Benner From Novice To Expert Pdf 5

Course Description

Benner Novice To Expert Pdf
Benner From Novice To Expert Pdf 5000
Benner's Novice To Expert Model
Benner From Novice To Expert Pdf 500

This course covers the challenges of central line associated blood stream infections and incorporates content regarding clinical skills development.

View Benner’s Novice to Expert Presentation.pptx from CS MISC at Chamberlain College of Nursing. BENNER’S NOVICE TO EXPERT SHANE N. BROWN QUEENS UNIVERSITY PATRICIA BENNER, RN, PHD, FAAN. Benner's Theory Novice to Expert Introduction The following essay intends to shed light on the significance of Benner’s Theory Novice to expert. In the following, the researcher intends to conceptualise Benner’s theory. Moreover, the five typical stages that are involved in the theory has also been discussed in the essay.

Accreditation: KLA Education Services LLC is accredited by the State of California Board of Registered Nursing, Provider # CEP16145.

Course Objectives

Upon completion of the course the course particpant will be able to:

Discuss current issues with CLABSIs.
Describe Benner’s application to theory
List 7 of Benner’s domains of nursing.
Discuss an example of applying theory to practice related to CLABSIs.

Course Content

INTRODUCTION

Healthcare associated infections (HAIs) account for an estimated 10 billion dollars in to the United States health-care system (Zimlichman et al., 2013). These preventable events can cause great harm to patients and associated with high costs. More specifically central line associated blood stream infections (CLABSIs) are the most costly at $45,814 per event and represent about 18.9% of the overall problem, resulting in an estimated 1.8 billion in costs. The CDC defines a CLABSI as a positive single blood culture for organisms not common to the skin or two positive blood cultures for organisms commonly on the skin, when a patient has a central line at the time of infection or within the 48-hour period before. The infection may not be related to any other infections they have had growing or on admission (Vital signs, 2011). These adverse events are a critical problem in health care causing affecting 5% of all hospitalized patients each year in the United States (Vital signs, 2011). A substantial number of CLABSIs are primarily in hemodialysis units and Intensive Care Units (ICUs) resulting in elongated hospital stays, additional hospital stays, and a mortality rate from 12% to 25% (Vital signs, 2011).

Proper care and maintenance of central lines by nursing staff is pertinent to preventing CLABSIs. Care and maintenance includes proper flushing, handling of tubing and needleless connectors, sterile dressing changes, patient/family education, accurate data collection, etc. The model of care and nurse-patient relationship is directly influenced by nurse theory in place, and the application of a selected theory can offer structure and organization, providing a systematic, predictable practice (McEwen & Wills, 2011). This can encompass collection of data, practice guidelines, nursing orders, progress notes, and strategic interventions resulting in a defined, effective nursing practice (McEwen & Wills, 2011). Related to CLABSIs, this article will consider the application of nursing theories that can further support the development of methodologies to practice that may result in better patient outcomes.

APPLICATION OF MIDDLE RANGE THEORY

Benner’s Model of Skill Acquisition in Nursing outlines five stages of skill acquisition: novice, advanced beginner, competent, proficient, and expert (McEwen & Wills, 2011). Her work applied the Dreyfus model of skill acquisition to nursing which was published in 1984 and encompasses five stages of skill acquisition with regard to administration, education, practice, and research.

BIOGRAPHY

Patricia Benner received her Bachelor’s in Nursing from Pasadena College, Masters of Science in Nursing from the University of California – San Francisco, and her PhD from the University of California – Berkley (Nursing Theories, 2013). She has written nine books and numerous articles while teaching and conducting research since 1979. She currently is a Professor Emerita at the University of California, San Francisco and noted international speaker on health, stress, coping, skill acquisition, and ethics (Nursing Theories, 2013).

MAJOR INFLUENCES

Dr. Benner acknowledges her concepts in Nursing have been influenced by the Dreyfus Model of Skill Acquisition and Virginia Henderson. She adapted the Dreyfus Model to encompass five levels of skill acquisition including novice, beginner, competent, proficient, and expert (Novice to Expert, 2013). The classifications as seen in Figure 1 are widely used to provide a means of assessing and supporting progress in the development of skill or competencies, and to provide a definition of acceptable level for the assessment of competence or capability (Novice to Expert, 2013).

CONCEPTS

Benner considers ‘excellent care practices’ gained through an evolutionary process grown from experiential learning and transmission into practical skills. She stresses the importance of retaining and rewarding clinicians for their expertise (McEwen & Wills, 2011). Her central concepts are those of competence, skill, acquisition, experience, clinical knowledge, and practical knowledge (McEwen & Wills, 2011). She identifies seven domains of practice in nursing:

Helping role
Teaching role
Diagnostic client-monitoring function
Effective management of rapidly changing situations
Administering and monitoring therapeutic interventions and regimens
Monitoring and ensuring quality of health care practices
Organizational and work-role competencies (McEwen & Wills, 2011)

These levels reflect progress from reliance on past abstract principles to the use of past concrete experience as paradigms and change in perception of situation as a complete whole in which certain parts are relevant (Nursing Theories, 2013). This process evolves through the five levels of skill acquisition as clinicians use clinical guidelines and algorithms or ‘rules’ at first and through experience and empirical research, transition to the use of a more focused intuition.

PROPOSITIONS

Clinicians have varying situational experience which is what separates novice from expert. As clinicians test and refine propositions, hypotheses, and expectations, expertise develops. Benner considers experience a requisite for becoming and expert and distinguishes a difference in a nurse that “knows that” and “knows how” (Benner, 1984). As clinicians move to a higher level of practice, a more holistic approach is used. The expert clinician perceives situations as a whole and moves past concrete situations to focus directly on the problem. No time is wasted on irrelevant items.

Benner proposes nurses rely heavily on past experience and nurses must deepen their process of acquiring knowledge through their clinical situations. She emphasizes knowledge development through experience but does not neglect analytical thinking. Critical thinking is necessary at all skill levels. She considers analytical thinking the backbone for problem solving (Benner, 1984). Benner considers clinical judgment an essential skill also for all nurses. With experienced, expert nurses, her theory proposes actions are determined quickly without referring to rules or guidelines.

The acquisition of knowledge is strengthened through reflection. The process of reflection should be combined with the use of narratives as nurses often know more than they can communicate (Benner, 1984). The use of narratives helps to articulate meaning and further help develop learning from decision making related to their respective outcomes. Benner highlights the expert nurse as one that uses intuition based on unique attributes obtained through experience, self-awareness, and reflection.

LITERATURE EXAMPLE

A search via Cumulative Index of Nursing and Allied Health Literature reveals many listings with articles citing Benner’s model. Standing (2007) used Benner’s model in a longevity study to help determine how clinical decision-making skills were acquired. Writers commonly discussed her applicability in development of protocols for orientation of new nurse graduates (McEwen & Wills, 2011).

One article described the importance of mentors during professional transition to an expert in the oncology setting (Dest, 2008). She cited the process from novice to expert and explained the personal steps she accomplished with the help of mentors along the 24 year journey. Research shows 83% of influential nurses have been mentored (Dest, 2008). Her journey involved expert mentors seeing something in her she didn’t see in herself, encouraging her to go back to school where she became an oncology nurse practitioner.

PRACTICE APPLICATION

Benner’s model has been used in the nursing profession to make innovative changes in how knowledge is acquired and developed, continuing education’s rationale, and serve as a foundation for how nurses build and improve skills based on acquiring experience (Benner, 1984). Benner’s model may be helpful to the current problem of CLABSIs by application to education. Performance and learning needs of staff nurses can be identified and classified based on her five levels of skill acquisition. This process can serve to identify experts that could serve in a teaching and mentoring role to those staff members that are still in the novice to beginner phase. Having an understanding of the skill level of each nurse would better prepare the nurse in the educator role.

Education of staff is an ongoing process that should never cease. To provide safe, effective care for central lines, staff must be proficient in caring for tubing, needleless connectors, dressings, and have proper technique for medications infusions, blood withdrawals, blood culturing, and flushing. Additionally, they must be trained and proficient in assessing for infection, occlusion management, removal, proper tip location, and patient/family education. Acquiring this set of skills and knowledge takes time and mentoring. Learning this skill set will help the clinician become one that not only “knows that” but “knows how.”

Often, a problem in facilities that lead to contamination of central lines is a lack of knowledge and lack of compliance to policies that are designed to prevent infection through proper care and maintenance of central line catheters. Implementing a training and competency model based on Benner’s concepts could help to give the structure needed for a successful CLABSI prevention program. Expert nurses have the ability and “know how” to mentor those in need of proper skill and knowledge. These nurses also could stay up to date with best practice by serving on key committees and being active members of key professional organizations such as the Association for Vascular Access (AVA), Infusion Nurse Society (INS), or Association of Professional in Infection Control (APIC). The skills necessary for proper care of central lines need to be taught through demonstration. Benner’s concept of reflection can be used to bridge the gap between theory and actual skill. This can be appropriate for nurses and patient families performing a return demonstration, further proving they have the knowledge and know how when faced with a situation or task (1984). Deeper meaning and skill can be enhanced by reflection in practice, leadership, and education (Benner, 1984).

REFERENCES

Benner, P. A. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley

Benner Novice To Expert Pdf

Dest, V. M. (2008). From novice to expert. RN, 71(6), 7.

McEwen, M & Wills, E.M. (2011). Theoretical Basis for Nursing (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Novice to Expert (2013, September 16). Novice to Expert: the Dreyfus model of skill acquisition. Retrieved from http://www.sld.demon.co.uk/dreyfus.pdf

Nursing Theories (2013, September 16). From Novice to Expert – Patricia Benner. Retrieved from http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html

Standing, M. (2007). Clinical decision-making skills on the development journey from student to Registered Nurse: A longitudinal inquiry. Journal of Advanced Nursing, 60(3), 257-269.

Vital signs: central line--associated blood stream infections --- United States, 2001, 2008, and 2009. MMWR: Morbidity & Mortality Weekly Report [serial online]. March 4, 2011;60(8):243-248. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 8, 2013.

Zimlichman E, Henderson D, Tamir O, et al. Health Care–Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System. JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.9763.

Dr. Patricia Benner is a nursing theorist who first developed a model for the stages of clinical competence in her classic book “From Novice to Expert: Excellence and Power in Clinical Nursing Practice”. Her model is one of the most useful frameworks for assessing nurses’ needs at different stages of professional growth. She is the Chief Faculty Development Officer for Educating Nurses, the Director of the Carnegie Foundation for the Advancement of Teaching National Nursing Education and honorary fellow of the Royal College of Nursing.

Patricia Benner was born in Hampton, Virginia, and received her bachelor’s degree in Nursing from Pasadena College in 1964, and later a master’s degree in Medical-Surgical Nursing from the University of California, Berkeley. After completing her doctorate in 1982, she became an Associate Professor in the Department of Physiological Nursing at the University of California, San Francisco. Dr. Benner is an internationally known lecturer and researcher on health, and her work has influenced areas of clinical practice as well as clinical ethics.

Benner From Novice To Expert Pdf 5000

This nursing theory proposes that expert nurses develop skills and understanding of patient care over time through a proper educational background as well as a multitude of experiences. Dr. Benner’s theory is not focused on how to be a nurse, rather on how nurses acquire nursing knowledge – one could gain knowledge and skills (“knowing how”), without ever learning the theory (“knowing that”). She used the Dreyfus Model of Skill Acquisition as a foundation for her work. The Dreyfus model, described by brothers Stuart and Hubert Dreyfus, is a model based on observations of chess players, Air Force pilots, army commanders and tank drivers. The Dreyfus brothers believed learning was experiential (learning through experience) as well as situation-based, and that a student had to pass through five very distinct stages in learning, from novice to expert.

Benner's Novice To Expert Model

Dr. Benner found similar parallels in nursing, where improved practice depended on experience and science, and developing those skills was a long and progressive process. She found when nurses engaged in various situations, and learned from them, they developed “skills of involvement” with patients and family. Her model has also been relevant for ethical development of nurses since perception of ethical issues is also dependent on the nurses’ level of expertise. This model has been applied to several disciplines beyond clinical nursing, and understanding the five stages of clinical competence helps nurses support one another and appreciate that expertise in any field is a process learned over time.

Benner From Novice To Expert Pdf 500

Dr. Benner’s Stages of Clinical Competence

Stage 1 Novice: This would be a nursing student in his or her first year of clinical education; behavior in the clinical setting is very limited and inflexible. Novices have a very limited ability to predict what might happen in a particular patient situation. Signs and symptoms, such as change in mental status, can only be recognized after a novice nurse has had experience with patients with similar symptoms.

Stage 2 Advanced Beginner: Those are the new grads in their first jobs; nurses have had more experiences that enable them to recognize recurrent, meaningful components of a situation. They have the knowledge and the know-how but not enough in-depth experience.

Stage 3 Competent: These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Competent nurses recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners.

Stage 4 Proficient: At this level, nurses are capable to see situations as “wholes” rather than parts. Proficient nurses learn from experience what events typically occur and are able to modify plans in response to different events.

Stage 5 Expert: Nurses who are able to recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. Analytical tools are used only when they have no experience with an event, or when events don’t occur as expected.

Beginner nurses focus on tasks and follow a “to do” list. Expert nurses focus on the whole picture even when performing tasks. They are able to notice subtle signs of a situation such as a patient that is a little harder to arouse than in previous encounters.

The significance of this theory is that these levels reflect a movement from past, abstract concepts to past, concrete experiences. Each step builds from the previous one as these abstract principles are expanded by experience, and the nurse gains clinical experience. This theory has changed the perception of what it means to be an expert nurse. The expert is no longer the nurse with the highest paying job, but the nurse who provides the most exquisite nursing care.

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