MODULE 3: Understanding the contextual environment

1 IiiiiMODULE 3: Understanding the contextual environmentiiiiiiiiiiMODULE 3: Understanding the contextual environmentiiiiiiiiiiiiiiiMODULE 3: Understanding the contextual environmentCONTENTSCONTENTSCONTENTSCONTE NTSCONTENTSMODULE 3: Understanding THECONTEXTUAL ENVIRONMENTO bjectives1 Session 52 Introduction to assessing the contextual issues2 Values2 Ethics4 Traditions5 Gender7 Risk9 References11 Information sheet - International Council of12 Nurses Code of Ethics for NursesFacilitator s guide - Assessing contextual issues:14 Values, ethics, traditions, and risksExercise sheet - Values clarification check list16 Exercise sheet - Ethics intensity assessment tool18 Exercise sheet - Harmful traditions assessment20toolExercise sheet - Gender analysis tool22 Exercise sheet - Risk prioritization tool24ivivivivivMODULE 3: Understanding the contextual environment11111 MODULE 3: Understanding the contextual environmentMMMMMODULEODULEODULEODULEODUL E 3 3 3 3 3 Understanding THECONTEXTUAL ENVIRONMENTO bjectivesObjectivesObjectivesObjectivesO bjectivesUpon completing this session, the reader should be able to:Apply a values clarification tool to describe own and others ascribed valuesAnalyse the strength of intensity of ethical issues you maybe confronted withAssess harmful traditions which work against the interestsof individuals, families and communities555555555555555 MODULE 2 Identifying and Analysingthe Stakeholders andNetworksMODULE 5 Managing Communicationand the Change ProcessMODULE 3 Understanding theContextual EnvironmentMODULE 1 Identifying the Problemand the Desired OutcomeMODULE 6 Monitoring and Evaluatingthe ProjectMODULE 4 Understanding the Policy,Political and Decision-Making ProcessesTTTTTT22222 MODULE 3.

2 Understanding the contextual environmentSession 5 Session 5 Session 5 Session 5 Session 5 Introduction toassessing thecontextual issuesPolicy, planning and decision-making are each influenced bythe environmental context within which they operate. Anunderstanding of the major influences and how to considertheir impact will contribute to more positive planning your approach to advocating, it is wise toconsider all possible contingencies, risks, behaviours andarguments which may be put before you. The influencescovered in this session are not all of those that may arise,but certainly include the main ones and the ones likely tohave the most impact on your progress. The probability ofan influence occurring and the strength of its impact will alsobe may not be required to use all the tools in a given situationbut over the course of your advocacy on behalf of nursesand midwives you will draw on most of session will consider: Values Ethics Traditions Gender Risk (people, environment , finance, reputation)ValuesValues are one of the most important aspects of our character.

3 Our personal values underlay every aspect of our life. Values give meaning and purpose to what we do. We value what we care about. Sometimes we find ourselves in conflict with a work orlife situation because it clashes with our development, planning and decision-making are to alarge extent about values, that is they are value ladenprocesses. As influential agents, those responsible for policydevelopment, planning and decision-making need somesense of what they bring to their work. Their own values,shaped by their background - their ways of working,knowledge base, information sources, contacts, culture andlife experiences - influence the way they perceive a policyVALUESare one s judgment of whatis valuable or important 3: Understanding the contextual environmentissue and the approach they take. So too do the values of thesystem in which they change over time in response to changing lifeexperiences.

4 Recognizing these changes and understandinghow they affect one s actions and behaviours is the goal ofthe values clarification process. Values clarification will nottell you what your values should be; it simply provides themeans to discover your own values and the values of who choose to influence policy development,planning or decision-making must: be aware of their own values and those of theenvironment in which they operate; and understand how these influence their decision-makingand the decision-making of others. (See Exercise )ExamplePreference for sonsIn many societies, preference for sons is a powerful tradition. Thispreference manifests itself in neglect, deprivation, and discriminatorytreatment of daughters to the detriment of their physical and preference begins early in life. In regions where this practice isfirmly entrenched, high rates of poverty and infant mortality frequentlyoccur.

5 Parents with scarce economic resources may feel that it is moreimportant for male children to survive. Dowries, to be paid whendaughters marry, may be a further incentive for son preference. As aresult, female children and infants are often fed after males and receivefood of lower nutritional value. In rural Bangladesh, malnutrition is nearlythree times as common among girls as among boys. Further, boys aremore than twice as likely as girls to receive medical care for India, every sixth infant death is specifically due to practices arisingfrom son values displayed here include: Economic security PowerTherefore, to change this situation, one would have to ensure thateconomic security is provided in another way ( social securityprogrammes, family planning) and that the family structure is 3: Understanding the contextual environmentExerciseUsing the Values Clarification Tool (Exercise Sheet ), completethe following Select the 10 statements which you relate to more thanother statements and then select your top 5 Consider a person in a decision-making position whom youhave had a disagreement with on a work issue and selectwhat you think their values were that led them to theirparticular position on the Compare your values with those of the other person andnote any Write down what you might have done differently if you hadbeen aware of any difference in values.

6 EthicsFulfilling the role of community advocate dictates that nursesand midwives support actions that are in the best interest ofpublic health and defend the rights of rights of patients include accessibility, accountability,quality, effectiveness, efficiency, safety, responsiveness,continuity and Code of Ethics provides nurses with direction for ethicaldecision-making and practice in everyday situations as theyare influenced by current trends and conditions. A codeapplies to all nurses whether they are engaged in clinicalpractice or delegating care to providers at other levels ofcare. This code also plays a role in other areas, for example,the role and impact of ethics has to be taken intoconsideration when developing teaching materials for nursesin training. Ethics will also play a role in administration interms of influencing resource allocation decisions.

7 Withrespect to research, ethics will also influence thedevelopment of programmes to evaluate the cost- andquality-effectiveness of different care are a number of codes produced by various nursingorganizations. It is suggested that you obtain a copy of theCode of Ethics produced by the nursing organization in yourcountry. Should one not be available, you could use theone provided by the International Council of Nursing (ICN).(See Information Sheet )When advocating on behalf of nursing and midwifery on aparticular issue you may analyse ethical issues to: support your argument for change on the grounds thatthe current policy is unethical; or ensure that the approach you are advocating is term ethics commonlyrefers to the rules andprinciples that define rightand wrong 3: Understanding the contextual environmentThe ethics of policy development and decision-making canbe influenced by values and tradition but values and traditionswhich are different from one s own do not necessarily resultin unethical decision-making.

8 However, ethical standardsare not universal. So it is better to consider the intensity ofthe impact of the decision rather than the decision itself. (SeeExercise Sheet )ExampleUsing the Preference for sons case study: Low Medium HighHow great a harm (or good) is done to Xthe recipients of the act in question?How much consensus is there that the act Xis harmful (or good)?What is the probability that the act will Xactually take place and will cause the harm(or benefit) predicted?What is the length of time between the act Xin question and its expected consequences?How close do you feel (socially, psycholo- Xgically or physically) to the recipients of theharmful (beneficial) act in question?A large number of people are harmed; there is not generalconsensus that the act is harmful; there is a high probabilitythat the act will take place and actually cause harm; there isa short time for the consequences of the act to surface; andobservers feel close to the recipients of the act.

9 The sum ofthese characteristics indicates that this is an important the Ethics Intensity Assessment Tool (Exercise Sheet ),complete an assessment on an issue that you consider might constitute learned habits which are passed on fromgeneration to generation and which form part of the identityof a particular community. People adhere to these patternsof behaviour, believing that they are the right things to are often guarded by taboos and are not easy traditions are harmful and can either influence policyor in some cases policy can reinforce the harmful the customs, beliefs andvalues of a communitywhich govern and influencemembers 3: Understanding the contextual environmentA harmful tradition can be as simple as a nursing procedurewhich exists through custom and practice rather than throughevidence to support its effectiveness, or as extreme as genitalmutilation sanctioned by advocating on behalf of nursing and midwifery on aparticular issue you may need to support your argument forchange on the grounds that current policy is a traditions exist in many different forms, but theyusually share origins in the historically unequal social andeconomic relationships between men and women.

10 Effortsto alter or eradicate harmful traditional practices are oftenmet with suspicion or hostility from those communitiespracticing them, particularly when efforts originate fromoutside the community. For many members of thesesocieties, ending their traditions is unimaginable, as suchpractices constitute an integral part of their traditions are powerful, and only careful andsustained efforts will alter or eliminate harmful ones. Effortsto change harmful traditions are most effective when theyoriginate within the culture that practices them. (SeeExercise Sheet )ExampleUsing the Preference for sons case study: LowMedium HighHow great a harm is done to the individual Xor group by the continuance of thetraditional practice?What is the level of agreement that the Xpractice is harmful?To what extent does the traditional practice Xdisempower the individual or group?