Core Values are those elements of Associate Degree Nursing that are essential to entry level registered nursing practice and are inherent in the four roles of nursing practice: human flourishing, human judgment, professional identity, and spirit of inquiry. The core values include caring, diversity, ethics, excellence, holism, integrity, and patient centeredness and are defined as:
- Caring: promoting health, healing and hope in response to the human condition" (NLN, 2010, p.1 1) '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.' (NLN, 2007).
- Diversity: recognizing differences among "Persons, ideas, values, and ethnicities," while affirming the uniqueness of each (NLN, 2010). "A culture of diversity embraces acceptance and respect. We understand that each individual is unique and recognize individual differences, which can be along the dimensions of race, ethnicity, gender, sexual orientation, socioeconomic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies. A culture of diversity is about understanding ourselves and each other and moving beyond simple tolerance to embracing and celebrating the richness of each individual. While diversity can be about individual differences, it also encompasses institutional and system-wide behavior patterns." (NLN 2007).
- Ethics: involves reflective consideration of personal, societal and professional values, principles, and codes that shape nursing practice. Ethical decision-making requires applying an inclusive, holistic, systematic process for identifying and synthesizing moral issues in health care and nursing practice, and for acting as moral agents in caring for patients, families, communities, societies, populations, and organizations. Ethics in nursing integrates knowledge with human caring and compassion, while respecting the dignity, self-determination, and work of all persons. (NLN, 2010, p.13).
- 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" (NLN, 2007).
- Holism: the culture of human caring in nursing and health care that affirms the human person as the synergy of unique and complex attributes, values, and behaviors, influenced by that individuals environment, social norms, cultural values, physical characteristics, experiences, religious beliefs and practices, and moral and ethical constructs, within the context of a wellness-illness continuum (NLN, 2010, p.14).
- Integrity: "respecting the dignity and moral wholeness of every person without conditions or limitations." Integrity within nursing practice... [recognizes], with humility, the human dignity of each individual patient, fellow nurse, and others whom we encounter in the course of our work. It means accepting accountability for our actions while being fully committed to the betterment of patient care while advocating for patients in a consistently professional and ethical manner (NLN, 2010, p.13).
- Patient-Centeredness: an orientation to care that incorporates and reflects the uniqueness of an individual patient's background, personal preferences, culture, values, traditions, and family. A patient-centered approach supports optimal health outcomes by involving patients and those close to them in decisions about their clinical care (NLN, 2010, p.14).
Emerging from core values are six integrating concepts. These concepts are defined as:
- Context and Environment: "...the conditions or social system within which the organization's members act to achieve specific goals. In health care, context and environment encompass organizational structure, leadership styles, patient characteristics, safety climate, ethical climate, teamwork, continuous quality improvement, and effectiveness." (NLN, 2010, p.I 6)
- Knowledge and Science: "...the foundations that serve as a basis for nursing practice, which, in turn, deepen, extend and help generate new knowledge and new theories that continue to build the science and further the practice. These foundations include (a) understanding and integrating knowledge from a variety of disciplines outside nursing that provide insight into the physical, psychological, social, spiritual, and cultural functioning of human beings; (b) understanding and integrating knowledge from nursing science to design and implement plans of patient-centered care for individuals, families, and communities; (c) understanding how knowledge and science develop; (d) understanding how all members of a discipline have responsibility for contributing to the development of that discipline's evolving science; and (e) understanding the nature of evidence-based practice." (NLN, 2010, p.20)
- Personal 'Professional Development: "...a lifelong process of learning, refining, and integrating values and behaviors that (a) are consistent with the profession's history, goals, and codes of ethics; (b) serve to distinguish the practice of nurses from that of other health care providers; and (c) give nurses the courage needed to continually improve the care of patients, families, and communities and to ensure the profession's ongoing viability." (NLN, 2010, p.23)
- Quality and Safety: "...the degree to which health care services are 1) are provided in a way consistent with current professional knowledge; 2) minimized the risk of harm to individuals, populations, and providers; 3) increase the likelihood of desired health outcomes; and 4) are operationalized from an individual unit and systems perspective." (NLN, 2010, p.25)
- Relationship-Centered Care: "positions (a) caring; (b) therapeutic relationships with patients, families, and communities; and (c) professional relationships with members of the health care team at the core of nursing practice. It integrates and reflects respect for the dignity and uniqueness of others, valuing diversity, integrity, humility, mutual trust, self-determination, empathy, civility, the capacity for grace, and empowerment." (NLN, 2010, p.27)
- Teamwork: to function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care." (NLN, 2010, p.30)
Goals of nursing education for entry into nursing practice are defined as:
- Human Flourishing:"...an effort to achieve self-actualization and fulfillment within the context of a larger community of individuals, each with the right to pursue his or her own such efforts. ...Human flourishing encompasses the uniqueness, dignity, diversity, freedom, happiness, and holistic well-being of the individual within the larger family, community, and population." (NLN, 2010, p.33)
- Nursing Judgment: encompassing "...critical thinking, clinical judgment, and integration of best evidence into practice. Nurses must employ these processes as they make decisions about clinical care, the development and application of research and the broader dissemination of insights and research findings to the community, and management and resource allocation." (NLN, 2010, p.34) This process is driven by Maslow's hierarchy of needs to assist in the prioritization of patient-centered care.
- Professional Identity: "... the internalization of core values and perspectives recognized as integral to the art and science of nursing. The nurse embraces these fundamental values in every aspect of practice while working to improve patient outcomes and promote the ideal of the nursing profession." (NLN, 2010, p.35)
- Spirit of Inquiry: "...a persistent sense of curiosity that informs both learning and practice. A nurse infused by a spirit of inquiry will raise questions, challenge traditional and existing practices, and seek creative approaches to problems." (NLN, 2010, p.36)
Functional Health Patterns are ways of living that include a configuration of behaviors that occur across time. The patterns are interrelated, interactive and independent. Functional and dysfunctional patterns determine client strengths and/or nursing diagnoses. There are eleven (11) functional health patterns that include: health perception/health management, nutrition/metabolism, elimination, activity/exercise, self-perception/self-concept, role/relationships, sexuality/reproduction, coping/stress/tolerance, and value/belief and are defined as:
- Health Perception-Health Management: the client's perceived pattern of health and well-being and how health is managed. It includes the client's perception of his/her own health status, the general level of health care behaviors, and adherence to health practices.
- Nutritional-Metabolic_: the client's pattern of food and fluid consumption relative to metabolic need and pattern indicators of nutrient supply. It includes skin integrity, nutritional intake, nutrient supply to tissues, and metabolic needs.
- Elimination: patterns of excretory function (bowel, bladder, and skin). It include
the client's perceived excretory functions, changes or disturbances in function,
devices used to control excretion, and family/community disposal patterns.
- Activity-Exercise: patterns of exercise, activity, leisure, and recreation. It includes activities of daily living requiring energy expenditure, type and quality of exercise, and factors that interfere with the expected pattern (neuromuscular deficits, musculoskeletal abnormalities, and cardio-pulmonary insufficiencies).
- Sleep-Rest: patterns of sleep, rest, and relaxation. It includes the perception of quality and quantity of sleep, rest-relaxation, and energy levels.
- Self-Perception-Self-Concept: the client's self-concept pattern and perception of self (self-conception/worth, body image It includes attitudes of self, perception of abilities (cognitive, affective, or physical) image, identity, worth, and emotional patterns.
- Role-Relationship: the client's pattern of role engagements and relationships. It
includes the client's perception of his/her major roles, responsibilities, and relationships in current life situations.
- Sexuality-Reproductive: the client's patterns of satisfaction and dissatisfaction with sexuality pattern. It includes reproductive patterns, satisfaction with sexual relationships and sexuality patterns.
- Coping-Stress-Intolerance: the client's general coping pattern and effectiveness of the pattern in terms of stress tolerance. It includes the capacity to resist challenges to self-integrity, modes of handling stress, support systems, and ability to control or manage situations.
- Value-Belief: patterns of values, beliefs (including spiritual) and goals that guide the client's choice of decisions. It includes perceptions of what is important in life, and conflicts in values, beliefs or expectations that are health related.