Patricia Benners Nursing Theory - Essay Example

Running head: PATRICIA BENNER Patricia Benner's Nursing Theory: from Novice to Expert Excellence in Clinical Nursing You're Abstract The basis for the scientific practice of nursing includes nursing science; the biomedical, physical, economic, behavioral and social sciences; ethics; and philosophy. A nurse's ability to be a critical thinker and to use this knowledge in the delivery of nursing care is essential to the well being and safety of those for whom nurses care. Patricia Benner's theory is so similar to other nursing theories in many ways, as this research will show it to be. She perceives that the knowledge that nurses gain is one of the most projected forces in nursing care and it is something that has to be charted so that nurses can gradually improve upon the care that they give. This is an excellent perception in the field of nursing and draws on concepts from Nightingale as well which make it even more powerful. The main points of this research with regard to this theory will emphasize that patients deserve the best quality of care that can be given and nurses can only do this by drawing upon the knowledge and experiences that they have gained through clinical areas and on into areas of more pronounced nursing care from their past as well. All of these experiences help the nurse become better attuned to her nursing duties and more prepared to know what to do in times of great stress also. As the conclusion will point out, sharing this knowledge with other nurses and medical professionals is what strengthens the nursing care that patients are meant to receive. It helps the knowledge and acquired skills to grow, moving certain forms of nursing over from novice care givers to care givers who are full of excellence and continue to grow in order to provide even more improved supportive services to those who need it the most. Patricia Benner's Nursing Theory: from Novice to Expert Excellence in Clinical Nursing Introduction Patricia Benner states "Knowledge development in a practice discipline consists of extending practical knowledge (know-how) through theory based scientific investigations and through the charting of the existent know how developed through clinical experience in the practice of that discipline" (Benner 2005). Benner's theory expects nursing to gradually improve the care we provide through academics and experience. She also believes that nursing only benefits if that knowledge learned is shared. Processes can only be improved with the knowledge of what is wrong. Clinicians and leaders should develop programs in their facility to allow for discussion of patient observation, mistakes and mishap to enhance the clinical judgment of the entire nursing staff. Following a strategic theorization such as Benner's emphasizes the power to minimize medical mistakes and errors resulting from misguided care, especially due to the fact that much of the knowledge is shared among the medical practicing team (American Nurses Association 2000). Such accidents are errors that could be avoided, which are considered to be sentinel events that stem from an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof due to lack of knowledge, experience, or even shared knowledge among the nursing staff (Ballard 2002). Benner's theory defines that the top recommendation for nursing leaders is to come to the forefront and recognize errors and near misses as learning tools to prevent future errors. The basic premise is that nurses do not go to work to harm patients, but the processes that are in place put everyone at a greater risk. This shows that this theory focuses heavily on patient safety and the concerns of the patient; as well it should since there are so many errors that take place in the medical environment in current day (Institute of Medicine 2000). For instance, in terms of lives lost, patient safety is as important an issue as worker safety. Every year, over 6,000 Americans die from workplace injuries. Medication errors alone, occurring either in or out of the hospital, are estimated to account for over 7,000 deaths annually. Due to calculations such as these Benner seemingly has the right approach to try and curtail mistakes and errors such as these that have been mentioned. As she emphasizes in her nursing theory, establishing a system to report errors that is non-punitive and supportive of the nursing staff will promote near miss reporting and an environment of care that is supportive of learning from past mistakes. Error reporting is the scientific investigation that provides the experience needed to facilitate the know-how for a safer environment of care and therefore is appearing to be fundamental in the profession of nursing (Needleman et al 2002, pg. 1715). Improving Nursing Care through the Utilization of Benner's Theorization Firstly, in order to improve upon the current nursing standards a nurse has to have the ability to see that their skills as a critical thinker, and how they use their knowledge in the delivery of nursing care is essential to the well being and safety of those for whom they are caring for. This is one of the first steps to changing conventional thinking patterns in nursing, following Benner's approach. In discussing contemporary nursing practice, the American Nurses Association (2003) states that an essential feature of nursing is the provision of a caring relationship that facilitates health and healing. Patricia Benner's theorization does not minimize this concept in nursing but rather her approach towards using shared knowledge expands upon it to improve the practice that nurses have underpinned in their philosophy of care. It could even be said that perhaps Nightingale helped lead the way to new theorizations such as Benner's taking place in the nursing profession. In the Crimea, Nightingale conducted some of the earliest nursing studies on factors influencing the outcomes of patient care (Nightingale, 1859). It is important that nurses work to continue these traditions by strengthening the nurse-patient relationship and diligently using research findings so as to provide safe care for patients. Benner's conceptualization seemingly applies this type of knowledge as she is incessant when she discusses how important it is to chart progress, utilize discovered information, and then share this information among each other to increase the chance for positive patient outcomes. With the writings of Florence Nightingale, the beginnings of a unique nursing knowledge base were identified. Although Nightingale did not use the term nursing theory in her work, she focused on how nurses could manipulate the environment to benefit the patient. Early in nursing history, Florence Nightingale advocated for safe care. She proposed that nurses through their practice had to put the patient in the best condition possible for nature to act upon the patient. Even though Benner focuses on different aspects of nursing, it is obvious she draws many of her beliefs and the philosophy of her theory from some of the views that Nightingale placed into the profession of nursing herself. It is even more plausible to realize that basically all nursing theories have definitely stemmed from the beginnings that Nightingale laid down in the profession. The care of the patient and their needs are the most important with regard to the treatment being planned. By following the proposal set out by Benner, sharing excess knowledge and gaining more knowledge through past clinical experiences brings more positivism into the field and can indeed lead to the idea of excellence in nursing. How Benner's Theory Affects Decision Making in Nursing Care The decisions that nurses make when caring for a patient can either provide the excellent care they need to make a positive recovery or it can promote adversity that places the patient more at risk for potential health problems. Therefore, the decision making styles play a definite role in the quality of care that is being given (Bryans & McIntosh 1996, pg. 24). Here again, Benner believes that the knowledge nurses have gained through all of their nursing trials and experiences are what are the most important when attempting to make difficult decisions in the treatment process. However many influencing factors are involved with the nurses decision making. For instance, reflection plays a large part in reaching strategic decisions in patient care for many nurses. The use of reflection enables nurses to learn from their experience and build up an expert knowledge base. However if you don't learn from your mistakes it doesn't make you an expert. In this area Benner's philosophy is slightly lacking because many experts in medical research claim that knowledge is not necessarily the only way to improve upon patient care, there are an innumerous amount of other factors that do affect the decision making skills of nurses (Dowie & Elstein 1988, pg. 24). However, Benner argues that it is through the years of gained clinical experience and an inept knowledge that the nurse can continue to expand upon the clinical knowledge he or she has gained and can become a skilled practitioner who has the abilities to adequately perform the following outlined functions: Identify, communicate, and fulfill patients needs efficiently, adequately and with sincere care Coordinate and utilize facility and community resources to meet every patients needs Promote a multidisciplinary approach to patient care Assume a teaching-coaching role with other nurses and health team members Maintain a flexible approach to resource constraints (Elstein et al 1978, pg. 117). In this regard, Benner claims that the various decision making skills are achievable based on the numerous acquired skills, knowledge, experiences, personal intuition, and shared information that is available following this guide. Her theory also concludes that through knowledge being used as an intuitive guide, and with fine "discretionary judgment, experience and leadership" a Clinical expert is found to be able to appropriately give excellent patient care in a safe and caring medical environment (Benner 2005). This is of course irrefutable as Benner's theory has been used as the foundation for the development of the 'SN' in the medical environment. Again, the theory demonstrates that the situation based, interpretive approach is what develops the excellence in clinical practice because it can be found in everyday interactions and activities in the clinical environment. Benner claims that these nurses who have gained knowledge in this manner have the ability to handle situations that change rapidly and therefore their decision making styles show high quality and competent management of the direct patient care routines in clinical work and other areas of nursing where emergencies take place as well (Harbison 1991, pg. 404). Conclusion Through using expert clinical reasoning the nurses draws on a deep understanding of the patient situation and holistic care needs. Intuition is a quality that nurses have traditionally valued for many years now and Benner's theory works to bring these types of actions, attitudes, and decision making styles back to the forefront of nursing. This is regardless of the fact that evidence based practice has in some ways minimized the effectiveness of this type of style. The reason this is stated is because evidence based approaches focus more on a rationale type of thinking in nursing and don't take all of the holistic concepts into consideration such as a theory like Benner's does. Because Benner focuses a lot on patient safety and the patient's needs, etc, it is considered to be more applicable by many researchers towards improving the field of nursing care, especially clinical nursing care. Furthermore, Benner (1984) argues that the knowledge that can be gained does not have to always have a rationale but an understanding of the patients needs developed through the nurses own intuition. Benner (1984) argues that during a long nursing career, nurses can gain a great deal of knowledge and skill practice, this leads to them being intuitive about the decisions they make. Intuition is not something that is measurable according to Benner (1984); it is developed through experience, expertise and knowledge, along with personal awareness and personality. At the same time that her theory projects positivism in these areas other researchers refute it with new and even old ideas. Nevertheless, she has much support in her theorization as McCutcheon and Pincombe (2001, pg. 342) also believe that there are benefits derived from intuition in practice, such as enhanced clinical judgment and effective decision making. Although Cioffi (1997, pg. 203) argues that holistic patient assessment and improving nurse-patient relationships are being undermined by a drive for evidence based care. Intuition has been identified as a useful tool as nurses can analysis the situation as a whole rather that a series of tasks (McCutcheon and Pinchcombe 2001, pg. 343). In finality, Intuition has been identified as a useful tool that needs to be recognized within nursing; however a need for a rational approach along side it is necessary. This will enable nurses to provide evidence based care with clear rationales. There are many aspects of nursing that cannot be subjected to measurement, and intuition is one of them, and so is caring. To ignore intuition as a nursing skill would be to deny the patient of truly holistic care. It is now a common fact that through sharing knowledge with other nurses and being willing to collaborately work together, the patient outcomes are far more positive than without this type of initiative. Benner brings this philosophy to life in her theory and it is in a highly positive way, allowing for amendments from other areas in the profession of nursing entering into the concept as well without exclusion due to differing opinions and beliefs. It is through this philosophy that nurses in the clinical practice can develop into excellent practitioners and can prioitorize and identify with potential problems far quicker than before. Understanding how to avoid pitfalls in patient care is a priority of nurses and again, by following Benner's points in her theory clinical nurses has better opportunities to prevent adversities from taking place, far more efficiently today. In conclusion by speaking to other nurses, References American Nurses Association (2000). Nurse Staffing and Patient Outcomes in the Inpatient Environment. Washington: ANA Press Publication. Ballard, K. (2002). The World of Nursing Practice: You're Career in Nursing. New York: Simon and Schuster Publishing. Benner, P. (2005). Novice to Expert. Retrieved August 18, 2006 from the World Wide Web: http://www.eden.rutgers.edu/kmckee/ Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison-Wesley Publishing. Bryans, A. & McIntosh, J. (1996). Decision Making in Community Nursing: An Analysis of the Stages of Decision Making as they Relate to Community Nursing Assessment Practice. Journal of Advanced Nursing 24, 24-30. Cioffi, J. (1997). Heuristics, Servants to Intuition in Clinical Decision Making. Journal of Advanced Nursing 26, 203-208. Dowie, J. & Elstein, A. (1988). Professional Judgment: A Reader in Clinical Decision Making. Cambridge: Cambridge University Press. Elstein, A. & Schulman, L. & Sprafka, S. (1978). Medical Problem Solving: An Analysis of Clinical Reasoning. Cambridge: Harvard University Press. Harbison, J. (1991). Clinical Decision Making. Journal of Advanced Nursing Practice 16, 404-407. Institute of Medicine (2000). To Err is Human: Building a Safer Health System. Washington: National Academy Press. McCutcheon, H. & Pinchcombe, J. (2001). Intuition: An Important Tool in the Practice of Nursing. Journal of Advanced Nursing 35, 342-348. Needleman, J. & Buerhaus, P. & Mattke, S. (2002). Nurse Staffing Levels and the Quality of Care in Hospitals. New England Journal of Medicine 22, 1715-1722. Nightingale, F. (1860-1969). Notes on Nursing: What it is, and what it is not. New York: Dover Publishing. Read More