As knowledge has been explored differently at different times and different groups, nevertheless, it has always been linked to clarification, prudence, truth, authority, professionalism, and science. The relationship of nursing with these components of knowledge has caused to question the role and essence of nursing (Zanotti, 1997). The significance of exploring nursing essence is due to the professional status associated with it; along with regulating the technical nursing accomplishments, and emphasizing research, theory and practice. Concerns related to development of nursing theory and knowledge became evident in the early 1960`s (Newman, 1972). According to Kidd and Morrison (1988), the evolution process of a women and nurses are similar to the development of theory and research methodology as described initially by Belenkey, Clinchey, Goldberger, and Tarule (1986).
The process is classified in five different stages: silent, received, subjective, procedural and constructed; out of which three of them are further discussed in this paper with its impact on nursing. For nursing to achieve harmony between practice and theory, integration of different source of knowledge is crucial for its development. Despite the fact that these stages were developed during different times, the description of knowledge can be traced by the nurse caring for patients in hospital through five stages of Benner`s theory of skills acquisition related to novice to expert continuum.
According to Belenkey et al., the first stage of nursing theory development is described as the silent stage. It can be traced back to the 19th century and was prevailing till the mid-20th century. In this stage, the nursing knowledge was envisaged as a set of distinctive of rules that nurses are taught to implement nursing activities (Reed 1995, Bradshaw 2000). In essence, nursing phenomena was related to set of descriptive rules with application of moral support in patient care, with the intent of doing good. During this time, the impact on nursing was that there was no provision of explanatory power and regulations were legitimated by authorities, in form of physician or nursing managers (Reed 1995).
Benner’s theory of skills acquisition can also be incorporated at this stage. Benner’s first stage as a novice nurse is also applicable in this context. A novice nurse is more focused on context-free, predetermined objectives and rules, resulting in obeying and carrying out physician order without any conceptual and theoretical affiliations (Benner, 1984). Examples include knowing the normal range for blood pressure (BP) readings. A novice nurse can differentiate that if a patient`s BP readings are not within the specified range as outlined by physician`s order, then it needs to be addressed. Hence, the nurses understanding of descriptive rules by the authorities is witnessed without any consideration to the context at this stage.
The third stage of nursing theory development as per Belenkey et al., is the Subjective stage. Initiated in 1950`s, the first nursing theories were emerged during these times. The focus of nursing knowledge at this point was shifted towards nature of nursing theory development as an independent practice. The impact of nursing is evident when the set of descriptive rules by the authorities were ceased and a unique body of nursing knowledge was established in relationship to vindicating practice and integrating hierarchies (Slevin 2003).
The analyses were based on theories derived from other discipline (Melesis 1997). The momentous contribution of this stage is that the nurses acquired a key role position in describing the nursing phenomenon and designing nursing knowledge (Mckenna, 1997). Benner`s third stage as a competent nurse can be applied at this stage. The competent nurse devises a plan or chooses a perspective factoring in the essential aspects of the situation (Benner, 1984). Hence, the nurse utilizes the ability to manage critical emergencies but lacks in the promptness and flexibility in nursing practice.
The final and the fifth stage of nursing knowledge is defined as the constructed knowledge, according to Belenkey et al. At this stage, predominant in the 1990`s, the nurse through reexamining, analyzing and transposing views nursing knowledge from a unifying perspective (Jasper 1994, Cowling 2007). “Critical reflexibility” is the major impact and tool in nursing for achieving this knowledge (Rolfe et al. 2001). In this moment, nursing knowledge is exemplified by a critical and inquisitive part on individual nursing practitioners, provoking solutions and giving rise to graduate studies (Miller, 1997).
Last stage of Benner`s model mentions expert level can be related to this stage. The expert nurse with the amount of experience is context-specific and relates her understanding of the patient`s situation without any assistance, dictum and rules or guidelines (Benner, 1984). As example, Mr. X with LVF (Left Ventricular Failure), and is on Furosemide every day. A low-experience nurses when sees the patient develop shortness of breath may relate this as respiratory distress and initiate nebulizer therapy. But an expert nurse will think that the symptoms are too acute, call for doctor and anticipate giving furosemide. Henceforth, the expert nurse rapidly responds to any critical situations related to her patient.
For nurses to distinguish their role, integration of nursing practice with nursing theory development is crucial for professional growth. Nursing theory provides a framework to enhance patient care with integration of improved communication and direction towards nursing research and education. The stages described by Belenkey et al. defines the progression of nursing theory and research development. Additionally, its integration with the Benner`s Model of skills acquisition, provides an applicable framework for nurses at their areas of expertise.
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