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Artificial intelligence (AI) is rapidly revolutionizing health care and education globally, including nursing practice and education. The responsible utilization of AI in a nursing context requires thoughtful consideration of its alignment with nursing values such as compassionate and patient-centered care provision, and respect for diverse perspectives. Values clarification, a vital teaching strategy in nursing education, can reinforce the foundational values and beliefs that guide nursing practice, thereby facilitating nurses’ critical evaluation of the ethical implications of AI implementation. The early introduction of values clarification into nursing education (a) provides students with a framework to prioritize and reflect on the impact of nursing values on their practice, (b) enables educators to make informed decisions and enhance teaching strategies, (c) contributes to the continual improvement of nursing education programs, and (d) fosters an ethical and values-driven approach to the integration of AI into nursing education and practice. This article examines the integration of values clarification into nursing education, offers strategies for nurse educators to integrate AI into their teaching toolkit effectively and ethically, and addresses concerns regarding potential misuses of AI.

Ethical decision-making is challenging for most students. Values clarification exercises (VCEs) can help reduce decisional conflicts and feelings of regret. Scholars have suggested Ethical decision-making is challenging for most students. Values clarification exercises (VCEs) can help reduce decisional conflicts and feelings of regret. Scholars have suggested designing values deliberation exercises based on moral dilemma scenarios to help students to identify their values system. However, such exercises are challenging to complete for most teachers and students. Therefore, the development of artificial intelligence (AI)-supported decision aids is warranted. Studies have revealed that using a one-on-one interactive chatbot is a feasible learning strategy for improving the dialectic skills of students. Thus, this study proposed a human-machine learning framework that helps students to perform values clarification in the context of moral dilemmas. To assess the effectiveness of the framework, the present study incorporated the chatbot Chat Generative Pre-trained Transformer into the business ethics course of a university to develop a generative-AI-chatbot-assisted VCE (GAIC-VCE) system for university students. In total, 70 university students were recruited and divided into an experimental group and a control group. The experimental group completed GAIC-VCEs, whereas the control group completed conventional VCEs. The results revealed that the GAIC-VCE system effectively improved the experimental-group students' ethical self-efficacy and ethical decision-making confidence and reduced their decisional conflicts.

Values clarification, a key but under-implemented component of shared decision-making (SDM), involves identifying what matters to a patient relevant to a health decision. It is especially important for patients with limited health literacy (LHL), who often struggle to express preferences. General practitioners (GPs) play a central role in facilitating this process, yet their experiences are underexplored. To explore how GPs experience values clarification with patients with LHL, the challenges they face, and which support or strategies they consider helpful to better integrate values clarification into decision-making. We conducted semi-structured interviews with 15 GPs purposively selected from practices in lower socioeconomic areas. Interviews were audio-recorded, transcribed verbatim, and analyzed using the framework method. Four themes emerged: GPs consider values clarification important but challenging; it goes hand in hand with problem analysis; trust and continuity of care are essential foundations; and relatives can support and hinder the process. GPs described two contrasting situations: patients with LHL adopting a passive role, prompting a more paternalistic approach, and patients with LHL with strong expectations that can conflict with clinical guidelines. GPs expressed needs for training, prompts or scripts, and strategies to explore expectations before consultations. Values clarification in the context of SDM with patients with LHL is complex and context dependent. Given their ongoing relationships with patients, GPs are well-positioned to facilitate this. GPs' experiences indicate that values clarification may occur throughout the consultation - often intertwined with problem analysis - reflecting the dynamic nature of SDM in general practice.

Background Women’s access to abortion care is often denied or hampered due to a range of barriers, many of which are rooted in abortion stigma. Abortion values clarification and attitude transformation (VCAT) workshops are conducted with abortion providers, trainers, and policymakers and other stakeholders to mitigate the effects of abortion stigma and increase provision of and access to abortion care. This study assesses changes in knowledge, attitudes, and behavioral intentions of VCAT workshop participants. Methods Pre- and post-workshop surveys from 43 VCAT workshops conducted in 12 countries in Asia, Africa, and Latin America between 2006 and 2011 were analyzed to assess changes in three domains: knowledge, attitudes and behavioral intentions related to abortion care. A score was created for each domain (range: 0-100), and paired t-tests or Wilcoxon matched-pairs signed-ranks tests were used to test for significant differences between the pre- and post-workshop scores overall and by region and participant type (providers, trainers, and policymakers/other stakeholders). We also assessed changes in pre- and post-workshop scores for participants with the lowest knowledge and negative attitudes on the pre-workshop survey. Results Overall, the mean knowledge score increased significantly from 49.0 to 67.1 ( p  < 0.001) out of a total possible score of 100. Attitudes and behavioral intentions showed more modest, but still statistically significant improvements between the pre- and post-workshop surveys. The mean attitudes score increased from 78.2 to 80.9 (p < 0.001), and the mean behavioral intentions score rose from 82.2 to 85.4 ( p  = 0.03). Among participants with negative attitudes pre-workshop, most shifted to positive attitudes on the post-workshop survey, ranging from 35.2% who switched to supporting unrestricted access to second-trimester abortion to 90.9% who switched to feeling comfortable working to increase access to contraceptive services in their country. Participants who began the workshop with the lowest level of knowledge experienced the greatest increase in mean knowledge score from 20.0 to 55.0 between pre- and post-workshop surveys ( p  < 0.001). Conclusions VCAT workshop participants demonstrated improvements in knowledge, attitudes, and behavioral intentions related to abortion care. Participants who entered the workshops with the lowest levels of knowledge and negative attitudes had the greatest gains in these domains.

PurposeOver half of males experience fertility impairment after childhood cancer therapy, which often causes psychosocial distress. Yet, fertility preservation (FP) remains underutilized. The goals of this study were to determine the feasibility and impact of implementing a family-centered FP values clarification tool on sperm banking attempts among adolescent males newly diagnosed with cancer, and identify key determinants of banking attempts.MethodsA prospective pilot study was conducted among families of males (12–25 years old), prior to cancer therapy. Thirty-nine of 41 families agreed to participate (95%); 98 participants (32 adolescents, 37 mothers, 29 fathers) completed the Family-centered Adolescent Sperm banking values clarification Tool (FAST). Analyses assessed the impact of the FAST on banking attempts and examined associations between demographic/medical characteristics, FAST subscales (perceived threat, benefits, barriers), and banking attempts.ResultsTwenty-three (59%) adolescents attempted to bank, compared to 8 adolescents (33%) during baseline assessment (p=.04). Significant associations were identified between banking attempts and adolescents’ report of perceived threat (rpb=.45, p=.01) and benefits (rpb=.57, p=.01). Only mothers’ proxy reports of adolescent perceived threat (rpb=.42, p=.01) and benefits (rpb=.47, p=.003) were associated with banking attempts, while fathers’ self-reported perceived benefits (rpb=.43, p=.03), self-reported barriers (rpb=.49, p=.01), and proxy reports of adolescent perceived threat (rpb=.38, p=.04) and benefits (rpb=.59, p=.02) were associated with banking attempts.ConclusionAdolescent sperm banking attempt rates significantly increased after implementation of a family-centered FP values clarification tool prior to cancer treatment. Findings underscore the importance of targeting both adolescents and their parents, particularly fathers, in FP efforts.

The affordances of Open Educational Resources (OER) have resulted in various initiatives around the world, but most of them cease to exist once the initial project funding stops. Communities might be a means to create sustainable practices, yet, such communities can only function if their members perceive these communities as valuable. We applied the value creation framework of Wenger, Trayner, and De Laat to examine the value teachers ascribe to their engagement with an inter-institutional community on OER. In this community, 15 universities of applied sciences collaborated on sharing knowledge and resources across their institutional barriers. We collected data through user statistics, an online questionnaire, and semi-structured interviews. Major value creation occurred from teachers’ personal needs, with dominant immediate and potential values. Findings on applied and realized values denote that it became easier for teachers to connect with peers, and to initiate collaboration projects across institutes. The framework we used is helpful to inform actions to further promote value creation in communities on OER. Recommendations relating to communities’ aspirations, its relations with the wider organization, and adoption of OER are formulated to inform sustainable practices of inter-institutional communities.

BACKGROUND: Patients with advanced cancer may receive cancer treatment that does not reflect their values because they may not be completely aware of what is important to them regarding treatmentrelated decisions when they are diagnosed. OBJECTIVES: The purpose of this review was to determine whether existing values assessment tools can improve awareness of treatment-related decisional values in patients with advanced cancer. METHODS: PubMed[R], CINAHL[R], and PsycINFO[R] databases were searched for original English-language articles evaluating values assessment tools that could be used to assess patients with advanced cancer. The quality of the identified tools was evaluated using selected International Patient Decision Aid Standards instrument, version 3.0, criteria. FINDINGS: All tools identified are appropriate for use in patients with advanced cancer. Two scored at least 80% on the selected International Patient Decision Aid Standards criteria. The Short Graphic Values History Tool was developed with patient and clinician input and may be particularly useful for low-literacy patient populations with advanced cancer. No values assessment tools have been identified specifically for use in patients with advanced cancer. KEYWORDS values assessment; patient preferences; advanced cancer; values clarification

Purpose Despite advances in Environmental and Sustainability Education (ESE) scholarship and practice, ESE has not yet contributed to mitigate the sustainability-related problems it is meant to remedy. As part of an explanation, some scholars have argued that current ESE scholarship and practice overemphasizes intellectual and neglects (intra-)personal competencies as envisaged learning outcomes of ESE learning programs and activities. To date, however, such personal competencies have not been systematically specified in terms of the challenges they are meant to respond to. This paper aims to derive personal competencies from an analysis of inner challenges individuals face when engaging with the cause of sustainable consumption. Design/methodology/approach The study is conceptual and proceeds in two steps: In the first step, it analyzes existing research on challenges individuals experience when intending to change their consumer behavior and engaging in consumption-related learning activities. In a second step, a set of personal competencies for sustainable consumption are derived from the analysis of challenges. Based on the set of competencies, suggestions for future research empirically corroborating the reflections of this paper are made. Findings The discussion of challenges indicates that both sustainable consumption and consumption-related learning activities can come along with a series of affective-motivational challenges. In contrast to established competency frameworks, personal competencies emphasize the importance of affective-motivational learning outcomes instead of intellectual ones. They are defined here as abilities, proficiencies or skills related to inner states and processes that can be considered necessary to engage with the cause of sustainability. Personal competencies responding to the inner challenges of engaging with sustainable consumption include ethics, self-awareness, emotional resilience, self-care, access to and cultivation of ethical qualities and mindsets for sustainability. Research limitations/implications Given that this paper is conceptual, further research is needed to empirically inquire into the importance of personal competencies for sustainable consumption and corroborate the provided reflections. Furthermore, the study has not responded to some of the concerns a few ESE experts have expressed concerning the concept of (intra-)personal competencies more generally. To address these concerns, future research should be dedicated to empirically validating and operationalizing personal competencies, eventually leading to tools allowing for a systematic assessment of these competencies. Based on such assessment tools, pedagogical formats should be elaborated and evaluated with regard to their potential to stimulate personal sustainability competencies. Originality/value The concept of personal competencies explicitly acknowledges that current unsustainability is associated with the experience of inner, affective-motivational challenges. ESE learning programs and activities should prepare learners for these challenges. However, a specification of these inner challenges and corresponding personal competencies has not yet been undertaken. The set of personal competencies outlined in this paper can serve as a first starting point for specifying personal sustainability competencies and makes a case why their consideration is important when it comes to designing and evaluating ESE learning programs and activities.

The social exclusion of adolescent mothers has negative repercussions for them, their children, and their families. Community health workers (CHWs) are well-placed to address the social exclusion of adolescent mothers if they are adequately trained and supported. This paper examines CHWs' perspectives about an intervention designed to strengthen their capacity to deliver gender-responsive life skills training to adolescent mothers. We drew on information obtained from focus group discussions with 14 CHWs who facilitated life skills sessions for adolescent mothers in Blantyre in southern Malawi. Prior to the sessions, the CHWs participated in a values clarification and attitudes transformation and a training of trainers workshops on life skills training. The CHWs posited that gender responsive life skills training enabled them to shift from judgmental views of adolescent mothers to greater acceptance and openness to support them. The study underscores the benefit of interventions that enable CHWs to provide gender-responsive support to adolescent mothers. L'exclusion sociale des mères adolescentes a des répercussions négatives pour elles, leurs enfants et leurs familles. Les agents de santé communautaire (ASC) sont bien placés pour lutter contre l'exclusion sociale des mères adolescentes s'ils sont formés et soutenus de manière adéquate. Cet article examine le point de vue des ASC sur une intervention conçue pour renforcer leur capacité à dispenser aux mères adolescentes une formation aux compétences de vie qui tienne compte des dimensions de genre. Nous nous sommes appuyés sur les informations obtenues lors de discussions de groupe avec 14 ASC qui ont animé des séances de préparation à la vie active pour des mères adolescentes à Blantyre, dans le sud du Malawi. Avant les sessions, les ASC ont participé à un atelier de clarification des valeurs et de transformation des attitudes, ainsi qu'à un atelier de formation des formateurs sur la formation aux compétences de vie. Les auxiliaires de santé ont affirmé que la formation aux compétences de vie tenant compte de la dimension de genre leur a permis de passer d'une attitude de jugement à l'égard des mères adolescentes à une plus grande acceptation et à une plus grande ouverture pour les soutenir. L'étude souligne l'intérêt des interventions qui permettent aux ASC d'apporter un soutien aux mères adolescentes en tenant compte de leur sexe.