Benner’s Theory

 “From Novice to Expert.” This concept explains that nurses develop skills and an understanding
of patient care over time from a combination of a strong educational foundation and personal
experiences.
 Benner proposed that a nurse could gain knowledge and kills without actually learning a theory.
She describes this as a nurse “knowing how” without “knowing that.” She further explains that
the development of knowledge in fields such as nursing is made up of the extension of
knowledge through research and understanding through clinical experiences.
 The theory identifies five levels of nursing experience: novice, advanced beginner, competent,
proficient, and expert.
 These different levels of skills show changes in the three aspects of skilled performance:
movement from relying on abstract principles to using past experiences to guide actions; change
in the learner’s perception of situations as whole parts rather than separate pieces: passage
from a detached observer to an involved performer, engaged in the situation rather than simply
outside of it.

Novice

 The person has no background experience of the situation in which he or she is involved.
 There is a difficulty discerning between relevant and irrelevant aspects of the situation.
 Beginner to profession or nurse changing area of practice (Frisch, 2009)
 Generally, this level applies to nursing students.

These inexperienced nurses’ function at the level of instruction from nursing school. They are unable to
make the leap from the classroom lecture to individual patients. Often, they apply rules learned in
nursing school to all patients and are unable to discern individual patients needs. These nurses are
usually new to the workplace after a long absence and are re-educated in refresher programs.

Novice

A nursing student or any nurse transitioning to a new specialty

Advanced beginner

A nurse who has some experience, including mere observation

Competent

A nurse in the same setting for 2-3 years; able to anticipate & plan long term goals for specific patients

Proficient

A nurse in the same setting for more than 2-3 years; able to understand situations as a whole and makes
decisions based on previous experiences

Expert

A nurse with intuitive understanding of clinical situations; able to anticipate potential problems; can be a
mentor to other nurses
*Novice to expert scale picture*

Qualities of a Professional Nurse

N – Nobility, Knowledge

U – usefulness, Understanding

R – Righteousness, Responsibility

S – Simplicity, Sympathy

E – Efficiency, Equanimity

Types of Role

A role is a set of expectations society assumes a person in a certain position or occupation will
perform.

Role of Nurses

 Educator
 Counselor
 Collaborator
 Rehabilitator
 Comforter
 Care giver
 Decision maker
 Client protector and advocate
 Manager and coordinator
 Communicator

As a caregiver, a nurse provides hands-on care to patient in a variety of settings. That includes physical
needs, which can range from total care (doing everything for someone) to helping a patient with illness
prevention. The nurse maintains a patient’s dignity while providing knowledgeable, skilled care.

In addition, nurses care holistically

As a decision maker, is to use critical thinking skills to make decisions, set goals and promote outcomes
for a patient. These critical thinking skills include assessing the patient, identifying the problem, planning
and implementing interventions evaluating the outcomes. A nurse uses clinical judgement his or her
ability to discern what is best for the patient to determine the best course of action for the patient

As a communicator, the nurse understands the effective communication techniques can help improve
the healthcare environment. Barriers to effective communication can inhibit the healing process. The
nurse has to communicate effectively with the patient and family members as well as other members of
the healthcare team. In addition, the nurse is responsible for written communication, or patient

As an advocate, the nurse responsibility is to protect the patient’s rights. The nurse acts on the patient’s
behalf and support their decisions, standing up for his best interest at all times.
Expanded Role of Nurses

1. Advanced practice nurses

a. Clinical nurse specialists
b. Certified nurse midwife
c. Certified registered nurse anesthetist
d. Nurse practitioners
2. Nurse educator
a. Education
b. Clinical supervision
c. Role model and mentor
d. Continuing education
e. Research
3. Nurse administrator
4. Nurse researcher
a. The nurse researcher investigates problems to improve nursing care and to further
define and expand the scope of nursing practice. The nurse researcher may be
employed in an academic setting, hospital or and independent professional or
community service agency.

Four-fold Responsibilities of nurses

Responsibility Ethical principles Guidelines to be Observed

Nurses and People  Values spiritual beliefs,
and customs held by
individual
 Respect patient’s
autonomy
 Personal information
confidentiality
Nurses and Practice  Human life is inviable
 Quality in care for
patients
 Accuracy in
documentation of
actions and outcomes
of care
 Advocate to patient
 Awareness to ethic-
moral and legal
dimension of practice
Nurses and Co-workers  Maintain a collaborative
working relationship
 Consider individuality
when giving care
 Take into consideration
the spiritual beliefs (diet
and treatment) the
rights and culture of
patients.
 However, welfare and
safety must take
precedence
 Know the scope of her
practice
 Acquire and develop
necessary competence
in knowledge, skills and
attitudes
 Ensure patient’s records
 Respect “Patients Bill of
Rights”
 Maintain their
professional
role/identity while

Nurses and  Preservation of life,
Society/Environment respect for human
rights and promotion of
a healthy environment
 Establishment of
linkages with the public
in promoting local and
national and
international efforts to
meet health and social
needs of people
working with other
members
 Honor and safeguard
the dignity and
reputation of members
of nursing
 Contribute to
professional growth and
development of other
members
 Be conscious of their
obligations as citizens
 Be equipped with
knowledge of health
resources within the
community
 Project an image

Article VI Nursing Practice

SEC. 28. Scope of Nursing. — A person shall be deemed to be practicing nursing within the meaning of
this Act when he/she singly or in collaboration with another, initiates and performs nursing services to
individuals, families and communities in any health care setting. It includes, but not limited to, nursing
care during conception, labor, delivery, infancy, childhood, toddler, pre-school, school age, adolescence,
adulthood and old age. As independent practitioners, nurses are primarily responsible for the promotion
of health and prevention of illness. As members of the health team, nurses shall collaborate with other
health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of
health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be
the duty of the nurse to:

a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but
not limited to, traditional and innovative approaches, therapeutic use of self, executing health
care techniques and procedures, essential primary health care, comfort measures, health
teachings, and administration of written prescription for treatment, therapies, oral, topical and
parenteral medications, internal examination during labor in the absence of antenatal bleeding
and delivery. In case of suturing of perineal laceration, special training shall be provided
according to protocol established;
b) Establish linkages with community resources and coordination with the health team;
c) Provide health education to individuals, families and communities;
d) Teach, guide and supervise students in nursing education programs including the administration
of nursing services in varied settings such as hospitals and clinics; undertake consultation
 services; engage in such activities that require the utilization of knowledge and decision-making
skills of a registered nurse; and
e) Undertake nursing and health human resource development training and research, which shall
include, but not limited to, the development of advance nursing practice;

Provided, that this section shall not apply to nursing students who perform nursing functions
under the direct supervision of a qualified faculty: Provided, further, That in the practice of nursing in all
settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of
safe nursing practice. The nurse is required to maintain competence by continual learning through
continuing professional education to be provided by the accredited professional organization or any
recognized professional nursing organization: Provided, finally, That the program and activity for the
continuing professional education shall be submitted to and approved by the Board.

Code of Ethics

Ethical Codes are:

 Systematic guides for developing ethical behavior

 Answers normative questions of what beliefs and values should be morally accepted
 NO CODE could possibly provide absolute or complete rules without conflict and ambiguity

Ethical codes are systematic

It is a set of principles that:

a) Is shared by the members of the group

b) Reflects their moral judgements over time, and
c) Serves as standard for their professional actions

Basic concepts of the code of ethics

1. Rights – according to the Webster dictionary, a right means “something to which one has a just
claim or the power or privilege.” Nurses must be aware of these rights since sometimes patients
may refuse the nursing care that they could give
2. Autonomy Nurses must be able to accept the fact that the individual may have different cultural
and religious background that could influence his or her submission to medical procedures.
Using a written consent during such cases can protect the patient and the hospital in particular
against legal violations of invading the privacy of an individual
3. Beneficence and nonmaleficence it is very important that nursing care must do no harm
(beneficence) but rather be safe for the patient. Likewise, nursing care must also be sure enough
that it cannot lead to intentional harm (nonmaleficence)
4. Fidelity is being accountable to your actions toward each individual or group you encounter

*Insert*
BOARD OF NURSING
Board Resolution No. 220
Series of 2004
PROMULGATION OF THE CODE OF ETHICS FOR REGISTERED NURSES
Filipino Patients’ Bill of Rights

1. The patient has the right to considerate & respectful care, irrespective of socio-economic status
2. The patient has the right to obtain from his physician complete current information concerning
his diagnosis, treatment and prognosis in terms the patient can reasonably be expected to
understand. When it is not medically advisable to give such information to the patient. The
information should be made available to an appropriate person in his behalf. He has the right to
know by name or in person, the medical team responsible in coordination his care
3. The patient has the right to receive from his physician information necessary to give informed
consent prior to start of any procedure and or treatment. Except in emergencies, such
information for informed consent should include but not necessarily limited to the specific
procedure and or treatment, the medically significant risks involved, and the problem duration
of incapacitation. Where medically significant alternatives for care or treatment exists, or when
the patient requests information concerning medical alternatives, the patient has the right for
such information. The patient has also the right to know the name of the person responsible for
the procedure and/or treatment
4. The patient has the right to refuse treatment/life-giving measures, to the extent permitted by
the law and to be informed of the medical consequences of his actions
5. The patient has the right to every consideration of his privacy concerning his own medical care
program. Case discussion, consultation, examination and treatment are confidential and should
be conducted discreetly. Those not directly involved in his care must have the permission of the
patient to be present
6. The patient has the right to expect that all communication and records pertaining to his care
should be treated as confidential
7. The patient has the right that within its capacity, a hospital must make reasonable response to
the request of patient for services. The hospital must provide evaluation, service and or referral
as indicated by the urgency of care. When medically permissible a patient may be transferred to
another facility only after he has received complete information concerning the needs and the
alternatives to such transfer. The institution to which the patient is to be transferred must first
have accepted the patient for transfer
8. The patient has the right to obtain information as to any relationship of the hospital to other
health care and educational institutions in so far as his care is concerned. The patient has the
right to obtain as to the existence of any professional relationship among individuals, by name
who are treating him
9. The patient has the right to be advised if the hospital proposes to engage on or perform human
experimentation affecting his care or treatment. The patient has the right to refuse or
participate in such research projects
10. The patient has the right ot expect reasonable continuity of care; he has the right to know in
advance what appointment times the physicians are available and where. The patient has the
right to expect that the hospital will provide a mechanism whereby he is informed by his
physician or a delegate of the physician of the patient’s continuing health care requirements
following discharge
11. The patient has the right to examine and receive an examination of his bill regardless of source
of payment
 12. The patient has the right to know what hospital rules and regulations apply to his conduct as a
patient

*insert ANA nurses bill of right*

Accountability

Accountability is an obligation in health care which is also and ethical and moral responsibility. It is
important to assume responsibility for one’s own nursing practice. The American Nursing Association
(ANA) has a code that states that the nurse will assume accountability for nursing judgment and actions.

Professional accountability

Professional accountability means that the professional take decision or action not because someone
told him/her to do so, but because, having weighed up the alternative and consequence in the light of
best available knowledge, he/she believe that his is the right decision or action to take

Accountable to whom?

Watson (1995) and Clark (2000) says that the nurse is accountable to

 Patient through a duty of care, underpinned by a common-law duty to promote safety and
efficiency, and legal responsibility through civil law;
 Management as defined by your contract of employment and job description;
 Medical profession

Four main areas of nurses’ accountability

 Professional values;
 Communication and interpersonal skills;
 Nursing practice and decision-making skills; and
 Leadership, management and team working

Being morally accountable and responsible for one’s judgement and actions is central to the nurse’s
role as a moral agent. Nurses who practice with moral integrity possess a strong sense of themselves
and act in a way consistent with what they understand is the right thing to do.

5Cs’ of caring

Compassionate

 Concern
 Caring

Confident

 Assertive
 Smart

Committed

 Willingness to perform her responsibility

Conscientious

 Honest

Competent

 Knowledgeable
 Effective/Efficient