21st century nursing is an evolving, rewarding, but challenging occupation. Unlike nurses in the past, the modern nurse's role is not limited to the physician's assistant, but rather takes on a critical partnership role with both doctor and patient. This role is multicimensional: advocate, caregiver, teacher, researcher, counselor, translator, and case manager. Of course, care is of the upmost importance and includes those activities that assist the client physically mentally and emotionally. This requires a holistic approach to the patient as a person, not a disease, number or statistic (Mariano, 2005). Using nursing theory and scholarship can help aid a nurse's toolbox as well as keep the nurse current with practice and philosophical ideas. Case histories, for instance, provide a way to examine different aspects of nursing theory with tangible, tactical solutions, as well as points for strategic discussion (Alligood, 2009, intro).
Five levels of capability: novice, advanced beginner, competent, proficient and expert.
Four domains of nursing: client / person; health, the environment, and nursing.
Change as the natural evolution of the practice; gleaned through experience.
Benner's theory focuses on the nature of the nursing practice and the way it evolves through chronology, technical improvement, and lifelong learning. For Benner, this process centers around the movement of base knowledge (book learning) through experience in seeting medical situations as holistic, actionable, and patient centered. Nursing becomes fluid, and like the educational theories of Bloom's Taxonomy, takes knowledge, builds upon it until there is unique analysis and finally synergism in practice. Using her theoretical approach, one can move quicker through the stages by understanding the needs and concerns of the patient through divergent ideas and beliefs (Altman, 2007).
Benner's theory focuses on the process of becoming -- becoming a nurse (clinical), becoming a care giver, and becoming an expert in their field. She based her theory on the Dreyfus model, which has five basic stages (novice, advanced begnniner, comepetent, profieicnet, and expert). Of course, this is a sliding scale, and Benner believes that there is a constant need for the evolution of growth and knowledge in order to become "all one can be" as a nurse. To advance between stages, nurses must use reflection to not only gain knowledge, but to understand how best to utilize that knowledge (Benner, 2009, p. 77). We may conceptualize these stages thus:
Basic beginner with no experience; needs to learn general rules that are context free; limited flexibility and judgement.
"Tell me and I will do it." Needs to learn and adapt as quickly as possible.
Demonstrates performance and acumen; gains some experience and brings prior knowledge to bear; begins to formulate how theory can translate into action.
Several "ah-ha" moments in which clinical knowledge moves into actionable offering.
2-3 years on the job experience; more aware of the big picture and long-term goals; perspective and abstract thinking.
Begins to take on the core competencies of leadership and development of staff and self.
Perceives and understand situations as a whole; holistic decision making; able to change and modify situations.
Calmer, more synergistic approach to the field; understands more interpersonal issues and is able to combine with carative and clinical paradigms.
No longer relies on principles, rules or guidelines to act; clinical and personal expertise; intuitive grasp of situations, performance is fluid, flexible and expert (From Novice, 2011).
Continually evolving, using evidence based and best practice techniques; networking, more educational experiences, growth and continual development.
For instance, the competent stage is the most pivotal in clinical learning because the nurse must recognize patterns and determine filters for them. The nurse devises new rules and reasoning procedures to make a plan that takes into account the quantitative clinical rules but puts the qualitative and holistic individualities of the patient into the paradigm for care. The idea is to become a clear thinker, to tie up emotions as needed, but not allow them to run the situation. At the same time, there needs to be a caring paradigm because that sets up the ability for the modern nurse to give and receive help. Benner's theory translates into moving from a…