Giving Voice to Values: An undergraduate nursing curriculum project

Please ciCollegian

ARTICLE IN PRESS+ModelCOLEGN-226; No. of Pages 7Collegian (2013) xxx, xxxxxx

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Giving Voice to Values: An undernursi

Sandra Lyncha, Bethne Hartb,, Catherine M. Costab

a School of Philosophy and Theology, and Director of the Centre for Faith, Ethics and Society,University ob School of

Received 28

KEYWOValues;Nursing Values eValues c

CorrespoNotre DameAustralia. Te

E-mail a

1322-7696/$ s

http://dx.dte this article in press as: Lynch, S., et al. Giving Voice to Values: An undergraduate nursing curriculum project. (2013), http://dx.doi.org/10.1016/j.colegn.2013.09.004

f Notre Dame Australia, AustraliaNursing, University of Notre Dame Australia, Australia

July 2013; accepted 17 September 2013

RDS

ethics;ducation;urriculum

Summary Among the competency standards stipulated by the Australian Nursing and Mid-wifery Council for graduating students are competencies in moral and ethical decision makingand ethics education within professions such as nursing has traditionally focussed on these com-petencies, on raising ethical awareness and developing skills of analysis and reasoning. However,ethics education in tertiary settings places less emphasis on developing students capacities toact on their values.

This paper explains and explores the adoption of Dr. Mary Gentiles curriculum (the GivingVoice to Values curriculum) which specically focuses on developing students capacities to acton their values. The curriculum (Gentile, 2010) assists students and professionals to explore,script and rehearse responses which build upon their capacity to respond in accordance withtheir own values in complex workplace settings in which they face conicts of value and belief.

The paper rstly examines the theoretical underpinnings of the Giving Voice to Values (GVV)curriculum. It then presents the integration and evaluation phase of a Project inspired by theGVV methodology, using a case study approach within two areas of an undergraduate nursingcurriculum. As a pilot project, this initiative has provided signposts to further curriculum devel-opment and to research pathways within the UNDA School of Nursing, by highlighting studentsuncertainties regarding their own professional values, and their intense struggles to voice theirvalues within health care contexts. 2013 Australian College of Nursing Ltd. Published by Elsevier Ltd.

nding author at: School of Nursing, University of Australia, 160 Oxford Street, Darlinghurst, NSW 2010,l.: +61 2 8204 4294; fax: +61 2 8204 4422.ddress: [email protected] (B. Hart).

Introduction

Giving Voice to Values: an overview

The Giving Voice to Values curriculum designed by Gentile(2010) offers an innovative approach to the teaching ofethics in tertiary institutions. It takes as its premise theproposition that practitioners within professional elds are

ee front matter 2013 Australian College of Nursing Ltd. Published by Elsevier Ltd.

oi.org/10.1016/j.colegn.2013.09.004ng curriculum project

graduate

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ARTICLE IN PRESS+ModelCOLEGN-226; No. of Pages 72 S. Lynch et al.

often able to recognize a conict of values in the workplace,but are less able to articulate their own position and to deci-pher a course of action which enables them to act on theirvalues in an effective way; that is, in a way which addressesand helps resolve the ethical conict they have encounteredand ensureadvantage their decis

Gentile demonstraconicts inwish to accclients, cusGVV curricognize, claconicts arway in whieffective mtake into corder to beworkplace

The distit focuses oers have beit emphasialignment purpose ofcess of selalso distincand practirationalizafor buildinrepeated pfeedback a

The mestrategies ues. They cthose involattempt topersuasionorganizatiotions of likaddress anof strategiRigolosi (2ing variousdescribing Rigolosi reclem recogn(e.g. via coattempts tresolve themunicationthat [c]osolutions tthe conicon comprelution by dproblem-soprescriptioticular situdoes not a

communicate assertively or how one might go about takingaccount of the needs of others within complex workplacecontexts.

By comparison, Gentiles approach by-passes the kind ofanalysis Rigolosi undertakes to focus on personal and pro-

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ande this article in press as: Lynch, S., et al. Giving Voice to Va (2013), http://dx.doi.org/10.1016/j.colegn.2013.09.004

s that they avoid or minimize any systematic dis-which might accrue to them as a consequence ofion to act.argues that both experience and research

te that many professionals will encounter values their professional practice, e.g. when what theyomplish conicts with the expectations of theirtomers, patients, students, peers or bosses. Theulum is designed to help individuals learn to rec-rify, speak and act on their values when thoseise. Thus the focus of this curriculum is on thech professionals raise an issue of concern in ananner; it addresses what professionals need toonsideration, what they need to do and say in

heard when facing ethical conicts in complexcontexts.inctive features of the GVV curriculum are thatn positive examples of ways in which practition-en able to act on their values in the workplace;zes the importance for practitioners of ndingbetween an individual sense of purpose and the

the organization in which they work via a pro-f-assessment and reection. The curriculum istive for the opportunity it provides to constructse responses to frequently heard reasons andtions for not acting on ones values; as well asg commitment and enhancing effectiveness byractice in delivering responses and providing peernd coaching.thodology acknowledges that there are differentthat can be used to enable us to act on our val-an involve looking for a win/win solution forved in conict; alternatively, a practitioner might

change a managers mind on an issue through and logic; approach a higher authority within then in an attempt to address an issue; or build coali-e-minded employees who might work together to

issue of concern. These are not unlike the kindses suggested by other theorists. For example,005) approaches conict resolution by identify-

potential strategies (including win/win) andthe process by which conict can be managed.ognizes phases in conict resolution from prob-ition, to routine attempts to resolve the problemnfrontation, compromise or accommodation), too redene the problem and nally to attempts to

redened problem. The role of assertive com- in resolving conict is recognized, as is the factnstructive conict resolution is characterized byhat respond to the needs of all participants int (p. 212). But Rigolosis focus appears to behensively clarifying the concept of conict reso-escribing what it is that causes conict, listinglving moves and then offering, in the form of an, guidelines for the negotiation of conict in par-ations (2005, p. 2069). However, her approachdequately address the question of how one can

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Genmoral Discusognizethe moin its cthis poand Bocertainnities,as honMarthaues, athree vidualreasontext oemotiothey mparcelmentswe mupartialthe go

Forpassiofocussdevelowhich are a these of heaThompLowe,: An undergraduate nursing curriculum project.

otivation to act, and on the development ofrs skill, condence and competence to act in

with their values. Gentiles methodology facil-rocess of exploring and producing appropriateo practical scenarios which illustrate ethical con--scripting, practicing, rehearsing and coaching

to those responses. In this sense it is Aristoteliannce this process can be seen as analgous to thent of habits or dispositions to behave in particu-ristotle took the habits we develop to be crucial,t we become temperate and good-tempered orent and irascible:

ving in one way or the other in the appropriate cir-ces. Thus, in one word, states of character ariseke activities. This is why the activities we exhibit

of a certain kind; it is because the states of char-rrespond to the differences between these. Ito small difference, then, whether we form habitsind or of another from our very youth; it makesreat difference, or rather all the difference.otle (1984) The Nichomachean Ethics, Book II, 1,

also bypasses another feature of contemporaryte: debate about the genesis of moral values.

of moral agency in the literature have long rec- tension between social constructionist views of

voice and the fact that moral language is uniques to certainty. For example, Tronto (1999) makesn discussing the work of Hekman and Susan (1995)n (1997). Gentile appears to deal with claims toy asserting that, as members of civilised commu-hare a commitment to some central values, such

respect, responsibility, fairness and compassion.sbaum makes a similar point about shared val-

Grace and Cohen (2005), when she argues forative criteria (compassion, reciprocity and indi-hich can be endorsed by a wide plurality of

ethical conceptions (2001, p. 48). In the con-book on love, Nussbaum (1990) is arguing thatuch as compassion are important in ethics sinceus alive to value and their assessment is part andhe overall assessment of a persons value judge-cognitive attitudes (2001, p. 460, 478); although

wary of the vicissitudes of personal emotion andcompassion is the eye through which people seend ill of others (2001, p. 392).tile, this convergence on values such as com-vides the basis for an ethics education that isn action, rather than on raising awareness or

skills of analysis, in relation to the ethical issueses and other healthcare professionals face. Therey useful texts available which deal well withr two aspects of ethics education in the contextare; e.g. Campbell, Gillett, and Gareth (2005),

Melia, Boyd, and Horsburgh (2006), Kerridge, Stewart (2009) and Butts and Rich (2005). The

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ARTICLE IN PRESS+ModelCOLEGN-226; No. of Pages 7An undergraduate nursing curriculum project 3

GVV methodology is distinctive for its focus on the momentof deciding to speak and on nding a way to do so that is bothmost likely to be effective in the situation at hand; and isalso one with which we are at ease, given our own personalstyle of communication and personality. Hence recognisingand responwell of thoconnectionand the vaworkplace condence

Consistethis projecand the coclear, is likindividualsconict. Fprovided btitioners aethical deb

Giving Vo

The preparpractice isof nursing with continmaking, ancompetencand criticarently, theNursing at Sydney, hacies. Theremake studate studenare fragmelate 2010, in its profand improDr. Mary Gsity campucontexts. AProject, inthis framew

The GVV

The GVV fwithin twoDegree dution of thepioneeringoping the values-basintroductioon convincits aim is already acsupportingeration wa

prior to beginning this project, but research by Martin andAustin (2010) questioned the validity of this tool. Due to thelimitations of time, no inventory was used. However, futureresearch will identify and use a validated assessment tool.

The introduction the students received summarized thedoloch, l un, choent,s eac

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ills rlly, ng difttente this article in press as: Lynch, S., et al. Giving Voice to Va (2013), http://dx.doi.org/10.1016/j.colegn.2013.09.004

ding to: ones personal attributes and style, asse of others involved in a situation of conict; the

between the private and public spheres of life;rious factors which combine to create complexcontexts is seen as crucial to the development of

and competence to act on ones values.nt with the GVV curriculum, the core premise oft is that training in developing such condencempetence, in situations in which a conict is

ely to develop the moral muscle which enables to respond with integrity to situations of ethicalurther study is needed to test that the trainingy the GVV curriculum will help develop in prac-nd trainee practitioners the capacity to tackleate on especially complex issues.

ice to Values: a nursing context

ation of nursing students for ethical professional a multidimensional challenge. The professionlegislatively requires safe and proper practice,uing competencies in moral and ethical decisiond signicantly in patient advocacy, cross culturale, team work, collaborative care, social justicel thinking (ANMC, 2006). Historically and cur-

undergraduate units of study in the Bachelor ofthe University of Notre Dame Australia (UNDA),ve dedicated areas of study to these competen-

has always been the pedagogical imperative toy meaningful and relevant for our undergradu-ts, whose experiences in health care contextsnted and whose life experiences are diverse. InUNDA began to examine the teaching of ethicsessional disciplines with the aim of supportingving its delivery. As part of this work, in 2012entile presented workshops across the Univer-ses, introducing the GVV framework in healthcare

core group of the academy established a GVVcorporating a pilot study of the implementation ofork into the undergraduate nursing curriculum.

nursing project

ramework for ethics education was undertaken Units of study within the Bachelor of Nursingring the latter semester of 2012. The presenta-

GVV Framework involved introducing GVV as a action-oriented pedagogical approach to devel-skills, knowledge and commitment requisite toed practice and leadership within nursing. Thisn noted that the GVV curriculum does not focusing students or practitioners to be ethical. Ratherto empower those of us who in many cases dot on our values, or want to act on our values, by

the development of moral competence. Consid-s given to using a moral competency inventory

methoapproaoreticavaluesalignmaddressulatesciviliseesty, rthat thcally dthat aon theenablemalisaand hefourthpersonarise.

Theages uour seferencattentin inteof devin Lovaddresof the emphaskill anare couationattentare offidentif

Witexplaingiven knowleareas oas eduCarol Gof carefor onetheir va transtify exmade iThey wicts amight ation othe skcarefupectinbeing a: An undergraduate nursing curriculum project.

gy and explained the Seven Pillars of the GVVdescribing those factors which provide the the-derpinnings of the approach. These pillars areice, normalisation, purpose, self-knowledge and

voice, and reasons and rationalisations. To brieyh of these, the rst of the pillars (values) encap-

assertion as explained above, that members ofcieties share a set of central values, such as hon-ct, responsibility, fairness and compassion andet of shared values provides the basis for ethi-sible action. The second pillar (choice) assertsman beings have a choice as to whether to actlues and all can examine the factors which eitherisable them from doing so. The third pillar (nor-

encourages us to see ethical conicts as normalto approach them calmly and competently. Ther (purpose) enjoins us to have reected on ourd professional purposes before ethical conicts

h pillar (self-knowledge and alignment) encour-generate a self-story which is consistent withage and which builds on our strengths and pre-

assist us in voicing our values. This pillar drawso self-awareness and to the relevance of emotionsion with reason and imagination in the processng ethical competence. Martha Nussbaums worknowledge and also in Upheavals of Thought,above, provides a rationale for our recognition

of emotion in moral life. The sixth pillar (voice) the importance of practice, of developing thee habit of speaking up in a style with which wetable and which is most appropriate to the sit-

nal pillar (reasons and rationalisations) drawso the typical and predictable rationalisations that

for failing to act ethically and encourages us tounter-arguments.the introduction the seven GVV pillars weren the context of nursing ethics. Three pillars werecular attention (choice, normalisation and self-

and alignment) since these drew attention toncern as regards ethical education in our opinionrs. These pillars were discussed in the context ofans three stage process of developing an ethicsaring for oneself, caring for others; and caring

and others. In the context of the goal of voicings, students recognized that each stage involvedal period at which individuals were able to iden-es of a conict or anxiety as regards choices to benaging and integrating different aspects of care.

able to recognize the inevitability of such con-hen to consider and rehearse approaches whichlve the problem. With regard to the consider-lf-knowledge and alignment, students identiedequisite to working through a problem: listeningot interrupting, seeking clarication and res-ferences, particularly cultural differences; andtive to anothers body language or being able to

Please cit lues: An undergraduate nursing curriculum project.Collegian


succinctly explain a point of view while still being empathictoward the others perspective. This discussion led studentsto focus on the implementation of decisions to act ethically,rather than on conceptual analysis and decision-making.

In addition to the seven foundational pillars of theGVV curriccurriculumhuman beirecognitionriculum alsand act onthat we nby comparthat indivivalues if tquently enis powerfucommon racannot assucurriculumand interpwe know ostrengths aweaknessevoice and will do so; act on our succeed inour values capacity tointegrity.

With thnings of thexplored twith a mocommonly education g(http://wwpdf) offersdecision-mby Stephe(2004). Thstages: iderelated tomight resochosen as mof the improcess.

The GVVtre model,extends anbecomes cmodel, idetion of a pthe GVV mexplicitly win identifyimust expelar values wwe recognithis probleMarkkula C

Table 1 A Tale of Two Stories.

A Tale of TRecall a ti

conictarticed tosiste

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e of Tl a tiictarticand siste

happdid ytivatsatispondr ideal scenario, rather than to justify/criticise yourt actions.)

would have made it easier for you to speak and act?nsider both things within your control and thingshin the control of others.)

ude consideration of a variety of factors which may beal (e.g. involving reection on our motivations, fearsirations); organisational (e.g. related to institutionalres, limited resources or vested interests); or relatedal-cultural or professional expectations.ing the workshop which followed the students intro-n to the GVV method, students participated in smallexercises which required them to identify two storiesles Tale of Two Stories, 2010, 523) as outlined in.

goal of these exercises was to encourage studentsntify a list of factors which they considered to posi-(enablers) and/or negatively (disablers) impact uponbility and willingness to voice and act on their val-

small and then larger group discussions, facilitated byic staff, students were encouraged to analyze their

and then to consider how the enablers and disablersentied resonated with the pillars and assumptions

GVV curriculum; e.g. how their own and otherstions, values and communication styles affected theirs. Then they were asked to begin to develop, practicecept coaching in possible responses they may havein situations in which they did not voice their valuessh they had been able to do so.e this article in press as: Lynch, S., et al. Giving Voice to Va (2013), http://dx.doi.org/10.1016/j.colegn.2013.09.004

ulum, a set of twelve assumptions underpin the. These assumptions acknowledge the desire ofngs to voice and act on their values and their

that they have done so in the past. The cur-o assumes that we recognize that we could voice

our values more often or more effectively andd it easier to voice our values in some contextsison with others. In addition, it acknowledgesduals are more likely to voice and act on theirhey have practised potential responses to fre-countered ethical conicts; and that our examplel, since mastering and delivering responses totionalisations can empower others, although weme that we know who those others might be. The

also include assumptions about self-knowledgeersonal interaction, suggesting that the betterurselves, the more able we are to play to ournd when necessary to protect ourselves from ours; that the more we believe that it is possible toact on our values, the more likely it is that wethat we are not alone in our desire to voice andvalues; and nally, that while we may not always

our endeavours to do so, voicing and acting onis worth doing since it positively inuences our

make better decisions and upholds our sense of

ese assumptions and the theoretical underpin-e GVV curriculum made explicit, the projecthe way in which the GVV curriculum alignsdel of ethical decision-making which has beenused within the nursing school and in ethicsenerally. The Markkula Centre for Applied Ethicsw.scu.edu/ethics/practicing/decision/making.

a model which is similar to a number of ethicalaking models, a selection of which are outlinedn Cohen in The Nature of Moral Reasoninge Markkula Centre model includes the followingntication of a problem; data or fact collection

the problem; exploration of strategies whichlve the problem; implementation of the strategyost likely to be effective; and nally evaluation

pact of the strategy and the decision-making

method can be mapped onto the Markkula Cen- but in doing so the way in which the GVV methodd develops traditional decision-making modelslear. For example, under the Markkula Centrentifying the problem may involve us in a descrip-articular situation and of the risks it poses. Butethod encourages us to go beyond this to engageith our own attitudes and expectations so thatng the problem we also remind ourselves that wect problems to arise; we reect on the particu-hich are being challenged by this situation; and

ze that we have a choice as to whether we act onm. With regard to the data collection stage of theentre model, we go beyond the descriptive facts

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Theto idetively their aues. Inacademtalesthey idof themotivachoiceand acmade but wiwo Stories: exercise 1me in your work experience when your valuesed with what you were expected to do regardingular, non-trivial situation and you spoke up and

try to resolve the conict in a way that wasnt with your values.you do and what was the impact?ivated you to speak up and act?ed are you? How would you like to haveed? (This question asks you to consider your ideal, rather than to justify/criticise your past)ld have made it easier for you to speak and act?er both things within your control and thingshe control of others.)

wo Stories: exercise 2me in your work experience when your valuesed with what you were expected to do regardingular, non-trivial situation and you did not speakact to try to resolve the conict in a way that wasnt with your valuesened?ou not speak up and act? What would haveed you to do so?ed are you? How would you like to haveed? (Again, this question asks you to consider



Student evaluations

Student evaluations were conducted one week following thepresentation of the GVV workshop. These consisted of open-ended quefollowing:

What wwork?

What wGVV fra

What doof ethic

What fu

The stucally analy2004; Richusing the erence to workshops knowledgevalues.

Case studethical is

The Unit Lyear Unit central to sibilities ofof clinical different smoral angarise in reThe aim oto criticallthey may to the GVVunit in twosion and wgroup actiin relationthe unit osented forthe studenand in preshop, this con their owtudes to coself-identitiation. Thto particuknowledgestudents rtudes to cstyles (seevalues ratSchool for tion (Johns

2nd year student evaluationsPerceived benets in learning the GVV framework.Evaluations indicated that students recognized that theGVV methodology gave them ways of dealing with con-ict, of speaking [their] thoughts and values and of

theowiccesStudmewplistanudenht ints] e fright udenhe res a cn-mved tionsto dain alica

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200o-orte this article in press as: Lynch, S., et al. Giving Voice to Va (2013), http://dx.doi.org/10.1016/j.colegn.2013.09.004

stions that asked for anonymous responses to the

ere the benets to you in learning the GVV frame-

ere the weaknesses for you in the learning of themework?

es the GVV Framework add to traditional modelsal decision making?

rther comments would you like to give?

dent evaluations were collated, and themati-zed (Minichiello, Sullivan, Greenwood, & Axford,ards, 2005). Reports on these evaluations, oftenstudents own words, are presented with ref-the two curriculum contexts in which the GVVwere held. Three dominant themes emerged:

of values, speaking on values and acting on

y one: the GVV framework in a legal andsues unit of study

egal and Ethical Issues in Nursing is a secondof study focussing on ethical and legal issuesnursing theory and practice and on the respon-

the nurse in caring for patients within a varietysettings. The students are encouraged to identifyituations in which a sense of moral obligation,uish or conscientious doubt would be likely tolation to ethical issues within nursing practice.f this unit is to improve the ability of studentsy analyze and debate ethical and legal issuesface in their nursing practice. The introduction

methodology occurred in weeks 6 and 7 of the lectures. This was followed by tutorial discus-orkshops in which students undertook the smallvity (A Tale of Two Stories) outlined above

to clinical scenarios that were generated byf study co-ordinator. These scenarios were pre-

shared discussion and reection, to facilitatets identication of their own tales. Prior toparation for the presentation of the GVV Work-ohort of students were rst encouraged to reectn values, personal and professional goals, atti-nict and risk-taking, communication styles andcation as regards their approach to ethical nego-e aim of this reection was to sensitise studentslar aspects of the GVV framework (e.g. self-

and alignment). The reective exercises entailedesponding to questions about aspirations, atti-onict and risk, communication and negotiation

Appendix A); and students also completed theing and ranking sections of the John HopkinsPublic Health Questionnaire for Values Clarica-, 2002).

havingact, shan aact. the frait simcircumally stinsigstudenthat thing ins[the stthat timpliedecisioPerceiEvaluatunity uncertits appunsureand pein biasbased that thory.The GVEvalua[studepatienit grovaluesdecisioa stratit guproact

Case sand re

The GVyear nstudy:organiics for also wpresenrary isworkshanticipize rurpowerBushy,study c: An undergraduate nursing curriculum project.

courage to speak; it enables the nurse tong . . . the enablers and disablers and acts assory to decision making. . .. [indicating] how toents comments also indicated that they foundork provided interesting new knowledge; thates ethical decision making, allows for personalces and can be applied to oneself. Addition-ts commented that the methodology providedto critical thinking, and into the value of . . . [thebeliefs and instincts. Students also commentedamework is more relevant to nursing care, giv-to critical thinking, and showing the value ofts] . . . beliefs and instincts. It can be presumedference to the frameworks greater relevanceontrast between GVV and the more traditionalaking models discussed in this unit.weaknesses in learning the GVV framework.

indicated that students wanted more oppor-iscuss the GVV framework and that they werebout their understanding of the framework andtion. Some students indicated that they werehow to respond when value conicts ariseved difculty in applying [the GVV framework]ontexts (hospitals). Students sought scenario-tice with relevance to nursing and commentedamework was hard to get conceptually as the-

amework in relation to other traditional models. indicated that the framework reinforces ouralues; gives a reason to stand up for rights ofd nurses; gives condence, certainty; thated actions; helps [students]. . . to respond toict and to act out/to speak [about] ethical; that it has a focus on actions and gives

rationale, a broader scope for practice; thatrational choices and encourages nurses to be.

y two: the GVV framework within a ruralte area nursing unit of study

amework was introduced to a small group of thirdg students who had selected an elective area ofl and remote area nursing. This Unit of study wass an interactive seminar series, with focus top-

week, extending over eight weeks. The studentsd collaboratively with the unit co-coordinator to

publish a seminar paper examining a contempo-ithin this domain of nursing practice. The GVVas scheduled in the sixth week of the series,

g that the enduring ethical issues that character-mote health and health care would have emerged

by this stage (Nelson, Pomerantz, Howard, &7). A clinical scenario (generated by the unit ofdinator) was presented for shared discussion and

Please cit luesCollegian


reection, to facilitate the students identication of theirtales.

3rd year student evaluationsPerceived bEvaluationsmethodoloassist studshyness. attention tour barriePerceived Evaluative understandand for spAboriginal ful contribshould bpower imbaical and nuThe GVV frEvaluationsmodels areworld, thinto practiablers anvalues; ancomment itraditional

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This pilot frameworkinvolved twdegree probetween athe studenprovide theinitiative.

The secidentifyingthere was se. This sufocus on vamust recogpositions tand to whsion of valwith an exsion, withiclear that rehearse vtext that gskills, selfGVV frameas being aaction, despeak up.to action ation.

The third year students exhibited uncertainty in theircapacity and ability to speak up. This cohort was com-pleting their undergraduate studies, with several clinicalpracticum experiences behind them, and an anticipationof their imminent transition to graduate nursing practice

atusad w

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therrienglyces torknd tn.rall,atoryops roceenceinicanicgh thameles ttion.educouldtructs cize tle exlso see an

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witstablcurre wiy. He pose this article in press as: Lynch, S., et al. Giving Voice to Va (2013), http://dx.doi.org/10.1016/j.colegn.2013.09.004

enets in learning the GVV framework. identied the GVV Framework as a valuablegy to allow input [of] our own values and toents to speak up without fear, humiliation orIt was also seen as a reective process that drewo enablers as well as disablers, which arers to speaking up.weaknesses in learning the GVV framework.comments identied needs for more time foring and application of the GVV frameworkecic relevance to Rural Remote Nursing andand Torres Strait Islander Health. An insight-ution recommended that the GVV frameworke inter-professional learning (to work throughlances and differences in practice amongst med-rsing staff).amework in relation to other traditional models.

indicated students thoughts that traditional often impractical and rarely used in the realat the GVV framework allows theory to be putce; that it shows us the enablers and dis-d involves our own experiences, beliefs andd that it gives pathways for speaking up. One

ndicated that students often can not remember models.

ns from the educators

project evaluated the integration of the GVV within the Bachelor of Nursing Program. Ito cohorts of students at different phases of theirgram. We acknowledge that there are differencesnd within these two cohorts, but maintain thatt evaluations and our teaching experiences do

basis for important reections on this curriculum

ond year students exhibited uncertainty about and articulating their own values, and for someuncertainty even about the nature of values perggests a need in the curriculum for an increasedlues clarication within pedagogy, but that focusnize the connection between values and dis-o act: what ethicists might refer to as virtuesich Kirschenbaum (1992) alludes in his discus-ues clarication. This can be effectively alignedploration of the values of the nursing profes-n historical and sociological analyses. It is alsothese students sought further opportunities tooicing of their values within a learning con-ave space for the acquisition of communication-condence, and interpersonal awareness. Thework was recognized at this introductory level

valuable framework that supported consideredcision making and developing the capacity to

The process of identifying enablers and barriersppeared to support both awareness and reec-

and stthey hwithininequadecisioand thvery ring pravalueswithined bato stroresourframewicts apositio

Oveexplorworkshtive pexperithe clues coalthouGVV frstrugghesita

As lum wmore sstudenrecogna fertithat aobserv

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This pof Nurresultsof simucentragogicaplace will bsystemthe scinformidentifriculumis to ebased practicpetencinclud: An undergraduate nursing curriculum project.

. They readily identied values conicts thatitnessed and experienced during their learninglth care contexts. They were aware of powers and inter-professional dynamics that inuenceaking and action. Their role as patient advocates,eveloping professionalism intersected with the

imits that they perceived as shaping their nurs-e. In this regard, they appeared certain of theirt were uncertain about acting on these values

contexts of health care. They readily identi-rs to giving voice to their values, yet struggled

identify enablers. Condence and courage werehat they sought to strengthen. However, the GVV

did support both their analysis of values con-heir motivation to give voice to a reasoned value

the GVV framework gave students a structured space in which to speak out. During the GVVthere was an evident interaction between affec-ss, and cognitive development. Some studentsd mixed emotions and distress in referring tol scenarios in which they had experienced val-ts. Their sense of disempowerment was notable,eir exploration of thoughts and actions within thework did appear to assist them in their difculto nd ways of dealing with their uncertainty and

ators, we have concluded that the GVV curricu- be more effective if we had presented it in atured format and made it more relevant to thelinical experiences and areas of study. We alsohe benets of trans-disciplinary teaching in whichchange of ideas creates a gestalt of knowledgerves as a collaborative template for students tod learn within.

on

roject has been completed as the UNDA School also enters a stage of curriculum review. Thehis initiative suggest that the educational poweron, experiential or scenario-based learning that isthe GVV methodology is clearly a valuable peda-iative, one which ought to take a more prominentr educational endeavours. Our recommendationat the School of Nursing should facilitate the

integration of the GVV framework throughouts revised curriculum. This pilot Project will also

development of research that aims to rigorouslye outcomes of the introduction of the GVV cur-hin the schools existing units of study. Our visionish the Bachelor of Nursing Program as a values-iculum, from which graduates emerge ready forthin a profession dedicated to values-based com-owever, readiness to practice must be taken tosessing the condence, competence and courage



to give voice to ones values when faced with a conict;and to collaboratively and effectively function in deliver-ing healthcare with integrity and in an ethically defensibleway.

Appendix A.

Reective exercise (2nd years)

Questions of purpose: What are your personal and profes-sional goals? How do you dene your impact? What do youhope to accomplish?

Questions of risk: What is your risk prole? Are you arisk-taker? Or are you risk-averse? What are the great-est risks you face in your line of work? Are they personal,professional or societal?

Questions of personal communication/style prefer-ence: How do you deal with conict? Are you non-confrontational? Do you prefer communicating in personor in writing? Do you think best from the gut and in-the-moment, or do you prefer to take time out to reect andcraft on your communications?

Questionloyalty lemploye

Questionin regardhaps as

Referenc

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Australian tered nCompete

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Butts, J., & RPublishe

Campbell, AMelbourn

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Gentile, M. (2010). Giving voice to values: How to speak your mindwhen you know whats right. New Haven and London: Yale Uni-versity Press. Curriculum site:. www. GivingVoiceToValues.org

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Hekman, & Susan, J. (1995). Moral voices, moral selves: Carol Gilli-gan and feminist moral theory. University Park: PennsylvaniaState University Press.

Johns Hopkins Bloomberg School of Public Health Center for Com-munication Programs. (2002). Questionnaire for Values Clarica-tion. Maryland: USA (p. 24). accessed at http://www.jhuccp.org/research/download/Valuesinstrument.pdf

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s of loyalty: Where would you say your greatesties: to your family, your work colleagues, yourr or to other stakeholders?s of self-image: do you identify as shrewd or naive

to negotiation? As idealistic, pragmatic or per-opportunistic?

es

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Giving Voice to Values: An undergraduate nursing curriculum projectIntroductionGiving Voice to Values: an overview

Giving Voice to Values: a nursing contextThe GVV nursing project

Student evaluationsCase study one: the GVV framework in a legal and ethical issues unit of study2nd year student evaluationsPerceived benefits in learning the GVV frameworkPerceived weaknesses in learning the GVV frameworkThe GVV framework in relation to other traditional models

Case study two: the GVV framework within a rural and remote area nursing unit of study3rd year student evaluationsPerceived benefits in learning the GVV frameworkPerceived weaknesses in learning the GVV frameworkThe GVV framework in relation to other traditional models

Reflections from the educatorsConclusionReferencesReferences

Documents

Giving Voice to Values: An undergraduate nursing curriculum project