Theoretical Foundations of Nursing – NCM 100 PDF

Theoretical Foundations of Nursing – NCM 100 Eleen Grace C. Manalese-Castillo, RN Patricia Benner, PhD, RN, FAAN “Caring, Clinical Wisdom, Ethics in Nursing Practice”  Discuss Caring, Clinical Wisdom, Learning ethics in Nursing Practice. Objectives: Differenti...

Theoretical Foundations of Nursing – NCM 100 Eleen Grace C. Manalese-Castillo, RN Patricia Benner, PhD, RN, FAAN “Caring, Clinical Wisdom, Ethics in Nursing Practice”  Discuss Caring, Clinical Wisdom, Learning ethics in Nursing Practice. Objectives: Differentiate the 5 Levels of skill acquisition and development. At the end of Understand the different major discussion, concepts and definitions. students will Discuss the metaparadigm in be able to: Nursing  Patricia Sawyer Benner  August 1942, Born in Hampton, Virginia, USA (82 y/0) CREDENTIALS AND  Spent her childhood in California BACKGROUND  1964 – Bachelor of Arts Degree in OF THE Nursing (Pasadena College) PHILOSPHER:  1970 – Master of Science in Surgical Nursing (University of California, SF)  1982 – Ph.D University of Calfiornia, Berkley  1984 – “From Novice to Expert: Excellence and Power in Clinical Nursing Practice’  Patricia Sawyer Benner  Benner has a range of clinical CREDENTIALS experience in medical-surgical, critical AND care, and home health care BACKGROUND OF THE  A Professor of Doctoral and Master’s and PHILOSPHER: Levels in UCSF  Author of 9 books  Currently Chief Development Officer for educatingnurses,com  NovEx used in hospital orientation and professional development programs  Patricia Sawyer Benner  Honorary Member of Royal Danish Nursing Society(2012)  Sigma Theta Tau International Book HONORS AND Author Award (2010) AWARDS:  1984, 1989, 1006, 1999, 2011 – American Journal of Nursing Book of the Year awardee for: - Novice to Expert: Excellence and Power in Clinical Nursing Practice (1984) -The Primacy of Caring, Stress and Coping in Health and Illness (1989) -Expertise in Nursing Practice: Caring, Clinical Judgement, and Ethics (1996)  Caring practices are imbued with knowledge and skill CARING, about everyday human CLINICAL needs, and that to be WISDOM, experienced as caring, these ETHICS IN practices must be attuned to NURSING the particular person who is PRACTICE being cared for and to the particular situation as it unfolds.  BENNER’S THEORY - NURSING PARADIGMS PERSON SITUATION HEALTH NURSING -A self-interpreting -Benner and Wrubel “Health”-defined as Nursing is a “caring being who define (1989) used situation what can be relationship”, course of living a life. because it conveys a assessed “enabling condition of -4 Major Aspects of social env’t means -not just the absence connection and Understanding the being situated and of disease and illness concern”. person: situated meaning “Disease” – what Nsg practice is a care 1. The role of which defined by can be assessed at and a study of lived situation person physical level experienced of 2. The role of health, illness, and embodied disease – the intelligent agent relationship of 3 elements 3. The role of -Each person’s past, “Well-being”- ‘Caring is primary bec. personal concerns present, and future human experienced caring sets up giving 4. The role of which include her/his of health and and receiving help’ temporarily own personal wholeness “embodiment” the meanings, habits, “Illness” is the capacity of body to perspectives, human experience of respond in situations influence the current loss or dysfunction SITUATION BENNER’S MODEL: 5 Levels of Skill Acquisition and Development:  5 LEVELS: NOVICE 1. NOVICE (students of nursing) - Stage of skill acquisition in the Dreyfus model, the person has no (nurse who background experience of the move and situation in which he or she is first time in involved. the area) - What is relevant and irrelevant aspect?  2. ADVANCE BEGINNER - Develops when the person can demonstrate marginally acceptable performance, having ADVANCED coped with enough real situations BEGINNER to note, or to have pointed out by (guided by rules) a mentor, the recurring (focus on task meaningful components of the completion) situation. - Clinical situations are viewed by nurses as demand of situation rather than needs of patient and responses  3. COMPETENT COMPETENT - Conscious and deliberate (focus on time management) planning that determines which (2 – 3 years of aspects of current and future experience) situations are important and (works in efficient which can be ignored(Benner, and organized 1984a) manner) - Most pivotal in clinical learning, because the learner begins to recognize patterns and determine which elements of the situation warrant attention and which can be ignored.  PROFICIENT -perceives 4. PROFICIENT situation as whole - The performer perceives the -has learned what situation as a whole( the total to expect in certain situations picture) rather than in terms of aspects, and the performance is guided by maxim (PRINCIPLE) - Demonstrate new ability to see changing relevance in situation  EXPERT 5. EXPERT -having intuitive - Is achieved when the performer no grasp of the longer relies on analytical principle situation (Rule, guideline, maxim) to connect -recognize an understanding of the situation to patterns from an appropriate action(Benner, 1984a) deep experiential - KEY ASPECTS OF EXPERT background -highly skilled  Demonstrates clinical grasp and analytic ability resource-based practice  Possessing embodied know-how  Seeing big picture  Seeing the unexpected  ASPECTS OF A SITUATION - ASPECT are the recurring meaningful situational components recognized and understood in context (recognized by Benner’s nurses due to experience) Major ATTRIBUTES OF A SITUATION Concepts - Attributes are measurable properties of a and situation that can be explained without Definitions previous experience in the situation (chills when high-fever)  COMPETENCY - Is an interpretively defined area of skilled performance identified and described  DOMAIN Benner’s - Is an area of practice having a number of Major competencies with similar intents, Concepts functions, and meanings(Benner, 1984a). and - (ICU cases) Definitions EXEMPLAR - first-person-experience-near narrative of a clinical situation that conveys common taken for granted meanings of nursing practice recognizable by other nurses   EXPERIENCE - Is not a mere passage of time, but an active process of refining and changing preconceived theories, notions, and ideas when confronted Benner’s with actual situations. Major MAXIM Concepts - Is a cryptic description of skilled and performance that requires a certain level of experience. Definitions PARADIGM CASE - Is a clinical experience that stands out and alters the way the nurse will perceive and understand future clinical situations (Benner, 1984a)  SALIENCE - Describes a perceptual stance or embodied knowledge whereby aspects of a situation stand out as more or less important(Benner, 1984a) Benner’s ETHICAL COMPORTMENT Major - Is good conduct born out of an engagement Concepts in a particular situation and entails a sense and of membership in the relevant professional group. Definitions  HERMENEUTICS - Means “interpretive”. - The term derives from biblical and judicial exegesis.  FORMATION - Address the development of sense, esthetics, perceptual acuities, Benner’s relational skills, knowledge and Major dispositions. Concepts SITUATED COACHING and Definitions - Was identified as the signature pedagogy in nursing from the educating Nurses study.(Benner et.al, 2010)  The skilled practice of nursing exceeds the bounds of formal theory. THEORETICAL ASSERTIONS Concrete experience facilitates learning about the exceptions and shades of meaning in a situation.  PRACTICE - Describes its usefulness for preceptor development, orientation programs, and career development ; Huntsman et ACCEPTANCE al.(1984). BY THE NURSING Balasco and Black (1988) and COMMUNITY Silver (1986a, 1986b) used Benner’s work as a basis for differentiating clinical knowledge development and career progression in nursing.  PRACTICE -Crissman and Jelsma(1990) ACCEPTANCE BY THE applied Benner’s findings to NURSING develop a cross-training COMMUNITY program to address staffing imbalances.  EDUCATION -Benner (1982)critiqued ACCEPTANCE the concept of BY THE NURSING competency based COMMUNITY testing by contrasting it.  RESEARCH - Maintains that there is excellence and power in ACCEPTANCE BY THE clinical nursing practice NURSING COMMUNITY made visible through articulation research.  CLARITY - An identification with the idea CRITIQUE of clinical wisdom and varying levels of clinical expertise development progressed very quickly. SIMPLICITY - The model is relatively simple with regard to the five stages of skill acquisition, and it provides a comparative guide for identifying levels of nursing practice from individual nurse descriptions validated by consensus.  GENERALITY - Has universal characteristics; that is, it is not restricted by age, illness, health, or location of nursing practice. “The nurse patient relationship is not a uniform, professionalize blueprint but rather a kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane moments of life.” Benner, 1984