Key concepts in values-based practice: the point, premise and process. Values-based practice

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Awareness of values includes awareness of the diversity of values, awareness of one’s own values as well as the values of others, and awareness of positive values (StAR values, ie strengths, aspirations and resources) as well as negative values (such as needs and difficulties)

  • Reasoning about values includes any of the established methods of ethical reasoning (such as principles reasoning, case-based reasoning (casuistry), or utilitarianism) when used to improve understanding of the values bearing on a given situation (to ‘widen our values horizons’) rather than (directly) to decide what is right

  • Knowledge of values covers tacit (or craft) knowledge as well as knowledge derived from research; and it includes the skills for knowledge retrieval from electronic databases.

  • Communication skills include skills for eliciting values (including strengths, as in ICE-StAR) and skills of conflict resolution

V-BP Professional relationships

Professional relationships in values-based practice involve person-values-centred practice and extended multidisciplinary team work

  • Person-values-centred practice means practicing in a way that focuses on the values of the patient while at the same time being aware of and reflecting the values of other people involved (clinicians, managers, family, carers, etc): this is important in tackling two particular problems of person-centred care, problems of mutual understanding and problems of conflicting values

  • Extended multidisciplinary team work means practicing in a way that draws not only on the diversity of skills represented by different team members but also on the diversity of team values: this is important both in identifying the values in play in a given situation and in coming to balanced decisions about what to do

Linking with evidence-based practice

The links with evidence-based practice are defined by three principles, the two feet principle, the squeaky wheel principle and the science-driven principle

  • The two feet principle is that all decisions whether overtly value-laden or not, are based on the two feet of values and evidence: clinically, this translates into the reminder to ‘think facts, think values!’

  • The squeaky wheel principle is that we tend to notice values only when (like the squeaky wheel) they cause trouble: clinically, this translates into the reminder to think values, think facts!

  • The science-driven principle is that advances in medical science and technology in opening up new choices (hence diversity of values) drive the need equally for values-based practice as for evidence-based practice: clinically, this translates into the reminder that as practice changes it is vital to think both facts and values!

Partnership in decision making

Partnership in decision making in values-based practice depends on both consensus and dissensus

  • Consensus involves differences of values being resolved (as in the development of shared frameworks of values)

  • Dissensus involves differences of values remaining in play to be balanced sometimes one way and sometimes in other ways according to the particular circumstances presented by different situations

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