# data[].attributes.body
Born in Hampton, Virginia

August 1942

Bachelor’s degree in Nursing (BSN)

Pasadena College 1964

Master’s in nursing (MSN)

Medical-Surgical Nursing

University of California, San Francisco,1970

Ph.D

University of California, Berkeley 1982

Associate Professor Department of Physiological Nursing

University of California, San Francisco

Internationally known as

lecturer

researcher on health

theorist: influenced clinical practice and clinical ethics

Director Carnegie Foundation for the Advancement of Teaching National Nursing Education Study

findings presented in book

"Educating Nurses: A Call for Radical Transformation" 2010

Chief Faculty Development Officer for Educating Nurses Videos

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Patricia Benner, R.N., Ph.D., FAAN

John Benner, Ph.D. Candidate, School of Education, University of Washington, Seattle

June 9, 2020

With the COVID-19 Pandemic, nurse educators must transform in-classroom teaching and learning to online learning. Understanding how students learn is the starting point for all teaching and learning, regardless of how a course is taught. Joshua Eyler (2018) notes that learning sciences have determined that " curiosity, sociality, emotion, authenticity, and failure " are essential for learning. These vital sources in education are challenges for online learning but can be deliberately designed into augmented forms of online learning. We can solve significant online difficulties such as sustained engagement, retention, and low-performance outcomes if we attend to curiosity, sociality, emotion, and authenticity. We recommend that all online design strategies be guided by current learning science and incorporate these five essential aspects of learning in any modality.

Affordances and Constraints of Online Learning

As with any context, there are affordances and constraints to a given learning context, be it a small discussion group, a lecture, an apprenticeship, or an online nursing class. With the advent of easy-to-use online meeting platforms combined with commonly used asynchronous learning management systems (like Canvas, or even Educating Nurses!), a wide range of options are unavailable to in-person instruction. With these advances, we may think that the constraints of in-person education and training magically vanish in a technological solution. The research shows that a more nuanced understanding of online learning is required. In the chapter on digital learning in the book How People Learn II, Learners, Contexts, and Cultures (National Academies of Sciences, Engineering, and Medicine, 2018), the authors identify the following affordances of digital learning:

Interactivity: Technologies that respond to the actions of the learner, such as online simulations or online discussions or chats with instructors and classmates, create a higher level of engagement, as the learner becomes an active participant. Viewing videos or reading materials are not interactive because the learners have no impact on the learning material, and information flows only from material to learner.

Adaptivity: The capacity for the technology to adjust to learner choices and behaviors. An example of this would be clinical simulations where patient outcomes change over time, according to student responses. This is different from a quiz or other form of assessment that does not vary depending on responses given. Situated cognition and knowledge-use can be learned with this enriched situated feedback based upon the student's interventions, actions, and evaluation of the outcomes.

Feedback: Like in-person learning, instructors can give rapid feedback to student responses, guiding them towards deeper understanding as in the case of online discussion boards. Technologies can also be designed to provide feedback on clinical decisions in simulations and alert instructors to knowledge gaps evidenced in practice, which supports a closer relationship between assessment and instruction. Programs providing analytics that demonstrate where the student's responses indicate mistakes and knowledge gaps can be a powerful source of learning. Students with similar knowledge gaps or misunderstandings can be gathered in a chat room or online discussion group to clarify the knowledge gaps or misconceptions.

Choice and Non-Linear Access: Digital learning can provide learners with a range of choices to modify their experience according to their needs and interests. Options include adjusting the pace of learning, the timing of when and what material is learned, the order that learning tasks are completed, and even the possibility of extending knowledge beyond provided course materials through independent research.

Open-Ended Learner Input: Digital technologies allow learners a wider range of across multiple modalities. Beyond writing papers or answering quizzes, learners can express themselves and learn through drawings, writing, video presentations, chat discussions, and even the creation of memes to convey concepts. For example, here is a meme about sepsis a nurse blogger created: https://licensetonurse.com/post/178344157906)

Communication: With the advent of Zoom, Skype, and Google Meet, online meetings are now accessible and allow additional opportunities for students to meet and collaborate beyond discussion boards or text-based chats. Students can also react in real-time with questions delivered via text. Also, creating breakout groups can allow small group learning.

As with any context, unique affordances bring distinct constraints. The most apparent digital learning constraint, of course, is access to the technology itself. The digital divide and access to high-speed internet is an ongoing problem in rural areas and impoverished urban areas. Low-income students are also less likely to have access to the technological requirements to participate fully in online learning. Additionally, there are the constraints that come with learning to navigate new technologies, a challenge for both professors and students alike (as those of us who have struggled with a Zoom connection or website crash can attest). Even if students have access to flawless technology, online learning spaces bring their challenges. Online learning can also cultivate a sense of isolation when peers are only able to connect superficially. They can create a disconnect between content and context when they rely on Cartesian epistemologies, such as an outdated information processing computer model of the mind (Dreyfus, 1986). They can limit learner agency and curiosity by restricting student expression to responses to quizzes or simulations. They can also be an avenue to distraction, as the same tool that we use to learn on, we use for entertainment, and the context cues to attend and learn that place-based learning affords are missing. Mitigate these constraints through thoughtful design and the application of evidence-based instructional strategies.

Teaching for Curiosity and Discovery.

Teachers and students can create strategies and climates that foster curiosity, engagement, and ownership for learning. In the following interview, H.L. Dreyfus contrasts teaching for learning that fosters curiosity, inquiry, and teaching to deliver well-delineated concepts and content.

This full video is only available to our members but please enjoy our preview below.

Dreyfus considered himself foremost as a learner. Openness and curiosity were evident in his interactions with students. In his full interview on mastery in teaching-learning, he genuinely seeks to learn from his students with each encounter with philosophical texts. Because Professor Dreyfus was such an engaged, curious learner, his students modeled his style of curiosity and learning. As teachers, we do well to consider how our form of teaching-learning influences our student's education.

Eyler (2018) notes that findings from the learning sciences show that inquiry-oriented approaches and fostering curiosity should be central to any pedagogical approach. Designing and imagining that teaching-learning equals telling and information-giving fails to stimulate student learning and dampens students' curiosity. Inquiry must be central to any course design. In the Carnegie Study of Nursing Education (Benner, Sutphen, Leonard-Kahn, & Day, 2010), we found that nursing faculty often had single, correct answers in mind, and engaged in "call and response" forms of questioning, rather than asking inquiry-oriented open-ended questions. Single correct answers do not lend themselves to authentic inquiry nor to fostering curiosity and discovery. Eyler (2018) points out:

An easy way to change fact-based questions to questions that will help generate discussion is to ask ourselves, "So what?" every time we come up with something, we want to ask our students. If we have developed a closed-ended question, this instigation will provide the impetus to change our question into something that addresses significance rather than memorized material (Eyler, 2018, pp. 47-48).

While open-ended and why questions are essential to stimulating curiosity and inquiry, questions should not be so broad or so open-ended that students do not engage in a focused discussion. Such discussions can be so open that student's responses are too unrelated or disconnected from one another.

When we revert to the default Cartesian paradigm of learning, online instructional activities can often devolve into passive forms of learning. For example, students watch videos of lectures or do assigned readings and then may be assigned single answer multiple-choice questions that do not require curiosity, creativity, or authentic inquiry. When we imagine learning as occurring only in the head, we see students as isolated receptacles of information, rather than what they are in the process of becoming: contributing members of healthcare teams and a wider community of practice of nurses. In online or in-person spaces, we must give students relevant experiences that do not just require knowledge of the content, but also the capacity to evaluate complex situations and identify salient information out of a cluttered field of information. Clinical practice is nuanced and collaborative, so it is essential to create online learning situations that duplicate that complexity and provide feedback to help student nurses learn to interpret and act productively.

Essential questions organize each field, and nursing and health care are no different. Most clinical courses require that the students learn to engage in situated clinical reasoning and consider what is most salient for recognizing changes in patients and the most urgent priorities for patient care interventions. What might be early warnings that a patient's clinical condition is changing? What responses are most critical for patient safety and rescue? How can "never events" be avoided? What are patient/family concerns in a particular clinical situation? How does the patient/family understand the illness conditions, the most important therapeutic interventions, and the typical course of treatment, recovery/rehabilitation? The patient's clinical condition necessarily spawns the most relevant questions and approaches in caring for the patient.

Sociality, Attunement, Moods, and Embodiment

Increasingly the importance of social learning is emphasized in learning sciences (Bandura, 1977; Vygotsky, L.S., 1980; Barkley, Cross, and Howel Major; 2005, Walton & Cohen, 2011; ) Learning is contagious and sparked by the curiosity, engagement, questions, and ideas of other learners. Dreyfus (2009) noted:

Certain classroom conditions lead to proficiency, e.g., where the teacher and learner sense that they are taking risks in each other's presence, and each can count on criticism from the other [in the Dreyfus Model of Skill Acquisition]. Additionally, only by acting in the real world can one acquire expertise (Dreyfus, 2009, Location, 1921, Kindle) ...meaningful distinctions require commitment and vulnerability, which require our embodied finitude [situatedness and engagement]. (Dreyfus, 2009, Location, 1933, Kindle).

Online discussions and collaborative projects can increase students' engagement, risk-taking, and create stakes in learning. Lee Shulman, former President of The Carnegie Foundation, noted that one of the greatest learning disabilities of students is the invisibility of the student to the teacher and to one another. It takes extra planning and effort to get to know students in online learning, but it is an effort that yields engagement, retention, and greater learning outcomes.

The sociality, and sense of belonging calls for an understanding that the social is prior to the private individual, and involves a refutation of a Cartesian, representational view of the mind, a rebuttal currently strong in the neuro-sciences of learning (See Dreyfus, 2009). In summarizing research on virtual communities of practice, Ardichvili (2008) identified the following as essential to cultivating engagement in online learning communities: promoting members' sense of belonging to the community, fostering conditions for an open, uninhibited exchange of ideas and information, by creating time and space for exchanging stories and expertise, and by teaching community members about the value of storytelling and how to develop and share stories. The research shows that online or in-person learning is dependent on trust and positive social interaction. In both settings, nurse educators should strive to create a learning community that fosters these qualities.

Social moods, such as a shared climate of curiosity and interest, come before the individual's own emotions, and are what open learners up to common disclosive spaces of understanding and commonly held meanings. Attunement to emotions and moods shared by others is central to perception and shared understanding and action. The mind is not separate from the embodied, embedded, intelligent agent engaged in the world. Situated learning is particular and central to any practice discipline such as nursing, medicine, teaching, and so on.

One challenge for designing online learning is creating highly interactive, social learning from peers. It is equally challenging to create online learning for the engaged, embodied intelligent agent (Taylor, 2016). Clinical reasoning about particular patients requires an engaged, embodied intelligent agent for a deep understanding of unfolding complex clinical situations. No one algorithm for decision making can replace the engaged sequential understanding of the intelligent, agent-practitioner in multifaceted, multicausal clinical situations. Passive, single answer or call and response instruction online or in-person fail to provide these kinds of critical experiences that nurses need to enter the profession.

One strategy to encourage a sense of community and sense of belonging in asynchronous contexts is to use video messages. Short, five to six-minute personalized messages from faculty to students and from students to class members can be very effective for increasing a sense of belonging and social connection. Faculty videos should be warm and engaging, and informal, reflecting the faculty styles of learning and engagements. These do not have to be highly polished but should be thought out in terms of learning goals and current topics in the class. These videos should show gestures, movement, posture, and stances to convey the teacher's embodied connection with the subject matter and with the students.

During the reign of cognitivism (Dreyfus & Dreyfus, 1988), a view of the mind as an information processing computer, the role of emotions as the portal for attentiveness, perception, and learning were all but ignored. In the information processing model of the mind, emotion was seen as disruptive "noise" that interfered with rationality and thinking. While it is true that emotions such as fear, alienation stemming from a sense of not belonging, and other disruptive emotions do block perception and learning. Perception and learning, however, do require positive emotions related to openness and receptivity, attunement, and concern. Additionally, the emotions accompanying curiosity, such as excitement and engagement, are essential for perception and learning. These positive emotions are linked to rationality, discernment, and judgment (Damasio, 1994; Dreyfus, 1992; 2009).

Strategies for including emotions such as openness, responsiveness, excitement, etc. include designing assignments that use short student videos about new insights gained, changes in understanding as a result of the course, assignments, discussions, or readings. These classroom disclosures about student learning, discoveries, changes in understanding will infuse the class with a contagion for learning and engagement. Another effective strategy is the use of first-person-near narratives about clinical learning (Benner, Hooper-Kyriakidis, Stannard, 2011). In these narratives, students are encouraged to share their concerns, questions, emotional responses, and questions. The narratives should not be overly prescribed, but instead framed in terms of new insights about clinical care, a story of excellence, or practice breakdown or a situation where the student learned something new. Context-free categories do not easily evoke memory (e.g., "Tell a story about ambulating a patient"), is less effective in evoking narrative memory than a story of significance such as "Can you describe a time when you were really worried about a patient?". Usually emotional tones, and significance trigger memory more effectively than formal categories or classes of events. Emotional openness and significance (mattering) are required for noticing, and noticing comes before any assessment can begin (Damasio, 2005; Benner & Wrubel, 1989). Emotion is a gateway for perception, attunement, and more. Objectified, removed, decontextualized information is not quickly learned nor remembered. It lacks emotional connection, embodiment, and situatedness. Adding significance and positive emotions of engagement and connection make online learning more salient and exciting (Brown, Collins, Duguid, 1989).

Authenticity

The authenticity of students and faculty is more readily discerned in face-to-face seminars and classrooms. Cognitive authenticity is central to learning (Eyder, Herrington & Herrington, 2007 ) Eyler notes:

Deep learning demands authenticity, and it is no different with college students....Like babies, we continue to learn the most from realistic problems and authentic scenarios....This kind of learning requires what some have called situated cognition. Cognition is situated insofar as it is heavily dependent on context and environment (Eyler, p. 153-154).

Authenticity has to be demonstrated and designed into online learning. Again, short faculty videos showing personal connections with the lesson are beneficial. Students' narratives and accounts of learning can make learning real and connected with the person's goals. We have many discussions about "socialization" in professional education, and fewer about the engaged learner trying to become who and what they need to be in order to be a good nurse, doctor, or teacher, i.e., formation and ethical comportment (Benner, Sutphen, Leonard-Kahn, & Day, 2010). Formation, developing ethical comportment in practice, requires more than role messages from team members. The student nurse must engage in personal insight about how they need to change to meet the challenges of being a good nurse in specific clinical situations. Demonstrating your authentic concerns about learning, giving real examples of making a medication error, or being able to be present in the face of patient-family suffering show more than "knowing that" or "knowing about," it demonstrates "knowing how and when," as well as "situated thinking in action". Authentic examples demonstrate how you embody your practice, your ability to take risks in the face of challenging situations, your genuine concern for patient/family welfare. Disclosing real upending learning experiences in practice can be powerful (Kerdeman, D. 2004). Gadamer (1975) points out that "experience," if counts as experience, and not just mean passage of time, it requires changing one's pre-understandings, beliefs, expectations, i.e., being turned around or upended in situations. We will speak to this further in the section on learning from failure. Grabinger, Dunlap, and Dunlap (1995) note:

...we consistently rely on decontextualized instructional strategies. In our desire to cover as much material as possible, we focus our instructional activities on abstract basic skills, concepts, and technical definitions. We believe that decontextualized skills have broad applicability and are unaffected by the activities or environments in which they are acquired and used. However, when we do this, students do not learn when to apply [use] those skills or within what kinds of contexts they work (Grabinger and Dunlap, 1995, p. 7)

We rely on generalization across diseases and context to reduce repetition and content in our courses. However, this approach to streamlining material covered has its limits. In practice disciplines, situated cognition, and an understanding of commonalities between situations, along with a dialogue between the particular case and the general, such as a population statistic, are central to all clinical reasoning, which is a form of practical reasoning: Clinical reasoning requires: "Reasoning across time through changes in the particular and or, changes in clinician's understanding of the situation" (Benner, Hooper-Kyriakidis, Stannard, 2011). Deep learning, situated cognition, knowing how and when, require higher-order thinking based upon experiential learning. Productive, situated use of knowledge requires more than the mere application of knowledge (e.g., the technique of measuring blood pressure). Higher-order, productive thinking requires the situated interpretation of particular blood pressures for particular patients across time.

Authenticity in teaching and learning requires the critical importance of authentic caring (Benner & Wrubel, 1989; Gordon et al., 1996; Valenzuela, 1999), not just for nurses in practice, but also by nursing educators for their students. Professors and students are living through previously unimagined turmoil as the shelter-in-place orders are extended or recklessly rescinded, and our lives and the lives of our loved ones are at risk. Our students of color are under additional pressure as the COVID-19 Pandemic has had a higher incidence of morbidity in their population. These pandemic demands are further exacerbated and made even more challenging by the continued episodes of police racism and violence, which lay bare the racial injustice permeating our society. Academic achievement and well-being are interdependent, and the expression and experience of care from one's professors can make all the difference for students struggling with heavy burdens. This is why it is essential to include research-based knowledge on the social determinants of health and disease in our nursing curricula. As faculty we have to embody a concern for student well-being, as well as patient well-being. While accountability is always important, in these trying times, grace, compassion, and flexibility are more critical than ever and will make a lasting impression on the next generation of nurses.

Failure

If you are like me, you like to skirt around "failure talk" because we always want to avoid failure and protect our students' self-esteem. We never set out to fail, but like it or not, "to err is human," and central to learning. The point of failure is not to raise the specter of shame and blame, but rather as a requisite for learning. As noted above, Gadamer's (1975) insight that "experience" depends on a turning around of prior taken-for-granted assumptions; otherwise, it does not count as experience. Large or small failures are at the heart of all experiential learning. Schultz (2010) points out that the capacity to err is central to knowledge and our humanity:

Far from being a moral flaw, it [to err or fail] is inextricable from some of our most humane and honorable qualities: empathy, optimism, imagination, conviction, and courage. Far from being a mark of indifference or intolerance, wrongness is a vital part of how we learn and change. Thanks to error, we can revise our understanding of ourselves and amend our ideas about the world. (Kathryn Schulz, pp.117-118, 2010).

An important point here is the concept of "productive failure." (Kapur & Kinzer, 2009) Productive failure refers to situations where learners struggle to make sense of and solve a complex problem. It is precisely through this struggle, including mistakes, that essential and meaningful learning takes place. Productive failure is cultivated in "ill-structured" problems, scenarios that contain rich, relevant, and irrelevant information and require students to engage in collaborative problem-solving. They can share in sense-making as they wrestle with determining a course of action from a realistic clinical presentation. In addition to online simulations, another option is to take advantage of the asynchronous and synchronous modalities together. For example, give students a chance to read through a case or a patient chart asynchronously, but use an online meeting to discuss together what is salient and what should happen next. These socially grounded interactions also give nurses vital practice in articulating their reasoning for their decisions in care.

Online simulations allow faculty and students to diagnose misunderstandings that cause errors. For example, a common Sentinel Event for new graduate nurses in NovEx (Disclosure: Drs. Patricia Hooper-Kyriakidis, Patricia Benner, and Tom Ahrens are Co-Owners NovExToExpert.org), an online clinical simulation program, stems from not clearly understanding the distinctions between an occlusive, clot-based stroke, and a hemorrhagic stroke. Consequently, they are likely to make a life-threatening error and give a blood-thinning agent to a patient with a hemorrhagic stroke. It is far better to make this fatal error with a simulated patient than with a real patient. With rich feedback and corrective directions to review the lessons, the student can work through their misunderstanding and avoid making such an error with actual patients. Identifying the knowledge gaps that spawn these mistakes through program analytics can enhance learning and enhance patient safety. Students are authentic in their desire never to make patient care errors that threaten the patient's life and need situated coaching to learn from "online simulated" errors. Faculty can gather students together who have made errors based upon shared misconceptions, and ensure active learning, and the formation of a narrative memory that will ensure improved patient safety and decrease incidents of "failure to rescue" when caring for real patients (HealthImpact.org also see, Roberts, 2016). The ethos of never covering up errors (indeed, disclosing, learning from, correcting, and preventing similar errors in the future) is at the heart of professional integrity and accountability. Developing this ethos of reporting, correcting, and preventing errors is more likely to occur if there is a strong culture of learning from mistakes. Assignments designed to help students reflect on learning from errors can help create a habit and expectation of learning from errors.

High Impact Learning

George Kuh (2008) defined High Impact Learning as comprised of ten components of undergraduate education:

1. First-year seminars and experiences. The University of Pennsylvania School offers a great example of seminars related to nursing practice implications of science pre-requisites during the first two years of college See: View Full Video here

2. Development of common intellectual learning experiences.

3. Active learning communities.

4. Writing-intensive courses.

5. Collaborative assignments: Collaboration requires more just group assignments with individual roles, where assignments require collaboration and teamwork in learning.

6. Undergraduate research.

7. Emphasis on diversity and global learning.

8. Service-learning and community-based learning. This is usually central to clinical practica. However, with limited clinical practica, faculty will have to generate new options for community-based learning.

9. Internships. Again, senior internships will have to be re-designed during the COVID-19 Pandemic.

10. Capstone Projects and Courses.

11. Learning Portfolios were added to Kuh's original ten High Impact Learning Practices (Linder & Hayes, (2018)

Linder and Mattison Hayes (2018) demonstrate how expert online educators create design solutions for these online High-Impact Learning activities. In the COVID-19 need for physical distancing, design for these High Impact Learning Strategies becomes even more challenging, since so many natural face-to-face experiences are not possible.

We welcome learning from you, our readers, on how you have designed for experiential learning for these kinds of High Impact Learning experiences with the current necessity of physical distancing. For example, using one's family or social grouping for reflection and inquiry may be a possibility, with care taken for permission and privacy rights. Learning portfolios can be developed based upon the student's narratives of clinical learning. Dramas and documentaries of illness experience, drug addiction, or facing death can form a base for experiential learning described and reflected in a learning portfolio. Immediate past clinical experiences can be reconsidered and become a basis for new levels of inquiry. We offer Learning Resources for Online Teaching that follow this article, including clinical videos that can be shared and discussed by students from EducatingNurses.com.

We are truly in unchartered areas of online learning during this time of physical distancing. As always, our teaching and learning need to be designed based upon learning science (The National Academies of Sciences. Engineering. Medicine, 2018; Talbert, 2017; Linder, K.E., Mattison Hayes, C. 2018). We need to study our students' experiences and learning outcomes to improve nursing education continually. Online or in-person, designing for curiosity, sociality, emotion, authenticity, and failure are essential for instruction that prepares our students to not just master content but become nurses capable of meeting the challenges of our uncertain times. In a future newsletter, we will present ways of evaluating online and online clinical replacement learning.
(References for this article follow the list of Learning Resources)
Getting up to speed in presenting high quality, learning science-based online courses

Discussion Triggers, Patient Scenarios Available on EducatingNurses.com

When she was a nursing instructor to first-year students at Columbia University and Adelphi University, Dr. Elizabeth Cohn hoped to teach her students how to support, educate and relate to their patients as whole persons, rather than just "The Patient in 9-Window". She wrote and delivered a monologue from the perspective of the patient that helped student nurses understand that there's more to nursing than performing tasks. This monologue was presented about the third or fourth week of Nursing Fundamentals class before the students began clinical. This full video is only available to our members but please enjoy our preview below.

Patricia Benner, RN., Ph.D., FAAN June 24, 2016 Copyrighted This month, we offer all our newsletter subscribers free access to a wonderful new video on people's responses to the news that someone has been recently diagnosed with cancer. Kristin Johansen and Ben Dziuba collaborated on this collection of people's responses to the news that Ben was diagnosed with a rare and aggressive cancer, one week after they were married nearly six years ago. In this dramatized video they share the humor and pathos in peoples' difficult responses, and offer alternative, more empathetic responses. Continue reading

This is a wonderful Ph.D. documentary from a doctoral dissertation. It is perfect for any cross-cultural and public health class on the health impact of colonization. Many of the stories have to do with addiction to alcohol and drugs. In each case healing involves recapturing a sense of Cree identity and spirituality. The short video clips 2-7 minutes can be used as discussion triggers in the classroom.

Students will be inspired and instructed by Ted Fellow Kitra Kihana. This strong loving family, and the strong spirit and love of life, has moved Rabbi Cahana beyond a "locked in brain syndrome." The family began exercise range of motion exercises immediately, and wove a web of love, and direct action in the care of Rabbi Cahana. This Ted Talk will make an excellent "Discussion Trigger." It is gratifying to know that Rabbi Cahana is now able to speak to his congregation, albeit from a wheelchair, but is still engaging in his life and soaring in his spirit.

Part 2:

Nursing takes place largely in Health Care Industrial organizations where efficiency, speed of completing tasks, are emphasized. This emphasis runs counter to many caring practices central to excellent nursing...the art of listening, of being present, available to respond to the concerns of patients and families. Dr. Kari Martinsen's work on caring emphasizes meeting the other with openness and presence, rather than a critical or judgmental eye.

This full video is only available to our members but please enjoy our preview below.

" I lay there listening to the sickening sounds of my mechanical breathing, all the while praying the oxygen tank wouldn't run dry. If the hose got twisted and the oxygen stopped flowing, a short alarm would sound. Immediately, a nurse would appear to correct the problem. But what if the tube slipped out of my throat? What if the alarm malfunctioned? What if the oxygen concentration wasn't high enough?"

In this life actor simulation, the patient is an adolescent who is depressed and has expressed some suicidal thoughts. The students are assigned the task of assessing the level of this Adolescent's depression and risk for suicide. The whole "flipped classroom", particularly the portion "Assessing for Suicide Risk" can be used to help students prepare to discuss this 15 minute role play with different students assigned to address different aspects of assessing this adolescent's risk for suicide.

This full video is only available to our members but please enjoy our preview below.

This is a dramatization of the medical error that caused the death of this Pilot's wife, in what should have been a simple routine surgery. This is a great presentation on patient safety and team work problems that contribute to patient care errors. In this re-enactment of a real event, the physicians are fixated on intubating a patient, and despite the nurses' clinical grasp that a tracheostomy is needed, the nurses fail to command the attention and action of the physicians. This is a great consciousness-raising video on the danger of silence and lack of patient advocacy for the patient's safety. Students should look up the current safety protocol on intubation, where limits are set on number of trials before tracheostomy is recommended.

Senior Nursing Students work with Esther, a patient with COPD, who is anxious about her friend with COPD who has just been placed on ventilator assisted breathing, and also anxious about her own disease progression, since she is just home from the hospital. This is a great discussion trigger about working with anxious patients, and with patients who are concerned about their approaching decline and death. Students can discuss how and the extent to which these senior students were able to help calm Esther and address her fears about end-of-life care.

This full video is only available to our members but please enjoy our preview below.

Patricia Benner describes the historical development of the use of narratives. She explains and illustrates different ways of using first person experience near narrative accounts for research, practice and education. Links are made with the Dreyfus Model of Skill Acquisition, particularly, the use of perspectives in clinical practice by proficient to master levels of performance. Ways of using narratives of students for reflection on practice are presented, including what to avoid, and examples of successful uses of narratives for teaching in practice and education.

This full video is only available to our members but please enjoy our preview below.

Sarah Shannon, who teaches clinical nursing ethics, provides real clinical cases that raise ethical issues and asks students what they would do in the situation. The case featured here is compelling and involves the ethical demand of disclosing the error of starting resuscitation on a patient who has a DNR order, unbeknownst to the clinical staff in the radiology suite. This is a great example of challenging students to think about what they would do, and consider what their ethical obligations are to the family of the patient.

Research-Based Books Related to Learning Science:

Peter C. Brown Henry L. Roediger III, and Mark A. McDaniel (2014) Make It Stick: The Science of Successful Learning. Los Angeles, CA: Dreamscape Media LLC, Publisher

Joshua R. Eyler (2018) How Humans Learn: The Science and Stories Behind Effective College Teaching. Morgantown, VA.: West Virginia University Press.

Darby, Flower with James M. Lang. (2019). Small Teaching Online. Applying Learning Sciences in Online Classes. San Francisco: Jossey-Bass (A Wiley Brand) Kindle Edition.

Dreyfus, H.L.(2009) On the Internet.(Thinking in Action) 2nd Edition. New York: Routledge, a Taylor Francis Group.

Dreyfus, H.L., Dreyfus, S.E. (1986) Mind over Machine: The Power of Human Intuition and Expertise in the Age of the Computer. New York: The Free Press.

Linder, K.E. Mattison Hayes, C. (Eds.) (2018) High-Impact Practices in Online Education. Stylus.

National Academies of Sciences, Engineering, and Medicine 2018. How People Learn II: Learners, Contexts, and Cultures. Washington, DC: The National Academies Press.

Richardson, W., Mancabelli, R. (2011) Personal Learning Networks: Using the Power of Connections to Transform Education (Essentials for Principals) Bloomington, IN. The Solution Tree Press.

Talbert, R. (2017) Flipped learning. A guide for higher education faculty. Stylus

Taylor, C. (2016) The Language Animal. The Full Shape of Human Linguistic Capacity. Cambridge, Mass: Harvard University Press

Web Based Resources for Designing Online Courses

What you need to know and where to find it.

5 minute introduction to the Flipped Classroom

Virtual Clinical Replacement Lesson Plans. 34 ready-to-use lesson plans cover 12 topic areas. Each supports an ATI screen-based solution with prepared independent and online group activities. Novice or seasoned educators can quickly and easily create customized lesson plans by interchanging activities as needed to replace clinical hours.

Online Clinical Plans. Comprehensive sets of faculty lesson plans, student checklists, and educator implementation guides accompany immersive screen-based simulation scenarios to replicate a full clinical day. They include pre- and post-conference activities for 5 RN and 3 PN topic areas and strategically adhere to NCSBN guidelines and INACSL's Standards of Best Practice: Simulation . Each begins with prebriefing, weaves together ATI screen-based solutions, and ends with debriefing and evaluation.

Promoting students' conscious understanding of how they learn

Enabling faculty to gather, share and promptly benefit from current data about students' learning by coordinating their efforts across disciplines, institutions and countries

Chronicle of Higher Education Online Articles on Online Courses.
Going Online in a Hurry: What to Do and Where to Start 5 Low-Tech, Time-Saving Ways to Teach Online During Covid-19 How to Be a Better Online Teacher
Inside Higher Ed.

By Jean Dimeo November 15, 2017 Take My Advice

This is the space where we explore the art and science of being more effective at facilitating learning. We also share ways to increase our personal productivity, so we can have more peace in our lives and be even more present for our students.

With Great Teaching, Students Succeed

ACUE prepares, credentials, and supports faculty to teach with the practices that improve student achievement and close equity gaps.

We are grateful to provide support to faculty that have made an extraordinary transition to online course delivery. Our free Online Teaching Toolkit and webinar series on Effective Online Instruction are designed to provide immediate guidance. After months in development, we're also now offering our Effective Online Teaching Practices course, as well as online micro-credential options, to ensure longer-term student success.

Now, more than ever before, we are committed to collaborating with our institutional and higher education association partners to ensure great teaching - in the classroom or online - so student succeed.

Welcome to our free newsletter and website that's dedicated to higher ed and instructors like you! Faculty Focus publishes articles on effective teaching strategies for the online and college classroom.

Faculty Focus was the winner of the 2017 MERLOT Faculty Development Classics Award and is currently ranked #8 in the Teach100 daily ranking of education blogs. Faculty Focus has been an important tool for instructors to share what they are implementing in the classroom and to learn what other instructors are doing worldwide.

Strategies and Preparation from Multi-Cultural Pavilion:

Strategies for Choosing and Using Activities and Exercises for Intergroup Learning
You're developing a diversity workshop or facilitating an intergroup dialogue and looking for ways to engage your participants. This document lays out eight strategies for effectively selecting and incorporating activities and exercises into your programming efforts.

A Guide to Setting Ground Rules
Ground rules or community norms can help your program or class run more smoothly. This guide describes commonly used ground rules and strategies for naming and enforcing them.
Icebreakers:
Knowing the Community: Ethnicity Exercise
Continues community building. Participants introduce themselves by sharing information on their ethnicity and background, highlighting the similarity and diversity among members of the group.

Name Stories
Works toward bringing the stories of individuals to the fore in the multicultural experience. Participants write and share stories about their names and nicknames, what they mean, why they were given them, and how they relate to them.

Sharing Ourselves: "Who I Am" Poems
Begins active introspective process while continuing to provide opportunities for individuals to make connections with each other. Participants write short poems, starting each line with "I am...," encouraging them to describe in their own words who they are and what's important to their identity.
Introspectives:
The Depth and Breadth of "Multicultural"
Explores the definition of "multicultural," the dimensions of culture, and the consistency with which we define our culture and the cultures of others. Participants go through a series of steps to gain a better understanding of the complexity of "multicultural"ness, and are then challenged to apply this both to themselves and to how they understand each other. An extra step challenges educators to rethink their conceptualization of "Multicultural Education" based on their perceptions of their own cultural dimensions.

Understanding Prejudice and Discrimination
Introduces concepts of prejudice and discrimination through self-reflection. Participants share stories regarding their experiences with prejudice or discrimination, as either victim or perpetrator.

Exploring Definitions
Considers language as a vital aspect of multicultural education and awareness. Participants discuss how they define words such as prejudice, discrimination, racism, sexism, classism and homophobia. Issues of power and institutional discrimination emerge.

Circles of My Multicultural Self
The Circles activity engages participants in a process of identifying what they consider to be the most important dimensions of their own identity, concurrently developing a deeper understanding of stereotypes as participants share stories about when they were proud to be part of a particular group and when it was especially hurtful to be associated with a particular group.

Inclusion/Exclusion
Participants share their own experiences as students, exploring different ways people are made to feel included in, or excluded from, the learning process. The existence of different learning needs and the necessity for a wide range of teaching styles emerge.

Student Fishbowl
A student fishbowl gives pre-service and in-service educators an opportunity to hear the experiences, ideas, and critiques of current students while giving the students an opportunity to be active in the dialogue on multicultural education and education transformation.

Equity Awareness Quiz
Critical thinking about all media and information is an essential aspect of equity learning. Test your and your students' or participants' understanding of race, gender, and socioeconomic class with this activity, leading seamlessly into a dialogue on stereotypes, misinformation, and prejudices and how they inform teaching and learning.

Facilitating the Difficult Dialogue: Role Plays
Teachers are often hesitant to introduce topics like racism, sexism, classism, and heterosexism in the classroom because their training has not prepared them to handle the issues and exchanges that may result. This activity provides participants an opportunity to share stories about when discussions about these topics took an unexpected turn they were unprepared to handle, then to share ideas about how to address these circumstances in the future.

Collaborative Problem-Solving: Case Studies in Education
The purpose of this activity is to engage teachers in a process of collaborative problem-solving around multicultural issues through the use of case studies. Participants will develop an understanding and appreciation for the necessity to include a variety of voices and perspectives to successfully address issues that arise around race, gender, culture, sexual orientation, or any other identity dimension. They will also begin to better understand the collaborative process and how they tend to participate in it.

Considerations for Evaluation in Simulation-based Education during COVID-19:

Research based advice on effective use of videos for online teaching and learning. Length of videos should be around 6 minutes for maximum student engagement.

Encourages and instructs students develop their own personal Personal Learning Network related to student's self-selected topics related to the course.
UW Video Podcast: Tapping the power of asynchronous learning
In a new podcast, University of Washington College of Education faculty members Megan Kelley-Petersen, Sara Lopez and Miriam Packard and instructional designer Britta Ossim discuss how developing asynchronous learning experiences for students can be more than a lifeline when school buildings are closed - it can open more avenues for students to share their ideas and learn.

References for "Designing Online Nursing Education Based Upon Learning Science and High Impact Learning Strategies":

Ardichvili, A. (2008). Learning and Knowledge Sharing in Virtual Communities of Practice: Motivators, Barriers, and Enablers. Advances in Developing Human Resources, 10(4), 541-554. https://doi.org/10.1177/1523422308319536

Bandura, A. (1977) Social Learning Theory. Prentice-Hall,

Barkley, E., Cross, P. Howell Major. (2005) Collaborative learning techniques: A handbook for college faculty.Jossey-Bass.

Bawa, P. (2016). Retention in online courses: Exploring issues and solutions ? a literature review. SAGE Open, 6(1), doi:https://doi.org/10.1177/2158244015621777

Benner, P., Wrubel, J. (1989) The Primacy of Caring: Stress and coping in health and illness. Prentice-Hall.

Benner, P., Hooper-Kyriakidis, P., Stannard, D. (2011) Clinical Wisdom and Interventions in Acute and Critical Care, Second Edition: A Thinking-in-Action Approach, New York: Springer.

Brown, J.S., Collins, A., Duguid, P. (1989) "Situated cognition and the culture of learning." Educational Researcher. 18, 32-42.

Damasio, (2005) Descartes error: Emotion, reason and the human brain. Penguin Books.

Dreyfus, H.L. (1986) "Misrepresenting human intelligence. THOUGHT VoI. 6 1 No. 243, pp. 430-442.

Dreyfus, H.L. (1992) What computers still can't do. A critique of Artificial Intelligence. M.I.T. Press.

Dreyfus, H.L. (2009) On the internet, 2nd Ed. Routledge.

Eyler, J. R. (2018) How humans learn: The science and stories behind effective college teachers. West Virginia University Press.

Grabinger, R., Dunlap, R.S., Dunlap, J.C. (1995) "Rich environments for active learning: A definition."Research in learning technology. 3:2, pp.5-34.

Herrington, A.J., Herrington, J.A. (2007) "What is an authentic learning environment?" In Online and distance learning: Concepts, methodologies, toos, and applications. (Ed.) L.A. Tomei, Hershey, PA: Information Science Reference. Pp. 68-77.

Kapur, M., & Kinzer, C. K. (2009). Productive failure in CSCL groups. International Journal of Computer-Supported Collaborative Learning, 4(1), 21-46. https://doi.org/10.1007/s11412-008-9059-z

Kerdeman, D. (2004)" Pulled up short: Challenging self-understanding as a focus of teaching and learning. In J.Dunn & P.Hoga (Eds.) Education and practice: Upholding the integrity of teaching and learning. (pp. 144-158) Blackwell.

Kug, G. (2008) High-impact educational practices: What they are, who has access to them, and why they matter. Association of American Colleges and universities.

Linder, K.E., Mattison Hayes, C. (Eds.) (2018) High-impact Practices in online education. Stylus Publishers.

Mursing Managed. (n.d.). Mursing Managed. Retrieved June 5, 2020, from https://licensetonurse.com/post/178344157906

National Academies of Sciences, Engineering, and Medicine. (2018). Ch. 8 Digital Technology. In How People Learn II: Learners, Contexts, and Cultures (pp. 163-196). National Academies Press. https://doi.org/10.17226/24783

Roberts, J. (2016) Experiential Education in the College Context: What it is, how it works, and why it matters.Routledge.

Schulz, K. (2010) Being Wrong: Adventures in the margin of error. Ecco.

Talbert, R. (2017) Flipped learning. A guide for higher education faculty. Stylus

Walton, G.M., Cohen, G. "A brief social-belonging intervention improves academic and health outcomes of minority students." Science 331. March 18, 2011: 1447-51.

Vygotsky, L.S. (1980) Mind in society: development of higher psychological processes. Cole, M. John-Steiner V., Scribner, S. & Souberman, E. (Eds.) Harvard University Press.

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Designing Online Nursing Education Based Upon Learning Science and High Impact Learning Strategies - Educating Nurses

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Patricia Benner, R.N., Ph.D., FAAN John Benner, Ph.D. Candidate, School of Education, University of Washington, Seattle June 9, 2020 With the COVID-19 Pandemic, nurse educators must transform in-classroom teaching and learning to online learning. Understanding how students learn is the starting point for all teaching and learning, regardless of how a course is taught.

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Founder of high middle range nursing theory

theory known as "From Novice to Expert"

Authored book “From Novice to Expert: Excellence and Power in Clinical Nursing Practice” 1984

based on her work leading the Achieving Methods of Intraprofessional Consensus, Assessment and Evaluation Project (AMICAE Project)

Highlighted model for stages of nursing clinical competence

Frequently utilized framework:

determines nurses' needs at various periods of professional growth

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Biography and Career of Dr Patricia Benner

Dr. Benner earned her Bachelor of Arts degree in nursing from Pasadena College in 1964. She went on to earn a Master of Science in Medical-Surgical Nursing from the University of California at San Francisco in 1970, and a Ph.D. from the University of California at Berkeley in 1982

In the late 1960s, Benner worked in the nursing field. This included working as a Head Nurse of the Coronary Care Unit at the Kansas City General Hospital and an Intensive Care Staff Nurse at the Stanford University Hospital and Medical Center. From 1970 until 1975, she was a Research Associate at the University of California at San Francisco School of Nursing.

Following that, she was a Research Assistant to Richard S. Lazarus at the University of California at Berkeley. From 1979 until 1981, she was the Project Director at the San Francisco Consortium/University of San Francisco for a project achieving methods of intraprofessional consensus, assessment, and evaluation. Since 1982, Dr Benner has been working in research and teaching at the University of California at San Francisco School of Nursing.

Dr Benner has published nine books, including From Novice to Expert, Nursing Pathways for Patient Safety, and The Primacy of Caring

. She has also published many articles. In 1995, she was awarded the 15th Helen Nahm Research Lecture Award from the University of California at San Francisco School of Nursing.

She is currently a professor emerita in the Department of Physiological Nursing at the University of California at San Francisco School of Nursing. Some of her works include:

Dr Patricia Benner's Contribution to Nursing Theory: From Novice to Expert Concept

Patricia Benner developed a concept known as "From Novice to Expert." This concept explains that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences.

Dr Benner proposed that a nurse could gain knowledge and skills without actually learning a theory. She describes this as a nurse "knowing how" without "knowing that." She further explains that the development of knowledge in fields such as nursing is made up of the extension of knowledge through research and understanding through clinical experience.

The theory identifies five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert.

1. A novice is a beginner with no experience. They are taught general rules to help perform tasks, and their rule-governed behavior is limited and inflexible. In other words, they are told what to do and simply follow instruction.

2. The advanced beginner shows acceptable performance, and has gained prior experience in actual nursing situations. This helps the nurse recognize recurring meaningful components so that principles, based on those experiences, begin to formulate in order to guide actions.

3. A competent nurse generally has two or three years' experience on the job in the same field. For example, two or three years in intensive care. The experience may also be similar day-to-day situations. These nurses are more aware of long-term goals, and they gain perspective from planning their own actions, which helps them achieve greater efficiency and organization.

4. A proficient nurse perceives and understands situations as whole parts. He or she has a more holistic understanding of nursing, which improves decision-making. These nurses learn from experiences what to expect in certain situations, as well as how to modify plans as needed.

5. Expert nurses no longer rely on principles, rules, or guidelines to connect situations and determine actions. They have a deeper background of experience and an intuitive grasp of clinical situations. Their performances are fluid, flexible, and highly-proficient. Benner's writings explain that nursing skills through experience are a prerequisite for becoming an expert nurse.

These different levels of skills show changes in the three aspects of skilled performance: movement from relying on abstract principles to using past experiences to guide actions; change in the learner's perception of situations as whole parts rather than separate pieces; and passage from a detached observer to an involved performer, engaged in the situation rather than simply outside of it.

The levels reflect movement from reliance on past principles to the use of past experience and change in the perception of the situation as a complete whole with certain relevant parts. Each step builds on the previous step as principles are refined and expanded by experience and clinical expertise.

Benner's theory of From Novice to Expert changed the understanding of what it means to be an expert in the nursing field. This moves the label from a nurse with the highest pay or the most prestigious title to the nurse who provided the best care to his or her patients.
For more detailed information: From Novice to Expert Concept

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Dr. Benner earned her Bachelor of Arts degree in nursing from Pasadena College in 1964. She went on to earn a Master of Science in Medical-Surgical Nursing from the University of California at San Francisco in 1970, and a Ph.D. from the University of California at Berkeley in 1982 In the late 1960s, Benner worked in the nursing field.

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Patricia Benner (1984) viewed nursing as "enabling condition of connection or concern"
Theory focus

"how" acquisition of nursing knowledge is gained

understand skill

Based on Dreyfus model of skill acquisition: how learners attain skills

practice

formal training

Expert nurses develop their knowledge of patient care/extensive skill through:

education

experience over time

Theory based on qualitative research

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The Five Dreyfus Model Stages

During the seventies, the Dreyfus brothers conducted a thorough research on the topic of how an individual obtains and masters a skill. They observed people with high-quality expertise in different spheres and came to the conclusion, that the individual doesn't only acquire more knowledge in his field, his whole perception and approach to the world evolves. They created a five-stage model which aims to describe the journey of a person from obtaining a skill to mastering it.

1. Being a Novice

When the individual has little or no experience at all in executing a particular skill. The Dreyfus brothers describe it in a manner, which is untraditional. By "experience" they mean the fact that performing the particular skill would lead to no change of perspective or thought within the person. There are plenty of cases to be given as an example, as many people work in the same position for years, but do not obtain any knowledge, nor "experience" and their ten years of experience on paper, could be taken as a one-year experience when observed through the Dreyfus Model.

The notice aims to succeed and focuses on results rather than knowledge. The latter explains why managing teams consisting of novices could be a struggle.

2. Advanced Beginners

The novice evolves by figuring out the mistakes in his work. The newly, "promoted" advanced beginner dwells into the world of troubleshooting. Unfortunately, the hasty mindset is not lost, and the individual still aims to acquire results fast, in this case gain knowledge and information. An example would be when a coder with years of experience starts learning a new program language, he could be a master in PHP but an advanced beginner in Python. Scrolling through the documentation will not lead to productive results.

3. Competent

We are in the middle ground of the model. An individual falls into this category when he is fully capable of troubleshooting and solving problems on their own, as well as planning their future actions while avoiding previous mistakes. The practitioner will still experience trouble when it comes to pinpointing the exact details to focus on. The IT sphere works mainly in teams in order to smoothen out these processes.

4. Proficient

The individual now looks at the bigger picture. Their focus falls onto understanding the essentials of the framework and often experience frustration when documentation is oversimplified. Proficiency is defined by the self-improvement skills which each person in the stage has. Not only does the proficient practitioner learn from his own mistakes, he observes others as well, anything could be a vital source of information.

5. Expert

The fifth and final stage of the model is when the individual becomes an expert in the field. The difference between the fourth and the fifth stage is that people in the fifth are a source of information and knowledge themselves. Their experience is so vast that other people look up to them. A major part of the work done by the expert is based on his intuition. They lead major teams, write books, conduct studies and etc.

Establishing where each member in all of your teams falls in the Dreyfus Model could determine the team's success.

Related Articles

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During the seventies, the Dreyfus brothers conducted a thorough research on the topic of how an individual obtains and masters a skill. They observed people with high-quality expertise in different spheres and came to the conclusion, that the individual doesn't ...

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Novice

little/no experience

taught general/universal rules

behavior is rule governed

Advanced beginner

prior actual experience

able to distinguish patterns/significant components

actions start to be directed by experience/principles

Competent

nurse with two to three years experience in specialty/relevant daily role

greater efficiency/organization/time management skills

mindful of long term goals

gains insight from own conscious/abstract/critical

Proficient

understand situation as whole parts

able to anticipate certain situations

increased holistic comprehension

improved decision making

Expert

decided actions not dependent on connection between situation and principles/rules/guidelines

increased foundation of experiences to draw from

highly proficient

smooth and flexible functioning in role

intuitive understanding of situation

Outcome of progression through stages: change in nurse's skills

decreased dependence on abstract ideas/principles

concrete experiences lead to increase in critical thinking

changes in perception = new ways of thinking: holistic/higher level

Transformation of nurse from initial dependence on abstract to concrete

use of concrete experience  creates internal structure to view situation as complete whole

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PREVIEW Novice to Mastery: The use of Narratives in, Research, Practice and Education

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Meretoja (2004) Assessing nurse competency
Novice to expert theory: to develop competency scale

goal: assess nurse competence in various hospital environments

73 item scale

validated as evidence based model

Evans (2006) Nursing model development
Novice to expert theory: evolution of nursing decision making skills as they progress through stages of theory

inquiry on  knowledge/skill/judgement in nursing practice

Findings: validated intuitive decision making as construct & knowledge and judgement improve as nurse progresses through five stages of novice to expert

Faley (2016) Clinical education
Novice to expert theory: competency through continued learning experiences

Attain skills as telemetry nurse through:

observation and imitation of preceptor actions

preceptors have already gained the experience to function at a higher level: novice able to study their actions/thought processes

Thomas (2017) Clinical education: Simulation
The Novice to Expert theory: provides model to guide simulation facilitator development and aid in comprehending student learning trajectory.
Goal: to use theory as guide as to develop clinical skills simulation program and assess student learning development.

Adams (2019) Clinical education: Nurse retention/transitioning to ED program
Novice to expert theory:

learning and progression through stages is derived from education and experience.

levels of nursing theory applicable: new ED nurse may be classified as advanced beginner but was considered expert in previous specialty

Goal: evenly progressive experience for nurses transitioning to ED
retain transitioning nurses

structured increases in  levels of responsibility

provides a support system for the transitioning RN

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Presentation on theme: "Evidence Based Practice using Theorist Patricia Benner"- Presentation transcript:

Evidence Based Practice using Theorist Patricia Benner
Denise Lyon Courtney Madsen Dawn Kooiman Lynda Chase Yvonne Robles Barb Lentz

Response to Work Complexity The Novice to Expert Effect

Practice Area of this Study
5 hospitals 23 RNs on cardiac/telemetry units - 8 classified as advanced beginners, 8 as competent and 8 as expert nurses A purposive sample of advanced beginner, competent, and expert nurses was recruited for this study. All participants were (a) employed for at least 3 months as a registered nurse on a cardiovascular telemetry unit that was not classified as a critical care unit, (b) employed a minimum of a 0.8 full-time equivalent, (c) at least 80% of the time was spent on the unit caring for patients at the bedside, and (d) scheduled to work during the hours of 7 a.m. to 7 p.m. All participants perceived their work day as normal.

Research Findings Four themes emerged from the data that illustrated differences in responses to the acute care's complex work environment. The themes identified were cognitive strategies, communication, integration of roles, and response to the work environment. Cognitive strategies addressed how the participants cognitively organized their work. Three subthemes were identified that described the nurses' cognitive strategies: prioritization and reprioritization, anticipation, and organizational tools. Prioritization and reprioritization The advanced beginners prioritized in a linear manner, doing one thing at a time. They were able to prioritize based on immediate concerns, and their focus was on getting all the required care done. They relied on experienced nurses for guidance and charge nurses when encountering unfamiliar situations Competent nurses considered multiple factors when establishing priorities, stacking their priorities to allow shifting from one task to another, and more efficiently completing nursing care. Fewer things were viewed as interruptions and they were able to keep on task when faced with interruptions. The competent nurses had a better sense of when to delegate something and when to just do it themselves. The expert nurse focused on the patient rather than the task, with a holistic view of the patient. For instance, the nurse who had a well-known patient considered physical and psychosocial issues while caring for her. The expert nurses also had a very good sense of when to delegate, frequently providing patient care while doing assessments and giving medications

Anticipation Advanced beginner nurses anticipated immediate events such as scheduled procedures or tests. Usually reacting to a situation The competent nurses anticipated procedures, tasks, and patient needs. Organization Tools All the nurses used an organizational tool such as a worksheet The advanced beginners were less skilled in using a tool effectively as they had difficulty determining what was important to include. The competent nurses had developed a worksheet or method of using a worksheet that fit the individual nurse's style and modified it to fit the assignment. They took time at the beginning of the shift to record information in a way that helped them stay organized, often coming in early to allow time for information gathering. The expert nurse used organizational tools in a very deliberate fashion. A detailed worksheet with careful organization of each patient's data was created.

Communication The advanced beginners oriented it to the patient's immediate needs. The competent nurses were able to communicate based on anticipated problems or needs and their communication with other nurses was consultative in nature. The expert nurses communicated with everyone - constantly consulting and clarifying aspects of patient care to meet all the patient's needs. Using therapeutic communication. Integration of Roles The advanced beginner limited teaching to the patient's concerns and made a special trip into the room. The competent addressed immediate concerns and was more likely to include family in instruction, often while assessing the patient. The expert takes a holistic approach to teaching, often anticipating what the patient may need to know for discharge or home care.

Response to the Environment
The advanced beginner experienced stress and perceived some events as crises. The competent nurse mentioned that they have days which are stressful, but have ways to avoid getting stressed out The expert nurses simply did not discuss getting stressed out or mention experiencing crises. Research Limitations Small sample size Implications for Practice As the nurses progressed in expertise, they were better able to organize, more effectively deal with interruptions, anticipate patient needs, integrate varied nursing roles into their work, and communicate effectively. Critical Reflection The result of this research was aimed to nurse educators and administrators to examine approaches to increase the student's ability to organize, prioritize and communicate.

CULTURAL COMPETENCE OF NORTH CAROLINA NURSES:
A Journey from Novice to Expert

Theoretical Nursing Framework for the Study
Benner's stages of novice to expert were paired with the stages of the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC) developed by Campinha-Bacoti. IAPCC along with Benner's stages were linked as follows: "culturally incompetent" range were "novice", "culturally aware" range were "advanced beginner", "culturally competent" range were "competent", "culturally proficient" range were "proficient". IAPCC scores range from 20 to 80. Culturally incompetent scores range from 20-39, culturally aware range from 40-59, culturally competent range from and culturally proficient at Background Variables Data Sheet (BVS) were also used to collect demographic data (age, gender, ethnicity, educational background, amount of inclusion of culture content in basic nursing program, and years of nursing experience) The BVS also requested information on any "paradigm cases".

Research Findings 71 participants; however only 66 were usable (93%) Majority of participants were female (97%) and white (92.4%) Highest age group participating was from age 20 to 50 Least age group participating was from age 51 and up Half of the participants had associates degrees as their highest level of education One third had more than 20 years of nursing experience (28.8%) 58 of the participants reported that their nursing education included some cultural diversity (87%) 42 participants reported getting information on cultural diversity from on the job in-services. (63.6%) IAPCC scores ranged from 39 to 72 (with a mean of 53.05) indicating that the group was at the level of "cultural awareness" congruent with Benner's advanced beginner stage. 10 scored at a level of "culturally competent" (Benner's competent) (15.2%) Only one scored "culturally incompetent (1.5%)

Implications for Practice
The faces of our patients, care providers and staff our changing. With our changing demographics it is essential that we are culturally competent. By becoming culturally competent we not only provide better care to our patients, we can maintain accreditation for our institutions in which we work. Providing in-services on cultural diversity will help improve quality care and patient outcomes.

Description of nursing model/theory in research study utilized
This medical center went from a clinical advancement ladder to the Clinical Practice Developmental Model Nurses gave a narrative of their clinical practice Narratives identified clinical practice behaviors and placement on a nursing developmental continuum (Nuccio, et. al., 1996) These narratives were compared to the model for advancement (Nuccio, et al., 1996)

Practice Area of this Study
600 bed medical center 90% of nursing areas represented Research Findings A possible need for changes in the organization by a shift of emphasis toward direct patient care activities and understand the shift's contributions toward patient outcomes (Nuccio, et al., 1996) Restructuring care delivery system to focus on nursing behaviors that address quality patient outcomes (Nuccio, et al., 1996) Defined nursing practices Research Limitations Some of the nurse responses were anger and leaving the organization Research involved only medical center

A Clinical Advancement Program
Evaluating 10 Years of Progressive Change

Practice Area of this Study
A 23-item clinical ladder satisfaction scale Data was collected in 1993, 1994, 1996 and 1998 using standard survey methods Subjects were registered nurses holding clinical positions at the University of Colorado Hospital Primarily female respondent group, most on rotating shifts More than 55% working between 5 and 10 years at the hospital Sample nursing population was 56% BSN, 25% Associate Degree Nurse, 18% diploma 2% Masters of Science in Nursing

Research Findings At first there were reported low levels of satisfaction, stimulating a series of meetings to gain nurses feedback for revising the program and a to reconstruct program components. Some of the revisions are as follows: Streamlining the categories from seven to four Rewriting the standard to incorporate clearer language and defining levels of practice more specifically Operating room nurses, consistently recorded the lowest satisfaction scores Has the fewest number of baccalaureate-prepared nurses Proved to be the most challenging group of nurse employees to engage in professional activities

Critical Reflection The result of this research was aimed to report the evolution of a clinical advancement program, UEXCEL. This program was initiated in 1989 to provide a professional framework for developing, evaluating, and promoting registered nurses. Hmmm

Expert to Novice: Clinicians Learning New Roles as Clinical Nurse Educators

Research Study Details
45 participating individuals are people who met a high-level of excellence in their field of nursing and will attempt to teach/precept other non-expert nurses Utilized in this study was the Clinical Nurse Educator Academy, which was designed to give a small amount of preparation to these expert nurses before taking on their new novice role Each person involved had four days of seminars with experienced educators Each person was to write three reflective papers describing their process of learning new skills as a clinical nurse educator (Cangelosi, et al, 2009) Each person was to answer three questions to aid in helping the authors decide if experienced nurses would do well with teaching others without extensive training in the field of education All participants were at the baccalaureate or masters level

Mentoring in the Dark "We were expected to do well since we are usually very competent in our practice. I did the best job I knew how to, but I am just muddling through" Comments made by the persons partaking in the study helped to evolve the names of these themes (Cangelosi, et al, 2009

Participant's Thoughts Cont.
What appeared to be most difficult for people involved was that their confidence level in doing things correctly with their patients was not there with the students they now needed to teach. Feelings of incompetency arose Many discussed the difficulties involved with leaving their safety zones On the other hand some stated that becoming novice in practice again, as when they began a nursing career, made them feel young again Some expert nurses believed that they had completely failed at the task at hand stating, "As educators we could have made a difference for these students, but we didn't, and now we have a few less future nurses because of it" (Cangelosi, et al, 2009)

Reference Cangelosi, P.R., Crocker, S., & Sorrell, J. M. (2009). Expert to Novice: Clinicians Learning New Roles and Clinical Nurse Educators. Nursing Education Perspectives, 30(6), Krugman, M., (2000). A Clinical Advancement Program: Evaluating 10 Years of Progressive Change. The Journal of Nursing Administration. 30(5) ISSN: Nuccio, S., Lingen, D., Burke, L., Kramer, A., Ladewig, N., Raaum, J., Shearer, B. (1996). The Clinical Practice Developmental Model: The Transition Process. The Journal of Nursing Administration 26(12), Retrieved from CINAHL database. Lampley, TM, Little, KE, Beck-Little, R, & Xu, Yu. (2008). Cultural competence of North Carolina nurses: a journey from novice to expert. Home healthcare management & practice, 20(6), doi: / Retrieved from Burger, J.L., Parker, K., Cason, L. Hauck, S. Kaetzel, D. O'Nan, C., White, A. (2010). Responses to Work Complexity: The Novice to Expert Effect. Western Journal of Nursing Research. 32(4) doi: /

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evidence based practice using theorist patricia benner

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Evidence Based Practice using Theorist Patricia Benner - ppt video online download

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Evidence Based Practice using Theorist Patricia Benner Denise Lyon Courtney Madsen Dawn Kooiman Lynda Chase Yvonne Robles Barb Lentz Response to Work Complexity The Novice to Expert Effect Practice Area of this Study 5 hospitals 23 RNs on cardiac/telemetry units - 8 classified as advanced beginners, 8 as competent and 8 as expert nurses A purposive sample of advanced beginner, competent, and expert nurses was recruited for this study.

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Based on qualitative research Descriptive

Congruent with current nursing standards

offers a framework in which to promote learning and skill acquisition and assess the professional growth of nurses.

The Institute for Healthcare Improvement (IHI): advocates for improvement in healthcare/model for change named, the Plan, Do, Study, Act (PDSA)

Nurse leaders: incorporate Benner's theory in QI

basis for understanding skill acquisition

implement PDSA improvement initiative

promote change to benefit patient safety and staff retention.

Benner's theory: well utilized model for a framework in nursing and clinical education

used as a foundation to assess nurse competency: validated, seventy-three item scale (Meretoja, 2004).

Benner's theory promotes cultural awareness:

caring practices must be adjusted to the individual

Benner's theory socially relevant:

takes into account care of individual as whole/includes social influences

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Theory is logically organized into five levels of skill acquisition:

Novice

Advanced beginner

Competent

Proficient

Expert

Theory differentiates:

practical knowledge “knowing how”

theoretical knowledge, “knowing that”

Theory promotes: use of narrative/reflective practice/collection and record keeping: refine skills/advance practice

perceptions

recognizing abilities,

meanings

characteristics

outcomes

Concepts:

Propositional: skills, experience, competence, progressive growth, caring, practical and clinical knowledge

Theoretical: environment, health, nurse, person

Metaparadigms

Person: recipient of care

Nurse: behavior, attitudes and characteristics of the individual providing care

Health: the overall state  pf physical, mental and social well being

Environment: encompasses all circumstances and influences both internal and external

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