Background to the Study
Professional values are standards for actions accepted by the practitioners and professional group that provide a frame-work influencing the behavior of the group (Hayes, 2006). It reflects how a group conduct themselves at work and how they relate to their patrons, colleagues and members of the community. It implies service with honesty and integrity, freedom of information and knowledge (Clark, 2009). Professional values are demonstrated in personal nursing practices that have altruism as the motivating force. This altruistic view is characterized by values such as “commitment, generosity, perseverance, benevolence and sympathy” (Altun, 2002). Professional nurses take responsibility for the conduct of their own activities; work to make policy decisions that support professional nursing, and practice according to nursing code of ethics (Joel and Kelly 2002). Despite gains in the process of professionalism, nursing continues to struggle with some aspects of professional status. To support the title of ‘profession ‘, nursing must embody and enact a set of professional values that guides its members.
The educational preparation of the registered nurse (RN) may make a difference in professional values. The two nursing education programmes in Nigeria (hospital and university based) instill in their students the understanding that they are professionals and members of the profession of nursing. However the curricula of these programmes differ in the extent to which professional values are emphasized, hospital-based programme as a rule emphases psychomotor learning and technical skills necessary to carry out basic nursing tasks and medically related functions and provide experiences in basic bedside nursing. It provides value on substantial clinical experiences. Baccalaureate nursing programme in addition to the mentioned values also emphasize liberal education based on the humanities and arts, philosophical and theoretical approaches and scholarship and include basic to complex nursing skills (Kubsch, Hansen and Huyser –EatWell, 2008; Clark, 2004). Baccalaureate students are provided with education that supports the American Association of Colleges of Nursing (AACN) (2005) core nursing values of human dignity, integrity, autonomy, altruism and social justice.
In practice, the professional nurse fills a variety of roles, including health promoter and care provider, learner and teacher, leader and manager, research consumer, political advocates, colleague and collaborator (Blais, Hayes, Kozier, and Erb, 2006). In these roles, the professional nurse assumes accountability and responsibility for enacting the full scope of nursing within the legal and ethical boundaries of the profession. However, each nurse professional values can influence the extent to which and the way in which these rules are enacted. For example, in the health promoter and care provider role, the professional nurse carries out the entire nursing process holistically with individuals, families, and communities (Blais et al. 2006). If the nurse does not value the concept of holism, the way the nursing process is carried out will not likely be holistic. If the nurse does not value nursing’s unique body of knowledge, the interventions used will most likely not emanate from this.
Advances in technology and expanding roles create complex ethical and moral dilemmas for nurses. If nursing is to remain a player in the era of health care transitioning, the values espoused by the professionals need to be brought to forefront of organizational decision making. According to Shaw and Degazon (2008), nursing has become more focused in the financial incentives, career opportunities and career stability, in today’s modern fast-paced world. Nursing gets targeted by bad press suggesting how patients are neglected by nurses, how they are being turned away from health institutions by nurses and most importantly the poor nursing care given by nurses (Schroeder, 2004; Sidumo, 2009). This gave rise to the importance of setting good value basics in every nursing faculty.
However, despite the claim that baccalaureate programme produces professional nurses and hospital-based programme produces technical nurses in some countries as documented by American Nurses Association (ANA), 2001). Kubsch, et al. (2008) in a qualitative study on the use of independent therapeutic nursing interventions found out that, all registered nurses regardless of educational preparation believe they are professionals and members of the profession of nursing. However, do all nurses practice as professionals? Are there differences in the endorsements of professional values by hospital and university based nursing programme students? What factors contribute to the observed differences? Therefore, it is important to assess whether differences exist; since the value hold by an individual may have an impact on the practice of nursing. Thus, the current study has been proposed to determine whether differences exist in the endorsement of core values essential for the professional nurses. It is believed that in view of the obtained results, suggestions concerning teaching ethics and values in present day nursing education shall be proposed.
Statement of the Problem
Determining or predicting one’s behavior is a difficult task and more difficult if it is to predict an individual’s professional behavior. One factor that has a significant impact on behaviour is the values and beliefs that one holds about an issue, phenomenon or a profession. While there is an ongoing process of reform in nursing education in Nigeria, many have continued to ask if there is a difference in the endorsement of professional values of hospital and university based nursing students (Hayes, 2006). In order to answer this question, it is important to assess the professional values endorsed by each group of nursing students.
All nurses, regardless of educational background, embrace the values in the code of ethics for nurses (ANA, 2001). The ANA endorses the code as the guide to professional behavior and decision making for nursing profession. While these values are introduced to nursing students in school, there are no consistencies in teaching and evaluating professional values between programmes or within like programmes (Duquette, 2004; Martin, Yarbrough and Alfred (2003). However, general outcomes from nursing education include an acceptance of the values and beliefs of the profession (Cragg, Plotnikoff, Hugo, and Casey 2001).
However, in discussions with colleagues, we often find ourselves comparing hospital-based nurses with graduate nurses. We make comments such as “Hospital- based or Graduate nurses have no sense of professional values or professional behavior”. “Hospital-based/graduate nurses are not aware of nursing traditions, nursing culture, or what it means to be a nurse. Have they not been taught the Code of Ethics?” Graduate nurses are not committed to the profession but are working just to earn salary (Laschinger, Finegan, Shcamaian and Casier, 2003: Swearinger and Lieberman, 2007). According to Thorpe and Loo, (2003) the skill may be comparable, but the question of whether or not behaviours are the same remains a question that needs an answer.
According to Shaw and Degazon (2008), nursing has become more focused on the financial incentives, career opportunities and career stability in today’s modern fast-faced world. Nursing gets targeted by bad press suggesting how patients are neglected by nurses, how they are being turned away from health institutions by nurses and most importantly the poor nursing care given by nurses. Based on the forgoing, it is necessary that nursing students professional values be assessed in order to generate a baseline data regarding their value behaviours. This is because it is expected that a trained nurse be one of enviable character. Anything short of this will affect his or her relationship with clients, patient’s care and other professional colleague.
Though a tool has been developed to measure professional values specific to the nursing profession and code of ethics for nurses, research has been limited in hospital and university based nursing students. In addition, no research was found in the literature examining professional values of nursing students in Nigeria. The above identified problems necessitated the conduct of this research.
Purpose of the Study
The purpose of this study is to comparatively assess the professional values endorsed by hospital and university based nursing students.
Objectives of the Study
In view of the above aim of study the following objectives were generated;
- To assess the professional values endorsed by nursing students.
- To ascertain the professional values endorsed by female and male nursing students.
- To assess the professional values endorsed by hospital and university based nursing students.
- To determine the professional values endorsed by female and male hospital-based nursing students.
- To determine the professional values endorsed by female and male university- based nursing students
The study examined the following questions:
- What professional values do nursing students endorse about nursing?
- What professional values do female and male nursing students endorse about nursing?
- What professional values do hospital and university based nursing students endorse about nursing?
- What professional values do female and male hospital-based nursing students endorse about nursing?
- What professional values do female and male university-based nursing students endorse about nursing?
- There will be no significant difference in the professional values endorsed by female and male nursing students.
- There will be no significant difference in the professional values endorsed by hospital and university-based nursing students.
- There will be no significant difference in the professional values endorsed by female and male hospital-based nursing students.
- There will be no significance difference in the professional values endorsed by female and male university-based nursing students.
Significance of the Study
This study will reveal professional values endorsed by students’ nurses. It will further reveal any difference in the professional values endorsed by hospital and university based nursing students, female and male nursing students etc.
The study will also serve as source of information on learning needs of the students, and thus as evidence for curriculum modification needs by the Nursing and Midwifery Council of Nigeria (NMCN) and proper implementation by the educators.
The findings from scores obtained in the various areas of the professional values will reveal the importance attached to that aspect of professional value. If any of these values happens to or shows to be of low score among either of the groups then it will serve as an evidence for need to review the curriculum in respect to that area
This research has the potential to show if students from hospital-based and baccalaureate nursing programmes have similar professional values. This information will assist nurse educators to better prepare nursing students for the work environment as a registered nurse.
The direction and magnitude of identified differences in professional values held by each group of the students will pave way for proper understanding of the direct and indirect effects of programme differences. It is hoped that this will bring about appropriate reform in nursing education programme by Nursing and Midwifery Council of Nigeria.
Academically, this work will be of immense benefit to future researchers in related field because it will become a source of reference.
Scope of the Study
The study was delimited to hospital-based nursing students in two Federal Government owned schools of nursing; School of Nursing, University of Nigeria Teaching Hospital (UNTH) Enugu, Enugu State; and School of Nursing Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra State; and University-based Nursing students of two Universities – Department of Nursing Sciences, Univesity of Nigeria, Enugu Campus, and Department of Nursing Sciences, Nnamdi Azikiwe University Awka, Anambra State. The final year students of each of these schools were recruited into the study. The focus is on obtaining the degree of relevance they attach to each of the value statements derived from the five core values of the profession. Reason for the choice of final year nursing students is based on the fact that these students at this time had completed their lectures on nursing ethics and have been exposed to various clinical experiences suffice to equip them with the actual values. Again the group represents a homogenous group in terms of curricula, clinical experiences and educational preparation.
Operational Definition of Terms
Professional Values: This is a measure of how strongly the nursing profession incorporates the values of altruism, autonomy, human dignity, integrity and social justice in its practice, as measured using Modified Nursing Professional Values Scale (MNPVS). In this study is represented by the degree of endorsement the subjects are willing to expend on each of the five core values.
Endorsement of Altruism: This refers to the degree to which a nursing student considers the altruism professional value as relevant to nursing practice, as indicated by the students response to the MNPVS used in this study; with Altruism described as being caring, selflessness, benevolence and serviceable.
Endorsement of Autonomy: Refers to the degree to which a nursing student considers the autonomy professional value as relevant to nursing practice, as indicated by the student’s response to the MNPVS used in this study as; independence, freedom of choice, confidentiality, informed consent, respect and openness
Endorsement of Human Dignity: Degree to which a nursing student considers the human dignity professional values as relevant to the nursing practice, as indicated by the student’s response to the MNPVS used in this study as; respectfulness, empathy, non- judgmental, acceptance and affirmation.