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

Unlock all answers in this set

Unlock answers
question
OVERVIEW OF BENNER'S THEORY
answer
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
question
OVERVIEW OF BENNER'S THEORY cont.
answer
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.
question
Overview of Benner's Philosophy of Clinical Wisdom in Nursing
answer
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
question
Five Stages of Skill Acquisition (NACPE)
answer
Novice stage Advanced beginner stage Competent stage Proficient stage Expert stage
question
Requires rules to govern practice
answer
Novice stage
question
Marginally acceptable level of care
answer
Advanced beginner stage
question
Recognizes patterns & knows what requires attention
answer
Competent stage
question
Able to see situation as a whole
answer
Proficient stage
question
Care is intuitive & has grasp of the situation and does not need the rules
answer
Expert stage
question
Person has no background experience Requires rules to govern performance Through instruction, learns rules for drawing conclusions and determining actions Applies to nursing students as well as experienced nurses when they are placed in an unfamiliar situation.
answer
NOVICE STAGE
question
Marginally acceptable level of performance after having experience coping with real situations Still guided by rules and are guided toward task completion and will continue to rely on the assistance of more experienced nurses to manage patient care Clinical situations are viewed in terms of the nurse's abilities and the demands the situation places on the nurses rather than on the needs of the patient.
answer
ADVANCED BEGINNER STAGE
question
The nurse now begins to recognize patterns feels a great sense of responsibility for his or her actions Displays a focus on time management and organization because planning and predictability are required to achieve a sense of mastery
answer
COMPETENT STAGE
question
The nurse perceives the situation as a whole, plans can be formulated intuitively The nurse demonstrates increased confidence in his or her abilities and has the ability to turn the focus away from self and toward the patient The nurse at this stage can start the transition into expertise
answer
PROFICIENT STAGE
question
no longer relies on rules to connect his or her understanding of the situations to the appropriate action, but rather has an intuitive grasp of the situation has the ability to recognize patterns owing to his or her deep experiential background practice is characterized by demonstration of a clinical grasp and resource-based practice, possessing embodied know-how, seeing the big picture and seeing the unexpected
answer
EXPERT STAGE
question
Seven Domains
answer
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
question
Competencies Within Domain of the Helping Role
answer
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
question
Competencies Within the Domain of the Teaching-Coaching Function
answer
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
question
Competencies Within the Domain of Diagnostic and Monitoring Function
answer
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
question
Competencies Within the Domain of Effective Management of Rapidly Changing Situations
answer
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
question
Competencies Within the Domain of Administering & Monitoring Therapeutic Interventions and Regimens
answer
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
question
Competencies Within the Domain of Monitoring & Ensuring Quality of Healthcare Practices
answer
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
question
Competencies Within the Organizational and Work-Role domain
answer
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
question
Nine Domains of Critical Care Nursing
answer
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
question
6 ASPECTS OF CLINICAL JUDGEMENT AND SKILLED COMPORTMENT
answer
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
question
Six Aspects of Clinical Judgment and Skilled Comportment
answer
Reasoning-in-transition Skilled know-how Response-based practice Agency Perceptual acuity and the skill of involvement Links between clinical and ethical reasoning
question
Major Concepts of Nursing Based upon Benner's Philosophy
answer
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
question
Assumptions of Benner's Philosophy
answer
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
question
Propositions of Benner's Philosophy
answer
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
question
Brief Critique of Benner's Philosophy
answer
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
question
Benner's Philosophy as a Framework for Nursing Practice
answer
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
Get an explanation on any task
Get unstuck with the help of our AI assistant in seconds
New