Groothuizen Johanna Elise
King's College London.
Nurs Ethics. 2025 Jun;32(4):1230-1239. doi: 10.1177/09697330241295369. Epub 2024 Oct 24.
Texts from various areas of the world highlight the importance of moral values like compassion and integrity in healthcare. Such values are held in high esteem by healthcare organisations and are actively 'taught' within nursing ethics education to ensure their presence within the future workforce. With such an emphasis, it is easy to overlook that moral values are not the only values that people, including nurses, hold. personal values - which may or may not conflict with moral values - are simultaneously present within individuals. Therefore, moral behaviour cannot be predicted solely by the presence/absence of certain moral values. Instead, it depends on how these integrate into an individual's broader values system.Using Schwartz's axiological Theory of Basic Human Values as a framework, I argue that moral values are but one part of an individual's greater personal values spectrum, which also includes, for instance, hedonism, achievement, and power. Within this spectrum, values are ordered hierarchically, influencing behaviour based on relative priority. When a conflict arises between moral and other personal values, the prioritisation of moral values is a requirement for moral behaviour.I discuss how socialisation in suboptimal clinical practice environments can cause moral values to be deprioritised and argue that the development of practical reasoning skills is paramount to learning to balance one's values and guide decision-making. I advocate for the integration of (meta-)axiological reflection - characterised by introspection and aimed at developing a deeper understanding of one's personal values spectrum - within nursing ethics education. This involves exploring the origin, meaning, and perceived relative importance of one's different personal values. By incorporating specific reflective exercises, students can increase self-awareness/insight and enhance their ability to recognise situations where conflicts between their moral values and other personal values may occur, which is likely to benefit moral decision-making in clinical practice.
来自世界各个地区的文本都强调了诸如同情心和正直等道德价值观在医疗保健中的重要性。这些价值观受到医疗保健组织的高度重视，并在护理伦理教育中得到积极“传授”，以确保未来的医护人员具备这些价值观。在如此强调之下，人们很容易忽视道德价值观并非包括护士在内的所有人所秉持的唯一价值观。个人价值观——可能与道德价值观冲突，也可能不冲突——同时存在于个体之中。因此，不能仅仅根据某些道德价值观的有无来预测道德行为。相反，它取决于这些价值观如何融入个人更广泛的价值体系。
以施瓦茨的基本人类价值公理理论为框架，我认为道德价值观只是个人更广泛的个人价值光谱的一部分，这个光谱还包括享乐主义、成就和权力等。在这个光谱中，价值观按层次排列，根据相对优先级影响行为。当道德价值观与其他个人价值观发生冲突时，对道德价值观的优先排序是道德行为的必要条件。
我讨论了在不理想的临床实践环境中的社会化如何导致道德价值观被置于次要地位，并认为培养实践推理能力对于学会平衡个人价值观和指导决策至关重要。我主张在护理伦理教育中融入（元）公理反思——其特点是内省，旨在更深入地理解个人的价值光谱。这包括探索个人不同价值观的起源、意义和感知到的相对重要性。通过纳入特定的反思练习，学生可以提高自我意识/洞察力，并增强他们识别道德价值观与其他个人价值观可能发生冲突的情况的能力，这可能有利于临床实践中的道德决策。
