From Novice to Expert : Excellence and Power in Clinical Nursing Practice

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  • Edition: 1st
  • Format: Paperback
  • Copyright: 1999-06-01
  • Publisher: Prentice Hall
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Winner of the 1984 American Journal of Nursing Book of the Year Award in the Nursing Education and Nursing Research categories, this landmark work is a testimonial to the importance of nursing This book provides ideas and images that nurses can draw upon in their interactions with others and in their interpretation of what nurses do. It documents nurses' concern for their clients' welfare and comfort, as well as the care that follows that concern. Based on Dr. Benner's seminal research, From Novice to Expert uses the Dreyfus Model of Skill Acquisition to explore how nurses progress in the development of expertise. It also explains the seven domains of nursing practice: helping, teaching-coaching, diagnostic and patient monitoring, effective management of rapidly changing situations, administering and monitoring therapeutic interventions and regimens, monitoring and ensuring the quality of health care practices, and organizational and work-role competencies. It includes many clear, colorful examples from actual nursing practice, as well as a special epilogue describing how the findings of this study have been applied in five major hospitals. This book is of direct and special interest to staff development educators, nursing administrators, and nurse educators in senior-level trends and issues courses.

Table of Contents

Prefacep. xvii
Uncovering the Knowledge Embedded in Clinical Nursing Practicep. 1
Differences Between Practical and Theoretical Knowledgep. 2
Knowledge Embedded in Expertisep. 3
Extending Practical Knowledgep. 4
Common Meaningsp. 6
Assumptions, Expectations, and Setsp. 6
Paradigm Cases and Personal Knowledgep. 8
Maximsp. 10
Unplanned Practicesp. 10
Summary and Conclusionsp. 11
The Dreyfus Model of Skill Acquisition Applied to Nursingp. 13
Methodsp. 14
Interpretation of Datap. 16
Novicep. 20
Advanced Beginnerp. 22
Competentp. 25
Proficientp. 27
Expertp. 31
The Meaning of Experiencep. 36
An Interpretive Approach to Identifying and Describing Clinical Knowledgep. 39
Performance Measurementsp. 43
Identifying Domains and Competenciesp. 44
Summaryp. 46
Domains of Nursing Practicep. 46
The Helping Rolep. 47
The Healing Relationship: Creating a Climate for and Establishing a Commitment to Healingp. 49
Providing Comfort Measures and Preserving Personhood in the Face of Pain and Extreme Breakdownp. 55
Presencing: Being with a Patientp. 57
Maximizing the Patient's Participation and Control in His or Her Own Recoveryp. 58
Interpreting Kinds of Pain and Selecting Appropriate Strategies for Pain Management and Controlp. 62
Providing Comfort and Communication Through Touchp. 63
Providing Emotional and Informational Support to Patients' Familiesp. 64
Guiding Patients Through Emotional and Developmental Changep. 66
Summary and Conclusionsp. 75
The Teaching-Coaching Functionp. 77
Timing: Capturing a Patient's Readiness to Learnp. 79
Assisting Patients to Integrate the Implications of Illness and Recovery into Their Lifestylesp. 80
Eliciting and Understanding the Patient's Interpretation of His Illnessp. 84
Providing an Interpretation of the Patient's Condition and Giving a Rationale for Proceduresp. 86
The Coaching Function: Making Culturally Avoided Aspects of an Illness Approachable and Understandablep. 89
Summary and Conclusionsp. 93
The Diagnostic and Monitoring Functionp. 95
Detection and Documentation of Significant Changes in a Patient's Conditionp. 97
Providing an Early Warning Signal: Anticipating Breakdown and Deterioration Prior to Explicit Confirming Diagnostic Signsp. 100
Anticipating Problems: Future Thinkp. 102
Understanding the Particular Demands and Experiences of an Illness: Anticipating Patient Care Needsp. 104
Assessing the Patient's Potential for Wellness and for Responding to Various Treatment Strategiesp. 106
Summary and Conclusionsp. 107
Effective Management of Rapidly Changing Situationsp. 109
Skilled Performance in Extreme Life-Threatening Emergencies: Rapid Grasp of a Problemp. 110
Contingency Management: Rapid Matching of Demands and Resources in Emergency Situationsp. 113
Identifying and Managing a Patient Crisis Until Physician Assistance Is Availablep. 116
Summary and Conclusionsp. 119
Administering and Monitoring Therapeutic Interventions and Regimensp. 121
Starting and Maintaining Intravenous Therapy with Minimal Risk and Complicationsp. 122
Administering Medications Accurately and Safelyp. 125
Combating the Hazards of Immobilityp. 127
Creating a Wound-Management Strategy that Fosters Healing, Comfort, and Appropriate Drainagep. 129
Summary and Conclusionsp. 132
Monitoring and Ensuring the Quality of Health Care Practicesp. 135
Providing a Backup System to Ensure Safe Medical and Nursing Carep. 137
Assessing What Can Be Safely Omitted from or Added to Medical Ordersp. 139
Getting Appropriate and Timely Responses from Physiciansp. 142
Summary and Conclusionsp. 143
Organizational and Work-Role Competenciesp. 145
Coordinating, Ordering, and Meeting Multiple Patient Needs and Requests: Setting Prioritiesp. 146
Building and Maintaining a Therapeutic Team to Provide Optimum Therapyp. 149
Coping with Staff Shortages and High Turnoverp. 151
Summary and Conclusionsp. 160
Implications for Research and Clinical Practicep. 163
Involvement versus Distancep. 163
Nurse-Patient Relationshipsp. 165
Early Warning Signalsp. 166
Outside the Boundaries of Nursingp. 168
Monitoring and Organizational Skillsp. 169
The Phenomenon of Caringp. 170
Implications for Career Development and Educationp. 173
Career Developmentp. 174
Nursing Educationp. 184
The Quest for a New Identity and New Entitlement in Nursingp. 195
Meaningful Incentives and Reward Systemsp. 199
A Clinical Promotion Systemp. 202
Increased Collaborative Relationshipsp. 204
Increased Recognitionp. 204
Excellence and Power in Clinical Nursing Practicep. 207
Transformative Powerp. 210
Integrative Caringp. 211
Advocacyp. 212
Healing Powerp. 213
Participative/Affirmative Powerp. 213
Problem Solvingp. 214
Epilogue Practical Applicationsp. 221
Research Application: Identifying the Use and Misuse of Formal Models in Nursing Practicep. 225
Implementation of Staff Nurse III at El Camino Hospitalp. 244
Focus on Excellencep. 258
Identification of the Skilled Performance of Masters Prepared Nurses as a Method of Curriculum Planning and Evaluationp. 262
Building Bridges Between Education and Practicep. 275
Referencesp. 285
Glossaryp. 291
Appendixp. 299
Indexp. 303
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