Patricia Benner: Caring, Clinical Wisdom, and Ethics in Nursing Practice PDF

PATRICIA BENNER: CARING, CLINICAL WISDOM, AND ETHICS IN NURSING PRACTICE  CREDENTIALS AND BACKGROUND OF PATRICIA BENNER LIfe Profession Patricia Benner was born on Bachelor Degree in Nursing 1942 in Hampton, Virginia. from Pas...

PATRICIA BENNER: CARING, CLINICAL WISDOM, AND ETHICS IN NURSING PRACTICE  CREDENTIALS AND BACKGROUND OF PATRICIA BENNER LIfe Profession Patricia Benner was born on Bachelor Degree in Nursing 1942 in Hampton, Virginia. from Paseda College, in 1964. She was married to Ritchard Master in medical-surgical Benner on 1967, they have son nursing from the University of and daughter. California, San Francisco (USCF), in 1970. PhD - from the University of California Berkeley, in 1982. Background 1985, Benner was inducted into the America Academy of Nurses Published 9 books and She is currently a Distinguished numerous articles Visiting Professor at Seattle Published “Novice to Expert University School of Nursing. Theory” in 1982 named an American Journal of Nursing Book of the Year for nursing education and nursing research in 1984.  COMPONENTS OF THE THEORY Novice Advanced Beginner Competent Proficient Expert  MAJOR CONCEPTS AND DEFINITIONS Novice 2. Advanced Beginner 3. Competent Novice are beginners who have At this stage, nurses have gained Competent nurses have more limited experience in a some practical experience and experience and are able to particular era. can identify common patterns in prioritize tasks and plan patient patient care. care efffectively. 4.Proficient 5. Expert Proficient nurses have Experts have extensive developed a deeper experience and intuitive grasp understanding of patient care of complex clinical situations. and can grasp the “big picture.”  MAJOR CONCEPTS AND DEFINITIONS 6. Aspects of a Situation 7. Attributes of a Situation 8.Competency The aspects are the recurring Attributes are measurable An interpretatively defined area meaningful situational properties of a situation that of skilled performance identified components and understood in can be explained without and described by it’s intents, context because the nurse has previous experience in the functions, and meanings. recognized as previous situation. experience. 10. Exemplar 9. Domain An area of practice having a An example of clinical situation number of competencies with that conveys one or more similar intents, functions, and intents, functions, and meanings. meanings, or outcomes easily translated to other clinical situations.  MAJOR CONCEPTS AND DEFINITIONS 11. Experience 12. Maxim 13. Paradigm Case Is not a mere passage of time, Is a cryptic (hidden) description Is a clinical experience (event) but an active process of refining of skilled performance that that stands out and alters the and changing preconceived requires a certain level of way the nurse will perceive theories, notions, and ideas experience, to recognize the and understand future clinical when confronted with actual implications of the Instructions. situations. situations. Paradigm cases creates new 14. Salience 15. Ethical Comportment clinical understanding and open new clinical perspective Perceptual stance or embodied Experts have extensive and alternative. knowledge whereby aspects of experience and intuitive grasp a situation stands out as more of complex clinical situations. or less important.  MAJOR CONCEPTS AND DEFINITIONS 16. Hermeneutics (interpretative) Refers to describing and studying “meaningful human” phenomena in a cartful and detailed manner as free as possible from prior theoretical assumptions, based instead on practical understanding.”  METAPARADIGM Nursing Nursing is described as a caring relationship, an “enblling condition of connection and concern.” - Dr. Benner “Caring is primary because caring sets up the possibility of giving and recieving help.” Nursing is viewed as a caring practice whose science is guided by the moral art and ehtics of care and responsibility. Dr. Benner understands that nursing practice as the care and study of the lived experience of health, illness, and disease and the relationships among the three elements.  PERSON Benner and Wrubel (1989) use Heidegger’s phenomenological description of person, which they describe as “A person is a self-interpreting being, that is, the person does not come into the world predefined but gets defined in the course of living a life. Benner and Wrubel (1989) conceptualized the following four major aspects of understanding that the person must deal with: The role of the situation The role of the embodied intelligent agent The role of personal concerns The role of temporality Health Health is defined as what can be assessed, whereas well-being is the human experience of health or wholeness. Patricia Benner focused “on the lived experience of being healthy and ill”. She defined health as what can ba assessed, while well-being is the human experience of health or wholeness. Well-being and being ill are recognized as different ways of being in the world. Health is described as not just the absence of disease and illness. Also, a person may have a disease and does not experience illness because illness is the human experience of loss of dysfunction, whereas disease is what can be assessed at the physical level. Situation Benner and Wrubel (1989) use the term situation rather than environment, because situation conveys a social environment with social definition and meaningfulness. “To be situated implies that one has a past, present, and future and all of these aspects influence the current situation.” - Dr. Benner  MAJOR ASSUMPTIONS There are no interpretation-free data The neutral science assumption: there is an independent reality whose meaning can be represented by abstract terms and concepts. 2. There are no nonreactive data 3. People sharing a common cultural and language history have a background of common meanings, that allow for understanding and interpretation.  MAJOR ASSUMPTIONS 4. Meanings are embedded in skilles, practices, intentions, expectations, and outcomes. They are taken for granted and often not recognized as knowledge and cannot be made completely explicit; but they can be interpreted by someone who shares a similar language and cultural background and can be consensually validated by tyhhe participants and relevant practitioners. 5. Humans are integrated, holistic beings  SUMMARY Patricia Benner created the theory Novice to Expert in Clinical Practice in 1982. The model consists of five distinct stages of the nurse’s evolvement into the profession from start to an end. The first stge is the novice nurse, they have no experience in the situations in the workplace. They require verbal cues from more experienced nurses and are not very confident in applyinh clinical skills in practice. Stage two is the advanced beginner who is practicing nurse just starting to gain knowledge in the clinical arena. This stage is one of learning as the nurse is acquiring knowledge but may need support periodically. Stage three is the competent nurse who has a few years under their belt, they can handle their own assignment in a timely fashion. This stage signifies the added skill of planning as they predict what patients may need at the initial assessment. Stage four is the proficient nurse who who can practice in a more relaxed fashion as they can see the big picture and are organized and efficient in the clinical arena. Lastly, is stage five, the expert nurse who has the ability to utilize intuition in practice, is fast, efficient, and holds focus while multitasking (Benner, 1984)