Values play an important role in one's life. They serve like a backbone to shape person's attitude, feelings, and behaviors. On the basis of individual's values, person act in the environment and perceive the environment as favorable or demoralizing. This article will explore the importance of nurses' values and how these values lead towards self-sacrifice which in turn develops caring.

A patient Y was admitted in a surgical ward. He was very sick. His clinical condition was unstable and that he could deteriorate anytime. It was a night shift. A nurse X was assigned for that patient along with four other patients as the nurse patient ratio was 1:5 in the ward at that time. Patients in this ward are usually in clinically stable state therefore, it was the first time that the nurse was taking care of very sick patient. The situation was very difficult for that nurse, she was nervous and anxious. She was taking good care of all the patients except one patient Y who was very sick due to his health condition. She was trying not to visit that patient and was avoiding him. The duty was going on very smoothly. Suddenly, towards the end of that shift when there was an overlapping time, the patient Y started deteriorating and cardiopulmonary resuscitation (CPR) was required. Another nurse present in the ward performed CPR while the nurse X took care of other patients. In this situation, nurse X could have handled the situation, but she avoided this situation by handing over the task to other nurse present in that ward. Here the questions arise why she avoided this situation? Why she didn't attend the CPR herself? Why she was not attending this patient? What were the values involved which were constraining her?

Values are ideals and beliefs of an individual. Individuals carry different set of values which are important for them (Altun, 2002). Nurses' value system is important to recognize because they are the one who take care of patients. Identification of self-values helps nurses in providing care to the patients according to their needs. Pask (2003) explained two types of values: intrinsic and extrinsic. Intrinsic values is the one which are achieved as a result of professional achievements and extrinsic values are the values which are set by the nurses for her, both results in the feeling of satisfaction and feeling of fulfillment of one's duty.

Intrinsic values comprise of passion, harmony, eros, self transcendence, self-sacrifice, hope, agape and dedication. These notions refer to the dedication and commitment. One way of showing commitment and dedication is listening to the patients and answering their needs without any personal intention. Therefore these values are essential for nurses for taking care of patients. These values are the source of vitality, liveliness and passion and they provide spiritual and physical energy. These values form the caring attitude in nurses and therefore, nurses work for the betterment of their patient at the cost of self-sacrifice.

Self-sacrifice and self-transcendence refers to the giving up something with one's conscious for the benefit of others without any intention (Helin & Lindstrom, 2003). Personal values form the foundation of self-sacrifice and self transcendence. On the basis of personal values, an individual interpret the environment and react accordingly. If an individual has internalized and analyzed his own values only then he can do self-sacrifice and reach to the highest level of human development, i.e. self transcendence. It is a self-conscious effort which requires one's intellect and emotions to give meaning to self values and critically analyze it. Achievement of self transcendence results in self-satisfaction. Thus this is the self transcendence that demands nurses to move beyond the individual horizons to higher stage which leads to the charity. Charity is the benevolence love for others and through charity we can fill the gap between the personal and professional values and can appreciate values in each human being (Perry, 2004).

Self-sacrifice is important for caring relationship. Sacrifice accompanies responsibility, respect for human dignity, faith and love. These elements are the basic components of caring which is emphasized in nursing theories. Also, being professional demands self-sacrifice. Nurses are encouraged to analyze their values and think at higher level to develop better nurse-patient relationship.

Theorists have indicated that self-sacrifice and self transcendence are the essential concepts of nursing. Theorists have used these concepts of values to illustrate that it is essential for caring (Tomey & Alligood, 1998). Ernestine Wiedenbach in theory of “the helping art of nursing” explained that nurses' action is directed towards the achievement of a specific purpose which is, act and make decision for the patients for their betterment. Similarly, Faye Glenn Abdellah defined that nurse's attitude, intellectual competencies and technical skills strengthen nurses' ability, which could help patient in their needs. Here it focused the self-sacrifice in term of nurses' value and attitude and giving self to patient. Lyndia Hall also identified the self-awareness as an endeavor to help their patients. She focused that the more nurses are self-aware the more they will be able to control their behavior. Here self awareness refers to the clarity of personal values. Jean Watson in her work “philosophy and science of caring” identified ten essential elements for nurses to show caring. One of these is giving and extension of self. Patricia Benner from novice to expert” also emphasized importance of caring. She described nursing as a caring relationship and it is the primary factor through which nurses help patients. Florence Nightingale emphasized the importance of environment in health status. She relates that nurses are the one who have the responsibility of patient's health and therefore self-sacrifice is needed to take care of the environment and be responsible for the patient care which is one aspect of caring. Viginia Henderson explains that nurses need to assist the patient in their activities and this can only happen if nurses are self-sacrificed for the patients and help them to gain independence.

Personal values are a set of values that a person has and that direct his actions. Professional values are the values that form the basis of idealistic behavior and action in that profession. Nurses in their professional life face many of such encounters, where it is difficult to decide what is right and wrong. Nurses continuously evaluate situations in decision making. Many situations demand compromise and nurses are aware of it. Here the need is to look at the extent of the sacrifice that is acceptable. In nursing there is no clear boundaries that distinguish between personal values and professional values because once nurse is qualified they can never be non-nurse in any situation, which gives rise to a dilemma, to decide whether to prioritize personal values or professional values (Raeve, 2002). Therefore, one's interpretation of the situation is important in making decisions. Different situations face different moral issues in a different way, some may require compromise between the personal integrity and the professional integrity. It doesn't mean that one should suppress his conscious rather it's a reworking of the conscious in the light of the understanding which is developed on the basis of the professional integrity. Hence, nurses are not required to sacrifice whole heartedly that depersonalize the nurse (Raeve, 2002), instead nurses are required to analyze the situation according to the moral values and make decision which is appropriate in the professional integrity.

Nurses can handle a situation in many ways. Nurse's interpretation and judgment according to the context defines what she/he ought to do. Stuart (2004) has explained the virtue ethics. Virtue ethics means right thing for the right reason with the right emotion. It is one's own decision to judge the situation and make the right decision accordingly and therefore nurses' perception is important. Nurses' perception worked as a framework to guide the nurses to judge the situation and implement virtue ethics. The virtue of autonomy shows that level of independence also has an impact on nurses' action. Insufficient independence is associated with non-assertiveness, tendency to live one's life through others, fear in experimentation and excessive self-sacrifice. Thus nurses self values regarding the situation plays an important role in decision making. In the scenario, nurse didn't do the CPR and avoided the situation. It may be due to the differences in her personal values and professional values. Professional values demands dedication and commitment which were probably not as important to her as her personal values. She could have compromised her personal values and took initiative to attend patient's need.

Chiang, Chen, and Sue (2007) examined the nurses' experience who were taking care of severe acute respiratory syndrome (SARS) patients and grouped these responses in three categories: self-preservation, self mirroring and self-transcendence. These concepts can be applied to the case scenario which has been discussed earlier to fulfill the professional duty. Self-preservation is to prevent ourselves from getting harmed from the outside. In this situation nurse could have diverted her values from personal to professional in order to fulfill professional duty. Self-mirroring is one's analysis of his own actions taken to help others. In such situation nurse could have redefined her role and fulfilled the need of that patient. Self transcendence is to look at our own values and experiences and give care accordingly. In such situations, nurses analyze the challenges experienced by the patients and encounter them by facing those challenges to give care to the patients. In the scenario, the nurse could have done the CPR which was the urgent need of the patient at that time. She could have thought of the patient's need and by compromising her personal values, she could have adopted the professional values. She could have thought of her role as a nurse in this situation and could have given care to the patient.

Values of nurses are an essential and basic component of patient's caring. Values guide the way the nurse behave with their patients and the self-awareness of values is important for an excellent patient-nurse relationship. Values are an inspiring force for a nurse to self-sacrifice and to maintain professional integrity.

There are some recommendations for nurses for the self awareness of value. First, educating the importance of values during the basic training of nurses in the nursing school can play an important role in developing nurses' professional values. Open discussion will help students to explore their personal values and professional values. Participation in discussion with the professionals regarding the values involved in a dilemma can enhance nurses' knowledge regarding what they are supposed to do in that particular situation. Participation in case discussion and sharing one's professional values will increase self awareness and help to explore values of others. Second, reflecting on the situation and communication with other nurses can provide an opportunity to verbalize and explore their feelings attached with the situation. Third, assertiveness plays an important role. Assertive nurses believe in themselves and their ability leading to personal and professional empowerment. Lastly, social support and support from the management influences nurses' values and ability to work in complex situations.