Axiological reflection for nursing ethics education: The missing link in understanding value conflicts

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. Other 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.