Practice Award and was their

Lydia Hall Nursing Hall of Fame inductee

 Was born on September 21, 1906, in New York
City as Lydia Eloise Williams and died on  1984 - Was inducted into the
February 27, 1969 at Queens Hospital in New American Nurses Association (ANA)
York Hall of Fame

 Was a nursing theorist who developed the Care, Care, Cure, Core Model Of
Cure, Core Model of Nursing Nursing

 Spent her early years as a registered nurse

working for the Life Extension Institute of the
Metropolitan Life Insurance Company in
Pennsylvania and New York, where the main
focus was on preventative health

 Worked as the first director of the Loeb Center for

Nursing

 Her nursing experience was in clinical nursing,

nursing education, research, and in a supervisory
role

Timeline
 1927 - Graduated from New York Hospital CARE - Body / Nursing
School of Nursing with a diploma in nursing
 Achieve interpersonal
relationship with individual
 1935 - 1940 - Worked for the New York Heart
Association  Solely for nurses

CURE - Disease
 1941 - 1947 - Became a staff nurse with the
Visiting Nurses Association of New York  Other members of healthcare
team are included and provides
 1942 - Received master’s degree in the teaching medication
of natural life sciences from Columbia University
CORE - Person
 1945 - Married Reginald A. Hall (native of
 Patient should always be
England) included in making decisions

 1950 - Became a professor at Teachers College at

Columbia, where she taught nursing students to
function as medical consultants

 1967 - Received the Teacher’s College

Nursing Education Alumni Association
(TCNEAA) Achievement in Nursing

Individual
 Individual human who is 16 years of age or
older and past the acute stage of long-term
illness focuses on nursing care in Hall’s work
 The source of energy and motivation for
healing is the individual care recipient, not the
health care provider
 Emphasizes the individual’s importance as
unique, capable of growth and learning, and
requiring a total person approach
Health
 Can be inferred as a state of self-awareness
with a conscious selection of optimal
behaviors for that individual
 Stresses the need to help the person explore the
meaning of his or her behavior to identify and
overcome problems through developing self-
identity and maturity
Society And Environment
 The concept of society or environment is
dealt with concerning the individual
 Interventions focus on providing an
environment that is conducive to self-
development. In such a setting, the focus of the
nurses’ action is the individual
Nursing
 Is identified as participating in the care, core,
and cure aspects of patient care
Patricia Benner
 Born in Hampton, Virginia, and spent her
childhood in California, where she
received her early and professional
education
Timeline
 1964 - she obtained a baccalaureate of
arts degree from Pasadena College
Major in Nursing
 1970 - with a rich background in
research, she began this part of her
career as a postgraduate nurse researcher
in the School of Nursing at UCSF
 1970 - earned a master’s degree in
nursing, with major emphasis in
medical-surgical nursing, from the
University of California, San Francisco
(UCSF) School of Nursing
 1982 - her PhD in stress, coping, and
health was conferred at the University of
California, Berkeley
 1984 - her dissertation was published
 1989 - achieved the position of
associate professor at the Department
of Physiological Nursing at UCSF
and tenured professor
 2002 - she moved to the Department
of Social and Behavioral Sciences at
UCSF, where she was the first
occupant of the Thelma Shobe Cook
Endowed Chair in Ethics and
Spirituality. She taught at the
doctoral and master’s levels and
served on three to four dissertation
committees per year
 2008 - retired from full-time teaching
as professor emerita from UCSF, but
continues to be involved in
presentations and consultation, as
well as writing and research projects
 7. Accountability - accepting
 She is currently a Distinguished Visiting responsibility for your own actions
Professor at Seattle University School of
Nursing, assisting them with a From Novice To Expert
transformation of their undergraduate and  Derived from the Dreyfus Model of
graduate curricula Skill Acquisition
Notable Works
 From Novice to Expert: Excellence and
Power in Clinical Nursing Practice
(1984a)

 The Primacy of Caring: Stress and Coping

in Health and Illness (1989, with Wrubel)
Novice
 Expertise in Nursing Practice: Caring,
Clinical Judgment, and Ethics (1996, with  The person has no background
Tanner and Chesla) experience of the situation in which he
or she is involved.
 Clinical Wisdom and Interventions in
Critical Care: A Thinking-in-Action
Approach (1999, with Hooper-Kyriakidis  Context-free rules and objective
& Stannard) attributes must be given to guide
performance.
Caring, Clinical Wisdom, And Ethics
In Nursing Practice
 Identified an area of concern in clinical

 Difficulty discerning between relevant

and irrelevant aspects of a situation.

 Applies to students of nursing

 nursing practice that Nurses have been Advanced Beginner Stage

delinquent in documenting their clinical
learning
Ethics In Nursing Care
1. Autonomy - freedom (patient has own
thoughts)
2. Beneficence - act with good intentions; for
the benefit of the patient
3. Non-maleficence - avoiding actions that
may cause harm to the patient; don’t
compromise the patient for own benefit
4. Veracity - acting truthfully; only make
promises you can keep
5. Justice - fair and refutable equity of care
6. Fidelity - loyal in delivery of care
 Person can demonstrate marginally
acceptable performance
 Coped with enough real situations to note
 To have pointed out by a mentor, the
recurring meaningful components of the
situation.
 Enough experience to grasp aspects of
the situation
 Guided by rules and are oriented by task
completion.

 Have difficulty grasping the current patient
situation in terms of the larger perspective.
 Clinical situations are viewed by nurses who
are in the advanced beginner stage as a test of
their abilities and the demands of the
situation placed on them rather than in terms
of patient needs and responses.
 Advanced beginners feel highly responsible
for managing patient care, yet they still rely
on the help of those who are more
experienced.
 Most newly graduated nurses
Competent Stage
 Typified by considerable conscious and
deliberate planning that determines which
aspects of current and future situations are
important and which can be ignored
 Consistency, predictability, and time
management are important in competent
performance. A sense of mastery is acquired
through planning and predictability
 The level of efficiency is increased, but “the
focus is on time management and the nurse’s
organization of the task world rather than on
timing in relation to the patient’s needs”
 May display hyper responsibility for the
patient, often more than is realistic, and may
exhibit an ever-present and critical view of
the self
 Most pivotal in clinical learning, because the
learner must begin to recognize patterns and
determine which elements of the situation
warrant attention and which can be ignored.
 Devises new rules and reasoning procedures
for a plan, while applying learned rules for
action on the basis of relevant facts of
that situation.
 is pivotal in the formation of the
everyday ethical comportment of the
nurse
 Anxiety is now more tailored to the
situation than it was at the novice or
advanced beginner
 stage, when a general anxiety exists
over learning and performing well
without making mistakes.
 Nurses at this stage feel exhilarated
when they perform well and feel
remorse when they recognize that
their performance could have been
more effective or more prescient
because they had paid attention to the
wrong things or had missed relevant
subtle signs and symptoms.
Proficient Stage
 The performer perceives the situation
as a whole (the total picture) rather
than in terms of aspects, and the
performance is guided by maxims.
 Nurses at this level demonstrate a new
ability to see changing relevance in a
situation, including recognition and
implementation of skilled responses to
the situation as it evolves.
 No longer rely on preset goals for
organization, and they demonstrate
increased confidence in their
knowledge and abilities
 At the proficient stage, there is much
more involvement with the patient and
 family. which they describe as “A person is a
self-interpreting being, that is, the person
Expert Stage does not come into the world
 The expert performer no longer relies on
analytical principle (i.e., rule, guideline,
maxim) to connect an understanding of
the situation to an appropriate action

 predefined but gets defined in the course

of living a life. A person also has . . . an
effortless and non reflective
understanding of the self in the world”
 Having an intuitive grasp of the situation (p. 41). “The person is viewed as a
and being able to identify the region of the participant in common meanings'
problem without losing time considering a '(Benner & Wrubel, 1989, p. 23).
range of alternative diagnoses and
solutions.
 Finally, the person is embodied. Benner
 The expert nurse has the ability to and Wrubel (1989) conceptualized the
recognize patterns on the basis of deep following four major aspects of
experiential background. understanding that the person must deal
with:
 For the expert nurse, meeting the patient’s
actual concerns and needs is of utmost 1) The role of the situation
importance, even if it means planning and 2) The role of the body
negotiating for a change in the plan of 3) The role of personal concerns
care. 4) The role of temporality

Nursing Health

 Described as a caring relationship, an  Health refers to what can be assessed,

“enabling condition of connection and whereas well-being is the human
concern” experience of health or wholeness.

 Caring is primary because caring sets up  Not just the absence of disease and
the possibility of giving help and illness.
receiving help”
 A person may have a disease and not
 Nursing is viewed as a caring practice experience illness, because illness is the
whose science is guided by the moral art human experience of loss or dysfunction,
and ethics of care and responsibility whereas disease is what can be assessed
at the physical level
Person
Situation
 Benner and Wrubel (1989) use Heidegger’s
phenomenological description of person,  Situation rather than environment,
 because situation conveys a social
environment with social definition and
meaningfulness.
 They use the phenomenological terms being
 situated and situated meaning, which are
defined by the person’s engaged interaction,
interpretation, and understanding of the
situation.
 Personal interpretation of the situation is
bounded by the way the individual is in it.
This means that each person’s past, present,
and future, which include her or his own
personal meanings, habits, and perspectives,
influence the current situation.
Katie Eriksson
 Was born on November 18, 1943, in
Jakobstad, Finland
 One of the pioneers of caring science in the
Nordic countries
Timeline
 1965 - graduated Helsinki Swedish
School of Nursing
 1967 - she completed her public health
nursing specialty education at the same
institution
 1970 - graduated from the nursing teacher
education program at Helsinki Finnish
School of Nursing
 1974 - received her MA degree in
philosophy
 1976 - received her licentiate degree at
the University of Helsinki
 1984 - was appointed Docent of Caring
Science (part time) at University of
Kuopio, the first
 docentship in caring science in the
Nordic countries
 1992 - was appointed Professor of
Caring Science at Åbo Akademi
University
 1996 - she has served as Director of
Nursing at Helsinki University
Central Hospital, with
responsibilities for research and
development of caring science in
connection with her professorship at
Åbo Akademi University
 1970 - 1986 - scientific career and
professional experience at Helsinki
Swedish School of Nursing
 1986 - she founded the Department
of Caring Science at Åbo Akademi
University
 1987 - directed the Department of
Caring Science at Åbo Akademi
University
Theory Of Caritative Caring
 Focuses on the idea of love and care
as Central Elements in the nursing
practice
 Emphasizes the importance of the
Nurse and patient relationship and
the role of love and healing
 Built upon the unique framework
that combines Science and
spirituality
 Caring moments – special
instances where the nurse’s love and
 care intersect with the patient’s needs
creating a profound connection
Key Principles In Caritative Caring
1) Love
 Core of the theory
 Transcending professional
boundaries
 Leading to authentic connections
2) Suffering
 Essential part of life and that nurses must
be present in order to alleviate it
3) Growth
 Patient must be encouraged to grow and
develop during their healing journey
Human Being
 Is based on the axiom that the human being is
an entity of body, soul, and spirit
 Is fundamentally a religious being
 Is fundamentally holy
 Is seen as in constant becoming; he is
constantly in change and therefore never in a
state of full completion.
 seeks a communion where he can give and
receive love, experience faith and hope, and
be aware that his existence here and now has
meaning.
Nursing
 Love and charity, or caritas, as the basic
motive of caring.
 Eriksson brings out that caring through
the ages can be seen as various
expressions of love and charity, with a
view toward alleviating suffering and
serving life and health.
 The core of the caring relationship,
between nurse and patient as described
by Eriksson (1993), is an open invitation
that contains affirmation that the other is
always welcome.
 The caring act expresses the deepest
holy element, the safeguarding of the
individual patient’s dignity.
 The ultimate goal of caring cannot be
health only; it reaches further and
includes human life in its entirety.
Because the mission of the human being
is to serve, to exist for the sake of others,
the ultimate purpose of caring is to bring
the human being back to this mission
Environment
 Good caring and true knowledge become
visible through ethos. Ethos originally
refers to home, or to the place where a
human being feels at home

Health
 Defines health as soundness, freshness,
and well-being.
 In the current axiom of health, health
implies being whole in body, soul, and
spirit. Health means as a pure concept
wholeness and holiness (Eriksson,
1984).