“The Primacy of Caring Model”

FROM NOVICE TO EXPERT

by Patricia Benner

DEFINITION OF NURSING
Nursing is concerned with the social sentiment body that dwells in finite
human worlds; that gets sick and recovers; that is altered during illness, pain
and suffering; and that engages with the world differently upon recovery.

METAPARADIGM IN NURSING

1. NURSING – enabling condition of connection and concern which shows a high

level of emotional involvement in the nurse-client relationship.

Nursing is viewed as a caring practice whose science is guided by the moral art
and ethics of care and responsibility

Person – a self-interpreting being who does not come into the world predefined but
gets defined in the course of living a life
The person must deal with:
A. The role of the situation
B. The role of the body
C. The role of personal concerns
D. The role of temporality

Health – can be defined as “what can be assessed”

Well- being – Human experiences of health or wholeness
Illness – human experience of loss or dysfunction
Disease – what can be assessed at the physical level
Environment -she used the word “situation”, It suggests a social environment with
social definition and meaning.

SKILLS ACQUISITION IN NURSING

1. NOVICE
● The person has no background experience of the situation he is involved.
● Has difficulty discerning between relevant and irrelevant aspects of the
situation.
● Level where student nurses belong!
● Context-free rules and objective attributes must be given to guide
performance.
● Nurses at higher levels can be novice if placed in unfamiliar situations.

2. ADVANCE BEGINNER
● Person has sufficient experience to easily understand aspects of the situation.
● Clinical situations are viewed as a CHALLENGE of their abilities.
● Can demonstrate marginally acceptable performance, having coped with
enough real situations to note, or to have pointed out by a mentor, the
recurring meaningful components of the situation.
● They feel more responsible for managing patient care yet still rely on those
with more experience.
● Has enough experience to grasp aspects of the situation
● They have difficulty grasping the current patient situation in terms of the larger
perspective.
● Newly graduated nurses belong to this level!
 3. COMPETENT
● Competent performance considers consistency, predictability and time
management as essential component.
● A sense of mastery is acquired through planning and predictability.
● Typified by conscious and deliberate planning that determines which aspects
of current and future situations are important and which can be ignored.
● Increase level of efficiency is evident.
● Competent nurse develops new rules and reasoning procedures for a plan
while applying learned rules.
● Competent nurse displays more responsibility for the patient.
● Active teaching and learning is significant to help nurses shift from competent
to proficient.

4.PROFICIENT
● Person perceives the situation as a whole rather than in terms of aspects.
● Performance is guided by Maxims (concise rules of conduct).
● Person identifies the most significant aspects and has a better understanding
of the situation based on background understanding.
● They no longer rely on preset goals for organization.
● They show increased confidence in their knowledge and skills.
● There is much more involvement with the patient and family.

5. EXPERT
● Person no longer relies on analytical principles like rules, guidelines and
maxims to connect her understanding of a situation to an appropriate action.
● There is INTUITIVE GRASP of the situation and as being able to identify the
region of the problem without losing time considering a range of alternative
diagnoses and solutions.
Key Aspects:
● Demonstrate a clinical grasp and resource-based practice.
● Possess embodied knowledge
● See the big picture.
● See the unexpected

DOMAINS OF NURSING PRACTICE

1. The Helping Role Domain
- Includes competencies related to establishing a healing relationship,
providing comfort measures, and inviting active patient participation and
control in care
2. The Teaching-Coaching Function Domain
- Includes timing, readying patients for learning, motivating, change, assisting
with lifestyle alterations, and negotiating agreement on goals
3. The Diagnostic and Patient-Monitoring Function Domain
- Refers to the competencies in ongoing assessment and anticipation of
outcomes
4. The Effective Management of Rapidly Changing Situations Domain
- Includes the ability to contingently match demands with resources and to
assess and manage care during crisis situations
5. The Administering and Monitoring Therapeutic Interventions and Regimens
Domain
- includes competencies related to preventing complications during drug
therapy, wound management, and hospitalization
6. The Monitoring and Ensuring the Quality of health Care Practices Domain
 - includes competencies about maintenance of safety, continuous quality
improvement, collaboration and consultation with physicians, self-evaluation,
and management of technology
7. The Organizational and Work-Role competencies Domain
- includes competencies in priority setting, team building, coordinating, and
providing for continuity