Seven domains of nursing practice benner

Discussion Critique

please critique your peers’ works, such as purpose, concepts, assumptions, and theory's implications for nursing practice, nursing education, and nursing research. Does each group use concepts and the conceptual framework/theoretical framework/model of the theory to guide the nursing implications?
Discuss theory applications from their selected articles.
Please provide suggestions or opportunities for improvement.
Ask a challenge question to encourage your peers’ participations and critical thinking, for example a question about a unique situation and theory’s application, such as infection prevention.

GROUP 3 PROJECT 1

Lissette Valcarcel

Novice to Expert Outline of PowerPoint Presentation

1) TITLE PAGE

a) From Novice to Expert - Skills Acquisition Model

b) Jenna Cook, Roshani Patel, Sherley Thervil, Brandie Turner, Lissette Valcarcel

2) BACKGROUND ON PATRICIA BENNER

a) Self-Portrait

b) Birth place

c) Educational Background

3) BACKGROUND ON PATRICIA BENNER CONTINUED

a) Professional Appointments

b) Career Positions

4) BACKGROUND ON PATRICIA BENNER CONTINUED

a) Awards

b) Recognitions

5) FRAMEWORK OF NOVICE TO EXPERT THEORY

a) Overview

b) Framework Development

6) FOUR METAPARADIGMS

a) Person

i) Definitions

b) Environment

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ii) Definitions

c) Health

iii) Definitions

d) Nursing

iv) Definitions

7) ADDITIONAL CONCEPT

a) Skills Acquisition Model

i) Novice to Expert Graph

ii) Stage 1 - Novice

iii) Stage 2 – Advanced Beginner

iv) Stage 3 – Competent

v) Stage 4 – Proficient

vi) Stage 5 – Expert

8) ADDITIONAL CONCEPT

a) Seven Domains

b) List of Seven Domains

9) THEORETICAL ASSUMPTIONS AND PROPOSITIONS

10) STRENGTHS OF THE MODEL & WEAKNESSES OF THE MODEL

a) Strengths

b) Weaknesses

11) IMPLICATIONS IN NURSING PRACTICE

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12) IMPLICATIONS IN NURSING EDUCATION

13) IMPLICATIONS IN NURSING RESEARCH

14) APPLICATIONS IN NURSING PRACTICE

15) CONCLUSION

16) REFERENCES

17) REFERENCES

GROUP 3 PROJECT 4

Article #1: Cook, C. (2016). A TOOLKIT FOR CLINICAL EDUCATORS TO FOSTER LEARNERS’ CLINICAL REASONING AND SKILLS ACQUISITION. Nursing Praxis in New Zealand, 32(1), 28-37. Retrieved from https://search-proquest-com.southuniversity.libproxy.edmc.edu/docview/1817528441?accountid=87314

Summary by Brandie Turner:

The basis of the article is to discuss the characteristics of the expert nurse when given the circumstances of becoming the educator. The expert nurse often makes decisions and provides care to patients using pure intuition. Intuition cannot be taught or studied. When the expert nurse becomes a preceptor it is important for the preceptor to take on a novice approach to teaching to ensure full learning opportunity to the preceptee. The importance of the novice nurse to be able to work alongside of the expert nurse is a valuable learning experience. (Cook, 2016)

The article offers several options to assist in the education layout for the preceptor following Benner’s novice to expert model. The Model of Practical Skill Performance (MPSP) has five components: central to learning, content knowledge, substance, sequence and accuracy (Cook, 2016). The MPSP focuses on the role that the educator plays when preceptorship is in effect and how the novice nurse learns better when there is a caring component and the preceptor values the responsibility (Cook, 2016).

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The 4A model focuses on a series of questions; “Have you undertaken this procedure before?” “Tell me what you already know about…” “What went well?” “What was challenging last time you…?” The 4A model helps the novice nurse focus on their clinical skill and reflection of the knowledge from which the skill is drawn (Cook, 2016). Another model for the preceptor to follow is the Five Minute Preceptor (5MP) (Cook, 2016). The 5MP involves three steps. Step one is to have the student take a stand and know what is going on with the patient and the care that is being provided (Cook, 2016). Step two is to probe the student for answers this allows the preceptor to learn the students’ knowledge and the gaps that may be present (Cook, 2016). Step three is where the preceptor enables the student to apply their knowledge to their skill (Cook, 2016).

Article #2: Oshvandi, K., Moghadam, A.S., Khatiban, M., Cheraghi, F., Borzu, R., and Moradi, Y. (2016). On the application of novice to expert theory in nursing: A systematic review. Journal of Chemical and Pharmaceutical Sciences, 9(4), 3014-3020.

Summary by Roshani Patel:

The conceptual framework used in this study is Benner’s Novice to Expert Theory which used a variety of databases to find relevant studies that included the keywords ‘from novice to expert’ and ‘Benner’s theory’. The authors explain that the purpose of the study is to address the application of Benner’s novice to expert theory in nursing career. Benner, as a nursing theorist emphasizes on experience and the knowledge gained through experience (Oshvandi et al, 2016).

Benner explains expertise as a road with five sections which should be passed through by a practitioner to become clinically skilled and these sections are as follows (1) novice, (2) advanced beginner, (3) competent (4) proficient, (5) expert. The authors in this study aimed at examining the theory by explaining four scopes of nursing – education, practice, research, and management.

From the 988 articles gathered, all articles were assessed qualitatively and from those, eleven deemed relevant to the subject of the study. The articles were assessed using the STROBE Statement. To assess the representational quality of results in an observational study, ten outstanding researches from various countries such as Netherlands, Switzerland, Germany, England, Denmark, and United States of America developed a checklist composed of 22 main issues which would be taken into account to assess the quality of the journal article. This check is known as STROBE statement (Oshvandi et al, 2016). Poorolajal (2009) outlines the three main categories of observational studies have been considered by STROBE statement: cohort studies, case-control studies, and cross-sectional studies.

This study used all 22 items of the checklist to assess the quality of the articles and the results were categorized into four subsections and in each subsection the authors addressed the application of the novice to expert theory. The four subsections include application of the theory in: (1) nursing practice, (2) nursing education, (3) nursing research, (4) nursing management (Oshvandi et al, 2016).

The study noted that simulators are very useful training tools which can be employed in the novice and advanced novice steps for providing nursing with required skills. Neil (2009) adds that according to Benner’s theory nursing instructors can use simulators to facilitate the progress of nursing students in gaining clinical competencies. The simulators would provide students with a positive experience which make them enable to manage patients in a more proper manner. In using Benner’s theory, the competencies of performing special tasks and finding strategies for improving their performances would be assessed (Oshvandi et al, 2016).

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Cash (1995) summarizes that although the theory is regarded as an easy to understand model, there still are some complexities when it is used for distinguishing various strategies. Benner’s theory has been proven to be useful, effective tool by various related bodies, including nursing faculties, hospitals, community organizations, and Nursing Continuing Education Programs (Oshvandi et al, 2016). Altmann (2007) states that the role of education is not considered as important as it should be in this theory. The reason behind this deficiency is because the main focus of the theory is on gaining knowledge through experience rather than education. Applying the Benner’s theory principles in clinical scope and hospital require financial resource application for holding training courses and detection of situations through which knowledge of nurses can be promoted (Oshvandi et al, 2016). Cash (1995) states that in the nursing management domain, the theory is used for developing the career ladder, staff development plans, and reward programs.

Article #3: Davis, A., & Maisano, P. (2016). Patricia Benner: Novice to expert-A concept whose time has come (again). Oklahoma Nurse, 61(3), 13-15.

Summary by Lissette Valcarcel:

According to this article, new nurses graduate from nursing programs every year and start working in clinical settings. As the new nurses continue to gain more insight into the field and acquire knowledge in their new careers, they become seasoned nurses. They mentor new generations of nurses who are joining the clinical settings (Davis, 2016). Patricia Benner gave a detailed discussion of how long-term career development is essential in the nursing field due to responsibility and complexity of clinical nursing practice. She came up with a theory known as Novice to Expert theory.

The Novice to Expert theory was established and introduced to nursing practice by Dr. Benner in the year 1982. The theory discusses how nurses develop their knowledge, skills, understanding of patient care with time (Benner, 1982). Dr. Benner derived the theory form Dreyfus skill acquisition model. She focused on providing an objective way of assessing the progress of nursing skills and knowledge. The theory describes how a person starts at the novice stage (Davis, 2016). As the person gain new skills and knowledge, he/she progresses through several stages up to the expert stage.

The five proficiency stages in this theory are novice, advanced beginner, competent, proficient, and expert stages. In the first stage, novice, a person has no experience with any clinical situation. New nurses belong here, and they learn simple but objective attributes which they can identify easily (Davis, 2016). The second stage is advanced beginner. Nurses in this stage have participated in various real-world clinical situations which the recurrent element is identified easily. Nurses in this stage need help and support in the clinical area. The third stage is competent. The nurse can prioritize tasks or situations at hand using past experience. They can also work efficiently and in an organized manner. The next stage is proficient. Here, the performance of a nurse is guided and directed by maxims because of seeing a clinical situation as a whole (Benner, 1982). Nurses in this stage have a holistic understanding of clinical situations they face. The last stage is the expert stage. Nurses in this stage have substantial knowledge of various clinical situations, this allows for confidence as well as intuitive understanding of complex clinical situations.

The Patricia Benner theory has been applied in many areas of the nursing field. It has had a major impact on clinical nursing practices in the healthcare sector. The theory facilitates for gaining knowledge and acquiring skills as a person progresses through every stage (Davis, 2016). The theory also describes essential teaching strategies for all stages of the theory. An example of this would be how nurses in the advanced beginner stage would benefit from mentoring because support is required in discovering important things and setting priorities (Davis, 2016). The Patricia Benner theory has also been used in professional development for nurse leaders and managers.

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In conclusion, Benner’s Novice to Expert theory has and is been applied in the healthcare sector to create and develop leadership programs, mentorship programs, enhance nurse retention and offering teaching aids for nurses and nurse leaders. In leadership programs development, using mentorship together with guides on self-assessment can enable constant growth and development for current as well as future nurse leaders. Commitment and appropriate leadership preparation can result in improved nursing staff retention, reduced costs of turnover, and improved quality and patient outcomes. Provision of professional growth and development based on the Benner theory for nurse leaders helps healthcare systems to create capable and confident leaders who can contribute to quality and safety in patient care while increasing staff retention.

Article #4 : Savage, P., Fitzgerald, B., & Lee, C. T. (2015). Piloting an integrated education pathway as a strategy to prepare for and encourage oncology specialty certification. Canadian Oncology Nursing Journal, 25(2), 195-200. doi:10.5737/23688076252195200

Summary by Jenna Cook:

This study evaluated and described a pilot program intended to improve education programs for oncology nurses. The conceptual framework was based on Patricia Benner’s From Novice to Expert theory, which attempts to explain how skills and knowledge are acquired and then used as building blocks on the path from novice nurse to expert nurse (Benner, 1984). Savage, Fitzgerald and Lee (2015) explain that the purpose of the article is to describe the education program that was implemented, and to assess the effectiveness after one year (Savage, Fitzgerald, & Lee, 2015).

Savage, et al. (2015) first identified barriers to obtaining the type of education necessitated by the oncology field, which included lack of funding and lack of staff. Then, a literature review on post-licensure nursing programs and training workshops was conducted, which revealed fewer than 10 studies on these types of programs (Savage et al., 2015).

Benner’s From Novice to Expert theory was used as the curriculum foundation and as a basis for the three distinct roles in oncology nursing, as well as nine standards of care and seven competencies (Savage et al., 2015). The three roles include generalist nurse (one who works in a non-specialized oncology setting), the specialized nurse (one who works in an oncology setting), and the advanced nurse (one with a Master’s degree and specializing in oncology) (Savage et al., 2015). The distinction between these roles is important in the oncology setting as it requires a completely different skill set and very specific knowledge.

The application of Patricia Benner’s theory is also evident in the description of the pathway program. The program is segmented into three phases, each of which have an associated timeframe. The emphasis Patricia Benner places on experiential learning, which is essentially hands-on learning with reflection on the experience, is also seen by the teaching instruments used in this study. The nurses who participated in this pilot program were also asked to rate their level of competence, from novice to expert, which further underlines the experiential learning component of Benner’s theory, and the reflection on the experience that helps to instill knowledge (Alligood, 2014).

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The authors of this paper concluded that although the results were limited due to the minimal one-year evaluation and small sample size, this program improved participants’ skill level and knowledge regarding nursing care in the oncology setting (Savage et al., 2015).

Article #5: Benner, P. (January, 2005). In: Nursing Education Perspective. Retrieved from:

ebscohost-com.southuniversity.libproxy.edmc.edu/

Summary by Sherley Thervil:

In this article the author wants to promote a change in the health care system. She wants to make health care higher in quality, accessible and equitable. The author focuses on psychosocial issues such as illness management and prevention, also on the shaping of health care policy. She mentioned as well the poor image of nurses in the media, film, and television.

According to the author, women were not recognized as influential agents until the time of the equal rights feminist movements. Nurses voices were not recognized in the newspapers. The media had minimized or ignored the efforts of the nurse. Therefore, the negative effects of the depiction of women by the media, including the portrayal of nurses, tend to discourage women’s occupational aspirations. In addition, Nurses have not occupied places at the major health care policy-making tables.

According to the article, the nursing profession is considered primarily as a women’s profession, and is tremendous responsible for the welfare and well-being of the population. The profession has little recognition, little authority, almost no power associated within its level of responsibility. Nurses don’t have much say in the public arenas. As a profession, Nurses can no longer wait for the media to come to them, nor for health policy-making bodies to invite them to join the policy committees. Nurses must develop the skills in policy science and the skills of presenting themselves in the media and to the media. The have to take more responsibility for moving from silence to voice. Nurses can describe better what they know in their practice and science. According to Patricia Benner the health care reform and society will benefit from nurses contribution.

GROUP 3 PROJECT 9

References for Five Articles

Benner, P. (January, 2005). In: Nursing Education Perspective. Retrieved from:

ebscohost-com.southuniversity.libproxy.edmc.edu/

Cook, C. (2016). A Toolkit for Clinical Educators to Foster Learners’ Clinical Reasoning and Skills Acquisition. Nursing Praxis in New Zealand, 32(1), 28-37. Retrieved from https://search-proquest-com.southuniversity.libproxy.edmc.edu/docview/1817528441?accountid=87314

Davis, A., & Maisano, P. (2016). Patricia Benner: Novice to expert-A concept whose time has come (again). Oklahoma Nurse, 61(3), 13-15.

Oshvandi, K., Moghadam, A.S., Khatiban, M., Cheraghi, F., Borzu, R., and Moradi, Y. (2016). On the application of novice to expert theory in nursing: A systematic review. Journal of Chemical and Pharmaceutical Sciences, 9(4), 3014-3020.

GROUP 3 PROJECT 10

Savage, P., Fitzgerald, B., & Lee, C. T. (2015). Piloting an integrated education pathway as a strategy to prepare for and encourage oncology specialty certification. Canadian Oncology Nursing Journal, 25(2), 195-200. doi:10.5737/23688076252195200

GROUP 3 PROJECT 11

Coble, R. (2015). Center for Teaching. Retrieved from https://cft.vanderbilt.edu/guides-sub-pages/pedagogy-for-professional-schools-and-students/

Key Words and Definitions

1. Advanced Beginner – Demonstrates marginally accepted performance.

2. Competent – Plans nursing care and coordinates multiple complex care demands.

3. Concepts – The building blocks of the theory; abstract ideas or mental images of phenomena or reality.

4. Conceptual Framework – A group of related concepts.

5. Domains – An area of practice having a number of competencies with similar intents, functions, and meanings.

6. Environment – The internal/external surroundings of the client.

7. Expert – No longer relies on rules or guidelines to connect an understanding of the situation to an appropriate action.

8. Framework – A basic structure supporting anything.

9. Health – the Client’s state of well-being.

10. Metaparadigm – global concepts specific to a discipline

11. Novice – Nursing student or nurse entering a clinical setting with no clinical experience.

12. Nursing – A discipline from which client care interventions are provided.

13. Person – The recipient of nursing care (individuals, families, groups, and communities).

14. Proficient – Perceives a situation as a whole rather than just its individual aspects.

15. Proposition – A statement that expresses the relationship between concepts and is capable of being tested, believed, or denied.

16. Skill acquisition – The process whereby a learner progresses from slow, memory-intensive on a task, to rapid, automatic, near-error-free performance.

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17. Theory – set of interrelated concepts that guide thinking.

References

(for the Key Words and Definitions)

Johnson, T. R., Wang, H., & Zhang, J. (2005). Skill acquisition: Models. In L. Nadel, Encyclopedia of cognitive science. Hoboken, NJ: Wiley. Retrieved from http://thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=https%3A%2F%2Fsearch.credoreference.com%2Fcontent%2Fentry%2Fwileycs%2Fskill_acquisition_models%2F0%3FinstitutionId%3D6543

Theory. (2010). In A. B. Powers, Dictionary of nursing theory and research (4th ed.). New York, NY: Springer Publishing Company. Retrieved from http://thecampuscommon.com/library/ezproxy/ticketdemocs.asp?sch=suo&turl=https%3A%2F%2Fsearch.credoreference.com%2Fcontent%2Fentry%2Fspnurthres%2Ftheory%2F0%3FinstitutionId%3D6543

Kozier, B., Erb, G., Blais, K., and Wilkinson, J.M. (1995). Fundamental of nurse: Concepts, process, and practice (5th ed.). Redwood City, California: Benjamin/Cummings Publishing Company, Inc.