21.
To understand the role of social problems as influencing factors in the cause of
GROUP – 04 OUTLINE
21 NURSING PROBLEM THEORY:
FAYE GLENN ABDELLAH
• Faye Glenn Abdella is a celebrated nurse theorist, military nurse, and leader in
nursing research.
• She is a nursing research pioneer who developed the “Twenty-One Nursing
Problems.”
• She was the first nurse officer to rank a two-star rear admiral, the first nurse, and
the first woman to serve as a Deputy Surgeon General.
• She was born on March 13, 1919, in New York.
METAPARADIGM OF NURSING:
Person - She describes nursing recipients as individuals (and families), although she does
not delineate her beliefs or assumptions about the nature of human beings.
Environment - is included in “planning for optimum health on local, state, and
international levels.” However, as Abdellah further delineates her ideas, the focus of
nursing service is clearly the individual.
Health - She did not give a definition of health, she speaks to "total health needs" and "a
healthy state of mind and body" in her description of nursing as a comprehensive service.
Nursing - She considers nursing to be a comprehensive service that is based on art and
science and aims to help people, sick or well, cope with their health needs.
WHAT IS A NURSING PROBLEM?
The client’s health needs can be viewed as problems, overt as an apparent condition,
or covert as a hidden or concealed one.
ABDELLAH’S TYPOLOGY OF 21 NURSING PROBLEMS
3 Major Categories of 21 Nursing Problems
• Physical, sociological, and emotional needs of patients.
• Types of interpersonal relationships between the patient and nurse
• Common elements of patient care.
21 Nursing Problems
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, sleep
3. To promote safety by preventing accidents, injuries, or other trauma and
preventing the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition for all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiologic responses of the body to disease conditions—
pathologic,
physiologic, and compensatory.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory function.
12. To identify and accept positive and negative expressions, feelings, and reactions.
13. To identify and accept the interrelatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement and personal spiritual goals.
17. To create or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical, emotional,
and developmental needs
19. To accept the optimum
possible goals in the light of limitations, physical and emotional.
20. To use community resources as an aid in resolving problems that arise from an
illness.
illness.
CLASSIFICATION OF 21 NURSING PROBLEMS
❖ Basic to all patients
❖ Remedial care needs
❖ Sustenance care needs
❖ Restorative care needs
BASIC TO ALL PATIENTS
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, sleep
3. To promote safety by preventing accidents, injuries, or other trauma and preventing
the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.
SUSTENANCE CARE NEEDS
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition for all body cells.
7. To facilitate the maintenance of
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiologic responses of the body to disease conditions— pathologic,
physiologic, and compensatory.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory function.
REMEDIAL CARE NEEDS
12. To identify and accept positive and negative expressions, feelings, and reactions.
13. To identify and accept the interrelatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement and personal spiritual goals.
17. To create or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs.
RESTORATIVE CARE NEEDS
19. To accept the optimum possible goals in the light of limitations, physical and
emotional.
20. To use community resources as an aid in resolving problems that arise from an illness.
21. To understand the role of social problems as influencing factors in the cause of illness.
ADAPTATION MODEL
SISTER CALLISTA ROY
• Born on October 14, 1939
• Nursing theorist, professor, and author.
• She is known for her groundbreaking work in creating the Adaptation Model of
Nursing.
• Received her Bachelor of Arts Major in Nursing from Mount Saint Mary’s College in
Los Angeles in 1963 and her master’s degree in nursing from the University of
California.
• Began her education in sociology, receiving both a master’s degree in sociology in
1973 and a doctorate degree in sociology in 1977 from the University of California.
• Worked as a pediatric nurse and noticed a great resiliency in children and their
ability to adapt in response to major physical and psychological changes.
• Associate professor and chairperson of the Department of Nursing at Mount Saint
Mary’s College until 1982 and was promoted to the rank of professor in 1983 at
both Mount Saint Mary’s College and the University of Portland.
• Began the newly created position of resident nurse theorist at Boston College
School of Nursing.
• In 1991, she founded the Boston-Based Adaptation Research in Nursing Society
(BBARNS), which would later be renamed Roy Adaptation Association.
Metaparadigm of Nursing:
1. PERSON
An adaptive system with coping mechanisms manifested by the adaptive modes:
physiologic, self-concept, role function, and interdependence.
PHYSIOLOGIC ADAPTIVE MODE
Behavior pertaining to the physical aspect of the human system.
Determined by physiologic needs:
(Oxygenation, nutrition, elimination, activity, rest, and protection)
(The senses, fluids and electrolytes, neurologic and endocrine
functions).
SELF-CONCEPT MODE
The composite of beliefs and feelings held about oneself at a given time.
Focus on the psychological and spiritual aspects of the human system.
Need to know who one is so that one can exist with a state of unity, meaning,
and purposefulness of 2 modes (physical self and personal self)
Determined by interaction with others.
ROLE FUNCTION MODE
Set of expectation about how a person occupying one position behaves
toward another occupying another position.
Refers to the performance of duties based on given societal norms or
expectations.
BASIC NEED: social integrity.
The need role clarity of all participants in group. Example “mothering”.
INDEPENDENCE MODE
Behavior pertaining to interdependent relationships of individuals and groups.
Focus on the close relationships of people and their purpose. Each
relationship exists for some reason. Involves the willingness and ability to give
to others and accept others. Balance results in feelings of being valued and
supported by others.
BASIC NEED: a feeling of security in relationships.
Involves ways of seeking help, affection, and attention. It is also the ability to
love, respect, value and accept.
2. ENVIRONMENT
Encompasses all conditions, circumstances, and influences surrounding and
affecting the development and behavior of human as adaptive systems, with
particular considerations of person and earth resources.
ELEMENTS: stimuli from the human adaptive system and stimuli from around
the system.
3. HEALTH
A state and a process of being and becoming an integrated whole human
being.
INTEGRITY- soundness or an unimpaired condition leading to wholeness.
4. NURSING
The science and practice that expands adaptive abilities and enhances person
and environment transformation.
STIMULUS- provokes a response, a point of interaction for the human system
and the environment.
Nursing can either maintain, increase or decrease stimuli.
GOAL: to promote adaptation for individuals and groups in the four adaptive
modes, thus contributing to health, quality of life, and dying with dignity by
assessing behaviors and factors that influence adaptive abilities and by
intervening to enhance environmental interactions.
ROY ADAPTATION MODEL
• KEY CONCEPTS AND THEORETICAL ASSERTIONS
• Adaptations: the process and outcome whereby thinking and feeling
persons.
• Coping process: innate or acquired ways innate or of interacting with the
changing of environment.
(REGULATORS and COGNATORS)
• Regulator subsystem- a basic type of adaptive process that responds
automatically through
1. neural,
2. chemical, and
3. endocrine coping channels,
4. automatic response to stimulus.
• Cognator subsystem- a major coping process involving four cognitive-
emotive channels:
1. perceptual and information processing,
2. learning,
3. judgment and
4. emotion.
• Adaptive Responses: responses that promote the integrity of human system.
FIGURE 1: ADAPTIVE/EFFECTIVE RESPONSE THROUGH FOUR ADAPTATION MODELS.
• The level of adaptation of a person is determined by the COMBINED EFFECT OF
STIMULI, which could either be focal, contextual or residual.
1. FOCAL STIMULI
- The confrontation with one's internal and external environment.
- Those that immediately confront the person.
2. CONTEXTUAL STIMULI
- All other stimuli present or contributing factors in the situation.
3. RESIDUAL STIMULI
- Unknown factors such as beliefs, attitude or traits that have an
intermediate effect or influence on the present situation.
FOR EXAMPLE, the false belief that a patient cannot bathe after an
injection.
• Ineffective Response
• Response that do not contribute to the integrity of the human system.
Roy’s model revolves around the concept of man as an adaptive system. The person
scans the environment for stimuli and ultimately adapts. The nurse, as part of his
environment, assists the person in his effort to adapt by appropriately managing his
environment.
TRANSCULTURAL THEORY
MADELEINE LEININGER
- An area of study that focuses on comparative cultural care based on the BELIEFS,
PRACTICES, and VALUES of care-seeking patients.
MAIN PURPOSE: to provide both universal and culture-based nursing practices that
promote well-being and health.
BACKGROUND:
• 1948 – diploma in nursing from St. Anthony’s School of Nursing Denver, CO.
• 1950 – BS in Biological Science from Benedictine College, Atchinson, Kansas.
• 1953 – MSN from Catholic University, Washington, DC.
• 1965 – Ph.D. in Anthropology from University of Seattle.
• 1966 – offered the first course in transcultural nursing at the University of
Colorado.
• Developed her theory, Culture Care Diversity and University from a combination
of anthropology and nursing beliefs and principles.
• 1985 - first published her theory in Nursing Science Quarterly.
• 1988 – further explained her theory in the same journal
 • Madeleine Leininger was a pioneer nurse anthropologist. Appointed dean of the
University of Washington, School of Nursing in 1969, she remained in that position
until 1974.
METAPARADIGM:
Person
✓ Humans are believed to be caring and to be capable of being concerned about the
needs, well-being, and survival of others.
✓ Human care is universal, that is, seen in all cultures.
✓ Humans are universally caring beings who survive in a diversity of cultures through
their ability to provide the universality of care in a variety of ways according to
different cultures, needs, and settings.
Environment
Being represented in culture, is a major theme in Leininger’s Theory. The totality
of an event, situation, or experience.
Health
• Health system, health care practices, changing health patterns, health promotion,
and health maintenance.
• Health is an important concept in transcultural nursing.
• Health is viewed as being universal across cultures but defined within each culture
in a manner that reflects the beliefs, values, and practices of a particular culture.
• Heath is both universal and diverse.
Nursing
Nursing as a profession has a societal mandate to serve people and, as a discipline,
is expected to discover, develop and use knowledge distinctive to nursing focus
on human care and caring.
TRANSCULTURAL NURSING MODEL
Transcultural Nursing is how professional nursing interacts with the concept of culture.
Based on ANTHROPOLOGY AND NURSING, it is supported by theory, research and
practice. Leininger’s theory is to provide care measures that are in harmony with an
individual or group’s cultural beliefs, practices, and values. In the 1960’S she coined the
term CULTURALLY CONGRUENT CARE, which is the primary goal of transcultural
nursing practice. Culturally congruent care is possible when the following occurs within
the NURSE-CLIENT RELATIONSHIPS.
THEORY ASSUMPTIONS:
Leininger postulated several theoretical assumptions or basic beliefs, designed to assist
researchers in exploring Western and non-western cultures.
1. Care is the essence and the central dominant, distinct, and unifying focus of nursing.
2. Humanistic and scientific care is essential for human growth, well-being, health,
survival, and facing death and disabilities.
3. Care (caring) is essential to curing or healing, for there can be no cursing without
caring.
4. Culture care is the synthesis of two major constructs that guide the researcher to
discover, explain, and account for health, well-being, care expressions, and other
human condition.
5. Culture care expressions, meanings, patterns, processes, and structural forms are
diverse, but some commonalities (universalities) exist among and between cultures.
6. Culture care values, beliefs, and practices are influenced by and embedded in the
worldview, social structure factors (e.g., religion, philosophy of life, kinship, politics,
economics, education, technology, and cultural values), and ethnohistorical and
environmental contexts.
7. Every culture has generic (lay, folk, naturalistic mainly emic) and usually some
professional (ethic) care to be discovered and used for culturally congruent care
practices.
8. Culturally congruent and therapeutic care occurs when cultural care values, beliefs,
expressions, and patterns are explicitly known and used appropriately, sensitively, and
meaningfully with people of diverse or similar cultures.
9. The three modes of care offer therapeutic ways to help people of diverse cultures.
10. Qualitative research paradigmatic methods offer important means to discover
largely embedded, covert, epistemic, and ontological culture care knowledge and
practices.
11. Transcultural nursing is a discipline with a body of knowledge and practices to
attain and maintain the goal of culturally congruent care for health and well-being.
ORIENTATIONAL THEORY DEFINITIONS
- Leininger used orientational (not operational) definitions for her theory to allow
the researcher to discern previously unknown phenomena or ideas. Orientational
terms allow discovery and are usually congruent with the client’s lifeways.
a. CULTURE – the learned, shared, and transmitted values, beliefs, norms, and
lifeways of a particular group that guides their thinking, decisions, and actions in
patterned ways and often intergenerationally.
b. CARE - those assistive, supportive, and enabling experiences or ideas toward
others with evident or anticipated needs to ameliorate or improve a human
condition or lifeway. Caring refers to actions, attitudes, and practices to assist or
help others toward healing and well-being. Care is both an abstract and a concrete
phenomenon.
c. CULTURE CARE – subjectively and objectively learned and transmitted values,
beliefs, and patterned lifeways that assist, support, facilitate, or enable another
individual or group to maintain well-being and health, to improve their human
condition and lifeways, or to deal with illness, handicaps, or death.
d. CULTURE CARE DIVERSITY – the differences or variabilities among human beings
with respect to culture care meanings, patterns, values, lifeways, symbols, or other
features related to providing beneficial care to clients of a designated culture.
e. CULTURE CARE UNIVERSALITY – the commonly shared or similar culture care
phenomena features of human beings with recurrent meanings, patterns, values,
lifeways, or symbols that serve as a guide for caregivers to provide assistive,
supportive, facilitative, or enabling people to care for healthy outcomes.
f. PROFESSIONAL (ETIC) CARE – formal and explicit cognitively learned professional
care knowledge and practices obtained generally through educational institutions.
They are taught to nurses and others to provide assistive, supportive, enabling, or
facilitative acts for or to another individual or group in order to improve their
health, prevent illnesses, or help with dying or other human conditions.
g. GENERAL (EMIC) CARE – the learned and transmitted to lay, indigenous,
traditional, or local folk knowledge and practices to provide assistive, supportive,
enabling, and facilitative acts for or toward evident or anticipated health needs in
order to improve well-being or to help with dying or other human conditions.
h. CULTURE CARE PRESERVATION AND/OR MAINTENANCE – those assistive,
supportive, facilitative, or enabling professional acts or decisions that help cultures
to retain, preserve, or maintain beneficial care beliefs and values or to face
handicaps and death.
i. CULTURE CARE ACCOMMODATION AND/OR NEGOTIATION – those assistive,
facilitative, or enabling creative provider care actions or decisions that facilitate
adaptation to or negotiations with others for culturally congruent, safe, and
effective, care for their health, well-being, or to deal with illness or death.
j. CULTURE CARE REPATTERNING AND/OR RESTRUCTURING – those assistive,
supportive, facilitative, or enabling professional actions and mutual decisions that
help people to reorder, change, modify or restructure their lifeways and institutions
for better (or beneficial) health- care pattern, practices, or outcomes. These
patterns are mutually established between caregivers and receivers.
k. ETHNOHISTORY – the past facts, events, instances, and experiences of human
beings, groups, cultures, and institutions that occur over time in particular contexts
that help explain past and current lifeways about culture care influences of health
and well-being or the death of people.

l. ENVIRONMENTAL CONTEXT – the totality of an event, situation, or particular
experience that gives meaning to people’s expressions, interpretations, and social
interactions within particular geophysical, ecological, spiritual, socio-political, and
technological factors in specific cultural settings.
m. WORLDVIEW – the way people tend to look out on their world or their universe
to form a picture or value stance about life or the world around them. Cultural and
social structure factors, religion (spirituality): kinship (socialites); politics; legal
issues; education; economics; technology; political factors; philosophy of life; and
cultural beliefs and values with gender and class difference. The theorist has
predicted that these DIVERSE FACTORS must be understood as they directly or
indirectly influence health and well-being.
n. CULTURALLY CONGRUENT CARE – culturally based care knowledge, acts, and
decisions used in sensitive and knowledgeable ways to appropriately and
meaningfully fit the cultural values, beliefs, and lifeways of clients for their health
and well-being, or to prevent illness, disabilities, or death.
THE SUNRISE ENABLER: A CONCEPTUAL GUIDE TO KNOWLEDGE DISCOVERY
➢ Developed to provide a holistic and comprehensive conceptual picture of the major
factors influencing culture care diversity and universality.
➢ The enabler serves as a cognitive guide for the researcher to reflect different
predicted influences on culturally-based care.
➢ Can be used as a valuable aid in the cultural and healthcare assessment of clients.
PHILOSOPHY AND SCIENCE OF CARING
BY: MARGARET JEAN WATSON
• Born in WEST VIRGINIA
• 1966 – BSN;
• 1973 – Ph.D. in Psychology and Counselling.
• 1979 – Philosophy and Science of Caring
Metaparadigm:
Person – a valued person in and of him or herself to be cared for, respected, nurtured,
understood, and assisted; in general, a philosophical view of a person as a fully function
integrated self. He, human is viewed as greater than and different from, the sum of his
or her parts.
Health – WHO definitions
THREE ELEMENTS OF HEALTH:
1. high level of overall physical, mental, and social functioning.
2. A general adaptive maintenance level of daily functioning.
3. The absence of lines (or the presence of efforts that leads in absence).
Environment – caring has existed in every society; a caring attitude is not transmitted
from generation to generation; transmitted by the culture of the professional as a unique
way of coping with the environment.
Nursing – concerned with promoting health, preventing illness, caring for the sick, and
restoring health; focuses on health promotion and treatment of disease. She believes that
holistic health care is central to the practice of caring in nursing; a human science of
persons and human health-illness experience that are meditate by professional,
personal, scientific, esthetic and ethical human transactions.
CARING AS THE ESSENCE OF NURSING:
Caring connotes responsiveness between the nurse and person.
The purpose of caring is to assist the person in gaining control and becoming
knowledgeable, and in the process, promote health changes.
The concept is common to Filipino culture; “kakayahan” or “patibayin ang kakayahan”
meaning assisting the person in gaining control.
MAJOR CONCEPTUAL ELEMENTS OF WATSON’S THEORY:
1. Carative Factors-evolving toward the “Clinical Caritas Processes.
2. Transpersonal Caring Moment.
3. Caring moment / Caring Occasion.
10 CARATIVE:
1. FORMATION OF A HUMANISTIC ALTRUISTIC VALUE SYSTEM:
- the value of altruism (regard for others as a personal (action) is learned at
early age. Caring based on humanistic value and altruistic behavior “can be
developed through an examination of one’s own views beliefs interactions
with various cultures and personal growth experience.” This development is
perceived as necessary for the nurse’s own maturation.
2. INSTALLATION OF FAITH-HOPE
The use of FAITH-HOPE as a nursing intervention allows nurses to explore
alternative methods of healing, like meditation. The goal for this activity is
the provision of a sense of well-being through belief system that are
meaningful to the client.
3. CULTIVATION OF SENSITIVITY TO SELF AND OTHERS
Nurses promote “health and higher-level functioning only when they perform
person-to-person relationship as opposed to manipulative relationships.
There is a need for the nurse to develop and examine one’s own feelings. They
become honest and promotes self-growth and self-actualization. Watson
state, that “the highest level of nursing, the nurse’s human care responses,
human care transactions, and presence in the relationship transcend the
physical material world.”
4.DEVELOPEMNT OF A HELPING-TRUST RELATIONSHIP
COMMUNICATION, both verbal and non-verbal, is a mode of accomplishing a
helping-trust relationship to establish rapport and caring. Characteristics
common to this carative factor are CONGRUENCE, EMPATHY, WARMTH, and
HONESTY. Positive acceptance of another is most often expressed by body
language, touch, and tone of voice. I’m sure that given your clinical
experiences, you can think of many situations to relate to this fourth carative
factor.
5. PROMOTION AND ACCEPTANCE OF THE EXPRESSION OF POSITIVE AND NEGATIVE
FEELINGS.
According to Watson, it is important to facilitate awareness of both negative
and positive feelings to be considered in a caring environment. Being aware of
both positive and negative feelings leads to a better understanding of
behavior.
6. SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING METHOD FOR DECISION-
MAKING
This factor gives notice to the limitations nurses have in assessing the issue of
developing a scientific base because most of the time is dedicated to the
performance of nursing tasks such as procedures and treatments. Thus,
recognition is given to the use of the systematic problem-solving method in
building nursing knowledge. In the same way, the argument extends to other
methods of knowing like utilizing research-based findings in order to improve
nursing practice and holistic care.
7. PROMOTION OF INTERPERSONAL TEACHING-LEARNING
Through this factor, persons (clients) gain control over their own health
because it provides them with both information and alternatives. Learning
offers opportunities to individualize information dissemination. The caring
nurse focuses on the clients perception of the situation. This provides for a
cognitive plan workable within the client’s frame of reference.

8. PROVISIONS FOR A SUPPORTIVE, PROTECTIVE, AND (OR) CORRECTIVE MENTAL,
PHYSICAL, SOCIOCULTURAL, AND SPIRITUAL ENVIRONMENT.
There are two divisions or categorizations relative to this factor: external
variables (physical, safety, and environmental factors); Internal variables
(mental, spiritual, or cultural activities which the nurse may manipulate for
the person’s well-being). Interdependence exists between internal and
external factors since the person perceives the situation in the environment
as either threatening or non-threatening.
9. ASSISTANCE WITH THE GRATIFICATION OF HUMAN NEEDS.
The hierarchy of human needs is the essence of this carative factors. It is
grounded in a hierarchy of needs similar to that of Maslow’s. Watson has
created a hierarchy which she believes is relevant to the science of caring in
nursing. According to her, each need is equally important for quality nursing
care and the promotion of optimal health. All the needs deserve to be
attended to and valued.
10. ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL-SPIRITUAL FORCES
PHENOMENOLOGY is a way of understanding people from the way things
appear to them, from their frame of reference. EXISTENTIAL PSYCHOLOGY is
the study of human existence using phenomenology is the study of human
existence using phenomenological analysis. This factor helps the nurse to
reconcile and mediate the incongruity of viewing the person holistically while
at the same time attending to the hierarchical ordering of need thus assists
the person to fin the strength or courage to confront life or death.
ORDERING OF NEEDS AS PROPOSED by Watson, 1979.
TRANSPERSONAL CARING RELATIONSHIPS:
A special kind of human relationship that depends on:
1. Nurse’s commitment to protecting and enhancing human dignity and a
deeper/higher self.
2. Nurse’s caring consciousness to preserve and honor the embodied spirit
there by not reducing the patient to moral status of an object.
NOVICE TO EXPERT
PATRICIA BENNER
Background of the Theorist
• Life born in 1942 in Hampton, Virginia, and spent her childhood in California.
• Married to Richard Benner in 1967; they have a son and a daughter.
• Professional Bachelor degree in nursing from Pasadena College, in 1964.
• Master in medical-surgical nursing from the University of California, San Francisco
(UCSF), in 1970.
• Ph.D. – from the University of California Berkeley in 1982.
• 1985, Benner was inducted into the American Academy of nurses.
• Benner retired from full-time teaching in 2008 as a professor from the University
of California, San Francisco (UCSF) She is currently a Distinguished Visiting
Professor at Seattle University School of Nursing.
• Published nine books and numerous articles.
Metaparadigm of Nursing
1. Person
- The person is a self-interpreting being; that is, the person who does not
come into the world predefined but gets defined in the course of living a life.
2. Health
-Dr. Benner focuses on the lived experience of being healthy and being ill.
Health is defined as what can be assessed, whereas well-being is the human
experience of health or wholeness. Well-being and being ill are understood
as distinct ways of being in the world.
3. Environment
-Benner uses situation rather than environment because situation conveys a
social environment with social definition and meaningfulness. “To be
situated implies that one has a past, present, and future and that all of these
aspects…influence the current situation”.
4. Nursing
-Nursing is described as a caring relationship, an “enabling condition of
connection and concern.” -” Caring is primary because caring sets up the
possibility of giving and receiving help.”
-Nursing is viewed as a caring practice whose science is guided by the moral
art and ethics of care and responsibility. -Benner understands that nursing
practice is the care and study of the lived experience of health, illness, and
disease and the relationships among the three elements.
5 Levels of Capabilities, according to Benner
1. Novice
-The person has no background experience of the situation in which he or she
is involved.
-There is difficulty discerning between relevant and irrelevant aspects of the
situation.
-Generally, this level applies to nursing students.
2. Advanced Beginner
-The advance beginner stage develops when the person can demonstrate
marginally acceptable performance having coped with enough real situations
to note, or to have pointed out by the mentor, the recurring meaningful
components of the situations.
-Nurses function at this level is guided by rules and oriented by task
completion.
3. Competent
-The competent stage is the 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.
4. Proficient
-The performer perceives the information as a whole (total picture) rather
than in terms of aspects and performance.
5. Expert
-The fifth stage is achieved when “the expert performer no longer relies on
analytical principals to connect her or his understanding of the situation to an
appropriate action.