Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics » (2nd Edition)

Patricia Benner, RN, PhD, FAAN, is Professor of nursing in the Department of Social and Behavioral Sciences Nursing at the University of California, San Francisco. She is a fellow in the American Academy of Nursing and an Honorary Fellow in the Royal College of Nursing, United Kingdom. Dr. Benner is the author of From Novice to Expert: Excellence and Power in Clinical Nursing Practice which has been translated into 8 languages and provides the background for this research; co-authored with Judith Wrubel The Primacy of Caring, Stress and Coping in Health and Illness; is editor of the book Interpretive Phenomenology: Caring, Ethics and Embodiment in Health and Illness, and Clinical Wisdom and Interventions in Critical Care: A Thinking-in-Action Approach, Benner,P, Hooper- Kyriakidis,, P and Stannard, D. A forthcoming book. By Patricia Benner, Molly Sutphen, Vickie Leonard Kahn and LisaDay, Educating Nurses: Teaching and Learning a Complex Practice of Care reports findings from The Carnegie Foundation for the Advancement of Teaching National Nursing Education Study.

Christine A. Tanner, RN, PhD, FAAN, is the Youmans-Spaulding Distinguished Professor of Nursing, School of Nursing, Oregon Health & Science University in Portland, Oregon. She has conducted research on clinical judgment in nursing for over two decades, resulting in the publication of numerous journal articles and books. She is the Senior Editor for the Journal of Nursing Education. Since the mid 1980's she has been an outspoken advocate for nursing education reform, Most recently, she has worked with a team of nurse educators to develop, implement and evaluate the innovative Oregon Consortium for Nursing Education. (OCNE). She is currently the PI or CO-PI on two studies of this work, one focused on the outcomes of the OCNE curriculum, supported by grants from the Meyer Memorial Trust and the Robert Wood Johnson Foundation and a second focused on the effectiveness of a transformed clinical education model, supported by grants from Kaiser Permanente, the Northwest Health Foundation, the Ford Family Foundation, and Department of Education Fund for Improvement of Post-Secondary Education.

Catherine A. Chesla, RN, DNSc, FAAN is professor in the Department of Family Health Care Nursing, University of California, San Francisco. She teaches family theory and research, family intervention and interpretive research methods to graduate nursing students. In her research, she examines family responses over time to the chronic illness of a member, using interpretive phenomenological approaches, mixed methods and Community Based Participatory Research. She has published research and methodological articles in journals such as Diabetes Care, Journal of Family Nursing, and Research in Nursing & Health. Currently, she is working with a multi-disciplinary research team on an interpretive study of family practices in type 2 diabetes comparing foreign-born and US-born Chinese Americans. She is also beginning a Community Based Participatory Research Project with members of the Chinese community to improve diabetes care for this ethnic group.

Nursing practice is a complex and varied field that requires precision, dedication, care, and expertise. Clinicians must have both the skills and the tools to attend to changes in patients' responses, recognize trends, and understand the nature of their patients' conditions over time.

This book clearly delineates the skills needed to become an expert nurse. In this new edition, the editors present a report of a six-year study of over 1,300 hospital nurses working in critical care. Expanding upon the study conducted in the previous edition, this new book documents and analyzes hundreds of new clinical narratives that track the development of clinical skill acquisition, including caring, clinical judgment, workplace ethics, and more.

Highlights of this book:

• Includes transitional guidance for nurses new to the field
  
• Discusses the primacy of caring and the importance of good clinical judgment
  
• Includes new practice models, including the Dreyfus Model of Skill Acquisition
  
• Provides guidelines for strengthening the nurse-patient relationship
  
• Presents implications for nursing education and patient safety
  

Ultimately, this work defines expertise in nursing practice. The book serves as a valuable resource that will enable nurses to expand their knowledge base, cultivate their clinical skills, and become successful experts in nursing practice.

Contributors vii

Acknowledgements ix

Introduction xiii

1 The Relationship of Theory and Practice in the Acquisition of Skill Hubert L. Dreyfus Stuart E. Dreyfus 1

2 Entering the Field: Advanced Beginner Practice 25

3 The Competent Stage: A Time of Analysis, Planning, and Confrontation 61

4 Proficiency: A Transition to Expertise 103

5 Expert Practice 137

6 Impediments to the Development of Clinical Knowledge and Ethical Judgment in Critical Care Nursing Jane Rubin 171

7 Clinical Judgment 199

8 The Social Embeddedness of Knowledge 233

9 The Primacy of Caring and the Role of Experience, Narrative, and Community in Clinical and Ethical Expertise 279

10 Implications of the Phenomenology of Expertise for Teaching and Learning Everyday Skillful Ethical Comportment Hubert L. Dreyfus Stuart E. Dreyfus Patricia Benner 309

11 The Nurse-Physician Relationship: Negotiating Clinical Knowledge 335

12 Implications for Basic Nursing Education 369

13 Implications for Nursing Administration and Practice 405

Appendix A Background and Method 435

Appendix B Description of Nurse Informants 463

Appendix C Background Questions for Interviews and Observations 465

References 471

Index 491