NSG/416 Week 5: Theory, Caring and Expertise in Professional Practice, sample paper

A Personal Framework for Professional Practice: How Caring Science and the Novice to Expert Model Fit Together on a Neonatal Unit

[Student Name]

University of Phoenix

NSG/416: Theoretical Development and Conceptual Frameworks

Week 5 Assignment

[Instructor Name]

[Date]

The nurse, the unit and the families are a composite written for a model paper.

Over the past four weeks, I have written about the levels of nursing theory, used Watson's caring science to understand a father who would not approach his son's incubator, and traced a colleague's growth through Patricia Benner's stages as she learned to recognize sepsis in premature infants. This final paper asks how the two theories fit together and what framework for my own practice they produce.

Two Theories, Two Questions

Watson and Benner answer different questions. Watson asks what nursing is for. Her answer is that nursing exists to protect and enhance human dignity through caring relationships, and that the caring relationship itself contributes to healing (Watson, 2008). Benner asks how nurses become skilled. Her answer is that nurses develop through experience from rule-following novices to experts who grasp situations as wholes and respond intuitively (Benner, 1984).

The two theories sit at different levels. Watson's theory is a grand theory, abstract and concerned with the discipline's values. Benner's model is closer to a middle-range theory: it describes one phenomenon, skill acquisition, in terms that can be studied. Read together, they answer the two questions a nurse's practice needs answered: what the work is for, and how the nurse gets good at it.

Where They Agree

The theories agree more than their different levels suggest. Both place the particular situation at the center. Watson describes each caring moment as unique, happening between two particular people at a particular time. Benner found that expert nurses think in particular situations rather than general rules, and that expertise lives in stories of real patients (Benner, 1984). Neither theory treats nursing as the application of a general procedure.

Both also treat caring and clinical skill as connected. Benner et al. (2009) argued that clinical judgment and caring are not separate abilities: an expert nurse notices a family's distress for the same reason she notices an infant's changing color, because she is engaged with the people in front of her rather than with a checklist. Watson would say the same thing from the other side: caring is not a soft addition to technical care but part of how the nurse perceives the patient at all.

Where They Differ

The theories differ on the nurse's development. Watson describes caring as available to every nurse who chooses to practice it; a new graduate can be authentically present on her first day. Benner's model suggests that some parts of caring practice also develop with experience. In my own unit, new nurses are often warm with families but do not yet see which family is struggling, because they are still occupied with the infant's numbers. Tanner (2006) found that what a nurse notices depends on what she brings to a situation, including her experience, and that finding supports Benner's side: the intention to care may be present from the start, but the perception that directs caring grows.

The theories also differ in how they can be tested. Benner's stages can be studied through observation and interviews, and later research has used them to design residency programs. Watson's theory is harder to test directly, which is its most common criticism, although parts of it, such as the effect of presence and trust on patient experience, can be examined.

What Each Theory Would Miss Alone

Each theory, used by itself, leaves a gap that the other fills. A unit that took only Watson's theory seriously might value caring deeply and still leave new nurses to discover by accident which families need them most, because the theory does not describe how a nurse learns to see. The father in Week 2 stood at the doorway for four days on a unit full of caring nurses; what was missing was not the intention to care but the perception that he was stuck. A unit that took only Benner's model seriously might produce nurses who recognize a septic infant hours before the laboratory does and still treat the parents as visitors, because the model describes the growth of skill without saying what the skill is for. Neonatal nursing needs both the purpose and the perception, and a nurse who holds only one of them will be good at part of the job.

My Framework for Practice

Drawing on both theories, I can state my framework in three sentences. Nursing on a neonatal unit exists to support an infant's physiological stability and a family's growth into parenthood, and both are served through caring relationships. My ability to see what an infant or a family needs grows with experience and reflection, so I am responsible for continuing to learn and for sharing what I have learned. The measure of my practice is whether the infant is safer and the family more able to parent because I was there.

The Framework Applied: Precepting a New Graduate

Next month I will precept a new graduate for twelve weeks, and the framework changes how I plan it. From Benner, I take the knowledge that she will begin as an advanced beginner at best, so she needs clear priorities and rules, and she needs me to explain my own perceptions aloud. When I notice an infant looking gray, I will say what I see and why it matters rather than simply acting on it. I will ask her at the end of each shift to tell me the story of one infant, not the list of tasks, because stories are how experience turns into expertise (Benner et al., 2009).

From Watson, I take the reminder that she is also a person in a caring relationship with me. New nurses leave neonatal units in part because the first year is frightening. Being present with her after a hard shift, and letting her say what frightened her, is part of precepting, not a distraction from it. And I will make sure she sees family care as nursing work from the first day, by bringing her with me when I sit with a parent.

Conclusion

Watson's theory tells me what my practice is for, and Benner's model tells me how I and the nurses I teach will get better at it. Together they describe professional nursing on a neonatal unit as caring made skillful through experience. That is the framework I will carry out of this course and into the next twelve weeks with a new graduate.

References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Benner, P., Tanner, C. A., & Chesla, C. A. (2009). Expertise in nursing practice: Caring, clinical judgment, and ethics (2nd ed.). Springer.

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). University Press of Colorado.