NUR 205 Q4 Benner’s Clinical Wisdom in Nursing – Flashcards

Benner's work focuses on perceptual acuity, clinical judgment, skilled know-how, ethical comportment and ongoing experiential learning 'through experience, skilled performance is transformed from the halting, step wise performance of the beginner...to the smooth, intuitive performance of the expert" Good conduct is a product of an individual relationship with the patient that involves engagement in a situation combined with a sense of membership in a profession. Professional conduct is socially embedded, lived and embodied in the practices, ways of being and responses to clinical situations that promote patient well-being, where clinical and ethical judgments are inseparable

Benner's theory is based on clinical situation interviews and observations of nurses in actual practice. From these interviews and observations, 31 competencies and seven domains were identified and described. Later, as if this wasn't enough, Benner and her colleagues identified nine domains of critical care nursing.

Benner identified five stages of skill acquisition based on the Dreyfus model of skill acquisition as applied to nursing along with characteristics of each stage Dreyfus' model of skill acquisition studied pilots and how they learned the skilled of flying

Novice stage Advanced beginner stage Competent stage Proficient stage Expert stage

Novice stage

Advanced beginner stage

Competent stage

Proficient stage

Expert stage

NOVICE STAGE

ADVANCED BEGINNER STAGE

COMPETENT STAGE

PROFICIENT STAGE

EXPERT STAGE

The helping role The teaching-coaching function The diagnostic and patient monitoring function Effective management of rapidly changing situations Administering and monitoring therapeutic interventions and regimens Monitoring and ensuring the quality of healthcare practices Organizational work role competencies

Creating climate for and establishing commitment to healing Providing comfort measures and preserving personhood in face of pain and extreme breakdown Presencing (being with the patient) Maximizing the patient's participation and control in his or her own recovery Interpreting kinds of pain and selecting strategies for pain management and control Providing comfort and communication through touch Providing emotional and informational support to patients families Guiding a patient through emotional and developmental change

Capturing a patient's readiness to learn (timing) Assisting patients to integrate the implications of illness and recovery into their lifestyles Eliciting and understanding the patient's interpretation of his or her illness Providing an interpretation of the patient's condition and giving a rationale for procedures Making culturally avoided aspects of an illness approachable and understandable

Detection of changes in patient's condition Anticipating breakdown and deterioration prior to explicit confirming diagnostic signs Anticipating problems Understanding particular demands and experiences of illness Assessing patient's potential for wellness and for responding to various treatment strategies

Skilled performance in extreme life-threatening emergencies Rapid matching of demands and resources in emergency situations Identifying and managing a patient crisis until physician assistance is available

Starting and maintaining intravenous therapy with minimal risks and complications Administering medications accurately and safely, including monitoring untoward effects, reactions, therapeutic responses, toxicity, and incompatibilities Combating the hazards of immobility, including preventing and intervening with skin breakdown, ambulating and exercising patients to maximize mobility and rehabilitation, and preventing respiratory complications Creating a wound management strategy that fosters healing, comfort, and appropriate drainage

Providing a backup system to ensure safe medical and nursing care Assessing what can safely omitted from or added to medical orders Getting appropriate and timely responses from physicians

Coordinating, ordering, and meeting multiple patient needs and requests—in other words, setting priorities Building and maintaining a therapeutic team to provide optimal therapy Coping with staff shortages and high turnover

Diagnosing and managing life-sustaining physiological functions in unstable patients Using skilled know-how to manage a crisis Providing comfort measures for the critically ill Caring for patients' families Preventing hazards in a technological environment Facing death: end-of-life care and decision making Communicating and negotiating multiple perspectives Monitoring quality and managing breakdown Using the skilled know-how of clinical leadership and the coaching and mentoring of others

In 1999, Benner and her colleagues Hooper-Kyriakidis and Stannard provide readers with not only exemplars for each of the domains of critical care nursing practice but also descriptions for 6 aspects of clinical judgment and skilled comportment

Reasoning-in-transition Skilled know-how Response-based practice Agency Perceptual acuity and the skill of involvement Links between clinical and ethical reasoning

Person: embodied person living in the world who is self-interpreting being, that is, the person does not come into the world pre-defined but gets defined in the course of living a life Environment: a social environment with social definition and meaningfulness Health: the human experience of health or wholeness Nursing: a caring relationship that includes the care and study of the lived experience of health, illness, and disease

Meanings are embedded in skills, practices, intentions, expectations, and outcomes Humans are integrated, holistic beings; the Cartesian notion of the mind-body split is abandoned Embodied intelligence enables skilled activity that is transformed through experience and mastery People who share a common cultural history and language have a background of common meanings that allows for understanding and interpretation Meanings embedded in skills, practices, intentions, expectations, and outcomes cannot be made completely explicit but they can be interpreted by someone who shares a similar background and can be validated

Discovering assumptions, expectations, and sets can uncover an unexamined area of practical knowledge, which can then be systematically studied and extended or refuted Clinical knowledge is embedded in perceptions rather than precepts Perceptual awareness is central to good nursing judgment Expertise develops when the clinician tests and refines propositions, hypotheses, and principle based expectations in actual practice Formal rules are limited and discretionary judgment is needed in actual clinical situations Clinical knowledge develops over time and each clinician develops a personal inventory of knowledge that can be shared in other clinicians

Easy to understand and readily generalized across settings and demographics Terminology used consistently throughout the philosophy Competencies and domains were derived inductively and have been tested Useful for practice and for further knowledge development within nursing

Assessment and Planning occur based upon patient needs within domains Implementation viewed through the lens of the domains and includes competencies within domains Evaluation based on the patient's outcome and interpretation of the outcome within his or her unique situation