TFN M 3

• Patricia Benner


  • Born in Hampton, Virginia
  • Obtained a baccalaureate of arts degree from Pasadena College in 1964
  • Earned Master's degree in Nursing with major emphasis in medical-surgical nursing from University of California, San Francisco, School of Nursing
  • Has a wide range of clinical experience, including acute medical-surgical, critical care and home health care
  • Noted that experience-based skill acquisition is safer and quicker when it is founded on a sound educational base
• Patricia Benner: '"Nursing is a caring relationship and practice that cares for and studies the lived experiences of patients on health, illness, and disease, and the relationships among these three elements."'
• Patricia Benner: '"The nurse - patient relationship is not a uniform, professionalized blueprint but rather a kaleidoscope of intimacy and distance in some of the most dramatic, poignant, and mundane moments of life"'
• Dreyfus Model


  Situational model that describes the five levels of skill acquisition and development: Novice (0 to 1 year), Advanced Beginner (1 to 2 years), Competent (2 to 3 years), Proficient (3 to 5 years), Expert (>5 years)

  
• Skill


  Nursing interventions and clinical judgment skills in actual clinical situations
• Expertise


  Developed when the clinician tests and modifies principle-based expectations in the actual setting
• Novice Stage


  • Characterized by a person who lacks background experience of the situation
  • Will usually have difficulty differentiating relevant and irrelevant aspects of a situation
  • Examples are nursing students and professional nurses who have been assigned to an area totally different from the one they are accustomed to
• Competent Nurse


  • Exhibits considerable conscious and deliberate planning which determines the important aspects of present and future situations
  • Exhibits a sense of mastery, increased level of efficiency, consistency, predictability, and time management
• Proficient Nurse


  • Already has a holistic view of a particular situation
  • The nurse's performance is guided by maxims by this stage
  • Can already show an intuitive grasp of the situation based on background understanding
  • Can see changing relevance in a given situation including recognition and implementation of skilled responses to the situation as it evolves
• Expert Nurse


  • Does not rely anymore on the analytical principles of rules, guidelines, and maxims to connect her understanding of the situation to an appropriate action
  • Demonstrates a clinical grasp and resource-based practice
  • Possesses embodied know-how
  • Sees the big picture
  • Sees the unexpected
• Competency


  An interpretively defined area of skilled performance identified and described by its intent, functions, and meanings
• Experience


  The active process of refining and changing preconceived theories, notions, and ideas when confronted with actual situations; it reflects that there is communication between what is found in practice and what is expected
• Maxim


  A mysterious description of skilled performance that requires a certain level of experience to recognize the implications of the instructions

  
• Paradigm case


  A clinical experience that stands out and alters the way the nurse will perceive and understand and open new clinical viewpoints and alternatives
• Hermeneutics


  Interpretive; it describes meaningful human activities or phenomena in a careful and detailed manner, based purely on practical understanding of the phenomena
• Nursing (Benner's theory)


  • Described as a caring relationship and practice that cares for and studies the lived experiences of patients on health, illness, and disease, and the relationships among these three elements
• Person (Benner's theory)


  • Viewed as a self-interpreting being who gets defined in the course of living a life, has an effortless and non-reflective understanding of the self in the world, and is a participant in common meanings and is embodied
• Health (Benner's theory)


  • Defined as what can be assessed, with well-being as the human experience of health or wholeness, and illness as the human lived experience of loss of function or dysfunction
• Environment (Benner's theory)


  • Described as situations, the social environment with a social definition and meaningfulness, where each person's past, present, and future, including their own personal meanings, habits, and perspectives, influence the present situation
• Embodiment (Benner's theory)


  • The body's capacity to respond to meaningful situations with 5 dimensions: the unborn complex, the habitual skilled body, the projective body, the actual projected body, and the phenomenal body
• Marilyn Anne Ray


  • Went to LA, CA to work at OB-Gyn, ER, CCU in 1958
  • Became a US Citizen and served in the US Air Force as a flight nurse, clinician, administrator, educator, researcher with a rank of Colonel, and was the first nurse to go to the Soviet Union with the Aerospace Medical association
  • Earned a BSN-MSN in MCN at the University of Colorado, where she was influenced by Dr. Madeleine Leininger, a nurse anthropologist
  • Appointed as an Eminent Scholar at Florida Atlantic University and continues as Professor Emeritus
  • Her research interests continue to focus on nurses, nurse administrators and patients in critical care and intermediate care, and in nursing administration in complex hospital organizational cultures
• Theoretical sources of Marilyn Anne Ray's theory

  • Dr. Leininger's transcultural nursing and ethnographic-ethnonursing research methods
  • Hegel's positing of the interrelationship among thesis, antithesis, and synthesis
  • Chaos Theory, which describes simultaneous order and disorder, and order within disorder
• Holography


  Everything is a whole in one context and a part in another, with each part being in the whole and the whole being in the part
• Caring (Ray's theory)


  A complex transcultural, relational process grounded in an ethical, spiritual context (charity and right action, love as compassion in response to suffering and need and justice or fairness of what to be done)
• Spirituality (Ray's theory)


  Involves creativity and choice and is revealed in attachment, love, and community
• Structures of caring (Ray's theory)

  • Educational
  • Physical
  • Social-Cultural
  • Legal
  • Technological
  • Economic
  • Political

  
• Nursing (Ray's theory)


  • Holistic, relational, spiritual and ethical caring that seeks the good of self and others in complex community, organizational and bureaucratic cultures
• Person (Ray's theory)


  • A spiritual and cultural being, created by God, the Mystery of Being, and engaging co-creatively to find meaning and value
• Health (Ray's theory)


  • Provides a pattern of meaning for individuals, families, and communities, with beliefs and caring practices about illness and health as central features of culture
• Environment (Ray's theory)


  • A complex spiritual, ethical, ecological, and cultural phenomenon that embodies knowledge and conscience about the beauty of life forms and symbolic systems or patterns of meaning, which are transmitted historically and preserved or changed through caring values, attitudes, and communication

  
• Implications of Ray's theory

  • Clarity: Major structures are defined clearly, consistent with definitions commonly used by practicing nurses
  • Simplicity: The theory simplifies the dynamics of complex bureaucratic organizations
  • Generality: The theory addresses the nature of nursing as caring
  • Accessibility: Has undergone continued revisions based largely on research, with high empirical precision and concepts grounded in observable reality
  • Importance: Addresses issues that confront nurses today, including economic constraints in the managed care environment and the effects of these constraints on the nurse-patient relationship
• Unborn complex


  The fetus and newborn baby does not yet have any signs of the effects of culture
• Habitual skilled body


  The body language of a person as he learned through time by the processes of identification, imitation, and trial and error
• Projective body


  The predetermined action of the body in response to a situation; for example, walking or running
• Actual projected body


  The body's capacity to fit or be skilled in a given situation; for example, driving an automobile
• Phenomenal body


  The body's awareness of itself and its ability to imagine and describe touch sensations