Fundamental Values in Nursing Care: The Person’s Perspective

Study Design

A qualitative descriptive and exploratory study was conducted, guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ as Supplemental Material) checklist. ¹¹ This design was chosen to enable an in-depth exploration of participants’ experiences, perceptions, and meanings related to values in nursing care.

Participants and Sampling

The sample consisted of 11 participants (7 men and 4 women), aged between 37 and 72 years, recruited through convenience sampling. The inclusion criterion was having been hospitalized within the previous 6 months, ensuring recent experience with nursing care. Exclusion criteria included cognitive impairment or communication difficulties that could compromise participation in the interview.

The sample size was not predefined; participants were recruited until data saturation was achieved, defined as the point at which successive interviews no longer generated new information relevant to the study aims. Data saturation was reached after the 11th interview. There was no prior relationship between the researcher and the participants before study recruitment, and no participants who were invited to take part in the study declined participation or withdrew after consenting.

Data Collection

Data were collected through individual, face-to-face semi-structured interviews conducted between July and September 2024. The interviews were conducted by a nurse researcher with academic training in nursing and qualitative research.

Interviews took place in a quiet and private setting during working hours, at a time convenient for participants, and each interview lasted approximately 45 min.

All interviews were audio-recorded with participants’ consent and transcribed verbatim. Audio files were securely stored and used exclusively for research purposes. The interview guide was previously validated and comprised open-ended questions designed to explore individuals’ fundamental values, their expectations regarding nurses, and their perceptions of how these values were integrated into nursing care.

No third parties were present during the interviews. Repeat interviews were not conducted, and field notes were not systematically collected during or after the interviews.

Data Analysis

Data analysis followed Mayring’s qualitative content analysis approach, ¹² using a systematic and interpretative framework. Transcripts were first subjected to a “clean read,” preserving the original meaning while ensuring textual clarity.

Subsequently, latent content analysis was applied to identify underlying meanings, patterns, and relationships among categories. The analytical process involved coding, categorization, and thematic abstraction, with categories continuously reviewed and refined after each interview to ensure methodological rigor and analytical depth. ¹³

To avoid interpretative overlap between categorical and latent content analysis, the analytical process was conducted in sequential and complementary phases. Initially, a deductive–inductive categorical analysis was performed to identify manifest content and organize data into clearly defined categories. Subsequently, latent analysis was applied within each stabilized category to explore underlying meanings, relationships, and contextual nuances, rather than generating new categories. This 2-step process ensured conceptual depth while maintaining analytical coherence and grounding latent interpretations in participants’ explicit narratives.

Data coding and analysis were conducted by multiple researchers, with regular meetings held to discuss coding decisions and ensure analytical consistency. Data analysis was conducted manually, without the use of qualitative data analysis software.

Study Credibility

Study credibility was ensured through strategies aligned with qualitative rigor criteria, namely credibility, transferability, dependability, and confirmability. ¹⁴ Credibility was enhanced through purposive participant selection and achievement of data saturation. Transferability was supported by thick description of participants’ experiences. ¹⁵

Dependability was strengthened through peer debriefing with a health professional knowledgeable about qualitative research and the study topic. ¹⁶ Confirmability was ensured through a transparent description of the analytical process and the inclusion of interview excerpts to illustrate emerging categories. Participants were identified using the letter “I” followed by a number (eg, I1).

To minimize potential researcher bias, reflexive attention was maintained throughout data collection and analysis, ensuring that interpretations remained grounded in participants’ narratives. Interview transcripts were not returned to participants; however, participant validation of the study findings was undertaken by sharing the preliminary results and themes for confirmation.

Ethical Considerations

This study was approved by the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA: E) under opinion P1033_04_2024 on May 22nd, 2024.

Confidentiality and anonymity of the data collected were ensured for all participants. Data were used exclusively within the scope of this research and destroyed after transcription.

Participants received an invitation letter and were subsequently contacted. Interviews were scheduled for those who agreed to participate. Participants were asked to sign an informed consent form (explaining the objectives and methodology of the study) and informed that participation was voluntary and anonymous, ensuring confidentiality throughout the study. The informed consent also explained the conditions for participation and included the request for audio recording, in accordance with ethical principles. ¹⁶ After being anonymized, the transcripts were stored by the lead researcher until publication.

Sociodemographic Characterization of the Participants

The sample consisted of 11 participants (Table 1), with a mean age of 55.5 years (standard deviation = 7.89 years). Most participants were men (63.64%) and married (81.82%).

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Table 1.

Sociodemographic Characterization of Participants (n = 11).

Attributes	Mean	SD
Age	55.5	7.89
		n (%)
Gender	Male	7 (63.64)
	Female	4 (36.36)
Marital status	Married	10 (81.82)
	Divorced	1 (9.09)
Education	4th grade	1 (9.09)
	9th grade	2 (18.18)
	12th grade	2 (18.18)
	Bachelor’s degree	2 (18.18)
	Master’s degree	2 (18.18)
	PhD degree	2 (18.18)
Occupation	Intellectual and scientific professionals	5 (45.46)
	Technicians and associate professionals	2 (18.18)
	Service and sales workers	1 (9.09)
	Elementary occupations	2 (18.18)
	Retired	1 (9.09)

Regarding education, half of the participants had completed first through ninth grade, while the other half had completed higher education (bachelor’s, master’s, or doctoral degrees).

In terms of occupation, 45.46% were professionals specializing in intellectual and scientific fields, 18.18% were technicians and associate professionals, and 18.18% held elementary occupations.

Four themes emerged from the data analysis: Person’s Fundamental Values, Values Expected from Nurses, Attributes Desired in Nurses, and Perceived Reasons for the Integration or Non-Integration of the Person’s Values into the Care Process (Table 2).

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Table 2.

Themes and Categories.

Themes	Categories
1. Person’s fundamental values	Respect
	Empathy
	Privacy
	Competence
	Honesty
	Interpersonal relationship
2. Values expected from nurses	Respect for the person
	Empathy
	Beneficence
	Honesty
	Affection
	Humanization
3. Attributes desired in nurses	Friendliness
	Availability
	Sense of humor
	Attentiveness
	Effective communication
4. Perceived reasons for the integration or non-integration of the person’s values into the care process	Organizational context
	Limited resources
	Work overload
	Awareness
	Training
	Vocation
	Institutional philosophy

Although the concepts of person’s fundamental values, values expected from nurses, and attributes desired in nurses may appear to overlap, they represent analytically distinct themes in this study. Person’s fundamental values refer to the core beliefs that individuals consider essential to their identity, dignity, and sense of self. Values expected from nurses correspond to the ethical and professional values that participants believe should guide nurses’ conduct throughout the care process. Attributes desired in nurses relate to personal and relational characteristics perceived as facilitating a positive therapeutic relationship. This conceptual distinction guided the thematic analysis and the organization of the findings.

Theme 1: Person’s Fundamental Values

Participants identified the following as fundamental values: respect, empathy, privacy, competence, honesty, and interpersonal relationships.

Respect was the value most frequently mentioned by participants during the interviews. Participants considered respect for their values to be essential when receiving care. According to the participants, care must acknowledge the uniqueness and vulnerability of each person.

“I think that values must be respected.” (I3)

“To see the person and not the illness. . . to see the person as important. . . to respect them.” (I9)

Empathy was also identified as a fundamental value: the ability to understand others and to recognize their vulnerability, or to be able to put oneself in their position. Participant I5 stated, “Having empathy for others is knowing how to put yourself in their shoes”.

Participants’ narratives also described privacy as fundamental. They valued situations in which nurses took care to preserve their privacy, such as using screens or curtains to prevent unnecessary exposure during procedures. Participants also highlighted the importance of nurses acknowledging potential embarrassment when people were treated by professionals of the opposite sex and ensuring that such situations were avoided in the future.

“I think privacy is important.” (I5)

“(. . .) They were careful when they came to do hygiene, they always closed the screen, especially because I didn’t feel very comfortable when male nurses, of course(. . .) did this work. I felt a little embarrassed, they must have realized this and from then on (. . .) they respected my privacy.” (I6)

Participants’ narratives about respect for privacy seemed to encompass not only respect for physical intimacy but also respect for the confidentiality of personal matters.

“The rooms there aren’t that big either, and I overheard the conversations between nurses or doctors and the patient next to me, there’s no privacy there. (. . .) I think these conversations should take place in the office.” (I1)

Competence was another fundamental value that participants expected nurses to demonstrate. When nurses did not demonstrate competence, participants felt insecure. They mentioned that behaviors such as forgetting a person’s name after interacting with them more than once or taking “notes on a [random] piece of paper, important notes about the person’s condition. . .I think that is not very professional” (I1) were signs of incompetence. Conversely, when nurses demonstrated their knowledge and skills, the care they provided contributed to the person’s sense of security.

“I really liked the treatment because you could see that they knew what they were doing.” (I1)

Participants highlighted honesty as a crucial moral quality for nurses. They valued sincerity and transparency when receiving information because it made them feel safe throughout the care process.

“I admire that, the honesty, respect, empathy, which are fundamental to me, I experienced those aspects.” (I4)

“(. . .) If we don’t know very well what’s coming next, we worry. . . we always have that feeling. . . did something go wrong?” (I3)

Participants also emphasized the importance of the interpersonal relationship established with nurses. They highlighted that nursing care should extend beyond technical procedures; nurses’ interaction and dialog with patients were seen as key to making them feel at ease and less alone and isolated. Furthermore, this contributes to a less distressing hospitalization experience.

“(. . .) Nurses have to be more attentive to talking, it’s not just about doing the treatment. . . let’s say it facilitates the hospitalization process much, much more, because some people feel isolated there (. . .)” (I6)

“Because (. . .) they also asked where I was from, if I had children. They asked more personal questions to put me at ease” (I8)

Theme 2: Values Expected From Nurses

Participants emphasized that nurses must embody certain values because, without them, they cannot be considered good professionals, given that nursing is a profession centered on caring for people.

“Being a nurse requires certain values (. . .) no matter how hard they try, they will never be good nurses, they have to have values!” (I1)

“Those who work in health and care have a very strong human side. They are not machines. . .” (I3)

According to the participants, the values expected from nurses are: respect for the person, empathy, beneficence, honesty, affection, and humanization.

Respect for the person was recognized as a value expected from nurses, considering that every person is different. Respect for the person encompasses not only the physical dimension but also a person’s convictions and decisions. When professionals fail to ask what matters to a person or disregard their decisions, that person feels objectified, and a fiduciary relationship is not established between them and their nurse.

“You have to respect them in the sense of respecting their differences.” (I4)

“Treat people with respect, and consideration for their physical and mental state, which is very, very fragile (. . .)” (I7)

“Nobody asked what I felt, what I wanted, (. . .) how I was living the moment, (. . .) so I couldn’t feel that relationship of trust. I felt like another object (. . .) professionals, in this case nurses, didn’t respect me as a person.” (I2)

Empathy was described as a priority value that people receiving care expect nurses to demonstrate, particularly since they are vulnerable when seeking healthcare. Participants expected nurses to be sensitive to their problems and able to empathize with them.

“But empathy is fundamental because people who go to the hospital, like me a few times, are sick and vulnerable, and nurses are expected to provide it.” (I4)

“Empathy, trying to put yourself in my place, what I’m feeling” (I2)

Beneficence was also highlighted. Participants expected nurses to demonstrate dedication, that “the nurse is doing the best for the patient” (I4), thus ensuring their professionalism and commitment to well-being.

“The vein was already [showing signs of phlebitis] and she was aware of this. That was very important to me.” (I5)

“Doing the best for the patient. I think it’s fundamental.” (I4)

Honesty was another essential value in nurses’ interactions. Participants expected nurses to be truthful and valued honesty in all situations. They also expected nurses to acknowledge mistakes, recognizing that everyone makes mistakes. What mattered most to participants was that nurses admit their mistakes without making excuses or shifting blame.

“Be honest, be nice, try, but be truthful with people” (I1)

“I felt that the professionals were honest with me. The first time, for example, they were honest, they told me, this didn’t go well.” (I4)

“Because everyone makes mistakes, we have to acknowledge them, we can’t dismiss, ignore them, or make excuses” (I1)

Affection was another value that participants expected to see in nursing practice. They stressed that sick people are vulnerable and that nurses should demonstrate affection rather than focus solely on technical procedures.

“But those who are hospitalized are vulnerable, regardless of the situation. No matter how annoying a patient is, they should make an effort to show affection.” (I5)

Humanization of care was also emphasized as a guiding principle in care. Participants argued that nurses should focus on the person during care delivery, showing genuine interest in their well-being and recovery. Humanized care helps sick people who feel fragile and vulnerable feel comforted and not abandoned.

“During the hospitalization, they should treat people well, if they treat people with humanity, make them feel as comfortable as possible, because I felt fragile, I felt completely abandoned (. . .)” (I7)

“This human side, this genuine interest they showed me are very important values.” (I3)

In their narratives, participants asserted that nurses should focus not only on technical tasks but also on the human dimension of the person. They mentioned additional care aspects that cannot be translated yet are fundamental, such as “Ensuring a reassuring presence” (I4), addressing people by their name, and respecting their convictions.

“(. . .) To go a little bit beyond the technical aspects. They respect my way of being. My way of life. Addressing the person by their name is something I think is very important.” (I4)

Theme 3: Attributes Desired in Nurses

Participants identified several attributes they desired in nurses: friendliness, availability, sense of humor, attentiveness, and effective communication.

For interviewees, these attributes were essential for building a relationship between the nurse and the person receiving care. Friendliness was highlighted as a facilitator of interaction with others. According to the participants, people value being cared for by someone who smiles and speaks calmly, noting that such attitudes made a difference in their experience of illness.

“Oh, it was the way they talked to me. . . all friendly. And their smile, they smiled. It’s important for someone in this situation (. . .) to see a smile (. . .) a calmer tone of voice and this make a difference to someone who is sick.” (I9)

Availability was also valued as a primary attribute for nurses. Participants emphasized that nurses should rethink their care practices and adopt an attitude of active listening, openness, and receptivity to the other person while delivering care.

“Sometimes they come, cross their arms, wait for the answer, and go away, so being available to listen to us is very important.” (I2)

“Being available to listen to the person, to listen to their problems, and that was done. I think that’s the first thing. . .” (I1)

Sense of humor was described by participants as a facilitator of communication because it helps ease tension in difficult or unpleasant situations. When nurses use humor with people they already know, it can serve as a way of meeting their needs.

“I think they must also have a sense of humor, to break the ice” (I3)

“[They] played with the situation and I think this is a way of trying to reach us, to show that they know us.” (I5)

Attentiveness was another attribute that participants expected from nurses, given the fragile and vulnerable state of people who are sick.

“I think they should be, they should be attentive because people are fragile. So, give attention, be attentive.” (I5)

Participants also valued nurses’ effective communication or interaction with people receiving care, noting that the use of both verbal and non-verbal communication is fundamental and makes a meaningful difference for those who are sick.

“To come, to greet, to smile, which are small things, but they make a lot of difference.” (I5)

“You can tell by the language and sometimes by the gestures. We can tell right away from the way they do things and in their tone of voice.” (I8)

For participants, careful communication by nurses fosters the empowerment of people receiving care and facilitates the negotiation of care.

“(. . .) Look, I’m going to do this and that, if it hurts, tell me and I’ll try to fix it (. . .). Let’s do it this way, they negotiated with me some types of care” (I7)

Theme 4: Perceived Reasons for the Integration or Non-Integration of the Person’s Values in the Care Process

Participants reflected on the perceived reasons for the integration or non-integration of the person’s values in the care process, identifying both facilitating and hindering factors. Facilitating factors included awareness, training, vocation, and institutional philosophy, whereas hindering factors were associated with the organizational context, limited resources, and work overload.

According to participants, nurses must understand the importance of integrating the person’s values into care. This requires actively asking the person receiving care about what matters to them because values are fundamental to each individual. Participants believe that awareness involves both professional training in this field and reflection on practices.

“First, I think they need to understand that values are important and that there are values that are important to each person, and that they must integrate them every day into the care they provide. Maybe they need to pause and reflect, perhaps they also need training on this and should ask people questions” (I2)

Professional training was identified as a key facilitator of the integration of the person’s values into the care process. Participants reported that nurses should develop a socio-moral capacity that aligns with their professional practice and considered training in the field of values to be fundamental. They emphasized that values must be integrated into nursing education.

“I think many complaints about healthcare, especially concerning nurses, are related to the lack of respect people feel when they use the services, and that is something you learn, you learn it, but it must be taught.” (I4)

“These values need to be instilled during classes, at school; many students already come here with an arrogant attitude.” (I7)

Participants also discussed the importance of vocation for being a nurse in order to adequately meet people’s needs.

“I think if you want to be a nurse, you need to have a passion for it, it’s a vocation. But some have it, and others don’t!” (I8)

The institutional philosophy was described as a factor that facilitates the integration of the person’s values into the care process. Participants perceived a difference in the respect shown for their values between private and public institutions. They felt that professionals in the private sector were more concerned with them as individuals and not solely focused on their clinical situation.

“In public services, it’s more difficult to create this type of environment” (I3)

“I think that they were more concerned with me because it was a private unit. Not just concerned with the situation. But I don’t know if it’s the same or not in a public hospital.” (I8)

The organizational context of healthcare institutions refers to their structure and the fact that multiple hospitalized patients may share the same physical space at the same time, along with the presence of several nurses. This means that conversations between professionals and people receiving care, as well as between people and their families, often occur without respect for individual privacy. Participants state that adhering to service routines results in their needs and choices not being respected, making them feel disrespected as individuals.

“The space, the resources (. . .) the lack of conditions.” (I5)

“the routines of the service, which were imposed, ignoring my needs and choices, and because of this, I felt very vulnerable, fragile, and really insignificant. (. . .) I was not respected as a person.” (I4)

Institutions’ limited resources, whether technical, human, structural, or time-related, were also seen as unfavorable conditions for integrating the person’s values. Participants also considered “the number of patients under the care of each health professional” (I11) an obstacle to the integration of the person’s values into the care process.

Participants further noted that work overload puts nurses under constant stress, which often compromises both their own values and those of people under their care. This pressure could lead to indifference and a disregard for people’s individuality. Participants also believed that nurses’ values are influenced by the pressure of work in a stressful environment.

“neutral attitude, a bit like going through the motions, where things just aren’t valued” (I4)

“They may have values, but working in stressful situations sometimes causes them to set those values aside because they are anxious, they are tense.” (I5)

However, some participants argued that workload alone was not sufficient to explain the non-integration of the person’s values into the care process. They suggested that, even during care procedures, nurses could take time to interact with people, assess their needs, values, and preferences, and incorporate them into care. In their view, failing to do so was more closely related to professional competence than to work overload.

“Many times, when the nurse administered the antibiotic, they could have taken that moment to talk to me, introduce themselves, ask how I was feeling? They need to rethink how they approach us and how they can meet our needs, choices, and values, the values of the clients.” (I2)