tfn - dom

was a nursing theorist who developed the Care,
Cure, Core Model of Nursing

lydia hall

Spent her early years as a registered nurse
working for the _____________________________________________________ in
Pennsylvania and New York, where the main
focus was on preventative health.

Life Extension Institute of the
Metropolitan Life Insurance Company

worked as the first director of the Loeb Center for Nursing

lydia hall

her nursing experience was in clinical nursing,
nursing education, research, and in a supervisor role

lydia hall

graduated from New York Hospital School
of Nursing with a diploma in nursing

1927 - lydia hall

worked for the New York Heart Association

1935 - 1940 - lydia hall

became a staff nurse with the
Visiting Nurses Association of New York

1941 - 1947 - lydia hall

received master’s degree in the teaching of
natural life sciences from Columbia University

1942 - lydia hall

married Reginald A. (native of England)

1945 - lydia hall

became a professor at Teachers College at
Columbia, where she taught nursing students to
function as medical consultants

1950 - lydia hall

received the Teacher’s College Nursing

1967 - lydia hall

was inducted into the American Nurses
Association (ANA) Hall of Fame

1984 - lydia hall

achieve interpersonal relationship with individual

CARE - Body / Nursing

other members of healthcare team are
included and provides medication

CURE - Disease

patient should always be included in
making decisions

CORE - Person

gibbs reflective cycle

description, feelings, evaluation, analysis, conclusion, action plan

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

individual

The source of energy and motivation for healing is
the individual care recipient, not the health care provider

individual

emphasizes the individual’s importance as unique,
capable of growth and learning, and requiring a
total person approach

individual

can be inferred as a state of self-awareness with a
conscious selection of optimal behaviors for that
individual

health

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

health

the concept of society or environment is dealt with
concerning the individual

society and environment

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

society and environment

is identified as participating in the care, core, and
cure aspects of patient care

nursing

born in Hampton, Virginia, and spent her
childhood in California, where she received her
early and professional education

patricia benner

she obtained a baccalaureate of arts
degree from Pasadena College Major in Nursing

1964 - patricia benner

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 - patricia benner

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

1970 - patricia benner

her PhD in stress, coping, and health was
conferred at the University of California, Berkeley

1982 - patricia benner

her dissertation was published

1984 - patricia benner

achieved the position of associate
professor at the Department of Physiological
Nursing at UCSF and tenured professor

1989 - patricia benner

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

2002 - patricia benner

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

2008 - patricia benner

She is currently a Distinguished Visiting
Professor at Seattle University School of
Nursing, assisting them with a transformation
of their undergraduate and graduate curricula

patricia benner

From Novice to Expert: Excellence and Power
in Clinical Nursing Practice

1984 - patricia benner

The Primacy of Caring: Stress and Coping in
Health and Illness

1989 - patricia benner

Expertise in Nursing Practice: Caring, Clinical
Judgment, and Ethics

1996 - patricia benner

Clinical Wisdom and Interventions in Critical
Care: A Thinking-in-Action Approach

1999 - patricia benner

Identified an area of concern in clinical nursing
practice that Nurses have been delinquent in
documenting their clinical learning

CARING, CLINICAL WISDOM, AND ETHICS IN
NURSING PRACTICE

ETHICS IN NURSING CARE

autonomy, beneficence, non-maleficence, veracity, justice, fidelity, accountability

freedom (patient has own thoughts)

autonomy

act with good intentions; for the
benefit of the patient

beneficence

avoiding actions that may
cause harm to the patient; don’t compromise
the patient for own benefit

non-maleficence

acting truthfully; only make
promises you can keep

veracity

fair and refutable equity of care

justice

loyal in delivery of care

fidelity

accepting responsibility for
your own actions

accountability

Derived from the Dreyfus Model of Skill Acquisition

from novice to expert

from novice to expert

novice, advanced beginner stage, competent stage, proficient stage, expert stage

the person has no background experience of
the situation in which he or she is involved

novice

context-free rules and objective attributes must
be given to guide performance

novice

difficulty discerning between relevant and
irrelevant aspects of a situation

novice

applies to students of nursing

novice

person can demonstrate marginally acceptable performance

advanced beginner stage

coped with enough real situations to note

advanced beginner stage

to have pointed out by a mentor, the recurring
meaningful components of the situation.

advanced beginner stage

enough experience to grasp aspects of the situation

advanced beginner stage

guided by rules and are oriented by task completion

advanced beginner stage

have difficulty grasping the current patient
situation in terms of the larger perspective

advanced beginner stage

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 beginner stage

feel highly responsible for
managing patient care, yet they still rely on the
help of those who are more experienced

advanced beginner stage

most newly graduated nurses

advanced beginner stage

typified by considerable conscious and deliberate
planning that determines which aspects of current
and future situations are important and which can be ignored

competent stage

consistency, predictability, and time management
are important in competent performance. A sense
of mastery is acquired through planning and predictability

competent stage

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”

cempetent stage

may display hyper responsibility for the patient,
often more than is realistic, and may exhibit an
ever-present and critical view of the self

competent stage

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

competent stage

devises new rules and reasoning procedures for a
plan, while applying learned rules for action on the
basis of relevant facts of that situation

competent stage

is pivotal in the formation of the everyday ethical
comportment of the nurse

competent stage

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

competent stage

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

competent 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

proficient stage

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

porficient stage

no longer rely on preset goals for organization,
and they demonstrate increased confidence in
their knowledge and abilities

proficient stage

there is much more involvement with the patient and family

proficient stage

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

expert stage

having an intuitive grasp of the situation and
being able to identify the region of the problem
without losing time considering a range of
alternative diagnoses and solutions

expert stage

has the ability to recognize
patterns on the basis of deep experiential background

expert stage

meeting the patient’s
actual concerns and needs is of utmost
importance, even if it means planning and
negotiating for a change in the plan of care

expert stage

Described as a caring relationship, an
“enabling condition of connection and concern”

nursing

Caring is primary because caring sets up the
possibility of giving help and receiving help”

nursing

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

nursing

Benner and Wrubel (1989) use Heidegger’s
phenomenological description of person, which
they describe as “A person is a self-interpreting
being, that is, the person does not come into
the world 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” (p. 41). “The person is
viewed as a participant in common meanings'
'(Benner & Wrubel, 1989, p. 23).

person

Finally, the person is embodied. Benner and
Wrubel (1989) conceptualized the following four
major aspects of understanding that the person must deal with

person

four major aspects of understanding that the person must deal with:

The role of the situation, The role of the body, The role of personal concerns, The role of temporality

refers to what can be assessed

health

is the human experience of health or wholeness.

well-being

not just the absence of disease and illness.

health

is the human experience
of loss or dysfunction

illness

is what can be assessed at the physical level

disease

situation rather than environment, because
situation conveys a social environment with social
definition and meaningfulness

situation

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

situation

They use the phenomenological terms __________________ and _________________, which are defined by the person’s engaged interaction, interpretation, and understanding of the situation

being situated and situated meaning

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.

situation

was born on November 18, 1943, in Jakobstad, Finland

katie eriksson

one of the pioneers of caring science in the Nordic countries

katie eriksson

graduated Helsinki Swedish School of Nursing

1965 - katie eriksson

she completed her public health
nursing specialty education at the same institution

1967 - katie eriksson

graduated from the nursing teacher
education program at Helsinki Finnish School of Nursing

1970 - katie eriksson

received her MA degree in philosophy

1974 - katie eriksson