Benner Model

8 August 2016

This paper will discuss the role of caring along with the Benner model’s seven domains and my level of proficiency in each domain. Each level of proficiency will be explored to show my strengths as a professional and also areas that I could improve on as a professional nurse. With the areas that need improvement I will show support through supportive rationale with a research article. I will describe how I plan on gaining proficiency in my area of needed improvement, all while using critical thinking and written communication skills. Role of caring The role of caring as a registered nurse is an ever changing role.

We as nurses must find the time to wear several different hats throughout the day even sometimes multiple hats at one time are needed to care for the patient at hand. Nursing theorist Jean Watson defines caring as a humanitarian science, and offers ten behaviors that demonstrate that. They are, in descending order: attentive listening, comfort, honesty, patience, responsibility, providing information so that the patient can make an informed decision, touch, sensitivity, respect, and calling the patient by name (Vance 2009). These are the multiple hats we as nurses must wear throughout the care of our patients.

Benner Model Essay Example

They are not complicated, but yet to the patient they make them feel like a real person rather than just another patient in a bed. As I practice nursing on an almost daily basis I utilize the different roles and adapt to the needs of my patient based on their needs. Every patient you come across has a different perspective on the care they are to receive, have received or received already. Not only am I as a nurse adapting to the patients most prominent needs, I am also adapting, overcoming and helping the patient’s family with their needs as well. Caring goes beyond just the patient.

It goes to the whole support system who is involved in the care of the patient. As I see it, you cannot help a patient to heal if one he/she is not cared for, and two if he/she’s support system is not cared for. The most important thing I do as a nurse, or so I think, is when I walk into the patients room I ask them their name (to identify I have the right patient) but then I also ask the patient what he/she likes to be called so I am not offending them with a nickname or with a name like “Honey”. By doing this I make the patient feel like they are in control and often times this can help them to be more open in their needs.

Benner model domains and level of proficiency Benner discusses seven domains; The helping role, the teaching-coaching function, the diagnostic and patient monitoring function, effective management of rapidly changing situations, administering and monitoring therapeutic interventions and regimens, monitoring and ensuring the quality of healthcare practiced, and organizational work role competencies. Within each domain you can be at a different stage depending on your experience level and your professional stage. These stages range from novice to expert. Novice is one who is unfamiliar with a situation and needs complete guidance.

This would be someone who is still in nursing school, or a very recent graduate. The next step up is advanced beginner. These people have relevant knowledge of the situation, but are still guided by the rules. These individuals still have a hard time grasping the whole picture. These would be your new floor nurses who don’t have a lot of experience on their own. Next is competent. These people have the ability to plan appropriately and discern which aspects are relevant verses irrelevant. They have the ability to alter rules as the situation warrants them.

These nurses would be your nurses who have over a year of hands on experience and feel confident in their patient care. After competent comes proficient, with this stage, skills have matured exponentially and they have the ability to ascertain information from subtly changes. This individual has begun the implementation of intuition to assist the skill set. These would be your nurses with three plus years of experience. Lastly we have the stage of expert. With this stage the ability to fully utilize intuition without the need for reliance on contemplating alternatives for diagnosis and treatment is met. These are your seasoned nurses.

The ones who know what to do and how to do things without help from anyone else. These nurses are usually the best to learn information from and best to help the novice stage. Helping role In the helping role, I find myself to be in the proficient stage, although my nursing career is still fresh and new I have always found the need to help people. Before I began my career journey to become a registered nurse, I was a nurse’s aide for three years. I learned so much from the expert nurses at that time of what I aspired to be when I finally did achieve my goal and get my registered nurse degree and license.

Just the ease of listening to a patient for those five extra seconds to let them voice their concerns, helps the patient feel very involved in their own care. Helping a patient is also helping the family that comes along with that said patient. I recall working one night in an emergency room when a little Amish family came in. The child they brought was not breathing so well and had a blue tint to him. The triage nurse rushed the child back to a room and asked the parents to wait in the waiting room until they got the boy stable. The look on the mothers face was that of agony.

I asked her if she needed anything while she waited. Her response was, “I just need someone to sit and pray with me”. Now my beliefs may not be that same of hers but I did just that. I sat next to her while she said her prayers and just that little gesture made her feel the care she and her family were receiving was extraordinary. It was not a good outcome for the boy, but when they ended up leaving the mother did stop and give me a hug and said “Thank you for everything you have done”. It was a moment I will never forget. Teaching-coaching role

In the teaching-coaching function domain, I find myself to be in the proficient stage. I am the kind of person who whole heartedly believes the saying “see one, do one, teach one”. I can remember my very first time watching a seasoned registered nurse start an intravenous catheter (IV) on a patient and by just observing and asking questions while she started the line I have been able to start an IV on the first try every time on a patient. After starting probably thousands of IV’s I have been able to teach new persons the technique that I have learned and how to feel confident in maintaining the vein.

Little things like starting an IV may not seem difficult, but the first few times as a brand new nurse I know how some can feel, and help calm their nerves with little extra techniques I have acquired through observing and asking questions. With the model of “see one, do one, teach one” I have found through my own experience that a hands on approach to learning is the best way for myself and other fellow nurses to gain the required knowledge of this profession. We as nurses are the patient advocate and are always hands on with the patient and their needs.

Diagnostic and patient monitoring function Diagnostic and patient monitoring function I find myself to be in the advanced beginner/ competent level. Depending on the situation at hand I feel I am in the end stages of advanced beginner and the beginning stages of competent. When it comes to “plain old” medical surgical patients I feel very confident in the diagnostic and monitoring functions, but when it comes to critical care or trauma patients I have a hard time with cardiac monitoring and some of the critical lab work just by a quick look at them to determine what is wrong with the patient.

I am sure over time and working in the emergency room longer with training and hands on I will move up in the competencies. I understand my cardiac rhythms on paper when I am able to sit down and count the little boxes and look thoroughly at the strip, but to just stand next to the monitor bed side I find it difficult to pick up on some rhythms.

Along with the laboratory values, I can pick up on the critical values and that something is off, but to look at for instance blood gases, I cannot just glance at it and determine whether they are in metabolic or respiratory acidosis, alkalosis and compensating or non-compensating, unless I sit down and figure out the values. Effective management of rapidly changing situations Effective management of rapidly changing situations I find myself to be in the competent level. I was in the military for five and a half years and I know all too well that situations can change at any given time.

I am now a registered nurse in a remote area hospital that does not have all the latest technology or services available to patients. When I came into nursing, I knew I wanted to be in a critical care area or an emergency room. I love the adrenaline rush that comes with the changing situations. Even though that gets my adrenaline pumping I still know how to keep a cool and calm manner to be able to critically think and help resolve the situation quickly and in the best nature for the patient. I love the fast pace and ever changing patients in an emergency room and the fact that time does matter for patient care in this area.

I can recall a patient who came to our emergency room for sudden onset of headaches. To many headaches are a daily occurrence and we don’t think much of them. But for this young lady who was 24 weeks pregnant with her third child, I just got that gut feeling something was not right. The doctor ran tests and ordered blood work, but since we are such a rural area and have limited resources the doctor thought it was best to just send her home. Before she was discharged I ran one last set of vitals on her and as I was doing this she started to have a seizure.

I recognized this as her having toxemia and knew she needed more care. With my judgment I was able to convince the emergency room doctor that she needed further care and she was transferred to Women and Children’s Hospital of Buffalo for further evaluation. It turned out she was very toxic and ended up delivering the baby the next night at 24 weeks and 5 days. Both mother and baby did very well and are both now at home well and recovering. Administering and monitoring therapeutic interventions and regimens Administering and monitoring therapeutic interventions and regimens I find myself to be in the advanced beginner stage.

I have not had a lot of experience with patients who are monitored over a course of a treatment to watch and maintain their levels therapeutically. I do however know that certain drugs cause certain issues for patients when they get out of therapeutic range and how to educate patients on those issues. I believe this is more of a primary physician’s office with say Coumadin and prothrombin time levels. In the hospital we only see patients for a very short period of time, and as we do try to keep their levels normal and therapeutic, we also don’t follow the patient closely enough like a primary doctor’s office would.

I do recall monitoring a patients lithium levels for therapeutic ranges while they were admitted to the hospital. This patient was brought to the emergency department for what appeared to be a stroke. He had slurred speech, confusion, dizziness, and ataxia or in-coordination of his arms and legs. We started a work up on him and soon found from his blood levels and past medical history that the patient had elevated lithium levels and this is what was causing these stroke like symptoms. We closely monitored this patient and admitted him to the medical/surgical floor for further evaluation and monitoring.

Monitoring and ensuring the quality of health care practices Monitoring and ensuring the quality of health care practiced, I find myself to be in the competent stage. I see firsthand “old timers” who have become very complacent in the way they work and the way they do certain interventions. Being a recent graduate who is working in an emergency department, I know first had that complacency is never good. The simplest things like washing your hands, or wearing gloves to start IV’s is not only in the policies for the hospitals safety but it’s in place for the safety of me as a nurse and the patient as well.

I know I never want to take any infectious disease home to my family and by monitoring and ensuring my practices in health care are done properly it is going to keep myself and my family safe. After watching these “old time” nurses remove one finger from a glove to start an IV and then watching the same nurse have to go through a series of testing because she had an exposure to the needle and was not safe guarded by the policy and procedures we have in place, was enough for me to learn her lesson and always wear gloves regardless of how hard it is to feel the veins.

I would rather miss an IV start than have to go through the series of testing and the unknown of whether the patient has an infectious disease or not. Organizational work role competencies Organizational work role competencies, I believe I am in the advanced beginner stage. I have only been working with the hospital I work in for about 6 months. Every hospital or healthcare provider has different work role competencies and organizational sets. I believe I follow the hospital’s competencies well but over time I will learn all of them and the extent of them and this will help me better myself as a professional.

As time goes on every nurse, myself included, learns the policies and procedures for the establishment they are working in. It may happen by a course of remediation or from seeing another co-worker not following the rules and get reprimanded, but eventually over time, I will become more proficient at the organizational work role competencies. I do find myself in alignment with my hospitals core values already though. I find this to be an important aspect to a place of employment and employee retention. If your values are not the same as those of the establishment you work in, it becomes very difficult.

My place of employments core values are; Compassion, dignity, integrity, excellence, stewardship and social responsibility. In compassion they inspire hope and bring comfort to those they serve by caring for their physical, spiritual, and social needs. For dignity they respect the sacred worth and diversity of each person. Integrity they demonstrate through their daily actions, the courage to speak and act honestly. Excellence is shown by their commitment to improving quality in all that they do. Stewardship is managing human, environmental, and financial resources responsibly.

Social responsibility they are called to serve each other, protecting the rights of all while advocating for the poor and vulnerable. All of which I strongly believe in and practice. Professional Strengths/Area for improvement As nursing is an ever changing profession with new technologies and new advances, I find myself to be strengthened in my career with the ability to adapt and over come. Every hospital system has a different computer operating system they use to document patient care and medication administration. Ever hospital has a different time or way of charting, whether it is positive charting or negative charting only.

Whether you have to scan a patient’s identification bracelet before giving medications or not is different at every facility. This is where I believe both my strength and weakness or area for improvement lay. I am not very computer savvy when it comes to learning new systems and sort of get stuck in my ways about how charting should be done. In the article “Use of the electronic medical record for trauma resuscitations: How does this impact documentation completeness” it explains in detail the problems we as emergency room nurses run into while caring for critical or trauma patients and the completeness of our electronic charting.

When you are in a critical or trauma setting you care more about caring for the actual patient then about the computer system at hand. When it comes to the charting on these patients, it is very helpful to have one nurse designated to charting and documentation alone. This nurse usually will write in on a progress note all the times things are happening and medications or interventions are given or performed. This way the nurse in charge of that patient can go back and document accurately the times and events in the computer system. The only downfall with this method is if the documenting nurse misses something, or forgets to write it down.

Myself personally would rather have the time to care for the patient and worry about the documentation later. In the organizational work role competency, I believe this is the reason I find myself to be an advanced beginner and need for the most improvement. Some ways I have found for improvement in myself and to help advance my career as a professional registered nurse and maintain a competent proficiency level in all categories are to continue my education. In the computer world and advancing technologies there are many classes and different help classes that can assist in the growing knowledge of the computer world.

I would continue my daily use of the computer system and ask questions when I was unsure of where or how to chart something. In the article “Risk assessment in the electronic age: application of the circle of caring model”, it shows how using electronic charting in the mental health field is difficult as the assessment tool is not very accurate. The article goes on to discuss how nurses have helped to change the way the assessment tool functions and helped adapt the new way of charting for the facility. This is an important component to electronic charting, as we the nurses are the ones using the system day in and day out.

Our feedback is what will help the health informatics technicians to change the program and be more realistic in our daily care of the patients. As a professional nurse I have always completed the surveys that come around asking what we like or don’t like about the computer system, or what changes would we make. Some things I understand are in the system a certain way and cannot be changed, but I have seen firsthand things are changed to accommodate the working nurses’ needs of charting. Professional goals Just as health care is changing, my professional goals are ever changing as well.

I have the urge to learn. I have the need to acquire as much knowledge as I can and my ultimate goal is to become a nurse practitioner in an emergency room or trauma center. I love the fast pace of the emergency room and with that love and my passion to continue learning I hope this goal is obtainable. The only thing holding me back from this goal is my other goals in life such as family. When you have two young children and another on the way, as much as my love for learning and my drive can push me professionally I have to look at what is best for both professional and family life.

Summary In this paper I discussed the role of caring along with the Benner model’s seven domains and my level of proficiency in each domain. Each level of proficiency was explored to show my strengths as a professional and also areas that I could improve on as a professional nurse. With the areas that need improvement I showed support through supportive rationale with a research article. I described how I plan on gaining proficiency in my area of needed improvement, all while using critical thinking and written communication skills. Conclusion

I enjoyed writing this paper to see the areas of my professional career that need more tender loving care and educational backings. I will one day obtain my professional goal of nurse practitioner and continue my career in the health care field. I enjoy the rewards of helping a patient or a family member of the patient in all aspects of their health needs, whether it be someone to just listen to them, or that person who helps bring their loved one back to life. I enjoy the fast paced of the emergency room even if it means computer charting and scanning patients for medication administration.

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