This week we want to explore, via the discussion board, a wide range of contemporary trends
affecting our values, assumptions, beliefs and expectations in advanced practice nursing,
leadership, or education depending on the program you are in. Clawson (2009), retired business
professor from UVa, describes the way an individual sees the world as conscious, semi-
conscious, and sub-conscious values, assumptions, beliefs and expectations (VABES). As
discussed in this week’s video, we have values we have literally grown up with that are so
ingrained they are almost unconscious. Personal values, because they are at the core of who we
are, end up coming out in the workplace. When we personally value something we can run into
tension—or even conflict, if that value is not being met.
Use Clawson's article and other readings to help you frame your VABEs. Dig deeper than the
surface---really think about this.
I'd like to see in a well-developed paragraph on background, followed by specific outline of the
specific value; associated assumptions; beliefs; expectations. The post should reflect Clawson’s
article on the VABEs piece and again, dig deeper than the surface.
In the past I’ve prompted students who are too general with the following:
Because you value _____________ you assume ____________ ______________
Because you believe so strongly in __________ you expect __________ (of others, of your
institution, of yourself, etc)
Q1: Discuss a major trend affecting your career today and how you are currently
contributing to it based on your VABES. Be specific about each category: values,
assumptions, beliefs, and expectations.
A major trend affecting my career today is the use of informatics technology (IT),
specifically the major trend of ineffective use of electronic health records (EHRs). According to
Alexander, Frith, & Hoy (2019), the introduction of IT is imperative in order to improve practice,
patient care delivery, and outcomes. However, too often during a patient encounter, request for
records from a specialist referred by the primary care PCP is not uploaded correctly in the EHR
or not the EHR at all. In general, (HCPs) sharing data with other health care providers and other
health care organizations utilizing an EHR is considered a routine part of utilizing a health IT
system to promote continuity of care between HCPs, hospital specialists, and other organizations
like a pharmacy (Savage & Savage, 2020). This trend has affected this writer both positively and
negatively.
According to Clawson (2009), social, cultural, and genetic influences are woven into
each person’s set of values, assumptions, beliefs, and expectations (VABES) which then, in turn,
affects this person’s performance, energy level, and overall disposition. Based on this article
review human behavior can be evaluated at three levels. The first level is simple and can be
evaluated by observing the behavior, like mannerism of the patient. In level two, the patient is
actively choosing to limit which behavior to exhibit to the world, thus the term conscious
thought. Lastly, the third level refers to conscious, semiconscious, subconscious behavior based
on our VABES. At this level, we are not able to be our authentic self since it is influenced by
deep-rooted values and what we believe the world expects of us.
Furthermore, across cultures, countries, and religions the beliefs and assumptions passed
down from generation to generation continue to create major conflicts because these beliefs are
so ingrained within the individual’s subconscious (Clawson, 2009). The individual in these
cultures or religions consequently remains in these habitual cycles despite the documented
negative outcomes. For example, this writer values teamwork, collaboration, problem-solving
because this was emulated to her by her parents, siblings, and other members of the family
throughout her childhood. Thus, because of this writer’s strong value of teamwork, she expects
cohesive teamwork across all institutions that she is involved in.
This Value or assumption that teamwork should exist in all institutions has been causing
conflict due to the particular trend of ineffective use of EHR and lack of collaboration and
teamwork exhibited by the specialists we referred the patient to. The writer assumed that since
she referred the patient to the specialist, the specialist would automatically forward consult notes
after seeing the patient within the same month. The three levels of studying human behavior
were suggested to be applied to management attitudes towards their subordinates (Clawson,
2009). In contrast, most managers carry the long-time belief that the employee’s feelings should
not get in the way of business production since most people operate at level three of the human
behavior concept. Most people operate in their conscious level of thinking to guide their
decision to continue performing tasks at work because it’s an obligation instead of expressing
how they really feel about their institution and leaders. In comparison, in a study conducted by
Dewa et al. (2020), employees with diagnoses of mental illness struggled to disclose their mental
illness status with their managers or institution. The workers expressed that one of the reasons
they would not disclose their diagnosis is lack of trust in management. The displayed behavior
by leaders that priority for the company is productivity, not employee satisfaction.
This writer’s value for problem-solving led to teleconference meetings with the office
managers of the specialists that we collaborate with to discuss the interventions needed to assure
that progress notes and treatment plans are shared through the EHR with us, the referring HCP.
This intervention has helped yield positive results and now has most of the notes in the chart at
the time of encounters. This led to an increase in productivity and job satisfaction while
completing my charts after the encounters. Clawson(2009) emphasizes that increased
productivity can only come from the ability to balance all three levels of human behavior and
being able to reflect and not be resistant to change or let go of some of the embedded VABES
that we have.
Q2: There are many definitions of leadership. After week one and two’s readings, how
would you define leadership, and how does definition reflect the nine tasks of leadership
and the essential elements?
The terms leaders and managers are often used interchangeably. Managers are often tasks
oriented and move through their tasks with minimal emotions. In contrast, leaders complete their
tasks, while communicating, motivating, engaging workers by acknowledging their VABES,
serving others, fair presentation of the group, and promoting continual change (Grossman &
Valiga, 2021). Understanding the tasks that leadership is essential to the successful growth of the
company is important. This author believes that an effective leader must be able to examine his
VABES in order to grow and lead order. We often believe that everyone should have common
sense but don’t take the time to define what this common sense should be. Grossman &Valiga
(2021) noted that gender perspective in leadership had long been defined by expected feminine
versus masculine treats. Unfortunately, when women exhibited the same characteristics as men,
they were branded with a negative connotation. For example, a businessman who exhibits
aggression is attributed to the maleness concept and is accepted as the norm. In contrast, a
businesswoman who exhibits the same characteristics are would be considered pushy. This is a
clear example of how embedded VABES can cause conflict among groups of people. This writer
agrees with the androgynous leadership style because it is a combination of both gender styles
promoting effective leadership for both men and women. This theory encourages leaders to
become change agents by directing and motivating members of their team to create both short-
term and long-term goals, team building being entrepreneurs and taking risks, and breaking the
existing misconceptions and attitudes about what a female or male leader is expected to be.
References
Alexander, S., Frith, K.H., & Hoy, H. (2019). Applied clinical informatics for nurses (2nd ed.).
Burlington, MA: Jones and Bartlett.
Clawson, J. S. (2009). Level Three common sense. Management Decision, 47(3), 470-480.
http://dx.doi.org/10.1108/00251740910946723
Dewa, C. S., Weeghel, J. V., Joosen, M. C., & Brouwers, E. P. (2020). What Could Influence
Workers' Decisions to Disclose a Mental Illness at Work?. The international journal of
occupational and environmental medicine, 11(3), 119–127.
https://doi.org/10.34172/ijoem.2020.1870
Grossman, S., & Valiga, T. M. (2021). The new leadership challenge: Creating the future of
nursing – With Access (6th ed.). Philadelphia: F. A. Davis Company.
Savage, M., & Savage, L. C. (2020). Doctors Routinely Share Health Data Electronically Under
HIPAA, and Sharing with Patients and Patients' Third-Party Health Apps is Consistent:
Interoperability and Privacy Analysis. Journal of medical Internet research, 22(9),
e19818. https://doi.org/10.2196/19818.
Environment relates to the settings, surroundings that the person is cared for or for
(Shelly & Miller, 2006). The interaction with family, clinics, or providers is also considered a
part of the patient’s environment. Each person is to care for their body in this instance and their
environment as if their body is a gift from God to be treasured. (King James Bible, 1769/2017,
Gen 1:28; 1 Peter 4:10). Nurse Practitioners (NPs) are called to keep our patient’s environment
safe. Following the policies, protocols set by the organization NPs work for will ensure the
delivery of a safe environment as our patients are viewed as a gift from God.
King James Bible. (2017). King James Bible Online. https://www.kingjamesbibleonline.org/
(Original work published 1769)
Shelly, J.A. & Miller, A.B. (2006). Called to care: A Christian worldview for nursing (2nd ed.).
Downers Grove, IL: InterVarsity Press. ISBN: 9780830827657.
RESPONSE 1 TO ADRIENNE
Hi Adrienne,
I thoroughly enjoyed reading your post. It is clear to me that you’re a thoughtful, forward-
thinking educator and leader. Clawson (2009) asserted that each person’s set of values,
assumptions, beliefs, and expectations (VABEs) guides the way they view and allow the world to
see them. VABEs are best classified into three levels and each level can be applied to managerial
behaviors within an institution. Moreover, management often presents proposals that include
“buy-in” concepts without consideration for each individual’s VABEs. The level one “buy-in”
technique is meant to influence an employee’s visible behavior which aligns with level one of
human behavior as described by Clawson( 2009, p. 7). “promises, rewards, and gifts” represent
positive reinforcements and forms of level one “buy-in” techniques (Clawson, 2009, p. 7). This
level can also be attached to a negative connotation such as bullying, intimidation if the
employee refuses to accept the “buy-in” offered. Level two “buy-in” techniques attempt to
change the employee’s assumptions based on evidence-based data and rationalization. I believe
that our assumptions of how the world should be. I believe that our VABEs are already shaped in
our childhood and despite how many techniques are applied, I still will continue to believe in my
assumptions to some degree. For example, because of your values that a leader does not give up
even if they fail, your assumptions and expectations of success will always be a reality to you.
Level three of the “buy-in” techniques however brings us closer to the idea that our employer is
concerned about our VABEs. For example, at my place of employment, we have a potluck once
quarterly after seeing patients on a Friday up until 12 pm to experience each other’s cultural
dishes and listen to samples of music from each other’s culture. This activity started two years
ago and I have learned to appreciate and value my co-worker’s culture to a deeper level which
otherwise may have not occurred if not for this activity. Level three is most often used by
organizations like a church(Clawson, 2009).
I can also Identify with your concern for the lack of sites for clinical rotations necessitating the
use of medical simulations. In a study conducted by Lee, Choi, & Jeon (2021), Computer
Simulation-Based education was initiated for students needing to complete clinical hours for
psychiatric rotations. The competency levels for skills were attainable and for the most part,
were translated when students finally got into a clinical setting. However, the communication
skills of the students were not effective because they were not able to adapt to the real scenario
of dealing with patients in an acute state or collaborating with the nurses and looking at orders
written by the doctor. As you have mentioned, a leader seeks to be innovative and encourage
collaboration that is needed in such situations. I trust that your leadership in this situation would
seek to assess the student’s behavior during simulations prior to starting clinical rotations to offer
the best outcome for both patients and students.
Reference
Clawson, J. S. (2009). Level Three common sense. Management Decision, 47(3), 470-480.
http://dx.doi.org/10.1108/00251740910946723
Lee, U., Choi, H., & Jeon, Y. (2021). Nursing Students' Experiences with Computer Simulation-
Based Communication Education. International journal of environmental research and
public health, 18(6), 3108. https://doi.org/10.3390/ijerph18063108
Simulation-based communication education has improved nursing
students’ communication knowledge and skills. However, communication
patterns that students commonly exhibit in simulated situations and
students’ responses to specific clinical situations have not been
systematically examined.
performing effective and empathic communication with patients and
colleagues in dynamic and case-specific clinical situations is not easy.
Nurses may feel challenged when communicating with emotionally
charged patients or patients of different sexes, ages, and sociocultural
backgrounds when managing the triangle of nurse–physician-patient
communication during a conflict
“False reassurance” –would have to become good at re-enacting a
scenario in the nursing lab after completing a simulation scenario.
particular, simulation-based education using standardized patients has
been widely used as an alternative for clinical placement, providing
hands-on exercises to improve communication skills among students
[4,13,14,15]. However, nursing schools with insufficient resources have
not been able to offer simulation-based learning experiences for their
students due to the difficulties in maintaining the quality and consistency
of standardized patients
Challenging situations include notifying the doctor about changes in the
patient’s condition, administering medication, and managing conflicts
between patients.
most nursing colleges focuses on performance, making it difficult to
assess individual characteristics such as learning attitude, level of
participation in education, learning speed, and learning depth.
Inefficient communication between medical staff members is a key issue
that causes medical accidents and delays in treatment, which threatens
patient safety. First, nursing students’ communication experiences were
evaluated only in a simulated environment. Therefore, future research
must investigate nursing students’ use of communication skills in an
actual clinical setting. Second, we were able to collect verbal
communication data only; thus, we were not able to explore students’
non-verbal communication patterns, which are an integral component in
patient care.
Particularly, scenarios where students can practice and learn how to
differentiate between false reassurance and emotional support, how to
communicate with doctors with confidence, and how to interact with
challenging patients are needed.
RESPONSE 2-APRIL
Hi April
I appreciate you sharing your experiences with telehealth/telemedicine medicine
within the facets of Long-Term Care (LTC). I also worked in the LTC community up until
03/2020. In recent years, the use of remote monitoring of chronic disorders is aimed at
improving patient adherence to medical regimens and monitoring patient outcomes.
Remote monitoring is mostly achieved by utilizing E-health tools like telehealth, digital
wearables, and smartphone applications (Alexander, Frith, & Hoy, 2019).
I understand your struggle dealing with the hurdles encountered when using
telehealth/telemedicine to assess patients’ needs. Prior to COVID, our team of Nurse
Practitioners would have to conduct monthly teleconferences with the different specialists
credentialed through the insurance plan that I worked for to determine the percentage of
resource utilization and decrease the number of unnecessary procedures ordered and
implemented. Although it was just coordination of a phone call, I felt like that took away
from my face-to-face time with my patients (my beliefs) at the time because we had to
wait for all who were invited to call in prior to starting the meeting. Those meetings could
last up to 2-6 hours. I too use to believe that face-to-face encounters are the best way of
providing care, however, the COVID era has presented an opportunity for me to grow by
accepting and embracing the use of telehealth/telemedicine. I have since let go of the
belief that one way of delivering care is the best way. I have found that I can conduct
office visits and telemedicine on the same day with some delays but with proper
planning, all patients were assessed and treated appropriately. I believe that this
assumption and value stem from watching my family value face-to-face doctor
appointments. They never signed up for anything electronic like an email or text message.
They would only communicate with their Health Care Providers by talking on the phone
or just going to the office to get an appointment if not able to get through the phone. In
fact, my parents still operate the same way, although I have signed up for a patient portal
on their behalf and spend time showing them how to browse through their emails.
My assumption is that patients that think like my parents don’t want to change. I
learned last week though that is so far from the truth after a telemedicine visit that I
conducted with my patient, his wife, and grandson. The patient was seen in the
emergency room and referred to a urologist. The patient has not been able to reach the
office by phone and is unable to drive. The patient’s wife works during the day during our
office hours and is unable to drive him to the office. The grandson while visiting his
grandparents created a portal login for the patient to help mitigate this issue. The
grandson then requested a telemedicine visit via the patient portal and stayed to ensure
that we could conduct a telemedicine visit utilizing his iPhone since the patient does not
have an android or iPhone. This scenario proved my assumption that certain groups of
people do not desire change to be wrong. From now on I will explore alternative ways of
providing and offering services to all different types of populations.
First of all Clawson (2009) asserts that people have habits that have been part of
them for a long time and that they are unconsciously holding to. We as clinicians have to
realize in order to be effective leaders and clinicians, we must be willing to expand our
ideas of cultural diversity, have self-awareness and have empathy (Goleman, 2019). A
leader who has self-awareness will be able to exhibit empathy across cultures which can
encourage others to consider evaluating their VABEs.
References
Alexander, S., Frith, K.H., & Hoy, H. (2019). Applied clinical informatics for nurses (2nd ed.).
Burlington, MA: Jones and Bartlett.
Clawson, J. S. (2009). Level Three common sense. Management Decision, 47(3), 470-480.
http://dx.doi.org/10.1108/00251740910946723
Goleman, D. (2019). The emotionally intelligent leader. Harvard Business Review Press.
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