Transcript Values Prob Solv Dec Making Final

Leader Values, Attitudes, &
Beliefs: Impact on Problem
Solving and Decision Making
Samuel Merritt University
School of Nursing
NURS 560 – Fall 2015
Dr. Mileva Saulo Lewis, All rights
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At the completion of this session,
learners will be able to:
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Describe the role that values play in problem
solving and decision making
Analyze a problem from a values
perspective
Analyze a situation from the perspective of
the values that serve as the basis for
professional nursing practice
Select a problem-solving/decision making
model appropriate to the situation
Apply the Ladder of Inference to a problem
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Suggested Approach
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First Part – Personal Values
– Check in; Announcements; Questions
– Values Clarification Process
– Personal Values Guiding Life Choices
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Second Part - Professional Values
– Diversity of values in the workplace and a multi-cultural society
– Problem Solving and Decision Making
– Mental models and Frames
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Third Part – Values and Policy
– Values and health policy
– Session Evaluation
– Review next session
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Values, Beliefs, Attitudes
VALUES Clarification Process
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CHOSEN
(Cognitive)
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ACT (Behavior)
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Freely
Without pressure
From among alternatives
After reflecting on
consequences
PRIZE (Affective)
– Guide to behavior
– Chosen beliefs are prized and
cherished
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Criteria for evaluations,
judgments
Moral codes, positive or
negative
Affirmed to others
Incorporated into one's
behavior
Repeated consistently in
one's life
•
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Uustall, D.B. (1993). Clinical
ethics and values: Issues &
insights in a changing healthcare
environment. East Greenwich,
RI: Educational Resources in
Healthcare.
4
Beliefs and Values Origins
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Childhood Value Messages
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Get your work done, then you can play
Tell me the truth, and I won’t punish
you
Nothing worthwhile comes easy
The early bird gets the worm
You can accomplish anything if you
work hard enough
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Virtue – Eastern Tradition
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Based on Chinese, Indian, African, Hindu,
Muslim philosophies
Loyalty to ones beliefs
Trustworthiness in words
Empathy
Benevolence
Acting well when alone
Less formerly constructed then Western
philosophy
• Pellegrino, E. (2013). Presentation, Georgetown
Bioethics Intensive.
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Buddhist Ethics and Virtues
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Connection to bioethics – Alleviation of
human suffering
Connection to teleology – eudemonia –
happiness as a goal
• Butts, J.B., & Rich, K.L. ( 2013). Nursing ethics
across the curriculum and into practice. (3rd
ed.). Burlington, MA: Jones & Bartlett
Learning.
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Four Noble Truths
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First - Dukkha – suffering exists
2nd – 4th – Suggest causes of suffering; it can
be overcome, propose a path for
transformation
Eightfold path – 8 right practices
Immeasurable Virtues
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Compassion
Loving kindness
Sympathetic joy
Equanimity
• Butts & Rich, 2013
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9
Judeo-Christian Tradition
The Ten Commandments
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You shall have no other gods before Me.
You shall not make idols.
You shall not take the name of the LORD your God in
vain.
Remember the Sabbath day, to keep it holy.
Honor your father and your mother.
You shall not murder.
You shall not commit adultery.
You shall not steal.
You shall not bear false witness against your neighbor.
You shall not covet.
– Exodus 20:2-17
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Virtue and the Golden Mean
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Virtue
– Intellectual - ability to think - rational
– Moral - acting correctly - reason
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Moral Virtue
– Passions
– Faculties
– States of character
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The Golden Mean - between deficiency
and excess
• Beauchamps and Childress, 2013.
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Universal Core Values
Kidder, R. (1995). How good people make tough choices. New
York: William Morrow and Co. p.90-92
Bernard Gert
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Hans Kung
“Shard World
Conversations”
Do not kill; lie
Love
Steal
Truth
Practice
immorality
Fairness
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Don’t
Kill
Cause pain
Disable
Deprive of freedom or
opportunity
Deprive of pleasure
Deceive
Cheat
Keep promises
Obey the law
Do your duy
Freedom
Respect parents
and love children
Unity
Tolerance
Responsibility
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for life
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Personal Values Exercise
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Your going on a trip.
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Select 10 values to
place in your
suitcase.
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Virtues – Nursing’s Values
Florence Nightingale, circa
1836
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Trustworthiness,
Good person
Courageous
Compassionate,
Responsible
Discernment
Truthful,
Fair
–
AACN Essentials for
BSN Programs (2008)
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Altruism
Autonomy
Human dignity
Integrity
Social justice
– AACN, 2008
LeVasseur, J. (1998). Student
scholarship: Plato, Nightingale, and
contemporary nursing. Image:
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Journal of Nursing Scholarship,
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30(2), 281-5.
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Virtues - Medical Students:
Our highest
aspirations- The Kind of Person you are: White Coat
Ceremony Georgetown –
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Fidelity
Compassion
Suppress selfinterest
Humility
Intellectual honesty
Moral courage
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Moral courage
Altruism –
Moral Integrity –
Where is it you say
“No”
– Some things you
must never do
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Live up to the
promise
• Pellegrino, 2013
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Values – Potential for Conflict
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Respect of Others - Autonomy
Do Good - Beneficence
Do no harm - Nonmaleficence
Tell the truth - Veracity
Faithfulness to role, promise keeping
Fidelity
Be Fair - Justice
Just use of scarce resources
Distributive Justice
• Beauchamps & Childress, 2013
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Moral Compass: The North Star
What happens behind the curtain/door
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Best interest of
patient
Serve them
Professionals and
promises;
Compassion +
skill + Objectivity +
knowledge
Everything
depends on
character
– Pellegrino, 2013
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Summary of Readings
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Asta Baisa: Eddy, D., Elfrink, V., Weis, D., & Schank, M. (1994). Importance of
professional nursing values: a national study of baccalaureate programs. Journal
Of Nursing Education, 33(6), 257-262.
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Leslie Bennett: LeDuc, K., & Kotzer, A. (2009). Bridging the gap: a comparison of
the professional nursing values of students, new graduates, and seasoned
professionals. Nursing Education Perspectives, 30(5), 279-284.
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Phyllis Carroll: Martin, D., Godfrey, N., & Walker, M. (2015). The Baccalaureate
Big 5. Journal Of Nursing Administration, 45(3), 121-123.
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Emily Cruz: Weis, D., & Schank, M. (2000). An instrument to measure
professional nursing values. Journal Of Nursing Scholarship, 32(2), 201-204.
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Small Groups – What did you learn?
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Of what relevance is this to you?
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Small Group Summary
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We’re going to a party….
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Value Cohorts in the Workplace
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“Value Programmed” where were you when
you were 10 yo?
Traditionalist
Baby-Boomer
Gen Y
Gen X
• Kupperschmidt, B.R. (2006). Addressing
multigenerational conflict: Mutual respect and
carefronting as strategy. OJIN: The
OnlineJjournal of Issues in Nursing, 11 (2),
Manuscript 3, May 31, 2006.
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Summary of Reading – Small
Groups
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McNeese-Smith, D., & Crook, M. (2003). Nursing
values and a changing nurse workforce: values,
age, and job stages. Journal Of Nursing
Administration, 33(5), 260-270.
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What did you learn?
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Of what relevance is this to you as leaders; advanced
practice nurses, first job search?
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Values, Ethics, Problem Solving
& Decision Making
NURS 560
Dr. Mileva Saulo Lewis
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Problem Solving - What’s a problem?
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Discrepancy,
Difference,
deviation, imbalance,
Gap between what is
and what is
appropriate or
desirable
Avoid “should”
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Problem solving
phase
Decision making
phase
Do not move to
decision making
until you are sure
you have correctly
named problem
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Problem analysis
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Diagnose self (your behavior)
Diagnose task (appropriate method)
Diagnose the system(dynamics in the system)
Synthesis of all of the above
• LaMonica Rigolisi, E. (2013). Management and leadership in nursing
and healthcare. (2nd ed.). New York: Springer.
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Ladder of Inference
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http://www.youtube.
com/watch?v=K9nF
hs5W8o8
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The Learning
Organization
Personal mastery
Mental models
Shared vision
Team learning
• Senge, P. (1990). The
Fifth Discipline. New
York: Doubleday
Currency
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Things are not always as they appear
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What do you see?
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Tools
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Not every problem is a nail
Fishbone analysis
Delphi
Decision Grids
Gap Analysis
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A problem to be solved
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Ambiguity Puzzle
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BSAINXLEATNTEARS
• Disch, 2001
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Health Resources Exercise
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Discuss:
– Top Three
– Bottom Three
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Values implied
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Implications
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Frames and Reframing
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Anti Smoking Campaign
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Health care reform
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Decision Making
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Emotions come first –
name it - put aside
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Reason comes next
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Brain studies
– Lehrer, J.(2009). How we
decide. New York: Houghton,
Mifflin, & Harcourt.
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A Moral “Tool Chest”
Ethical Theory & Principles
 Professional/Personal Values
 ANA - Nurses’ Code of Ethics
 Decision Making Models
 The Law
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– Nurse Practice Act
– Title XXII Regulations
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Codes of Ethics – We are a
global community
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American Nurses Association
– 2001
– 2015
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International Council of Nurses (2012)
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Canvas
– Compare and contrast
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Ethical Decision Making is Complex
King Features Syndicate  North America Syndicate Permissions
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What model….what framework?
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A personal choice
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There is no one right way to find a right way
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Principles, Theories, and Models are guides
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People resolve/manage problems
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Value of Models
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Intellectual device – Simply and clarify sources of a
complex problem
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Eliminates “errors” in naming the problem/s
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Clearer communication of a course of action
between and among stakeholders
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Helps to identify gaps in understanding of issue/s
– Park, E.J. (2012). An integrated decision making model for nurses.
Nursing Ethics, 19(1), 139-159.
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Literature – Moral reasoning
RNs and MDs
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Decision Making Process MDs and RNs
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Study of RNs and MDs
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Narrow and habitual
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No consistent approach – leads to:
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Elimination of significant and demanding process
elements
• Grundstein-Amado, (1993). Ethical decision –making processes
used by health care providers. Journal of Advanced Nursing, 18,
1701-1709
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Values in Conflict:
Personal vs. Professional
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What conflicts come
to mind?
What guidance from
Drs. Epstein &
Turner?
Guidance from Drs.
Gallagher and
Lachman?
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Frameworks for Analysis & Action
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Principles: Name the problem –
Jonsen Four Topics Model
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Variations on the Nursing
Process
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Dialogue/narrative models
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Integrative negotiation &
Mediation models
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Concepts/Theories
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See Canvas
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“Z” Method – Judge Not
Myers & Briggs, in Kersey & Bates, 1994
SENSING
iNtuition
Facts & Details
Alternatives
THINKING
FEELING
Objective Analysis
Impact on Others
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Problem Solving
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Gather the Facts -- Sensing and details
Brainstorm Possibilities -- Intuition to
develop multiple causes and solutions
Analyze Objectively -- Thinking to
consider the cause and effect
Weigh the Impact -- Feeling to consider
impact on people
–
Keirsey, 1998
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Implications – Take Home Messages
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17 September
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Role Based Professional Nurse as
Leader
Patient/Family Centered Care
Relationship Based Care
Case study – CM and NP scenarios
– Posted on Monday
– Be prepared to discuss
– Applying professional domains of practice,
values, ethics and decision making models
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ALL Supplemental Readings:
Berwick,
D.B. (2009). What ‘patient-centered’ should
mean: Confessions of an extremist. Health Affairs, 28(4),
w555-565.
Kennedy,
M.A. (2015). Revisiting patient satisfaction
surveys. Are hospitals using the results properly?
American Journal of Nursing, 115(8), 7.
O'Rourke, M. (2003). Rebuilding a professional practice
model: the return of role-based practice accountability.
Nursing Administration Quarterly 27(2), 95-105.
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Individual Reading Assignments:
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Sally Fang: Cropley, S. (2012). The
relationship-based care model. Journal Of
Nursing Administration, 42(6), 333-339.
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Lai Saechao: Manthey, M. & LewisHunstinger, M. (2006). Relationship-based
care: customized primary nursing. Creative
Nursing, (1), 4-9.
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Veronica Sandoval: Winsett, R., & Hauck, S.
(2011). Implementing relationship-based
care. Journal Of Nursing Administration,
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reserved.
41(6), 285-290.
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Session Evaluation
Socrative – Mycroft

https://b.socrative.com/login/student/

https://b.socrative.com/login/teacher/
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Thank you for your hard work!
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