Value Priorities,Honoring the Dignity of Persons,and Living the Art of Nursing

Values are typically defined as personal preferences that influence what is regarded as important; thus, value priorities often mirror chosen engagements and activities. Value priorities within theoretical approaches also reflect what is considered important with an array of illimitable options of building consistent disciplinary science, research, and practice traditions. Within the nursing discipline, the theoretical approaches include the scope, depth, breadth, and type of disciplinary phenomena that offer structure to nursing practice. The author here considers the connectedness of value priorities and theorical approaches, how they guide nursing practice, and what happens if the care is unfinished or missed.

The humanbecoming paradigm serves as an exemplar for illustrating the connectedness of values, theory, and practice. Within the humanbecoming paradigm, the designation of living the art is referred to as opposed to nursing practice. Living the art is a construct consistent with the ontology of humanbecoming, which focuses on humanuniverse as a seamless symphony of becoming (Parse, 2021). The heart of being with persons in this paradigm is termed true presence. True presence reflects a distinctive knowledge based in a way of being with others, attentive to moment-to-moment changes in “illuminating meaning, shifting rhythms, and inspiring anticipation” (Parse, 2021, p. 121). Persons and families as communities are the emphasis; the milieu does not provide the driving focus. The emphasis of the humanbecoming paradigm and living the art is on value priorities, and the focus is on the fact that persons are experts of their own living quality. Other nursing theoretical frameworks emphasize different nursing practice structures and processes. For example, within Roy’s adaptation model, nursing practice is structured to focus on adaptation. Adaptation and coping refer to human and environment interactions, and the nurse structures nursing care to promote human development, health, and/or a peaceful death (Roy, 2009).

Valuing is defined by Parse (2021) as an “all-at-once confirming-not confirming cherished beliefs in light of a personal world view” (p. 43). Valuing, as opposed to values, refers to a dynamic process that embodies cherished ideas, actions, dialogues, and silences. Parse references Raths et al. (1978), whose work provides insight into the valuing process. According to Raths et al., valuing depicts the following seven essential processes:

In summary, Raths et al. (1978) reported that values are chosen, prized, and acted upon. Embedded in the idea of values is the notion that when one values something, one chooses freely from alternatives, one prizes the choice by a willingness to affirm the choice, and one acts and repeats the pattern of choices. Thus, values raise the notion that an action is worthy of one’s time, effort, and priorities.

Entry into a school of nursing is an example of a value and choice that initiates a process of professional value instruction. The professional values are frequently defined as “standards for action that are accepted by the practitioner and/or professional group and provide a framework for evaluating beliefs and attitudes that influence behavior” (Schank & Weis, 2001, p. 226). Schmidt and McArthur (2017), in their concept analysis of professional nursing values, stated that personal values influence a choice of entering into the discipline of nursing and each discipline has a set of professional values. Schmidt and McArthur also state that members of a discipline need to develop and sustain professional values in order to embody a professional identity. At the conclusion of the authors’ article, a working definition of professional nursing values was described as “the professional nursing principles of human dignity, integrity, altruism, and justice . . . serve as a framework for standards, professional practice, and evaluation” (Schmidt & McArthur, 2017, p. 73).

In the discussion of values, a question arose as to where does the nurse acquire or further a sense of values within the practice milieu? Does this occur within educational institutions? Or is it within the operational area to inculcate values and responsibilities? Schank and Weis (2001) proposed that both service and education share responsibility, values are linked to practice, and value refinement occurs over time. Nurse education may initiate the process of professional nursing values development; however, these values and priorities continue to develop within workplace socialization and experiences (Schank & Weis, 2001). The partnership between education and practice includes the advancement and connectedness of nursing theoretical considerations and practice.

In separate articles, Kalisch et al. (2009) and Jones et al. (2015) referenced the ideas that quality and safety issues often reflect unfinished, missed, and implicitly rationed nursing care. Jones et al, 2015. synthesized a definition of unfinished care as “a problem of time scarcity that precipitates the process of implicit rationing through clinical priority setting among nursing staff resulting in the outcome of care left undone” (p. 27). Simply stated, implicit rationing reflects time constraints in which the nurse chooses to critically evaluate value priorities in what care is meaningful, actionable, and necessary to complete and what will remain unfinished. A concerning element in Jones et al. was the description of unfinished, missed, or implicit rationing of care included items such as emotional support, education, care coordination, discharge planning, care planning, and timeliness of medical tasks. These elements are often essential to being with persons and when not completed the dignity and, thus, the care of persons go unaddressed. The avenues suggested for easing these unmet safety and quality care needs were briefly described as: re-designing the nursing care model to reduce time scarcity, developing robust staff education to focus on safety, and advancing technological monitoring systems to promote additional time for patient-centered care (Jones, 2016). The missing element to these discussions was an emphasis on the patient perspective and patient values, along with the nursing theoretical framework that structures nursing practice. The idea that values and theoretical frameworks can be reduced to problem-solving unfinished, missed, or rationed care within the structure of the nursing process may not portray the true impact on persons and families as communities.