Table 1 Analysis of theories and models included in the study
Meleis' theory analysis | Five values of the nursing profession from the American Association of Colleges of Nursing (AACN) | Model of factors and corollary values influencing professional values development | The Professional Values Model in Nursing | Moral agency of nurses model | The process of attaining, enacting and socialising values | the Values Based Enquiry model | |
|---|---|---|---|---|---|---|---|
Theorist analysis | The American Association of Colleges of Nursing AACN works to establish quality standards for nursing education; assist schools in implementing these standards; influence the nursing profession to improve health care; and promote public support for professional nursing education, research and practice | Darlene Weis is the founder of the Nursing Professional Values Scale and Professor Emerita at Marquette University. Mary Jane Schank, an American nursing educator, is a member of the American Nurses Association, the National League for Nursing, the Association for Research in Nursing Education and the Midwest Nursing Research Association | The researcher is currently working as a research assistant at the Department of Nursing, Akdeniz University, Turkey, with research interests in principles of nursing, nursing, and critical care medicine | One of the researchers, Barbara J Daly, a nursing educator and nursing philosopher, led a task force from 1996 to 2001 that rewrote the American Nurses Association's code of professional ethics | The researcher team includes four people with health-related majors, including Sastrawan, a postgraduate student, and Jennifer, an associate professor at the University of Melbourne with a Ph.D. in education. Gabrielle Brand is a faculty member in the School of Nursing with expertise in qualitative research, and narrative medicine. Gulzar Malik is a senior lecturer in nursing at La Trobe University with a specialization in acute and critical care | The study involved the Centre for Curriculum Development at the University of Southampton,,UK and the researcher is a Principal Teaching Fellow in the School of Health at the University of Southampton. She has extensive experience in curriculum development and design and is currently the Programme Leader for the Pre-registration Nursing Programme for the Master in Nursing | |
Origin of the paradigm | Code for Nurses issued by the American Nurses Association | Code for Nurses issued by the American Nurses Association | (1) Watson's theory of caring (2) Pender's model of health promotion | (1) Self-esteem theory (2) Value theory The two theories above argue that (i) the self consists of multiple unique and meaningful identity standards and guides decision-making and behaviour. (2) Describes a potential internal conflict when a situation creates inconsistencies in identity standards or internalised value structures | A paradigm for constructivist grounded theory | Theoretical foundations: virtue ethics and values-based practice (1) Virtue ethics is based on Aristotle's theory that virtues can be developed from habits and that character can be conceptualised as those contribute to the achievement of specific goals (2) Values-based practice is a healthy way of practising because self-awareness and the skills needed to recognise and respond to the values of others are required in clinical practice and decision-making | |
Internal Dimensions | rationale on which the theory is built | Based on the 2001 American Nurses Association Code of Ethics and is described around the five main concepts of altruism, autonomy, human dignity, integrity, and justice | Interpretive propositions (1) The theory was developed before the American Association of Colleges of Nursing identified the fundamental values in baccalaureate nursing education in 1998 (2) Scholars at the time believed that nurses needed to learn cognitive and psychological domains and emotional skills and that these three areas were essential to professional development and professional socialisation | Existence propositions Theoretical assumptions: (1) Individuals attempt to create healthy behaviour that demonstrates personal values and will be influenced by personal experiences (2) Individuals always show change and development and have the possibility to express themselves (3) Individuals influence and are influenced by their environment at all stages of their lives (4) The higher the professional values of nurses, the higher their job satisfaction and quality of care | Interpretive propositions Theoretical assumptions: (1) Nursing professional values are based on the 2008 ANA Code, learned and internalised through environmental and social exposure (2) The three main premises of the internalisation of nursing professional values are that knowledge of values is personal (cognitive), the importance of values is subjective and relative to other held values (affective), and values can be maintained when perceived to be in flux (behavioural) (3) The identification of ethical dilemmas initiates a process of self-validation that requires a reflection of value identity, fulfilling of role expectations, and the skills and resources available for conflict resolution (4) Confidence in ethical decision-making is a subjective assessment of one's ability to identify conflicting values of interest, identify role expectations, reflect on skills and knowledge readiness, and assess one's ability to 'do the right thing' in a situation (5) Self-confidence in ethical decision-making plays an essential role in an individual's level of self-esteem (6) Self-esteem results from integrating personal and professional values, a motivation to maintain a commitment to identity standards, and a buffer against moral distress when values are inconsistent | Interpretive propositions The development of fundamental values for nurses contributes to developing of their value system. Interviews with nursing managers and other stakeholders were used to understand the various influences on their values, to describe events and past experiences and reflections that have influenced their values, and to ask questions such as "How did you develop as a professional nurse?", "How have you developed your personal, professional identity/values/views/attitudes?" | Existence propositions (1) The UK Nursing and Midwifery Council set new standards for nursing education in 2010, suggesting that graduates of nursing and midwifery should be of good character on entry to registration (2) Educators cannot directly endow students with good character but can motivate them to follow their paths in life |
system of relations | / | A field approach The model describes the role and influence of education, professional processes, and institutions/services in developing professional values, as well as the core value attributes of professional values. The relationships between the variables are described, the role of education as a driver of professional values development is affirmed, and it is explicitly argued that nurses' practice behaviours in clinical practice and their interactions with the organisation all impact on the formation of professional values | A monadic approach The theory focuses on explaining professional values through three basic concepts | A field approach The theory describes the relationship between nursing professional values, self-esteem, and ethical decision-making, thus reflecting how ethical decision-making and self-esteem can be influenced and changed at different stages of professional value enhancement | A monadic approach The process theory is based on how nurses form their professional values. The three stages of the social process of professional values formation are described, and the relationship between each stage is explained | A monadic approach The core of the model emphasises professional values of self-awareness, caring and compassion, and awareness of the values of others. The model specifies how professional values in nursing education should be internalised in future students who become nurses and midwives, focusing only on the characteristics of students' internalised professional values and is a consideration of a single factor | |
Content of the theory | / | Micro theory | Micro theory | Micro theory | Micro theory | Micro theory | |
Theory beginnings | / | Constructive beginning The theory is presupposed to be hypothetical, i.e. thinking about the relationships between variables in terms of assumptions. Ten premises of values formation are stated in the theory, including that values occur as practice progresses and may be subject to stagnation and imbalance; that there are key stages that facilitate and hinder the development of professional values; that preparation and purposeful experience are key factors in the development of values; that the personal values of the student component are aligned with nursing values; that the nurse-patient relationship and its values should be encapsulated in professional nursing education. Values related to social issues should be ranked as a secondary position, e.g. activism; higher education promotes values development; mentoring by individuals who have internalised values helps develop the professional values commitment of others; policy development, the nature, and scope of nursing practice should also be a nursing professional concern; professional values are reflected in action, etc | Principle theory beginning The nursing profession's values developed in this study contain three foundational concepts (1) Personal values: (i) Personal characteristics, experiences, perceived health and illness status, needs, priorities, environment, and society play an important role in the acquiring of values and the creation of value structures. (ii) Personal values guide the choices and priorities of individuals in the decision-making process. (iii) Values have a significant impact on individuals' decisions about their needs when they are healthy or ill. (iv) Values play an important influence in the individual's involvement or rejection of their care (2) The values of the nursing profession were identified by the American Association of Colleges of Nursing and, based on a review of the literature, have been developed as truth, integrity, altruism, autonomy, equality, human dignity, and aesthetics (3) The goal of the nursing profession is to provide effective and high-quality care based on patient's individual needs, using constantly updated knowledge | Constructive beginning It has been demonstrated that there is a relationship between self-esteem, ethical decision-making, and internalisation of professional values, so the researcher has confirmed that the relationship between the variables, in theory, does exist by hypothesizing and testing the relevant variables | Principle theory beginning The theory is based on the collection and analysis of data through the research methodology of constructivist rooted theory, which utilises an inductive approach to theory generation and proposes the need to go through three stages of realising values, formulating values, and socialising values | Constructive beginning The core propositions of the theory consider self-awareness, care, and compassion and the identification and understanding of the values of others to be central to students' development of their future identity as nurses and midwives (1) Students must be aware of their values and behaviours (2) Be mindful of the professional values of care and compassion (3) Reflect on how to relate to and respond to the values of others | |
Scope of theory | / | Situation-specific theory | Situation-specific theory | Situation-specific theory | Situation-specific theory | Situation-specific theory | |
Goal of a theory | Describe the five professional values based on the code of ethics for nurses | (1) Reflect on how education, professional practice, and the profession influence professional values (1) Reflects the social nature of the profession and its responsibilities to the public (3) Guide nursing educators in the preparation of future nurses (4) To guide providers in developing standards and assessment measures to advance the profession | (1) Describe personal characteristics, values, and experiences to provide personal care based on the whole person (2) Describe nurses' personal and professional values and clarify themselves (3) Improve nurses' professional values and job satisfaction (4) Provide quality care and increase patient satisfaction with care | Describing and validating the relationship between nursing professional values, self-esteem, and ethical decision-making will help educators to clarify the relationship between self-esteem development and the internalization of professional values | (1) Reflects on the basic processes nurses go through in forming their value systems (2) Reflects on how professional nursing values are formed and socialized into nursing practice | (1) To identify how to develop nursing and midwifery graduates with good character, provide students with intrinsic motivation, help them develop critical thinking, and develop their self-efficacy and moral agency (2) Provides support for a theoretical framework for ethics education developed under the Nursing Education Standards of the Midwifery and Nursing Council of the United Kingdom (3) Reflects the explicit conceptual nature of education with a broader nursing profession | |
Context of a theory | Knowledge of disorder The fundamental values of the nursing profession are set out in the Code for Nurses issued by the American Nurses Association, which emphasises that a code of professional ethics is essential to practice | Knowledge of order The model assumes that education, service institutions, and professional practice behaviour influence professional values. (1) Professional values are an important part of professionalism and reflect the nature of society and responsibility to the public. (2) Education, service, and the profession play an important role in professional development. That is, learning in the formal education species must be engaged by service professionals to be more fully integrated into the profession. (3) A common, and shared core value system is a hallmark of excellence within the organisation and the organisation plays an important role in enhancing the value of personal growth | Knowledge of order The theory suggests that professional values include three underlying concepts: personal values, professional nursing values, and quality of care | Knowledge of control In this model, high or low professional values in nursing affect professional identity standards. When an individual in an ethical dilemma has their ethical decision-making influenced by positive and negative circumstances, this allows for moral self-confidence changes, affecting self-esteem. In contrast, self-esteem can impact professional values and ethical decision-making | Knowledge of control The three stages developed in this study, of which the first stage is the realisation of values, is a theory that emphasises the important role that the family plays in shaping nurses' personal values, particularly in the early years of the nursing profession. The second stage is the formulation of values, which theorises that nurses' values are reactivated and reinforced during their professional training. The third stage is the socialisation of values, which suggests that nurses often share and continue to develop their values informally with colleagues around them, encouraging nurses to revisit values that have been neglected | Knowledge of control (1) The theory consists of a core section and prompt questions, which are a collection of three questions for instructors to promote the professional values of nursing students (2) The prompt questions promote the proposition in the theory that the formation of good professional values in nursing students requires the individual student to want to become a nurse or midwife in the future rather than 'learn' to do what it takes to become a nurse or midwife (3) Prompting questions to include three categories, namely critical and analytical skills, internal motivation, self-beliefs, and self-efficacy, based on which students can engage in reflective practice, and the researcher also describes and gives examples of how the three categories of prompting questions are used in the text | |
Abstractness | Low abstractness | Low abstractness | Low abstractness | Low abstractness | Low abstractness | Low abstractness | |
Method of theory development | / | It was developed based on literature research | Based on literature research, clinical experience, and the development of the researcher's knowledge and perceptions | A synthesis of self-esteem and values theories was used to form the theory | It was developed from an approach based on Charmaz's constructivist grounded theory. Data was collected through in-depth personal interviews, focus group interviews, anecdotes, and reflective writing and analysed through a continuous comparative approach to form the theory | Metaphors. Drawing on The Wizard of Oz, Dorothy encounters the Tin Man, the Cowardly Lion, and the Scarecrow, all of which are Dorothy's weaknesses, on her way home along the Yellow Brick Road. Eventually, without the help of the Wizard, Dorothy returns home and discovers that she has always possessed these personal qualities that she thought she did not have in the past. Therefore, the researcher describes the character development process as the 'yellow brick road' | |