In the discipline of nursing, professional advancement and development models are often used as frameworks for recognizing and acknowledging nurses’ clinical expertise, especially the nurses who provide direct care to patients (Gentile, 2012). Most of the earlier models revolved around the tasks that nurses were expected to become familiar with and master as their careers progressed. However, subsequent models went beyond the element of tasks and incorporated elements of leadership, continues education and reflective practice (Gentile, 2012). One of these models is Benner’s Novice to Expert model. This model applies the Dreyfus Model of Skill Acquisition and describes five levels of expertise through which nurses go through in their nursing experience. These five levels are; novice, advanced beginner, competent, proficient and expert. Novice is the basic level of expertise and is generally characterized by rigid adherence to regulations and rules and zero use of discretionary judgment because the nurse at this level has virtually no experience (Hoffman et al., 2009). The final and indeed the most accomplished level is the expert where a nurse is able to use both intuition as well a deep level of skills to grasp and assess situations, envision what is possible and make accurate and rational judgments. The model also consists of seven domains each which has various types of competencies, (Hoffman et al., 2009). On a personal level, I believe that I am in the competent stage. I have the ability to rely on long term plans and goals when assessing veracious situations. I also exhibit a feeling that I have the masters as we’ll as the ability to cope with various contingencies that may arise in the course of practice.
Personal Application of Benner’s 7 Domains of Practice
The Helping Role
Last year, I had the opportunity to care for sick children in the pediatric section of the hospital where I was stationed. During this time, I interacted and came across many sick children, some who were just a few days old. There was however one particular experience that stood out for me. This experienced touched my life as through it; I was able to make a difference in the life of a patient and personally improved as a nurse.
During my second week at the pediatric section, I was assigned a two weeks old baby who had been admitted to the hospital some few days before. The baby was named Judith and from the moment I laid eyes on her, I realized that she was one of the cutest baby I have across in my nursing practice. She was lying in her bed as I approached her, and her eyes lit up when I got close. She then cracked a very wide smile and at that moment; I knew that I would do anything to help this baby get back to normal health. Baby Judith was however very sick, and I had just caught her at some point of relief because no sooner had she stopped smiling that she started coughing so badly, and I realized just how sick she was. Judith had been diagnosed with an acute case of whooping cough. I was then told by one of attending nurses that Judith’s mother was a 16 year old high school student who showed absolutely no regard for her child and had only brought the child to hospital after intensive pushing by her parents. At this point, I realized that baby Judith needed my help more than never, and I was not just going to be a nurse to her but a helper.
I picked baby Judith up and loving ran my finger across very pretty face promising her that I was going to do everything to assist her. Over the next days as Judith continued getting her treatment, our bond got closer. It was obvious that she was not used to being held so lovingly and whenever I made my way to her bed, her brown eyes would lit up and she would hold her hands out where I would then pick her, up, cuddle her and rock her gently. It was at this moment that I was starting to realize just how much this child longed for affection. I was so attached, and I even grew over protective of her. I virtually took over all the duties of caring for her including feeding, playing and changing her. One day, after a brief assignment out of the unit, I met a new nurse who had just been assigned to the unit and had removed Judith from her bed and was feeding her while holding in a very dangerous manner. I almost snapped at her but I stopped myself and simply took baby Judith before proceeding to feed her myself.
Judith remained in the care unit for a total of three weeks by which she had recovered. The difference I made in her life was incredulous. I was not only her nurse but also her helper. In fact, my care for Judith is synonymous with the “the helping role” competencies described by Benner (2001). One of the competencies is providing communication and comfort through touch. Judith was only a few weeks old, and she could not talk. As a competent nurse, I knew that the only way I could communicate and comfort her was through my actions, especially my touch. I frequently reached out to her, ran my finger over her face, played with her comforted her and essentially showed her affection and love which she had obviously been missing from her own mother. I was able to do this because of all my experiences in nursing that has taught me how to deal with various situations. Another competency of the helping role is that of presence where a nurse takes a lot of time to be with the patient. I was with baby Judith for many hours because I knew the being with her was comforting and the emotional support I provided her with would play a great role in her recovery. My determination to keep Judith safe was a sign of my advocacy for her which is itself an element of power in clinical nursing as described by Benner. In all this, I was guided my relative belief and a feeling of mastery for patient care and my understanding that providing comfort, love and affection is one of the best ways of helping a patient.
Diagnostic/ Monitoring Function
According to Benner (2001), in spite of a nurse’s best efforts in a clinical setting. It may sometimes be impossible to avoid a patient’s deterioration or even the emergence of critical moments. It is crucial that a nurse has vigilant or wary assessment skills that can help to identify some of the warning signs of the potential deterioration. A few months ago, a young boy of about 10 years old was brought to the hospital suffering several traumatic injuries after having been involved in accident with his father while they were coming home from a baseball game. The father had managed to escape unscathed, but the child had suffered multiple injuries on vital body parts. The boy had fractured ribs, subdural hematoma and his pelvic bones had been broken. The boy’s condition seemed to deteriorate throughout the night, for instance; his blood pressure dropped to about 72/55 mm/Hg. Mitigating measures were taken at after some time, it appeared that deterioration had stopped. My colleagues seemed to be relaxed but from personal experience; I knew that this was far from over. The critical condition made me know that there could be a potential crisis in regard to the patient, and being the formal nurse assigned to the care of this patient, my care plan focused on vigilant and in fact a continuous assessment of the boy to make sure that if his condition changed for the negative, at any instance, I would be there to notice it. This is in line with the domain of diagnosis and monitoring function that has been forwarded by Benner (2001). Although, I had other duties and patients to attend to, I made sure that I stayed in close proximity to this patient. The next morning, a nurse had told me that the previous night, the boy had told her as she was administering medicine not to leave him and ensure that he did not fall asleep and that the boy had been very anxious. Given that the respiratory status of the boy had been compromised from the accident, I suspected the occurrence of hypoxemia since anxiousness is one of the common symptoms of this condition. According to Bennner (2001), one of the critical components of the diagnostic and monitoring domain is the ability to think about the future according to the current status of the patient and anticipate future problems and because of this, I made my way to the boy to make further assessment. As I started assessing the boy for his oxygen saturation and respiratory rate, he suddenly woke up, took a huge gasp of air and started shaking violently. His eyes also rolled back and forth. I quickly checked his blood pressure and desperately placed my hand on him to feel for a pulse. The blood pressure of the patient read zero, and I could hear a pulse. It was then that I took matters into my own hands. I initiated a comprehensive resuscitation process including CPR and chest compressions as I also called out for help. I did not panic for once, and I was determined to do the best I could utilizing concepts from both my education and experience to provide the best of care to this parent. After two minutes of intensive resuscitation efforts, the boy’s pulse started reading once again, and the blood pressure started returning to normal. It was because of my vigilant assessment and monitoring that the life of the patient was saved this day, and I, therefore, exhibited a competency in regard to Benner’s diagnosis and monitoring domain.
During the last few weeks of last summer, I had the opportunity to provide care to an 11-year-old boy. John was a 7th grader who had been brought to undergo a surgical operation to remove a tumor that had been growing in his brain. He was accompanied by his parents, and when I first met him, I was captivated by his enthusiasm for life. John was a majestic athlete despite his age, and both he and his parents had great hopes for him in regards to athletics. Both envisioned him playing in the NFL. Therefore, one primary issue of concern was how the surgery would affect John’s chances of seeing his NFL dream come to fruition. John’s mother was particular very emotional and even as we continued talking, she frequently burst into tears and asked me to promise that her boy would be alright. I knew that in accordance with Benners (2001), domain of teaching and coaching, I had to effectively teach and coach the patient as well as his parents about the details of the procedure and address all the concerns that they had. I also realized that I would not just address John’s immediate patient needs, but I would also need to address them from a personal level. The parents were also counting on me not just to explain fully about the condition but also to coach them on how to take care of their soon once he recovered. In accordance with the domain of teaching and coaching, I actualized consistency in providing the patient as well as his parents the details of the surgery that he was about to undergo in order to alleviate their worries and doubts. By using therapeutic communication techniques, I was essentially able to connect to the great fear and worry held by the patient and his parents and be able to alleviate these fears.
It emerges that Benner’s theory has been a huge component of my nursing practice. As I have continuously utilized some of the domains of this theory in my practice, it has enabled me to asses my level of expertise. It has helped me to establish any points of weakness and areas that I may need to augment on. As I continue moving towards the expert level of expertise, I plan to utilize Benner’s domains even further in order to provide the best of care to my patients and improve overall health outcomes.
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative Edition ed.). Upper Saddle River, New Jersey: Prentice Hall Health.
Gentile, D. L. (2012). Applying the novice-to-expert model to infusion nursing. Journal of Infusion Nursing, 35(2), 101-107.
Hoffman, K. A., Aitken, L. M., & Duffield, C. (2009). A comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbal protocol analysis. International journal of nursing studies, 46(10), 1335-1344.