Samuel Merritt University, School of Nursing 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 reserved. N 560 Values Prob Solv Dec Making Lewis

At the completion of this session, learners will be able to: Samuel Merritt University, School of Nursing At the completion of this session, learners will be able to: 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 Dr. Mileva Saulo Lewis, All rights reserved. N 560 Values Prob Solv Dec Making Lewis

Dr. Mileva Saulo Lewis, All rights reserved. Suggested Approach First Part – Personal Values Check in; Announcements; Questions Values Clarification Process Personal Values Guiding Life Choices Second Part - Professional Values Diversity of values in the workplace and a multi-cultural society Problem Solving and Decision Making Mental models and Frames Third Part – Values and Policy Values and health policy Session Evaluation Review next session Dr. Mileva Saulo Lewis, All rights reserved.

Values, Beliefs, Attitudes VALUES Clarification Process Samuel Merritt University, School of Nursing Values, Beliefs, Attitudes VALUES Clarification Process CHOSEN (Cognitive) Freely Without pressure From among alternatives After reflecting on consequences PRIZE (Affective) Guide to behavior Chosen beliefs are prized and cherished ACT (Behavior) Criteria for evaluations, judgments Moral codes, positive or negative Affirmed to others Incorporated into one's behavior Repeated consistently in one's life Uustall, D.B. (1993). Clinical ethics and values: Issues & insights in a changing healthcare environment. East Greenwich, RI: Educational Resources in Healthcare. Dr. Mileva Saulo Lewis, All rights reserved. Ethics Part I: Mileva Saulo Lewis All rights reserved

Beliefs and Values Origins Dr. Mileva Saulo Lewis, All rights reserved.

Childhood Value Messages 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 Dr. Mileva Saulo Lewis, All rights reserved.

Virtue – Eastern Tradition 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. Dr. Mileva Saulo Lewis, All rights reserved.

Buddhist Ethics and Virtues 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. Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Four Noble Truths 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 Compassion Loving kindness Sympathetic joy Equanimity Butts & Rich, 2013 Dr. Mileva Saulo Lewis, All rights reserved.

Judeo-Christian Tradition The Ten Commandments 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 Dr. Mileva Saulo Lewis, All rights reserved.

Virtue and the Golden Mean Intellectual - ability to think - rational Moral - acting correctly - reason Moral Virtue Passions Faculties States of character The Golden Mean - between deficiency and excess Beauchamps and Childress, 2013. Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Universal Core Values Kidder, R. (1995). How good people make tough choices. New York: William Morrow and Co. p.90-92 Bernard Gert Hans Kung “Shard World Conversations” Don’t Kill Cause pain Disable Deprive of freedom or opportunity Deprive of pleasure Deceive Cheat Keep promises Obey the law Do your duy Do not kill; lie Steal Practice immorality Respect parents and love children Love Truth Fairness Freedom Unity Tolerance Responsibility Respect for life Dr. Mileva Saulo Lewis, All rights reserved.

Personal Values Exercise Your going on a trip. Select 10 values to place in your suitcase. Dr. Mileva Saulo Lewis, All rights reserved.

Virtues – Nursing’s Values Florence Nightingale, circa 1836 AACN Essentials for BSN Programs (2008) Trustworthiness, Good person Courageous Compassionate, Responsible Discernment Truthful, Fair LeVasseur, J. (1998). Student scholarship: Plato, Nightingale, and contemporary nursing. Image: Journal of Nursing Scholarship, 30(2), 281-5. Altruism Autonomy Human dignity Integrity Social justice AACN, 2008 Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Virtues - Medical Students: Our highest aspirations- The Kind of Person you are: White Coat Ceremony Georgetown – Fidelity Compassion Suppress self-interest Humility Intellectual honesty Moral courage Moral courage Altruism – Moral Integrity – Where is it you say “No” Some things you must never do Live up to the promise Pellegrino, 2013 Dr. Mileva Saulo Lewis, All rights reserved.

Values – Potential for Conflict 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 Dr. Mileva Saulo Lewis, All rights reserved.

Moral Compass: The North Star What happens behind the curtain/door Best interest of patient Serve them Professionals and promises; Compassion + skill + Objectivity + knowledge Everything depends on character Pellegrino, 2013 Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Summary of Readings 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.   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. Phyllis Carroll: Martin, D., Godfrey, N., & Walker, M. (2015). The Baccalaureate Big 5. Journal Of Nursing Administration, 45(3), 121-123. Emily Cruz: Weis, D., & Schank, M. (2000). An instrument to measure professional nursing values. Journal Of Nursing Scholarship, 32(2), 201-204. Small Groups – What did you learn? Of what relevance is this to you? Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Small Group Summary Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. We’re going to a party…. Dr. Mileva Saulo Lewis, All rights reserved.

Value Cohorts in the Workplace “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. Dr. Mileva Saulo Lewis, All rights reserved.

Summary of Reading – Small Groups 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. What did you learn? Of what relevance is this to you as leaders; advanced practice nurses, first job search? Dr. Mileva Saulo Lewis, All rights reserved.

Values, Ethics, Problem Solving & Decision Making NURS 560 Dr. Mileva Saulo Lewis Dr. Mileva Saulo Lewis, All rights reserved.

Problem Solving - What’s a problem? Problem solving phase Decision making phase Do not move to decision making until you are sure you have correctly named problem Discrepancy, Difference, deviation, imbalance, Gap between what is and what is appropriate or desirable Avoid “should” Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Problem analysis 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. Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Ladder of Inference http://www.youtube.com/watch?v=K9nFhs5W8o8 The Learning Organization Personal mastery Mental models Shared vision Team learning Senge, P. (1990). The Fifth Discipline. New York: Doubleday Currency Dr. Mileva Saulo Lewis, All rights reserved.

Things are not always as they appear Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. What do you see? Dr. Mileva Saulo Lewis, All rights reserved.

Samuel Merritt University, School of Nursing Tools Not every problem is a nail Fishbone analysis Delphi Decision Grids Gap Analysis Dr. Mileva Saulo Lewis, All rights reserved. N 560 Fall 2007

Dr. Mileva Saulo Lewis, All rights reserved. A problem to be solved Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Ambiguity Puzzle BSAINXLEATNTEARS Disch, 2001 Dr. Mileva Saulo Lewis, All rights reserved.

Health Resources Exercise Discuss: Top Three Bottom Three Values implied Implications Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Frames and Reframing Anti Smoking Campaign Health care reform Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Decision Making Emotions come first – name it - put aside Reason comes next Brain studies Lehrer, J.(2009). How we decide. New York: Houghton, Mifflin, & Harcourt. Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. A Moral “Tool Chest” Ethical Theory & Principles Professional/Personal Values ANA - Nurses’ Code of Ethics Decision Making Models The Law Nurse Practice Act Title XXII Regulations Dr. Mileva Saulo Lewis, All rights reserved.

Codes of Ethics – We are a global community American Nurses Association 2001 2015 International Council of Nurses (2012) Canvas Compare and contrast Dr. Mileva Saulo Lewis, All rights reserved.

Ethical Decision Making is Complex King Features Syndicate  North America Syndicate Permissions

What model….what framework? A personal choice There is no one right way to find a right way Principles, Theories, and Models are guides People resolve/manage problems Dr. Lewis, All rights reserved

Dr. Lewis, All rights reserved Value of Models Intellectual device – Simply and clarify sources of a complex problem Eliminates “errors” in naming the problem/s Clearer communication of a course of action between and among stakeholders 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. Dr. Lewis, All rights reserved

Literature – Moral reasoning RNs and MDs Samuel Merritt University Literature – Moral reasoning RNs and MDs Decision Making Process MDs and RNs Study of RNs and MDs Narrow and habitual No consistent approach – leads to: 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 Dr. Lewis, All rights reserved Ethics Review 2015 Dr. Mileva S Lewis, All rights Reserved

Values in Conflict: Personal vs. Professional What conflicts come to mind? What guidance from Drs. Epstein & Turner? Guidance from Drs. Gallagher and Lachman? Dr. Mileva Saulo Lewis, All rights reserved.

Frameworks for Analysis & Action Samuel Merritt University Frameworks for Analysis & Action Principles: Name the problem – Jonsen Four Topics Model Variations on the Nursing Process Dialogue/narrative models Integrative negotiation & Mediation models Concepts/Theories See Canvas Dr. Lewis, All rights reserved Ethics Review 2015 Dr. Mileva S Lewis, All rights Reserved

“Z” Method – Judge Not Myers & Briggs, in Kersey & Bates, 1994 SENSING iNtuition Facts & Details Alternatives THINKING FEELING Objective Analysis Impact on Others Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. Problem Solving 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 Dr. Mileva Saulo Lewis, All rights reserved.

Implications – Take Home Messages Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved. 17 September 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 Dr. Mileva Saulo Lewis, All rights reserved.

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. Dr. Mileva Saulo Lewis, All rights reserved.

Individual Reading Assignments: Sally Fang: Cropley, S. (2012). The relationship-based care model. Journal Of Nursing Administration, 42(6), 333-339.   Lai Saechao: Manthey, M. & Lewis-Hunstinger, M. (2006). Relationship-based care: customized primary nursing. Creative Nursing, (1), 4-9. Veronica Sandoval: Winsett, R., & Hauck, S. (2011). Implementing relationship-based care. Journal Of Nursing Administration, 41(6), 285-290. Dr. Mileva Saulo Lewis, All rights reserved.

Dr. Mileva Saulo Lewis, All rights reserved

Session Evaluation Socrative – Mycroft https://b.socrative.com/login/student/ https://b.socrative.com/login/teacher/ Dr. Mileva Saulo Lewis, All rights reserved

Thank you for your hard work! Dr. Mileva Saulo Lewis, All rights reserved.