario in Box 3.

Box 3. Work within your limitations

Deepa is a student midwife. She is asked to carry out an examination on a pregnant woman by her practice assessor. She is unsure how to do this or what she is looking for. She is embarrassed to appear incompetent and goes ahead with what she thinks is being asked of her.

Discuss the issues surrounding her decision and link with the Nursing and Midwifery Council (NMC) Code.

• What does the NMC Code state?
• What could be the outcome for the patient?
• As Deepa is a student midwife, does she have responsibility if it does go wrong?

Promote professionalism and trust

Nurses, midwives and nursing associates must always uphold the reputation of the profession and display personal commitment to the standards and behaviours set out in the Code. Registrants should be a model of integrity and leadership who will inspire trust and confidence in the profession from patients and those who encounter them. All registrants must fulfil the requirements that the NMC outlines, updating their registration and revalidating every three years. Consider the scenario in Box 4.

Box 4. Raising concerns

You are on placement as a second-year student nurse. You have arrived late and have forgotten your uniform. You have not tried to contact the ward before arriving and you are overheard by a patient later discussing that you were out late at a friend’s birthday last night.

Using the Nursing and Midwifery Council Code to guide you, what are the professionalism issues raised in this scenario?

Values in nursing

Everyone has values and both professional and organisational values are instrumental to nursing as a profession. When you are entering the profession, you must take on and uphold the professional values that are stipulated by the NMC (2018). It is important to break down and understand what these values are and to know how to demonstrate them at both pre-registration and post-registration levels. Nursing models and theories are also important elements when developing skills and knowledge. Kaya and Boz (2017) advocate for a professional values model to be implemented within the profession. The framework of this model has three parts: individual values, professional values of nurses and nursing care quality.

Individual values

Values are an internal compass that guide us through decision making. It is quite probable that your values were assessed during the selection process, when you gained a place to study nursing. In essence, your values are the things that you believe are important in the way you live and work. These are formed by our families, previous experiences, and society. People often express their values in relationships with family and friends, and in their personal and professional development. It is imperative to know your own personal values prior to understanding professional values.

“Professional nursing values are important concepts and the foundations of your identity as a nurse”

Professional values

Professional values are the performance standards accepted by a specific professional group (Schank and Weis, 2001). Professional nursing values are mainly outlined by our governing body. The NMC (2018) stipulates all four fields of nursing must be able to demonstrate professional value competencies. The Code outlines the fundamental nursing values to practise autonomously, and be responsible and accountable for safe, compassionate, person-centered, evidence-based care.

The development and nurturing of professional values are instrumental during your time as an undergraduate nursing student. Professional nursing values are important concepts and the foundations of your identity as a nurse. It is fundamental that you do not just know them but act them on a daily basis. When healthcare students fail to develop and adopt professional values, they are more likely to violate their code of ethics, harming the public image and professional credibility of nursing (Papadakis et al, 2004). In the worst-case scenarios, patients suffer harm. One such example is patients being left on trolleys for a long period of time with no action to address their deteriorating clinical observations (Francis, 2013). When care is not being guided by professional values this can result in a decrease in patient safety and can lead to increased morbidity and mortality. Consider the activity in Box 5.

Box 5. Professional values

You are on clinical placement as a student nurse. Your practice supervisor has asked you to assist Mrs Green to have a shower and get dressed. Discuss how you would demonstrate professional nursing values, as outlined with the Nursing and Midwifery Council (2018) Code, when assisting Mrs Green.

Organisational values

As a nursing student, you will be spending some of your course working in clinical placements. The settings for placements will range from large-scale NHS organisations to the independent sector. The various organisations may identify with similar values that stem from core professional nursing values.

The report published by Francis (2013) placed organisational culture to the foreground as a key determinant in what creates a safe healthcare system. It reflected a lack of organisational values and illustrated how patient care was being severely affected. In healthcare, we are looking for organisations to ensure an implementation of the ‘6Cs’ and demonstrate this in everyday practice. NHS England introduced the 6Cs as values to be integrated into clinical practice (Cummings and Bennett, 2012).

The 6Cs articulate the core values essential for all health and social care staff. These are the values you may be most aware of during your time in university. They are:

• Compassion;
• Competence;
• Communication;
• Commitment.

Other organisations have adopted different values but ultimately these will be based on the professional values outlined above. Complete the activity in Box 6.

Box 6. Organisational values

Look up the values of the organisation that is providing your placement. How do these reflect the professional values?

The NMC Code is one of the key sources of guidance that will stay with you during your career. If you start by developing self-awareness of your own values and subsequently build on this with professional values, your professional identity will form over the duration of the course. It is not about knowing and being able to list values, it is about understanding these values and using them every day.

• Nursing students need to have a working knowledge of how to apply the Nursing and Midwifery Council Code to their professional and personal roles
• Values are a key component of professionalism and time should be spent to explicitly identify nursing students’ professional values
• The development of professionalism and the nourishment of professional values is key for nursing students
• Professional values should guide the way nurses behave with patients

Also in this series

• Professionalism in nursing 2: working as part of a team
• Professionalism in nursing 3: the value of self-care for students
• Professionalism in nursing 4: record keeping, consent and capacity
• Professionalism in nursing 5: social media and e-professionalism
• Professionalism in nursing 6: the nurse as innovator

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220309 professionalism in nursing 1 – how to develop professional values, journal-club-handout3.

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Core Values

The National League for Nursing promotes excellence in nursing education to build a strong and diverse nursing workforce to advance the health of our nation and the global community.

The National League for Nursing implements its mission guided by four dynamic and integrated core values that permeate the organization and are reflected in its work:

CARING: promoting health, healing, and hope in response to the human condition

A culture of caring, as a fundamental part of the nursing profession, characterizes our concern and consideration for the whole person, our commitment to the common good, and our outreach to those who are vulnerable. All organizational activities are managed in a participative and person-centered way, demonstrating an ability to understand the needs of others and a commitment to act always in the best interests of all stakeholders.

INTEGRITY: respecting the dignity and moral wholeness of every person without conditions or limitation

A culture of integrity is evident when organizational principles of open communication, ethical decision-making, and humility are encouraged, expected, and demonstrated consistently. Not only is doing the right thing simply how we do business, but our actions reveal our commitment to truth telling and to how we always see ourselves from the perspective of others in a larger community.

DIVERSITY & INCLUSION: affirming the uniqueness of and differences among persons, ideas, values, and ethnicities

A culture of inclusive excellence encompasses many identities, influenced by the intersections of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious and political beliefs, or other ideologies. It also addresses behaviors across academic and health enterprises. Differences affect innovation so we must work to understand both ourselves and one another. And by acknowledging the legitimacy of us all, we move beyond tolerance to celebrating the richness that differences bring forth.

EXCELLENCE: co-creating and implementing transformative strategies with daring ingenuity

A culture of excellence reflects a commitment to continuous growth, improvement, and understanding. It is a culture where transformation is embraced, and the status quo and mediocrity are not tolerated.

• Research article
• Open access
• Published: 05 July 2019

The importance of professional values from nursing students’ perspective

• Batool Poorchangizi 1 ,
• Fariba Borhani 2 ,
• Abbas Abbaszadeh 3 ,
• Moghaddameh Mirzaee 4 &
• Jamileh Farokhzadian 5  

BMC Nursing volume  18 , Article number:  26 ( 2019 ) Cite this article

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Professional values of nursing students may be changed considerably by curricula. This highlights the importance of the integration of professional values into nursing students’ curricula. The present study aimed to investigate the importance of professional values from nursing students’ perspective.

This cross-sectional study was conducted at the Kerman University of Medical Sciences, Iran. Data were gathered by using a two-section questionnaire consisting of demographic data and Nursing Professional Values Scale-Revised (NPVS-R). By using the stratified random sampling method, 100 nursing students were included in the study.

Results showed that the mean score of the students’ professional values was at high level of importance (101.79  ±  12.42). The most important values identified by the students were “maintaining confidentiality of patients” and “safeguarding patients’ right to privacy”. The values with less importance to the students were “participating in public policy decisions affecting distribution of resources” and “participating in peer review”. The professional value score had a statistically significant relationship with the students’ grade point average ( P  < 0.05).

Conclusions

In light of the low importance of some values for nursing students, additional strategies may be necessary to comprehensively institutionalize professional values in nursing students.

Peer Review reports

Introduction

Values are goals and beliefs that establish a behavior and provide a basis for decision making [ 1 ]. In a profession, values are standards for action that are preferred by experts and professional groups and establish frameworks for evaluating behavior [ 2 ]. Nursing is a profession rooted in professional ethics and ethical values, and nursing performance is based on such values. Core values of nursing include altruism, autonomy, human dignity, integrity, honesty and social justice [ 3 ]. The core ethical values are generally shared within the global community, and they are a reflection of the human and spiritual approach to the nursing profession. However, the values in the care of patients are affected by cultural, social, economic, and religious conditions dominating the community, making it essential to identify such values in each country [ 4 ].

Professional values are demonstrated in ethical codes [ 5 ]. In fact, ethical codes clarify nursing profession practices, the quality of professional care, and professional norms [ 2 ]. Advances in technology and expansion of nursing roles have provoked complex ethical dilemmas for nurses. Such dilemmas, if not dealt with properly, negatively affect the ability of novice nurses to make clinical decisions [ 6 ]. With the ever-increasing number and complexity of ethical dilemmas in care settings, promotion of professional values has become more crucial in nursing education. The acquisition and internalization of values are at the center of promoting the nursing profession [ 2 ]. When values are internalized, they will become the standards in practice and guide behavior [ 7 ]. Values can be taught, modified and promoted directly or indirectly through education [ 8 ]. Each student enters the nursing school with a set of values that might be changed during the socialization process [ 9 ]. Purposeful integration of professional values in nursing education is essential to guaranteeing the future of nursing [ 10 , 11 ].

One of the significant consequences of teaching ethics and professional values to students is increasing their capacity for autonomous ethical decision-making [ 12 ]. Nursing students acquire professional values initially through the teaching of their school educators and the socialization process. Professional socialization is the method of developing the values, beliefs, and behaviors of a profession [ 13 ]. In their study, Seda and Sleem reported a significant relationship between professional socialization of students and improvement of professional values [ 9 ]. Through professional socialization, which results in the complete acquisition and internalization of values, nursing students should acquire necessary skills and knowledge in cognitive, emotional, and practical dimensions. Presently, however, less attention is paid to the emotional dimension in the formation of values compared to the other two [ 14 ]. In order to develop a value system, individuals should reach the fourth or fifth level of learning of Bloom’s affective domain, i.e. organization and internalization of values. At this level, stabilization of values requires passage of time [ 15 ].

Studies have shown that education causes differences in the formation of professional values, and that nursing educators have significant influence on the stimulation of professional values [ 8 , 14 , 16 , 17 ]. Wehrwein reported that education related to ethics was effective when students’ awareness of ethical issues increased along with the application of values in the workplace. In addition, the ability to make ethical decisions was reported to be stronger in students who had passed an ethics course compared to those who had not [ 18 ]. Therefore, nursing educators play a key role in determining the future way in which nurses grow professionally and are prepared to confront new, unavoidable challenges [ 9 ].

Professors and educators, both in clinical settings and at each stage of education, have the role of facilitator in developing students’ perception of the nursing profession and the nurse’s role. Students may increase their commitment to professional values directly through role playing and indirectly through observing behaviors related to professional values [ 14 ]. Nursing educators are effective role models because of their clinical skills, sense of responsibility, professional commitment, and personal characteristics such as kindness, flexibility, and honesty. Nursing educators enhance creative learning by encouraging critical thinking and decision-making, establishing a supportive learning environment, having technical and ethical knowledge, and providing opportunities for fair evaluation and feedback. Nursing educators should teach nursing students effective strategies to confront ethical dilemmas [ 12 ].

Students’ perspectives on professional values influence their approach to applying professional values in their future profession [ 14 , 15 , 19 , 20 ]. Nursing educators need additional awareness of nursing students’ perspectives on importance of professional values as a basis to use more effective methods for applying professional values. Therefore, nursing educators are able to educate graduates who are ready for decision-making and can effectively deal with daily ethical challenges. Nursing educators’ and students’ awareness of professional nursing values is important for preparing nurses to provide care of patients in an ethical and professional manner [ 6 ]. Researchers have found insufficient information about nursing students’ professional values in Iran. Because of the potential impact of cultures and clinical environments on professional values, the present study aimed to examine the importance of professional values from nursing students’ perspective.

Study design and setting

This cross-sectional study was performed from February to May 2016 at the Razi Nursing and Midwifery School affiliated with the Kerman University of Medical Sciences (KUMS), in Kerman, Iran. This study is a part of a larger study. The results of the first part was published in previous study [ 21 ].

The participants included all undergraduate nursing students who were studying at the time of data collection ( n  = 177). The sample size ( n  = 106) was determined based on the Cochran formula ( d  = 0.06, p  = 0.05). Inclusion criteria were undergraduate nursing students in the fourth, sixth, and eighth semesters without official work experience in hospitals. Submitting an incomplete questionnaire was considered an exclusion criterion. The participants were selected using a stratified random sampling based on the proportion of students in each semester. Therefore, among the total of 50, 62, and 65 students in the three semesters, 30, 37, and 39 students were enrolled, respectively. Finally, of the remaining 106 students, 100 students completed the questionnaires, but six students did not return the questionnaires. Thus, the final sample consisted of 100 students (with the response rate of 94.34%).

A two-section questionnaire was used for data collection. The students’ demographic data including age, grade point average (GPA: 17–20 (level A), 13–16 (level B) and ≤ 12 (level C)), ethnicity, gender, marital status, economic status of family, educational semester, and participation in professional ethical training courses was collected by the first section. The second section was Weis and Schank’s Nursing Professional Values Scale-Revised (NPVS-R). The NPVS-R is a potentially useful instrument for measuring professional nursing values. In developing the professional values scale, Weis and Schank used the ANA Code of Ethics as well as the studies on nursing values and their promotion among nurses [ 2 ].

We used the Persian version of the NPVS-R in this study. The validity of the translated questionnaire was confirmed using face and content validity as well as expert opinion. Reliability of the NPVS-R was reported to be 0.91 using Cronbach’s alpha [ 22 ]. To establish reliability of the NPVS-R in Persian, a pilot study was conducted with 20 nursing students, which resulted in a Cronbach’s alpha coefficient of 0.90.

The NPVS-R includes 26 items with a Likert-scale format in five dimensions: 1) trust: 5 items, 2) justice: 3 items, 3) professionalism: 4 items, 4) activism: 5 items, and 5) caring: 9 items. The trust dimension reflects the nurse’s duty (the value of veracity) to patients. The justice dimension deals with patients as noted in statements reflecting equality and diversity issues. The professionalism dimension reflects the promotion of nursing competence, self-evaluation and reflection, and seeking professional growth. The activism dimension reflects participation in professional activities and solutions to professional problems. The caring dimension reflects respect for patients and protection of patient rights.

The participants specified the importance of each item on a Likert 5-point scale ranging from 1 to 5 with 1 = not important, 2 = somewhat important, 3 = important, 4 = very important, and 5 = the most important. The possible range of scores is 26 to 130 [ 2 ]. In this study, the scores below 43, scores between 43 and 86, and those above 86 were considered low importance, moderate, and high importance, respectively. A higher score indicates that professional values are very important, and that nurses are more oriented toward stronger professional values.

Data collection

The first researcher distributed the questionnaires among the participants and explained the study objectives. The researcher also explained to the participants how to fill out the questionnaires and asked them to specify the importance of professional values. In order to eliminate any ambiguity regarding questionnaire items, necessary explanations were provided. The researcher collected the questionnaires while maintaining anonymity and confidentiality of the data.

Statistical analysis

Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (independent samples, t- test, analysis of variance (ANOVA), Mann-Whitney, and Pearson’s correlation coefficient) were used. SPSS software version 19 was used for data analysis and level of significance was considered p  ≤ 0.05.

Ethical considerations

First, the study was approved by the ethics committee affiliated to the Kerman University of Medical Sciences (No code: 1394.238). Then, official permission for collecting data was obtained from the Razi Nursing and Midwifery School. Prior to distributing the questionnaire, the researcher guaranteed the confidentiality and anonymity of the questionnaires. The students’ informed consent was implied from returning completed questionnaires.

The results showed that the students’ mean age was) 21.9 ± 1.26 (and GPA was at B level (16.20 ± 1.20). Most of the students were female (75%), single (67%), and Iranian (97%). Around 37% of the students were in the eighth semester, and around 37.6% of the students had participated in professional ethical training courses (Table  1 ).

The high mean score of the professional values of the nursing students indicated high awareness and perception of the importance of professional values from the students’ perspective. The most important values as identified by higher mean scores were respectively as follows: “maintaining confidentiality of patients”, “safeguarding patients’ right to privacy”, “assuming responsibility for meeting health needs of the culturally diverse population”, and “maintaining competency in area of practice”. The values with lower mean scores were “participating in public policy decisions affecting distribution of resources”, “participating in peer review”, “recognizing role of professional nursing associations in shaping healthcare policy” and “participating in nursing research and/or implementing research findings appropriate to practice”, respectively (Table  2 ).

The results of the Pearson’s correlation coefficient test indicated that there was no significant relationship between professional values and age ( r  = 0.03, p  = 0.47), while there was a significant relationship between professional values and the GPA ( r  = 0.29, p  = 0.003). This revealed that the students with higher GPA had higher scores in professional values. There was no significant difference in the students’ professional values based on different educational semesters ( F  = 0.29, p  = 0.74). In addition, there were no significant differences in professional values based on the other demographic variables such as gender, marital status, ethnicity, and participation in professional ethical training courses (p  > 0.05) (Table 1 ).

The present study was conducted to examine the importance of professional values from nursing students’ perspectives. The results showed a high total score with regard to the importance of professional values. These findings are in agreement with the findings of the studies conducted in the United States [ 15 , 23 ], Taiwan [ 24 ], Korea [ 25 ], and Iran [ 21 ]. Results of these studies highlighted that instructors and nursing trainers were seen as role models by students.

In this study, the most important nursing professional values were “maintaining confidentiality of patients”, “safeguarding patients’ right to privacy”, “responsibility for meeting health needs of the culturally diverse population”, and “maintaining competency in area of practice”. The results of this study are in agreement with the results of the studies conducted by Lin et al. [ 19 ], Clark [ 15 ], Fisher [ 23 ], and Leners et al. [ 8 ], who identified these values as the most important values. One possible reason for the consistency between the results of this study and those of the other studies may be that these values are among the main values in the nursing profession and are closely associated with it. Leners et al. reported that maintaining competency in area of practice, accepting responsibility and accountability for own practice, and safeguarding patients’ right to privacy were values prioritized by students. Since these values are associated with the direct care of patients and given that students complete their clinical practices under supervision of nurses, students may learn the importance of these values through role modeling and application in clinical settings [ 8 ].

In this study, the least important values from the students’ perspective were “participating in public policy decisions affecting distribution of resources”, “participating in peer review”, “recognizing role of professional nursing associations in shaping healthcare policy”, and “participating in nursing research and/or implementing research findings appropriate to practice” . The results of this research are also in agreement with the results of the studies conducted by Lin et al. [ 19 ], Clark [ 15 ], Fisher [ 23 ], and Leners et al. [ 8 ]. A multitude of factors may have contributed to the lower importance placed on these values; some causes might be less information about the importance of these values in the development of the profession, low motivation, insufficient affirmation, and low encouragement by nursing educators.

The reason for the low importance placed on the values such as “participating in nursing research and/or implementing research findings appropriate to practice” might be the fact that nursing students do not acquire necessary skills (such as information literacy skills) to apply in evidence-based practices during their academic days [ 26 , 27 ]. Another reason for the low importance of the above-mentioned values might be graduate education programs; undergraduate students focus on the rules of clinical practice because they are novices. As they become more competent and eventually experts, the ranking of the values is likely to change.

Concerning the lower importance of the “recognizing role of professional nursing associations in shaping healthcare policy” value, Esmaeili et al. reported the following items as causes for reduction of participation in such associations: long working hours, lack of awareness about the associations’ objectives and activities, insufficiency of time, and lack of support from hospitals to play active roles in associations. Moreover, the inactivity of members in such associations and the weak relationship among these associations were other barriers confronted by such associations in Iran [ 28 ]. In addition, one other reason might be that nursing educators themselves do not participate in professional nursing associations because of high workloads and limited time. Professional nursing associations play major roles in promoting nursing authority and professional identity. Consequently, understanding and valuing the importance of participation in professional associations may require emphasis as an important professional value.

Regarding the low importance of values such as “participating in peer review” and “participating in public policy decisions affecting distribution of resources”, it can be mentioned that these activities are part of the manager’s duties, and that the nurses are not involved in peer evaluation and policy decisions.

In this study, a significant relationship was found between the GPA and scores of professional values. Students with high GPA Probably have the necessary scientific competency in their professional performance, which may result in giving higher importance to professional values as a significant index of professional competence. Lechner et al. emphasized that academic environments appear to elicit and reinforce values such as developing one’s capacities and pursuing one’s interests [ 29 ].

In this study, although no significant difference was found between educational semester and the students’ scores of professional values, the highest score was related to the sixth semester whereas the lowest score was related to the fourth semester. The studies conducted by Rassin [ 16 ] and Clark [ 15 ] had results similar to those of this study, with no difference found between total scores of professional values of students in different semesters of their nursing education. However, several studies [ 8 , 14 , 25 ] found significant differences between total scores of professional values of students in different semesters. It is difficult to compare these differences due to the use of different instruments to measure professional values, differences in nursing education curricula and environments, and differences in study designs. In line with the results found on the association between academic year and education with professional values, researchers reported in several studies that education had a positive effect on professional values, and nursing students’ education experience increased total scores of professional values in a positive direction from entry into school until graduation [ 8 , 14 , 19 ]. In their study, Weis and Shank concluded that higher focus on curricula of junior and senior students could change some professional values, indicating that time spent in school was associated with change in values [ 30 ].

The study had three limitations. First, the assessment of the students’ perspectives on professional values was limited only in the school affiliated with the KUMS in southern Iran, which may limit generalization of these findings. The second limitation was the translation of the NPVS-R into Persian. Cultural and language differences may have affected the meaning of the terms literally and in the context of nursing education in Iran. Third, this study did not assess how the students learned professional values. Similarly, we did not know to what extent students had these values prior to entering nursing education and we did not collect information on these two items; thus, we did not highly emphasize the role of nurse educators in this study. It is suggested that further studies with more accurate instruments are conducted in other nursing schools with different cultural and environmental conditions might lead to comprehensive strategies for internalizing professional values of nursing students.

Implications for nursing

Nursing educators can primarily facilitate professional values by urging students to participate both in research studies on the topic and in nursing education. Periodic classes and seminars about professionalism should be presented by clinical tutors and school educators, who play important roles as behavioral models for their students. It is also recommended to conduct studies to investigate the impact of educational environments and university educators as role models for students on advancement of professional values in students.

The study showed high mean total of professional values from the nursing students’ perspective. However, some professional values such as participating in public policy decisions and participating in nursing researches were less important. This shows low awareness about these values or educators’ insufficient emphasis on them, time limitations to promote these values, and negative attitudes of students toward these values. As future nurses, nursing students should be able to apply professional values in making decisions when confronted with the emerging ethical challenges in the healthcare area. This preparation should be provided for students by educators and professors during their professional socialization process in schools. The findings suggest that many of the values were similarly important in other countries, which can be a reflection of the globalization process in the nursing profession and the presence of professional values at the root of the discipline. However, strategies should be developed to improve weaknesses of nursing students in the professional values adapted to cultural, social, and religious conditions prevailing in the societies, faculties, schools, and hospitals.

Availability of data and materials

The datasets generated and analyzed during the current study are not publicly available because this study is part of a larger study. This datasets are available from the corresponding author on reasonable request.

Abbreviations

Grade point average

Nursing Professional Values Scale-Revised

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Acknowledgements

The researchers appreciate all nursing students who gave their time so generously in order to participate in the study.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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ICU, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran

Batool Poorchangizi

Department of Nursing Ethics, Medical Ethics and law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Fariba Borhani

Bam University of Medical Sciences, Bam, Iran

Abbas Abbaszadeh

Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran

Moghaddameh Mirzaee

Nursing Research Center, Kerman University of Medical Sciences, PO Box: 7716913555, Kerman, Iran

Jamileh Farokhzadian

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Contributions

BP, FB, AA, and JF contributed to conceiving and designing the research. The data were collected, analyzed, and interpreted by BP, MM, FB, and JF. BP, FB JF, AA, and MM contributed equally in writing the manuscript and approved the final manuscript.

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Correspondence to Jamileh Farokhzadian .

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Ethics approval and consent to participate.

First, the study and consent procedure was approved by ethics committee affiliated to Kerman University of Medical Sciences (No: 1394.238). Then, verbal and written informed consent was obtained from the students prior to the data collection. The students were ensured about anonymity and confidentiality of the data as well as voluntary participation in the study. All participants provided written consent by filling in the written questionnaires.

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Poorchangizi, B., Borhani, F., Abbaszadeh, A. et al. The importance of professional values from nursing students’ perspective. BMC Nurs 18 , 26 (2019). https://doi.org/10.1186/s12912-019-0351-1

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Waite and Fauci Discuss Health Inequities and Disparities, Burnout and Well-being

(May 15, 2024) — Roberta Waite, EdD, RN, dean of the School of Nursing, and Anthony Fauci, MD, a Georgetown distinguished university professor in the School of Medicine and the McCourt School of Public Policy, sat side by side recently for a wide-ranging discussion to launch National Nurses Week.

More than 1,500 students, alumni, faculty and staff registered for the May 2 conversation , titled “Equity & Well-being: The Delivery of Health Care,” with more than 100 attendees joining in person at Copley Hall and the remainder participating virtually via Zoom.

Workforce Diversity

Before touching on topics including health care worker burnout and the societal impact of COVID-19, Fauci spoke about the importance of diversity in the health care workforce, explaining that patients are more likely to trust their health care providers when they look like the community they serve.

Roberta Waite, EdD, RN, and Anthony Fauci, MD

“The confidence that the community has in the health care system is directly related to if the health care system is representative of who they are, where they came from, the experiences they’ve had,” Fauci said.

“If there’s no role models there to begin with, you’re not going to have people feeling comfortably entering that particular vein,” he added. “And we see that continually in every aspect of health care.”

The COVID-19 pandemic amplified existing health disparities, particularly among African Americans.

“The problem that we’re all facing is that you can more easily correct the defect of accessibility by putting a lot of effort … to bring people into the health care system,” Fauci said.

Addressing social determinants of health, however, is an imperative aspect of improving health equity.

“We’ve got to tear down … the root cause of those social determinants of health, which people are very reluctant to say that because it’s really stemmed back to our history of racism that goes back centuries, which then leads into discrimination,” he said. “And if we don’t admit that that’s the case, we’re never going to get to solving the root problem.”

Sustainability of Stress

In his previous role as director of the National Institute of Allergy and Infectious Diseases for nearly 40 years, Fauci managed multiple infectious disease outbreaks, including the HIV/AIDS crisis starting in the 1980s, prompting Waite to ask Fauci what is different about the burnout that health care workers are experiencing today.

Fauci compared the stress of the HIV/AIDS crisis with that of the COVID pandemic.

“Well, it’s the sustainability of the stress,” he said. “The problem with COVID is that the stress that was put on the health care providers was continual, constant and unremitting.”

Health care workers experience burnout because of their compassion for their patients, Fauci added.

“When you are a committed health care provider and you’re dealing with patients that are lying in the hallway because there are no beds for them, you’re not going to go home and walk your dog,” he said. “You’re going to stay in the hospital and you’re going to take care of them. And that really became the source of understandable burnout.”

Despite the trauma of losing more than 1 million people who died from the disease in the U.S., Fauci responded with confidence about Americans’ resilience when Waite asked him to reflect on the pandemic’s social and psychological impact. However, he acknowledged that school-aged children faced more serious long-term challenges to their mental health and education.

“We’ve got to appreciate that and we’ve got to make allowances for that,” he said. “We’ve got to make allowances for that in the educational loss and the psychological loss. So we’ve got to be aware we have mental health issues that we’re going to be dealing with for the next several years.”

Waite expressed the need for better mental health care during a crisis to help workers process trauma and grief, a statement with which Fauci concurred.

“And that means that you’ve got to be able to, on the spot, provide the kind of support in real time and not wait after the fact,” he said. “And I think that’s the lesson that we learned.”

Work-life Balance

Fauci described working nonstop during the first part of 2020 as the pandemic gripped the world. He credited his wife, Christine Grady (N’74, G’93), a nurse and Georgetown alumna, for providing the support he needed, noting that everyone needs a support system.

“I am not the poster child for work-life balance,” Fauci quipped.

“So she’s incredible in understanding the stress that I went through, particularly during the early years of HIV and very particularly during the first several months of COVID because in January, February and March 2020, I was implementing my somewhat antiquated ‘suck-it-up’ theory,” Fauci said.

“I am not the poster child for work-life balance,” he added, triggering laughter from the audience.

Core Values

Waite concluded the conversation with a focus on values.

Waite turned the conversation to the topic of values.

“Our Jesuit values are core in everything that we do: education, practice, research … how we judge situations, behave, see, manage challenges,” she said.

Fauci agreed, and commented that many of the challenges he faced not only involved many deaths from disease, but involved situations that were politically charged.

“It goes back to the principles of commitment, of integrity, of honesty and of energy to do the right thing,” he said. “So when you have the hard times that we’ve gone through, particularly in my own career because I’ve dealt with six or seven major infectious diseases, outbreaks that were all politically charged, some more than others, you have to get back to your core principles and you have to stick by them, because if you veer away from them, you become inconsistent.”

This event was sponsored in part by AMN Healthcare.

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May 14, 2024 | Tiana Tran

A Reflection on Asian Culture

UConn Health Pharmacist Tiana Tran shares an essay for Asian American and Pacific Islander Heritage Month

From left: UConn Health pharmacist Tiana Tran celebrates Tết with her sister, Viviana Tran, mother, Bachloan Phan, and father, Thoi Tran, February 2024. (Photo provided by Tiana Tran)

Growing up as a Vietnamese American, Vietnamese culture was perpetually ingrained into my home life. While both my sister and I were born in America, our parents made sure to include our culture in our childhoods. We were raised speaking Vietnamese and we spent quality time with our grandparents, which helped to solidify our language skills. We listened to Vietnamese music, played Vietnamese board games, and learned the history of our family. We enjoyed Vietnamese dishes nearly every day and celebrated Vietnamese traditions such as welcoming our departed ancestors home to eat dinner with us as well as colorful Lunar New Year festivities with family. As a result, my culture is very integral to my identity and I am proud of who I am.

Today, my family and I still perpetuate these traditions; just this February, my family got together and celebrated Tết, the Lunar New Year, in our own special way. I feel very grateful that my family and my culture are so present in my life.

A large part of my culture, and most East Asian, Southeast Asian, and South Asian cultures, revolves around community and family. In the spring, we celebrate Tết with our loved ones. We welcome the new year, full of new beginnings and good fortune, with our community. The celebrations are a chance for everyone to become closer and for communities to get together. It’s a chance for us to appreciate our roots, pay respects to our ancestors, and share well wishes for the new year with our loved ones.

With May’s arrival and spring in full bloom, I reflect upon the community I am a part of at UConn Health, and the immense pride I feel for working in and with a health system that truly cares for everyone. I am so incredibly grateful for the opportunities I have received that allowed me to contribute to the health care system as a pharmacist. This spring, I reflect on my identity and my culture, and how I am so proud of my heritage because it has made me the person I am today.

This May, I reflect on my roots, how my loved ones, my ancestors, and my culture have led me to where I am now. To everyone who has Asian or Pacific Islander heritage, I am so proud to see us represented at UConn Health, where we work together to cultivate a community of care in our health care system.

And to everyone in general, I invite you to do the same and reflect on your roots, and how they have led you to where you are today. Happy Asian American Heritage Month!

Tiana Tran, Pharm.D., is a 2022 graduate of the UConn School of Pharmacy. She completed her pharmacy residency at UConn Health a year later, and started as a staff pharmacist at UConn Health last August.

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Call for Papers: Values – axiology – cultures

We would like to invite you to submit proposals for articles for thematic issues "Values – axiology – of culture".

The dynamic reality of the second decade of the 21st century makes us think of the surrounding world as a sphere of constant change, full of violent events, breaking ties with what until recently seemed traditional and unchangeable. It also provokes reflection on how the sense of axiological crisis has been dealt with over the centuries, to what extent the methods of overcoming this crisis developed at that time have opened up new perspectives for the development of culture, literature and language, to what degree they have turned out to be a trap, and finally to what extent they are used in contemporary creative activities.

The sense of crisis that has been experienced for many years makes the cultural tendencies related to the search for stability more and more visible. Therefore, we also encourage you to reflect on the place of literature on the cultural map in this context. How do hierarchies of values and ways of evaluating reality function in language?

 We would like to invite you to reflect together on issues concerning the condition of literature, culture and language, both from the modern viewpont aswell as from the historical perspective. We are interested in reflection on the axiological determinants of various literary, cultural and linguistic phenomena. Therefore, we would like to invite you to co-create this year's volumes of "Annales UMCS. Sec. FF", which will focus on issues such as, e.g.:

 -        axiology in Polish and foreign literature (case studies, cross-sectional and comparative approaches);

 -        the place of literature in contemporary (pop)culture;

 -        literary awards as a way of promoting selected values;

 -        dialogues of literature and art as axiological discussions;

 -        literary and cultural traditions in confrontation with modernity;

 -        the political nature of literature/culture from a historical perspective;

 -        manifestations of the crisis and ways of overcoming it in culture, literature and language;

 -        ancient and contemporary manifestations of the axiologization of culture, literature and language;

 -        transformations of language in the face of socio-cultural reality;

 -        disputes about the value and functions of literature over the centuries;

 -        theories and methodologies of literary, linguistic and cultural research in the context of axiological issues;

 -        axiological chaos or unchanging status quo ;

 -        values and methods of evaluation encoded in the language;

 -        changes in the methods and scopes of linguistic evaluation.

 The presented set of issues is open-ended.

 Article submission deadline: June 6, 2024. We accept texts in English, French, German, as well as Polish.

Contact address: [email protected]

 Website: https://journals.umcs.pl/ff

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New Indigenous parenting app provides culturally grounded parenting advice

UBC Faculty of Applied Science researchers and Indigenous Elders and members of the səxʷkn̓xitəlx k̓l̓ c̓əc̓málaʔ Central Okanagan Aboriginal Early Years Table have launched a new app designed to support young Indigenous parents and contribute to revitalizing language within the Okanagan Nation community. 

The Two-Eyed Seeing for Parents app combines Indigenous wisdom and contemporary knowledge and is now available for download on  Google Play and Apple’s  App Store .

Tailored to meet the unique needs of Okanagan Nation families, the app provides information on nutrition, health, safety and traditional parenting approaches. It reflects the preferences of Okanagan Nation parents, who expressed a desire for content that integrates syilx parenting values, histories and traditions, including a mix of content in nsyilxcən and English to support language revitalization efforts.

The app was developed through a collaborative effort led by Elders Wilfred “Grouse” Barnes, Pamela Barnes and Margaret Eli, and facilitated by UBC School of Nursing professor emeritus Dr. Wendy Hall , in partnership with the Interior Health Authority and multiple community service providers.

“We believe that children are sacred gifts who deserve the best possible start in life,”  said Elder Wilfred “Grouse” Barnes. “Our app aims to empower Okanagan Nation parents with the knowledge, confidence and skills to nurture their children's development while honouring our cultural heritage.”

“Two-Eyed Seeing for Parents can be used offline, reducing potential cost and connectivity barriers for the communities where internet access and data costs may be challenging,” said Hall, a maternal and child health expert. By downloading the app in a location with internet access, like a coffee shop, parents gain access to a wealth of resources directly on their mobile devices, enabling them to learn at their own pace and revisit information when needed.

The Okanagan Nation, which includes seven communities in the southern interior of BC and the Colville Confederated Tribe in northern Washington state, faces significant challenges in accessing culturally relevant parenting support. Despite comprising almost six per cent of British Columbians, Indigenous groups face barriers including limited internet access in remote areas and expensive data rates. In response to these challenges, the Elders saw the potential of offline mobile technology to bridge gaps in access and provide vital support to parents.

“We recognize the importance of preserving our language and passing down our cultural teachings to future generations,” said Elder Margaret Eli. “Through this app, we hope to strengthen our community by empowering parents with the knowledge and tools they need to raise healthy, thriving children.”

Emma Dovell, a Westbank First Nation member and parent to two young boys has tested the app and commented: “The Two-Eyed Seeing for Parents app is very user-friendly, broken down into ages with different topics under those ages. 

“As a parent that doesn't have very much nsyilxcən and cultural protocol knowledge and limited ways to learn, it was great that this app incorporated nsyilxcən language with audio clips and videos throughout so that it can be easily accessed and used as a learning opportunity for myself and my children.”

About səxʷkn̓xitəlx k̓l̓ c̓əc̓málaʔ Central Okanagan Aboriginal Early Years Table

The səxʷkn̓xitəlx k̓l̓ c̓əc̓málaʔ Table works to promote children as sacred gifts who can flourish. Table members include representatives from Westbank First Nation, Ki-Low-Na Friendship Society, Okanagan Nation Alliance, Okanagan Métis Community Services Society, Central Okanagan Public Schools, and Interior Health Authority as well as a community Elder. They regard Two-Eyed Seeing — a blend of Indigenous and Western knowledge and principles, with past traditions and contemporary adaptations to society — for parenting as contributing to their mission to promote pride in their culture and heritage.

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Personal Nursing Philosophy, Values and Beliefs Essay

Introduction, my personal philosophy, why i am in school, works cited.

A personal philosophy can be defined as a set of beliefs, attitudes, concepts, and convictions that guide an individual’s way of living and doing things, personally and professionally. Many people consider the creation of personal philosophy as an elementary exercise that serves only to fulfill the requirements of certain academic endeavors. However, it is an indispensable component of proper life because it allows people to make better choices that are based on personal values and beliefs.

Moreover, it gives their life purpose because they act and behave in ways that aim to achieve certain desired outcomes. As a nursing major, my personal philosophy is based on my inclination to help people alleviate suffering and improve the quality of their lives. It is my duty to apply my knowledge and skills to prevent and manage illnesses so as to improve the physical, psychological, and spiritual well-being of patients.

My personal philosophy is founded on certain beliefs and values that guide my decision-making and that inspire me to engage in a meaningful contribution in my career as a nurse. My beliefs and values influence the choices I make every day. Therefore, it is important for me to identify them, clarify their influence, and live them daily. These values include honesty, responsibility, compassion, lifelong learning, and kindness.

Nursing is not only a career, but a calling that requires the possession of integrity, knowledge, and compassion (Kim 54). My personal philosophy postulates that I have a responsibility to use my knowledge and abilities to help people alleviate their suffering by providing safe and holistic patient-centered care regardless of their race, ethnicity, gender, religion, or sexual orientation. It is my responsibility to meet my needs and those of my patients by being honest, kind, and compassionate. Moreover, it is my obligation as a nurse to create a healthy environment that will promote a speedy recovery and improve the physical and psychological well-being of patients. I am committed to lifelong learning because that is the best approach to improving the quality of my life and progressing in my career.

I am a passionate and spiritual human being who is committed to using physical, mental, and spiritual capabilities to live a meaningful life through service in the nursing profession. I am a product of my beliefs, ideas, and values that have been acquired through life experiences and the acquisition of knowledge. Spirituality is an important component that enhances an individual’s kindness and compassion (Smith and Parker 83). Important components of self-identity include world view, self-esteem, personality attributes, physical attributes, and knowledge of one’s skills (Masters 95). Self-identity is an important aspect of building a strong character. I chose to pursue a career in nursing owing to my attributes that include compassion and commitment to alleviate physical suffering.

My goals are to graduate with a bachelor’s degree in nursing, maintain a lifelong learning habit, and help people to prevent and manage diseases through the application of skills and knowledge obtained in school. In addition, I want to become a nurse practitioner and researcher so that I can make meaningful contributions to society. After graduation, I intend to pursue a Master of Science in Nursing (MSN) degree and go into advanced nursing practice. I believe that pursuing a master’s degree in nursing will empower me to make significant contributions to society by becoming an advanced nursing practitioner (Hood 65). In addition, it will equip me with advanced research skills that will be useful in my commitment to lifelong learning.

I am in school to acquire the necessary knowledge that is required for advanced nursing practice. The nursing program’s courses, extracurricular activities, and personal as well as professional interactions and networks will equip me with the skills necessary for success in life. The main goal of attending school is to develop proper attitudes and competencies, as well as improving skills in human interactions, problem-solving, and decision-making (Smith and Parker 35).

The core skills, values, and attitudes of nursing can be obtained only by enrolling in an appropriate nursing program (Schober 62). One of my goals is to maintain a lifelong habit of learning. In that regard, attending school will enhance my creativity and research skills, which are necessary for lifelong learning. I am also in school to enhance my communication skills. Effective communication is an important skill to possess in nursing because it enhances the provision of quality health care (Smith and Parker 48).

My personal philosophy is applicable to all aspects of my personal and professional endeavors. It is based on values that include integrity, kindness, responsibility, compassion, and lifelong learning. My major goal is to pursue a Master of Science in Nursing (MSN) degree after completing my undergraduate degree. I want to go into advanced nursing practice because it will offer me the opportunity to contribute to society in a meaningful way. The knowledge and skills that I will acquire in school will be necessary for the attainment of personal and professional goals.

Hood, Lucy. Leddy and Pepper’s Conceptual Bases of Professional Nursing . Lippincott Williams & Wilkins, 2013.

Kim, Hesook Suzie. Essence of Nursing Practice: Philosophy and Perspective . Springer Publishing Company, 2015.

Masters, Kathleen. Role Development in Professional Nursing Practice . 4 th ed., Jones & Bartlett Publishers, 2015.

Schober, Madrean. Strategic Planning for Advanced Nursing Practice . Springer International Publishing, 2017.

Smith, Marlaine C., and Marilyn Parker. Nursing Theories and Nursing Practice . F. A. Davis, 2015.

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IvyPanda. (2021, May 18). Personal Nursing Philosophy, Values and Beliefs. https://ivypanda.com/essays/personal-nursing-philosophy-values-and-beliefs/

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IvyPanda . "Personal Nursing Philosophy, Values and Beliefs." May 18, 2021. https://ivypanda.com/essays/personal-nursing-philosophy-values-and-beliefs/.

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‘So much death and upset’: the nurses quitting the NHS after Covid – a photo essay

Working as a nurse in the NHS through the Covid pandemic gave Hannah Grace Deller a unique perspective on the hardship faced by her profession. She has photographed several nurses as they decided post-Covid to leave the service

H annah Grace Deller works as a paediatric matron at St Mary’s hospital in Paddington, central London. She is also a trained photographer, and during the Covid crisis she began to photograph the conditions in which she and her nursing colleagues were working. Some of her images were published widely and exhibited at the time, earning praise from Grayson Perry, Martin Parr and others, and inspiring an album by Chris Difford, of Squeeze.

She has now published a book, Working on the Frontline , documenting the experiences of nurses and the reaction of the public during the crisis and since.

Hannah Grace Deller and her team.

Before the pandemic, I had never really taken photographs at work – just a few snaps if someone was leaving to say goodbye, that kind of thing. I had never really looked at my job in that way at all. Work was work, and my camera came out when I left the hospital as my way to relax. It’s like a form of meditation for me.

Then one day at the start of the pandemic, I was responding to a bleep when I saw a cleaner, in full PPE, trapped behind a door, and asked to take his picture . After that I thought, something is beginning here. We didn’t know how long it would last, I thought maybe a month. But, with permission from my colleagues, I thought I would document what was happening. I didn’t bring in a camera, that wouldn’t have been appropriate; I’d just take pictures on my phone and use my real camera outside work to document everything else.

The photographs, including this of nurse Steffie, are the first taken by Deller inside a hospital.

This was around the time that people were clapping for NHS workers, and that was sweet – though most nurses didn’t get out of work before 8pm to hear it. As time went on, I think lots of nurses began to wonder how much that goodwill was worth.

Nurses started protesting about pay and recognition during the pandemic. At one fair pay protest I started chatting with a nurse who said: “I’ve had enough, I’m going”. We’d had a pay offer of 1% and she said: “Surely, after everything, we are worth more than 1%.”

Thousands of nurses protested on 29 July 2020 to call for a pay rise, saying workers had been ‘on their knees’ during the pandemic.

I’ve always had an interest in photographing protests. It’s that spirit that you see in people, regardless of whether I agree with what they are protesting about. But with the nursing protests, it felt a bit different.

I began talking to other nurses on the protests, from all different hospitals, who had had enough. One of the people I spoke to was Camille, who is French but had lived in Britain for ever. With Brexit and then the pandemic, it was like a double insult to her, and she told me she was leaving nursing completely.

Nurse Camille moved to France post-Covid. She said: ‘What with Brexit, Covid and the lack of appreciation in the UK for nurses from the government, I’m done.’ She now runs an Airbnb in France with her wife and son.

We arranged that after taking her picture I would take her uniforms back as she had moved out of London, but when I got to her house, she had decided to burn them; she said it felt really therapeutic. There is a lot of trauma that can be held in clothing. A lot of the stains you just can’t get out of the uniforms, no matter how hot you wash them. As she was turning them she said: “There’s a lot of blood, sweat and tears in that fire.”

Nurse Anna left the NHS and moved to New Zealand. She wanted to fold her uniform and bring it back to her workplace to say goodbye.

Nurse Natasha used to play the cello to the Covid patients.

Nurse Natasha left after the pandemic because of burnout and disappointment around the pay dispute with the government. She decided to travel with her husband. She washed her uniforms and hung them on the line as if for the last time. Natasha used to play her instrument to the Covid patients and sometimes when someone was dying she would play music on the ward.

Nurse Mila hangs her ‘RIP’ nursing dress.

There was also Mila – she wrote “RIP nursing” on the back of her dress. She now works on Portobello Road, in London, selling jewellery.

Ellie also worked through the pandemic but had had enough; I took a few pictures of her handing her nursing uniform back. She was in her 20s and she said: “I’m just too young to experience this, so much death and upset. I just want to go to Australia and lie on the beach.” There are so many untold stories like this.

Nurse Ellie brought her uniform to her job and handed it back to be put in the bin.

There is an image of nurses in which we are expected to be submissive and sweet, never raising our voices, just getting on with the job. We are not supposed to get angry, to speak up. But there is a lot of anger in these photographs.

Nurses throw their uniforms outside No 10 Downing Street to protest against the vaccine mandates in January 2022. ‘Clapped and sacked’ was the mantra; many felt they wanted to make their own decisions around vaccines.

Of course I feel that way too sometimes, but if I’m ever upset, or feel that I want to leave, I’ll often just go round and chat to the patients on the ward. And then I’ll remember, ah, that’s why I’m here.

Hannah Grace Deller was speaking to Esther Addley

Working on the Front Line is published by Image and Reality, and can be ordered through Kickstarter .

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Democracy Corrupted: Apex Corruption and the Erosion of Democratic Values

Democratic values are eroding just as citizens perceive increasing corruption, with numerous cases implicating the highest-level politicians. Could perceived increases in apex corruption be weakening democracy? We first present event study analyses of more than 170 high-profile corruption scandals involving some of the most prominent politicians in 17 Latin American countries. We show that in the aftermath of such apex corruption scandals, support for democracy falls by 0.07𝑠𝑑, support for authoritarianism rises by 11% and violent protests rise by 70%. We complement these results with a field experiment in Mexico. Randomized exposure to footage of apex corruption scandals, particularly implicating politicians known for their anticorruption platforms, decreases individuals’ support for democracy by 0.15𝑠𝑑, willingness to trust politicians and neighbors in incentivized games by 18% and 11%, volunteering as election observers by 45%, and actual voter turnout by about 5𝑝𝑝, while raising stealing from local mayors by 4%. The undermining of democratic values produces latent effects that even cumulate four months later. Seeking solutions, priming national identity proved an unsuccessful antidote, but providing exposure to national stock index funds holds some promise.

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