Skills Development and Levels of Knowledge Acquisition

¶ … skills development and levels of knowledge acquisition based on clinical experience. Nurses move from novice making decisions based on rules to expert who are able to see connections between actions and outcomes using critical thinking

Some claim that expert nursing comes from habituation in making decisions. Benner (2001), for instance, posits 5 different levels of development that the nurse moves through: novice, advanced beginner, competent, proficient, and expert. Each one builds on the other as the nurse uses the reflection gained from her experience to improve her practice. Each of these five different levels constitute proficiency and skill not only in practical labor, but also in other components -- such as skilled communication and mentoring -- that are integral to the field of nursing. The novice nurse, for instance, tends to see the patient as an object made up of discrete pieces of information / data and specific tasks that she, the nurse, has to master. The expert nurse, however, on the top of the rung, can move beyond that approaching her task in a more automatic fashion and seeing the patient as an individual who is worthy of and requires her full respect. At the same time, the expert nurse can effortlessly and diligently move through her tasks without being caught up in the technical details. The expert is able to transcend the tasks and patient to read the whole picture, but she ignores nothing else whilst doing so. Benner's thesis rests on regularity and repetition of skill.

It seems to me, however, that skilled nursing is made up too of critical thinking and that without critical thinking repetition of task not only falls flat but, actually, can be dangerous. It needs cautious and clever repetition of task to transform the novitiate to an expert.

evidence-based practice (EB) is very much a part of responsible nursing and EBP, according to Sackett (2009) is linked to five main ideas. These five principles are the following:

That application of epidemiological, economic and bio statistical principles as well pathophysiology and personal experience be integrated in one's practice,

That clinical and health-based decision should be formulated on the most authoritative evidence available.

That the nature and source of the evidence should be linked to the congruent and applicable clinical population.

That appraisal and review of the information be integrated in one's practice, and that,

There should be consistent monitoring of one's performance.

There is another way in which critical thinking is an essential part of nursing and, in fact, forms the seam between nursing knowledge and action in more realms than one. Carper (1979) proposed four different ways in which critical thinking appears in nursing:

1. Empirical -- in the evidence-based realm when nurses have to draw from reading to practice.

2. Personal -- knowledge and experience derived from personal experience and empathy with nurse critically reflecting on patient's experience and reliving it.