KTI FINAL PDF

Lesson 1: Theory: Formal construction of knowledge (understanding patterns) ‘ How theory is developed in a discipline: through lived expereience! Theory as a Lens: contains one’s perspective To develop a theory: requires both deductive and inductive reasoning Paradigm: it is a framework!...

Lesson 1: Theory: Formal construction of knowledge (understanding patterns) ‘ How theory is developed in a discipline: through lived expereience! Theory as a Lens: contains one’s perspective To develop a theory: requires both deductive and inductive reasoning Paradigm: it is a framework! Perspective; belief fsystem; how you come to values Parse (1987): Two opposing perspectives (GRAND THEORIES) Totality: o Humans are integrated beings o Humans adapt to their environments o Health and wellness viewed as a state along a continuum o Biological, Psychological, Sociocultural, Spiritual Simultaneity: o Unitary human being o Irreducible o Mutal process with enviornment o We can’t separate conciousness spirit, mind and body Grand Theories and Conceptrual Models: Broad and apply across range of practice settings Conceptualizations of profession and practice of nursing Metaparadigm (nurse, person, health, enviornment): concepts that shape practice Examples: parse, watson Middle Range Theories: Dervied by grand theory Middle of grand and practice Example: watson Practice Level Theories: Seen in practice Dervied from day to day expereinces of nursing Policies, entry to practice guidelines Example: peplau Code of Ethics: Accountability Advocacy Social justice Autonomy Beneficence Nonmaledicence Social Justice: An approacch to create equal benefits and burdens in society Fair distribution means the fair distribution of society’s benefits, responsibilities and their consequences, it focuses on the relative position of one social group in relation to others in society as well as on the root cause of disparities and what can be done to eliminate them Lesson 2: Social Determiniants of Health: Food insecurity Gender Geography Globilization Disability Education Early Child Development Race/Racism Access to Healthcare Income and Social Status (#1) Employment and working conditions Housing Immigrayion Indigenous Ancestry Social Exclusion Social Saftey Net Neoliberalism: economic and political policies associated with unrestrained, free markeey global capitalism  Limitation of government involvemnt in markets and trade ex. Privitatization of healthcare, private education, housing (government is “hands off”) Low income, material and social deprivation, social exclusion, hugher income, living longer, healthier lives Role of the Nurse: o Engage team o Educate client o Implement strategies to practice o Identify, Deliver, Connect, Encourage, Promote, Share Smith and Liehr Story Theory: Stories are part of human experience 3 Major Theoretical Concepts: Intentional Dialouge (complicating health challenge) o Nurse speaks with patient (reason for coming in) o Talks about health challenge! Connecting with self-in- relation (through development of story plot) o Pt shares expereinces, thoughts and feelings o Info about past, present and future o STORY PATH (HIGH, LOW AND TURNING PTS) o To connect with self-in-relation, people see themselves not as isolated individuals but as existing and growing in a context Creating Ease (while moving toward resolving) o Exploring bigger picture High points: when things are going well by story-sharer’s evaluation Low points: when things are not going well Turning points: when story twists/shifts in what is happening to create a revision in the storytellers forward view Lesson 3: Clinical Judgment Measurement Model & Trauma Informed Care Why do we need the CJMM?: Clinical decision making is more important than problem solving (ADPIE) 1. Recognizing Cues  Which cues are the most significany findings (VS, LOC, appearance) Good or bad change (what does the change mean?) 2. Analyzing Cues Aysmptomatic vs. symptomtic (what are you concered about) Any findings that seem contradictory? 3. Generating Hypotheses THE WHY? What could the pt be expereiencing? What will happen if this is not treated? What should be managed first? (priorities) 4. Generating Solutions Desired outcomes (ex. Increased O2, decresed pain or BP) Interventions (priorities) 5. Evaluating Outcomes New findings, results, pain reassessments Follow up data Trauma Informed Care: Focus on client, understand behavioural responses, truama expereince is individualized Types of Trauma: Short Term: ex. No major impact to emotional, mental or physical well being (ex. Breaking a bone) Long Term: can have minimal impact on above; expereince can cause triggers (ex. Car accident or surgery, abuse, neglect, violence or natural disaster) Generational Truama: passed down (silent, undefined, covert, systemic) ex. Racism, poverty, residential schools, contiual abuse Historical Trauma: based on major event (slavery, concentration camps, war) Trauma Informed Care: acknowledge trauma, recognize how it impacts client, respond appropriately and advocate Hildegard Peplau (Interpersonal Relations Theory): 1. Stranger: When a nurse first meets a patient, they are strangers to each other. The nurse should treat the patient with respect and courtesy, just like they would when meeting anyone for the first time. Example: On the first day of a patient’s hospital stay, the nurse introduces themselves and explains what to expect during their care. 2. Resource: The nurse acts as a source of information, helping the patient understand their health, treatment, and options. Example: A nurse explains to a patient how to take medication correctly and answers their questions about side effects. 3. Teacher: The nurse educates the patient, helping them understand their health condition and what they need to do to get better. Example: A nurse teaches a diabetic patient how to check their blood sugar levels and manage their diet. 4. Counselor: The nurse listens to the patient’s concerns, helping them process their feelings and cope with what they’re going through. Example: A nurse talks to a patient who feels anxious about surgery, helping them understand and manage their fear. 5. Surrogate: The nurse acts as an advocate or stands in for someone else, like a family member, especially when the patient feels vulnerable. Example: A nurse comforts a patient who is missing their family and feels lonely, offering emotional support and care. 6. Leader: The nurse guides the patient and works with the healthcare team to coordinate the patient’s care, making sure everyone is on the same page. Example: A nurse leads a team meeting with doctors and therapists to create a care plan for a patient recovering from a stroke. Phases of the Nurse-Paitent Relationship: Orientation Phase: Building trusting relationship Patient seeks assistance Working Phase: Develop care plan Nurse supports exploration of feelings to aid the patient Resolution Phase: Pateint becomes independent Puts aside old goals and creates new ones 5 Ways of Knowing: 1. Empirical: how we come to know science of nursing (theroies, principles, research, pharm, patho) 2. Personal: knowing yourself, client relationship 3. Ethical: what is right vs. wrong 4. Aesthetic: art of nursing 5. Emancipitory: knowing, doing, being (how social, political and economic forces can shape opinions) Lesson 4: Nursing Praxis (3 Dimensions) 1. Being/Becoming (ontology) a. WHO are we as persons and professionals? b. WHY do we do things? 2. Knowing (Epistemology) a. HOW do we know these things? 3. Doing (actions with consequences) a. Practice elements of nursing b. HOW do we do it? KNOWLEDGE VS KNOWING Knowledge is organized, testable, applicable, patterns Knowing is: conceptrual, moral, ethical, incorporates knowledge Delegation: CNO 3 Factor Framework 1. Complexity 2. Predicitability 3. Risk of negative outcomes Florence Nightingale: first nursing researcher (statistician) 5 components of enviornemental health Pure air (proper ventilation), pure water, effient drainage, cleanlieness (bathing + handwashing), light Truth and Reconciliation: Nurse MUST: acknowledge, be honest, be aware Indigenous Racism & Colonization: No land rights, access to healthcae, funding, housing, cleam water + resources Indian Act, Residential Schools, Colonial policies Interventions: Follow TRC, programs, healthcare, advocate Cultural Genocide: language banned, identity stripped, seizure of lands, destruction of cultures Reconciliation requires: awareness of past, acknowledgement of harm done, atonement and action Lesson 5: Parse: Theory of Human Becoming (Simultaneity) Metaparadigm Concepts: Nursing: state of biological, psychological, social and spiritual well being Person, Health and Environment are unified human becoming, personal commitment and responsibility Core Concepts: 1.Intentionality Definition: The purposeful direction of actions, thoughts, and feelings toward a specific health-related goal. 2. Human Subjectivity Definition: Each person’s health experience is unique, based on their perceptions, feelings, and beliefs. 3. Coconstitution Definition: The mutual influence between individuals and their environment, continuously shaping health and well-being. 4. Coexistence Definition: Health and well-being are influenced by the relationships and interactions a person has with others. 5. Situated Freedom Definition: The ability to make choices within the context of one’s life situation, influenced by social, economic, and health constraints. Three Major Themes 1.Meaning Definition: Meaning is about how individuals create and interpret their life experiences, shaping their health and illness in ways that are personal and unique. It involves imaging, valuing, and languaging, which reflect how individuals view, prioritize, and express their health experiences. Imaging: how clients view experience Valuing: values guide how they approach their illness Languaging: speaking to client; speaking to us; body image 2. Rhythmicity Definition: Rhythmicity reflects the ongoing, dynamic flow of life experiences, where individuals reveal and conceal themselves, experience freedom and limitations, and form connections and separations. This theme involves revealing- concealing, enabling-limiting, and connecting Revealing-concealing: how much we chose to share/conceal Enabling-limiting: limitations b/c of illness; enabling those to take over Connecting-seperating: may chose to be more independent or with family 3. Transcendence Definition: Transcendence refers to the process of moving beyond the present moment or circumstance to find new meaning or possibilities. It involves powering, originating, and transforming as individuals go beyond their current reality. Powering: affirming the universe  Originating: to conform or to not (finding new insights) Transforming: move toward acceptance and peace/sharing wisdom Maragaret Newman: Health as Expanding Consciousness (Simultaneity) Health is mind over matter We are more than our disease Disease is a manifestation of our patterns! Role of the nurse: help people realize the power within them to move to higher levels of consciousness Metaparadigm Concepts: Nurse: partners with patients; helps them achieve HEC Person: consciousness is the ability of the system to interact with environment Health: pattern of the whole (can’t lose or gain) Environment: interactions b/w person and environment are key Choice Points: 1. Potential Freedom (sense of opportunity) 2. Binding (restricted) 3. Centering (pros and cons) 4. Choice (commits or not) 5. De-centering (stepping back) 6. Unbinding (lets go of limitations) 7. Real Freedom Applications: Time and Presence: nurses must be truly resent, no linear timeframe to achieve HEC Resonating with Whole: understand meaning in pt lives (resonate) Attention to pattern and meaning: each person exhibits a pattern –characterized by meaning—manifests consciousness (how person interacts with environment) Mutality of Nurse-Client Interaction: being fully present with pt w/o judgement Lesson 6: Trans Health: 1. Knowledge gaps: professional training 2. Ask: client how they want to be addressed 3. Identify Health inequities: familiar with barriers 4. Support 5. Basic Expectations: respect, equity, equality, compassion 6. Advocate Roy Adaptation Model: Health or illness is a continuum; humans can adapt Metaparadigm: 1. Nursing: Nurses help patients adapt to changes in health and environment. Focuses on promoting patient well-being by supporting their adaptation processes. Nursing interventions are designed to help patients cope and improve their health. 2. Person: Viewed as a holistic being with physical, mental, and emotional aspects. The person constantly interacts with the environment and uses coping mechanisms to adapt. Seen as an adaptive system that responds to stimuli to maintain balance and well- being. 3. Environment: The surrounding conditions or stimuli that affect the person’s ability to adapt Focal (immediate stressor) Contextual (all other stimuli present that influence response to focal) Residual (environmental factors or personal beliefs) Includes both internal factors (thoughts, emotions) and external factors (physical surroundings, social interactions).  Environmental changes can either help or hinder the person’s ability to adapt. 4. Health: A state of being that reflects the person’s ability to adapt to changes in their environment. Health is not just the absence of illness, but the ability to maintain balance and adapt. It varies from person to person based on their adaptive responses. Assumptions: Category Main Points Philosophic - Humans are connected to the world and a God-figure. Assumptions - Meaning comes from a universal destiny. - Humans use awareness and creativity to influence the universe. Scientific Assumptions - Systems evolve into higher complexity. - Consciousness is shaped by the integration of person and environment. - Thinking and feeling guide actions. - Humans and Earth are interconnected, leading to adaptation. Cultural Assumptions - Culture affects how the Roy adaptation model is expressed. - Cultural context can influence nursing practice, education, and research. Subsystem Main Points Regulator - Physiological responses (chemical, neurological, endocrine) help Subsystem individuals cope with environmental changes (e.g., adrenal response to danger). Cognator Subsystem - Cognitive and emotional processes interact with the environment (e.g., processing fear and deciding how to avoid danger). Stabilizer - Group stability is maintained through structures, values, and daily Subsystem activities (e.g., family roles and responsibilities). Innovator - Groups adapt through innovation and change, using strategies like Subsystem planning and team-building (e.g., organizational growth and transformation). Mode Main Points Physiological - Focuses on physical interaction with the environment. Includes five Mode basic needs (oxygenation, nutrition, elimination, activity/rest, protection) and four complex processes (senses, fluid/electrolyte balance, neurological and endocrine function). The goal is physiological integrity. Self-Concept - Involves psychic and spiritual integrity, focusing on a person’s beliefs Mode and feelings about themselves (physical self and personal self). Key processes include self-development, perception, and focus. Role Function - Relates to social roles and expectations. It focuses on the need for Mode social integrity and understanding one's role in relation to others. Key processes are role development and role-taking. Interdependence - Centers on relationships and the giving/receiving of love and support. Mode The need is relational integrity, involving security in nurturing relationships, focusing on significant others and support systems. Kolcaba Comfort Theory Definition of Comfort: The immediate experience of being strengthened when needs for relief, ease, and transcendence are addressed in four contexts of experience Comfort is basic, holistic and can be healthy or unhealthy. Enhanced comfort: achieved in healthy ways Types of Comfort Relief: the state of having a specific comfort need met. Ease: the state of calm or contentment. Transcendence: the state in which one can rise above problems or pain. Context in which Comfort Occurs Physical: pertaining to bodily sensations, homeostatic mechanisms, immune function, etc. Psychospiritual: pertaining to internal awareness of self, including esteem, identity, sexuality, meaning in one’s life, and one’s understood relationship to a higher order or being. Environmental: pertaining to the external background of human experience (temperature, light, sound, odor, color, furniture, landscape, etc.) Sociocultural: pertaining to interpersonal, family, and societal relationships (finances, teaching, health care personnel, etc.) Also to family traditions, rituals, and religious practices Three Propostitions of CT Comfort Interventions: Effective interventions increase comfort by meeting basic needs (rest, homeostasis, communication). Nurses and patients benefit from these interventions. Barriers: When comfort isn’t achieved, nurses assess external factors (e.g., environment, finances) and help patients transcend challenges. Health-Seeking Behaviors (HSBs): Increased comfort enables patients to engage in health-seeking behaviors (HSBs), which are mutually set goals between nurses and patients. Institutional Integrity (InI): Engaging in HSBs enhances institutional integrity, improving care quality and supporting evidence-based practices. Comfort Interventions: Technical: Involves medical tasks like administering medications, treatments, monitoring, and inserting lines. Competency in technical skills is expected of nurses. Documented in patient care records, but often not remembered by patients.  Coaching: Supportive actions like active listening, reassurance, advocacy, and making referrals. Often implemented when time permits. Important to patients but rarely documented. Comfort Food for the Soul: Holistic, personalized care such as massages, guided imagery, music or art therapy, or walks outside. Requires more expertise and is highly valued by patients. Not typically recorded but leaves a lasting impact on patients and families. Lesson 7 Anti-Racism Implications of Systems of Power: Dehumanization Oppression vs Privilege Exclusion Indications of Oppression: Exploitation: Taking unfair advantage of someone’s work or resources without fairly compensating them or respecting their rights. Cultural Imperialism: Forcing or promoting the culture, beliefs, and values of a dominant group over others, often erasing or devaluing the cultures of marginalized groups. Powerlessness: A lack of control, influence, or access to resources, decision- making, and opportunities, often leaving people dependent on others. Marginalization: Excluding or isolating individuals or groups from social, economic, political, or cultural opportunities and rights. Violence: Using physical force, threats, or other harmful actions to control, intimidate, or harm individuals or groups. Assumptions vs Outcomes: Assumptions: a set of norms that are determined by a dominant group (antecedents of oppression) Outcome: Unjust treatment Denial of rights Dehumanizing of individuals Education from a lens of bias Care must foster: Respect Never assume Engage in relevant dialogue Cooperation (patient centered care) Intersectionality: attributes that are seen and unseen Discrimination: People are denied their basic rights Globalization Policy development 3 Canadian Discourses: 1. Recognition: Valuing and respecting diverse identities, cultures, and experiences, ensuring everyone feels seen and included in society. 2. Capabilities: Focuses on helping individuals develop the skills, resources, and opportunities they need to live a good life and reach their full potential. 3. Equality and Citizenship: Ensures everyone has the same rights, opportunities, and responsibilities in society, fostering inclusion and active participation in the community. Nursing Theorists: Harriett Tubman: Patient centered care: didn’t care what the patient looked like: just provided care during American civil war (underground railroad) Mary Seacole: During cholera outbreak, she starting doing autopsies on children to develop treatment  Taught her nursing skills during Crimean war ; Saved lives at hotel dew Critical inquiry writings and research Mary Eliza Mahoney: First nursing graduate She taught community nursing: innovation and creativity Nursing aesthetic ("art of nursing") Madeline Leiniger: Theory of Culture Care Diversity and Universality (Transcultural Nursing) Focuses on describing and explaining, predicting nursing similarities and differences Does not focus on medical symptoms Focuses on methods of approach to care that means something to the patients Metaparadigm: Nurse: A caregiver who uses cultural knowledge to provide holistic and individualized care. Person: A cultural being with unique beliefs, values, and practices that influence their health and well-being. Environment: The physical, social, and cultural context that affects a person’s health and care needs. Health: A state of well-being that is defined by the individual’s cultural beliefs and values. Sunrise Model: Generic Care: Traditional or home-based care practices passed down through generations, often influenced by culture and family. Examples include herbal remedies or spiritual rituals. Nursing Care Practices: Care provided by nurses that integrates both professional knowledge and cultural awareness to meet individual patient needs. Professional Care-Care Practices: Evidence-based, formalized care guided by professional standards and training, often blending with cultural practices to ensure culturally congruent care. Three Modes of Nursing Care (Modalities)  1. Cultural Care Preservation/Maintenance: Supporting and preserving cultural practices that benefit a patient’s health. o Example: Encouraging a patient to continue their traditional diet if it aligns with their health needs. 2. Cultural Care Accommodation/Negotiation: Working with the patient to adapt or adjust cultural practices to align with medical care. o Example: Modifying fasting practices during Ramadan to suit a diabetic patient’s needs. 3. Cultural Care Repatterning/Reconstructing: Collaborating with the patient to change harmful cultural practices while respecting their values. o Example: Guiding a patient to replace unsafe traditional remedies with safer, evidence-based alternatives. Lesson 8 Theory-Guided Evidence-Based Practice (TGEBP) Combines nursing theories with evidence-based practice (EBP) for holistic, patient-centered care. Evidence-based nursing practice (EBNP) emphasizes using the best evidence for decision-making, supported by randomized trials and systematic reviews. Nursing theories provide unique perspectives that enhance interprofessional practice (IPP). Interprofessional Practice (IPP) A collaborative approach where healthcare teams work together, maintaining unique roles and perspectives for optimal patient care. Nurses using theoretical frameworks contribute distinct knowledge to IPP, ensuring effective and comprehensive care. Type of practice with common characteristics: collaboration, teamwork, communication, decision making, person centered care Anti-Oppressive, Anti-Racist, Anti-Colonial Approaches Shift from focusing on cultural competency to addressing structural determinants of health (SDOH), such as structural racism and stigma.  Structural interventions (e.g., smoking bans, wage increases) address disparities but face challenges like lack of knowledge, training, and interdisciplinary cooperation. Decolonizing nursing involves examining how colonization influences nursing practices and promoting social justice through postcolonial and feminist theories. Key Strategies Advocate for structural changes to reduce health disparities. Recognize and challenge personal, cultural, and structural oppression in healthcare. Commit to critical social justice and human rights in nursing education and practice. Takeaways Nurses must integrate theory and evidence for culturally competent, patient- centered care. Collaboration within IPP strengthens patient outcomes. Addressing structural causes of oppression requires education, research, and systemic change. Lesson 9: Moral Courage : ex. Ausma Malik: first elected women to wear hijab in office Advocacy: Nursing Advocacy The concept of nurses acting on behalf of protecting/supporting/defending/pleading for/standing up for patients’ interests and rights CAN, 2023: “Advocacy involves engaging others, exercising your voice, and mobilizing evidence to influence policy and practice Seeing injustices and taking action Micro: at direct clinical level for our client Meso: getting involved with union or community members (ONA, RNAO) Macro: getting involved in policy development and legislation (government) Exercising Your Voice- Mobilize Influence  Recognize a systemic barrier or issue that may be rooted within a system Recognized inequity and inequality Recognize policy and procedures that benefit those are in power or makes policies Ex. Writing a position paper, educating fellow nurses and leadership on impacts, engaging in research and dialogue Barriers to Nursing Advocacy: Feelings of powerless Lack of support from management Fear of being ostracized (ex. COVID vaccine) Legal ramifications Being bullied Whistleblowing: ** ”…the reporting of information to an individual, group or body that is not part of an organizations usual problem-solving-strategy…phenomenon where a party or parties take matters that would normally be held as confidential to an organization outside the organization despite the personal risk and potentially negative sequalae associated with the act.” ** Canada is bad at this! Nurses don’t take part b/c they are not protected (can lose their jobs) Components of Whistleblowing: 1. The Whistleblower: YOU notice something is wrong 2. The Act: YOU speak out against it (write formal report) 3. Complaint Receiver: HR police, manager, government, ethics committee, PH 4. Organization: the target (disclose or not), the hospital where unsafe practices are happening Internal: within workplace External: government investigations Legislation: In ON and CAN, whistleblowers are not protected Ontario Securities Act states: o Confidentiality of whistleblowers  o Employer reprisals o Anonymous submissions Recommendations for Future: Legislature is not enough Culture shifts are needed Professional bodies need clarification on their roles Organizations should take accountability Nurses need to trust organization can change and take action Confidential and effective ways to report Lesson 10: Future of Nursing Lifting barriers to expand the contribution of nursing Strengthening nursing education Preparing nurses to respond to disasters Valuing community nursing Fostering nurses’ roles as leaders and advocates Supporting the health and wellbeing of nurses Designing better payment models Metaparadigm: Environment: Socialization, Development Human Agency Student: Self-efficacy, Intersectionality Health: Mental, Physical, Emotional Educator: Protect Hope, Proximity, Intentionality Advanced Nursing Practice: Generally involved masters preparation in Nursing Many titles- Advanced Practice Nurse, Clinical Practice Leader, Clinical Nurse Specialist, Clinical Educator Four Main Competencies listed by CAN: Clinical, Research, Leadership, Consultation & Collaboration Includes Nurse Practitioners- RN Extended Class “RN (EC)” o PHC o Acute Care Adul o Acute Care Pediatric o Anesthesia What Kind of Research Guided Nursing Practice? Dangers of using non-nursing research as the underpinning for EBNP: o Reliance on non-nursing research which naturally is not based on nursing theory because its conducted by researchers who don’t have knowledge of nursing theory o A reliance on nursing research that is either a theoretical based theories outside of nursing’s unique knowledge base o **May be valid and reliable but they do not represent nursing knowledge and should not be use to guide nursing practice Bottom Line: the focus of our professional uniqueness remains an area of debate! Perspective Transformation: Learning Process: Leads to a change in: Perspective Assumptions Values Beliefs Subsequently further change in: The way a person sees him/herself How we situate ourselves in our personal and professional world How we see the context of our relationships 9 Stages of Perspective Transformation: Stability A nursing student feels confident and in control during routine patient care, relying on learned skills and protocols. Dissonance The student encounters a situation where a patient refuses treatment due to religious beliefs, challenging their understanding of patient autonomy and care. Confusion The student feels conflicted, unsure how to balance respecting the patient’s beliefs with providing evidence-based care. Dwelling with Uncertainty The student reflects on the ethical dilemma, discusses it with instructors, and explores how personal values influence their perspective. Saturation The student immerses themselves in literature, case studies, and conversations, reaching a point where they feel overwhelmed by the complexity of the issue. Synthesis The student begins to organize their thoughts, identifying key principles like respect for autonomy and shared decision-making as guides.  Resolution The student develops a clear action plan to address the situation, balancing professional knowledge with sensitivity to the patient’s beliefs. Reconceptualization The student gains a deeper understanding of the importance of cultural competence and patient-centered care in nursing practice. Return to Stability With this new perspective, the student approaches similar situations in the future with confidence and a more holistic approach to care. Developing Nursing Knowledge: NOVICE TO EXPERT Benner’s (1984,1989) looks at the development of nurses themselves, as knowledge users and creators of knowledge Portrays nursing theory as situated within and derived from what nurses see, do and experience in the practice setting Stages: Novice A first-year nursing student is learning basic skills like taking vital signs and performing hand hygiene. They rely heavily on rules and guidelines and lack experience in clinical settings. Example: A student needs step-by-step instructions to administer a blood pressure reading and cannot yet adapt to unexpected situations. Advanced Beginner A new graduate nurse begins applying their knowledge in real-world settings and can recognize recurring patterns but still requires support and guidance from more experienced colleagues. Example: A new nurse can complete a patient admission but might need help prioritizing care for a patient experiencing chest pain while managing other tasks. Competent A nurse with 1–2 years of experience can efficiently manage multiple patients, organize tasks, and adapt care plans to changing conditions with some independence. Example: A nurse confidently administers medications, updates care plans, and coordinates with other healthcare professionals while handling a typical patient load. Proficient An experienced nurse develops a deeper understanding of patient care, anticipating needs and identifying subtle changes in patient conditions without needing explicit cues.  Example: A nurse senses that a patient’s condition is deteriorating based on slight changes in behavior or vital signs and takes proactive measures to prevent complications. Expert A highly experienced nurse acts intuitively, drawing on extensive knowledge and experience to make quick, accurate decisions in complex situations. Example: A nurse in the ICU immediately recognizes signs of sepsis in a patient based on minimal cues and initiates the appropriate interventions without hesitation. Stages of Proficiency Potential strategies for skills and Stage Definition knowledge acquisition The learner has had no previous experience Teach simple, objective making them struggle to decide which tasks concepts/attributes that are easily Novice are most relevant to accomplish. identified The learner has enough real-world situations Increase assistance and support in that the recurrent component is easily setting priorities to clients’ needs by Advanced identified when it is related to rules and providing guidelines for recognizing beginner guidelines. patterns The learner has been on the job two or three years and is able to see actions in terms of goals or plans and works in an efficient and Offer inservice education or Competent organized manner. opportunities Use case studies to stimulate critical The learner performs by using pieces thinking especially in situations with evidence (i.e. maxims) that provide principles or rule that are Proficient directions to see a situation as a whole. contradictory. Provide opportunities for experts to The learner grasps the situation and share their skills and knowledge and understand what needs to be accomplished also their analytical abilities to solve Expert beyond rules, guidelines, and maxims. new situations Benner’s 7 Nursing Roles: The Helping Role Example: A nurse sits with a patient experiencing anxiety before surgery, using active listening and reassurance to help them feel more at ease. Explanation: This role focuses on providing emotional support, building trust, and ensuring patients feel cared for during stressful situations. The Teaching-Coaching Function Example: A nurse educates a patient with diabetes on how to monitor blood sugar levels and administer insulin injections. Explanation: This role involves teaching patients or families about health conditions, treatments, and self-care, empowering them to manage their health effectively. The Diagnostic and Patient-Monitoring Function Example: A nurse identifies signs of an infection in a post-surgery patient, such as fever and redness around the wound, and reports it promptly. Explanation: This role emphasizes assessing and monitoring patients to detect changes in their condition and intervening as needed. Administering and Monitoring Therapeutic Interventions and Regimens Example: A nurse administers antibiotics to a patient and monitors them for any adverse reactions or improvements in their condition. Explanation: This role focuses on carrying out medical treatments and ensuring they are effective and safe. Monitoring and Ensuring the Quality of Health Care Practices Example: A nurse notices a colleague forgot to sanitize equipment properly and addresses the issue to maintain patient safety. Explanation: This role involves ensuring that healthcare practices meet professional standards and guidelines to protect patient outcomes. Organizational and Work-Role Competencies Example: A charge nurse creates a schedule for the nursing staff to ensure adequate coverage during a busy shift. Explanation: This role includes managing resources, delegating tasks, and organizing workflows to maintain an efficient and effective healthcare environment.