Running head: PROFESSIONAL DEVELOPMENT ASSIGNMENT 1

Professional Development Assessment

Mallory White

Aspen University

August 2016
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Professional Development Assessment

Every member of the healthcare team practices with a goal of providing the highest

quality safest care to our patients. Over the years, theories have been developed and tested

to determine best care practices. That is where nursing theory comes in to the picture. Just

as there are many different paths to take in nursing, there are many different types and beliefs

of nursing theories.

Personal Reflection

Before this class, I had little interest in nursing theories. I thought that I learned best by

hands-on simulation and practice. I have always known that nursing theories and evidence based

research was the reason behind my actions as a nurse, but did not put much thought or effort into

the theory behind it all. This class has reaffirmed the research and testing behind nursing

actions. It has also taught me the great deal of work and effort that goes into creating each and

every nursing theory.

From the first grand nursing theories to more modern practice theories, nursing practice

has had great influences. Grand nursing theories provide guidance for abstract concepts in

nursing. They focus on nurse-patient relationships and the roles of nurses (McEwen and Wills,

2014). Grand theories have served as the basis for other theory development. Middle range

theories came next which were more specific. They were concept specific and consisted of fewer

concepts than grand theories. Finally, practice theories are most specific. They discuss a

particular element of nursing care.

All of these theories can be applied to many different aspects of nursing. This class has

taught me to not only understand the theories, but to understand how they apply to my different
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roles in nursing. As a Nurse Educator, I understand that the curriculum of many nursing schools

was developed from grand nursing theories. The works of the most famous grand nursing

theorist, Florence Nightingale are still used in many nursing schools. My bedside practice has

also been influenced by Nightingale. She defined nursing care for the ill and she helped define a

nurse’s role in healthcare. Her work has influenced theorist to expand further on her ideas to

better nursing care.

One middle range nursing theory that has had a major impact on my nursing career is

Benner’s theories of skill acquisition. She described a nurse’s progression through five stages:

novice, advance beginner, competent, proficient, and expert. These ideas have been applied to

my personal practice as a bedside nurse. In the beginning, the feeling of being a novice was at

times nerve-wracking. Over the years, I have developed my practice skills, critical thinking

skills, and learned to trust my gut. I feel my practice has transitioned from a novice to proficient.

I do not think I will ever consider myself an expert as the practice of nursing is always changing

and I understand that I always will have something to learn.

Benner’s theories have had a great impact on my career as a Nurse Educator. Part of my

job is to coordinate the orientation program for new medical-surgical nurses. Benner’s theories

of skill acquisition have taught me more about levels of expertise and skill in nursing.

Understanding that it is important to pair novice nurses with proficient or expert nurses to help

further their knowledge and skills so that they can easily transition from novice to advanced

beginner and beyond.

Benner’s theories can also be applied to furthering nursing research. McEwen and Wills

(2014) explain that nursing expertise develops when the nurse tests and refines hypothesis,

propositions, and principle-based expectations in actual situations. Her theories can also be
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applied to my practice as a member of the nursing administration team. Benner’s theories

outline levels of clinical practice and expertise which help with career enhancement and

development goals. When analyzing staff development and career enhancement goals, Benner’s

theories have served as a guide.

Evidence-based practice theories have a tremendous influence on bedside nursing

practice. According to McEwen and Wills (2014), evidence-based practice [EBP] theories

utilize problem solving that have been proven to provide the current best care to patients. EBP is

the ‘why’ behind nurse’s actions. When nurses practice using EBP’s, they can feel confident

that they are providing safe quality care to their patients. Stevens (2013) explains that EBP aims

to design care that is effective, safe, and efficient. She continues to explain that EBP

competencies focus on utilizing knowledge in clinical decision making and producing

interventions that promote effective, safe, quality patient care. For example, many facilities

performed routine urinalyses after the insertion of Foley catheters to detect urinary tract

infections. Evidence showed that the urinalyses was not necessary, and could at times, show a

false positive result if the sample was not collected in a sterile manner. Because of this, facilities

changed their policies, no longer requiring a urinalysis after Foley catheter insertion. My role as

a Nurse Educator is to hold educational sessions and meetings to inform staff nurses of new

bedside practices.

The purpose of using EBP at the bedside is to take the latest evidence from research to

guide patient care to achieve the greatest possible patient outcomes. Using EBP helps improve

the quality and safety of patient care. It also provides a standard across facilities and different

levels of care. When nurses are using EBP they can be confident in their abilities to provide

quality patient care. They can also learn to think critically and conduct their own research to
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discover best practices. Nurses can overcome the barriers of EBP by assuming their own

responsibility on keeping up to date on best practices.

Nursing theories have had an impact on many different aspects of nursing since the days

of Florence Nightingale. The work of nursing theorists is present in every day nursing practice,

whether or not the nurse sees or understands. Nightingale set the precedence of nursing practice

and research. Since her time, theories have been developed to enhance nursing practice,

education, administration, and research. As long as there are patients to care for, there will

always be nurses. And as long as there are nurses, there will be nursing theories.

Representation of Learning

The meaning behind nursing theories are to make a positive impact on nursing practice.

Theories can be applied to many different aspects of nursing, including nursing practice,

administration, and education. Just as there are different kinds of theories, there are different

ways to apply theories to the workplace and to teaching.

Elements of Organizational Structure

Every healthcare organization has an organizational design to function properly.

Organizational structure serves as a formal framework for management processes. McEwen and

Wills (2014) describe six elements of organizational structure formed by management theorist.

The first element is workplace specialization. McEwen and Wills (2014) describe workplace

specialization as “having each step of the work process performed by a different individual rather

than the whole process being done by one person” (p. 453). At Firelands Hospital, every

department has their own specific jobs and/or roles. For example, physicians order lab work, a

phlebotomist performs the lab draw, and nurses monitor the patient’s laboratory values.
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Similarly, if a patient’s lab values are not within the norm, a physician can order a medication to

correct those values, a pharmacist then prepares those medications, and the nurse administers

them.

The second element describes the chain of command. Chains of command serve as

formal lines of communication and authority. Hospital chain of commands can be simple or

complex, depending on the size of the organization. At Firelands Hospital, the Chief Executive

Officer [CEO] is in charge of the entire hospital. Under him, there are Vice Presidents in

varying departments. For nursing, the Chief Nursing Officer [CNO] is second in command.

After her, follows nursing directors, then nursing supervisors, followed by charge nurses and

bedside nurses. Each nursing unit has their own staff nurses, charge nurse(s), and unit directors.

Third, is span of control. McEwen and Wills (2014) explain that span of control refers to

the number of employees a manager is in charge of. As previously stated, at Firelands Hospital,

each nursing unit has one unit director in charge. The number of employees the director is

responsible for varies greatly as the sizes of the units vary. For example, the medical-oncology

unit has 42 patient beds, around 50 nurses, and 35 nurse aids and secretaries. A smaller medical

unit only has 20 patient beds, so that director is only in charge of 20 nurses and 10 nurse aids and

secretaries.

Next comes authority and responsibility. This element deals with a line of command and

leader-follower relationships. This element can also describe different levels of management.

At Firelands Hospital, the CNO and vice presidents of ancillary departments are referred to as

upper management. Nursing supervisors and unit directors are under the category of middle-

management. Basic level managers include charge nurses. Each level of management can

delegate work to his/her subordinates, but is still ultimately responsible to ensure the job is done.
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Centralization or decentralization refers to decision making and disbursement throughout

the organization. Centralized organizations make decisions in groups or by one single individual.

Decentralized organizations make decisions at the lowest levels feasible. Firelands Hospital falls

somewhere in the middle. At Firelands, there are committees made up of different levels of

management and staff to make decisions. For example, a patient satisfaction committee has

implemented changes hospital wide to reduce noise to increase patient satisfaction. This

committee is made up of members from every department, only one management member is on

that team.

The final element of organization structure is departmentalization. At Firelands Hospital,

work and departments are grouped based on specialties. There are many specialty departments

for nursing like oncology, medical nursing, obstetrics, pediatrics, and psychology. There are also

ancillary departments, like physical therapy, radiology, wound care, and care management. All

of the departments work together to help patients receive the best care. There are also

departments in the hospital, like human resources, that help ensure the hospital has adequate

staffing and to ensure payroll is in order.

Theory-based Teaching Strategies

Just as nursing practice has changed, so has teaching strategies of nursing. One teaching

style is dialectic teaching. Prado, Pereia, Togerio-Fugulin, Peres, and Castilho (2011) explain

that in dialectical teaching, knowledge is built by the student based on his/her relationship with

the environment, professors, and fellow students. This type of teaching is used in many web-

based nursing programs. Professors develop questions in which student’s research, answer, and

discuss with others via discussion board posts. This type of education gives students a lot of
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autonomy allowing students to assume responsibility and commitment to participate in their

education.

Next, problem-based learning [PBL] strategies involve clinical situations and case studies

that are designed to enhance or stimulate a students abilities, skills, and knowledge (McEwen

and Wills, 2014). PBL differs from dialectic learning in that the educators are in charge of the

scenarios and determine the level of student independence. McEwen and Wills (2014) explain

that instructors can manipulate variables to change the complexity of issues. For example, a

teacher may let beginner students seek for solutions to simple problems to aid in their

development of critical thinking skills. This type of teaching and learning allows for students to

use technology and interpersonal communication to seek their answers. PBL can be a lengthy

process, depending on how easily a student or group of students finds their answers. PBL in

clinical settings can at times be a bad choice, as patient’s needs take prescience and student

nurses may not have the time to dedicate to seeking answers.

Operational teaching strategies in nursing involve using atypical activities to engage the

learner. Examples may include viewing non-medical videos or materials, debates, or games.

Operational teaching strategies are used because they are at times more enjoyable and can

engage learners better than other methods. Games can teach students critical thinking,

strategizing, and teamwork. Role playing can also help students research and act out scenarios

from others perspectives.

Finally, “logistic teaching strategies are based on the concept of mastery of sequential

learning” (McEwen & Wills, 2014, p. 490). Logistic teaching presents materials in a clearly

defined order with progression of knowledge. Knowledge learned in the beginning of the class is

expanded upon with each lesson. Unlike dialectic teaching, logistic teaching is formal and very
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structured. Students set to learn exactly what is presented with definitive units and testing.

Logistic teaching is common in nursing curricula because it has shown effectiveness in

knowledge and testing scores.

Curriculum Framework

Curriculum for nursing orientation on medical-surgical units at Firelands Hospital is

based off of Benner’s novice to expert theroy. This writer works as a lead clinical educator and

has helped develop and maintain this orientation process. Many of the newly hired nurses are

also new graduate nurses with no healthcare experience. The transition from student nurse to

practicing registered nurse is sometimes difficult. Firelands Hospital educators have developed a

program to help ease that transition. Benner described five stages of nursing knowledge and

experience.

The first stage is novice. During Nursing Orientation [NO], educators understand that the

new graduate nurse has no previous experience, so nurses take on patient assignments in a stair-

step fashion. Nurses will shadow an expert for one day, assume care of two patients for two

days, then three patients for three days, four patients for four days, and five patients for five or

more days. This gradual increase of patient assignment helps transition from a novice, to

Benner’s second stage, advanced beginner.

According to Drumm (2014), an advanced beginner is someone who can demoonstrate an

acceptable performance after dealing with enough real-world situations. Other components of

NO help that transition from novice to advanced beginner. For example, an EKG and

pharmacology class are taught by educatiors to help further the new nurse’s knowledge of
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regognition and treatment for arrythmias. This helps nurses become more comfortable

determining arrythmias and understanding physician ordered treatments.

Critical thinking class involves simuation with a mannikin to put together knowledge and

skills learned through clinical practice and EKG classes into recognizing changes in patient

conditions. Nurses are put into groups and each given a sceinario and are expected to determine

if patient symptoms warrant a call to the physician, the activation of a medical emgergency, or a

code blue.

The goal of NO is not to transition a novice nurse to an expert, but to transition him/her

to an advanced beginner. Educators use Benner’s ideas of proficient and expert nurses to

determine preceptors for the novice nurse to work with during the orientation process. Educators

work very closely with unit directors to determine which staff members have proficient and

expert knowledge of their designated work unit. Proficient and competent nurses provide bedside

knowledge and experiences to novice nurses that sometimes, educators can not.

NO at Firelands Hospital is somewhat based off of Benner’s novice to expert theory. The

hospital recognizes new nurses are novices and we seek to transition them to advanced beginners

with the help from proficient and expert bedside nurses and educational programs and classes.

The NO curriculum provides a sequence of experiences that allow for knowledge and clinical

experience to build to ease the transition from novice to advanced beginner.

Conclusion

Nursing theories have a common goal of bettering nursing practice to provide safe quality

care to patients. Nursing theories can be used by all levels of nursing, from bedside nurse to
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educators and administrators. Nursing theories can help develop organization structures,

teaching strategies, and educational curriculum.

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References

Drumm, J. (2013). From our readers: Novice to expert-- a nurse educator's personal journey.

American Nurse Today, 8(4). Retrieved from https://americannursetoday.com/from-our-

readers-novice-to-expert-a-nurse-educators-personal-journey/

McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia:

Lippincot.

Prado, C., Pereia, I. M., Togerio-Fugulin, F. M., Peres, H. H., & Castilho, V. (2011). Seminars in

dialectical perspective: experience in the Nursing Administration discipline. Acta

Paulista de Enfermagem, 24(4), 583-585. Retrieved from

https://dx.doi.org/10.1590/S0103-21002011000400021

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas.

OJIN: The Online Journal of Issues in Nursing, 18(2).

doi:10.3912/OJIN.Vol18No02Man04